Durban - When talking about ADHD, most people picture a six-year-old boy tearing around the classroom while his peers sit studiously at their desks.
Hardly anyone pictures the work colleague sitting adjacent to them – the girl with the messy desk, who arrives late, can’t keep track of appointments or tasks and jumps up every half hour to get another cup of coffee. Yes, she might just be disorganised. Or she might be suffering from adult ADHD.
Not all children who are diagnosed with ADHD will continue to suffer from the disorder into adulthood, but all adults with ADHD certainly had the condition as children – and it’s likely, were never diagnosed or treated.
It could be that the symptoms were too mild in childhood to raise any concerns, or perhaps it was misdiagnosed, or even not diagnosed at all and the child was simply acknowledged to be “difficult”. Whatever the reason, if left misdiagnosed and untreated, ADHD can severely impact on adult life.
While local statistics are hard to come by, US figures hold that 60 percent of children diagnosed with ADHD continue to suffer from the disorder into adulthood. This translates into a total 4 percent of the adult population – a figure that probably holds true for the South African population too.
In the US, less than 20 percent of those afflicted adults have been diagnosed with the disorder. In South Africa, it’s probable that this figure is much higher, primarily due to the fact that very few people – even specialists – associate the disorder with adulthood.
The general perception is that ADHD is a childhood disorder, so when adults present behaviour that is typical of this condition, they tend to be labelled as lazy, or impatient and impulsive – and that is often the explanation given for their underachievement both socially and professionally.
Another reason adult ADHD is so misunderstood is it presents differently in adults than it does in children.
Adult ADHD disrupts the so-called “executive functions” of the brain, such as judgement, decision-making, initiative, memory and the ability to complete complex tasks.
This manifests in behaviour such as the inability to stay on task or to take on tasks that require sustained concentration, forgetting appointments, habitual lateness, and poor listening skills often characterised by a compulsion to finish other people’s sentences or to interrupt someone while they are talking.
The hyperactivity that is so often displayed in childhood ADHD is less obvious, and can present instead as a high level of impatience and a low frustration tolerance.
These behaviour traits often spell disaster on both a personal and professional level, which in turn can lead to the emergence of anxiety and mood disorders, depression, anti-social behaviour and even substance abuse.
These secondary issues are another reason why the disorder is so seldom diagnosed in adulthood – as they often act as a mask for the disorder at the heart of the problem.
But on the positive side, it is these issues that bring adults with ADHD into the psychiatrist’s office.
With careful history taking, plus input from parents and other relatives, he or she may pick up certain symptoms from childhood that would make ADHD diagnosis a possibility.
There are also adult ADHD rating scales and neuropsychological tests that can help confirm diagnosis.
Once diagnosed, a suitable treatment programme can be put in place. Depending on the severity of the disorder, this could include the use of stimulant medications such as methylphenidate (commonly known as Ritalin), or non-stimulant medications where there are contra-indications to stimulants such as cardiac conditions, or where there is concern the stimulant may be abused.
Occupational therapy and psychological interventions also play a major role in rehabilitation and treatment.
Adult ADHD is responsive to treatment provided regular follow-ups are done and co-morbid conditions are addressed. It
is a treatable and manageable disorder, provided it is correctly diagnosed.
As with far too many psychiatric conditions, it is often the stigma that presents more difficulties than the condition.
If more parents sought treatment for their children at an early age, less adults would suffer later on in life.
The Mercury
* Dr Molokashe Molokomme is a psychiatrist at Akeso Crescent Clinic.