Adults with ADHD often overlooked

Psychiatrist Dr Laura Comrie speaks about the prevalence of ADHD in adults.

With the passage of time and better medical science, Attention Deficit Hyperactivity Disorder (ADHD) is becoming better understood, and psychiatrist Dr Laura Comrie says there is much more to this disorder than meets the eye.

While its usually associated with children, the disorder is being more frequently recognised in adults.

Dr Comrie says there are many misconceptions around ADHD. People with ADHD are often thought of as simply being “hyperactive, distracted or generally disorganised”.

“It is in fact, a very real and legitimate problem, with regulating attention,” she says.

ADHD is a largely hereditary neuro-developmental disorder, which has to do with the wiring of the brain during a baby’s development, she says.

“While current figures for adults with ADHD are at around 4% of the general population, it is suspected that this number is much higher, but that due to a lack of awareness, it often goes undiagnosed.”

According to Dr Comrie, there are three sub-types of ADHD, each of which presents differently.

The hyperactive/impulsive form is characterised by fidgeting; an inability to sit still or wait patiently; talking too much, interrupting others; and highly active behaviour, as though there is a motor constantly running inside.

Those with the inattentive form tend to be distracted easily, often day-dreaming; have problems with completing or remembering tasks; make mistakes; lose things often; and have difficulty in being organised.

The third sub-type combines symptoms of the other two.

The hyperactive/impulsive type of ADHD tends to present more commonly in boys and men, while inattentive ADHD is more common in girls and women, she says.

“It is possible that because Inattentive ADHD is less of a visible concern, less disruption in class at school, it is more undiagnosed than Hyperactive/Impulsive or Combined ADHD,” she says.

The disorder occurs on a spectrum, so it is more severe in some than in others, she says. And many people with it are quite functional and have systems in place to help them manage their condition.

“Those with ADHD often have a strong entrepreneurial spirit as they tend to be creative thinkers and can experience incredible levels of focus on subjects about which they are passionate. At the same time, they can really struggle with more mundane tasks in life, such as doing the bookkeeping or remembering to run errands.“

This type of behaviour can be frustrating for family members and colleagues but it is quite literally out of the control of the person with ADHD.

“Because this is a neurological disorder, it often requires medical intervention to help regulate it. It is most certainly not the case that these individuals lack discipline or are lazy, as some people believe. In fact, they have the potential to make valuable contributions to society, provided they receive the medication, psychotherapy and societal support that they need,” she says.

Dr Comrie explains that ADHD affects the delivery of two neurotransmitters – dopamine and noradrenaline, also known as norepinephrine – to the front part of the brain that controls planning, organisation, maintaining focus during routine tasks and similar neural processes.

These neurotransmitters are important for ensuring that processes in the brain take place effectively.

In people with ADHD, dopamine and noradrenaline are not being properly delivered, and this affects the brain’s function.

“This has been studied with the use of magnetic resonance imaging (MRI), which has clearly shown measurable differences in the brains of those with ADHD and those without it,” Dr Comrie says.

Medication is important for these individuals to function in a neuro-typical or “normal” world, like school, university or certain workplaces, she says. This helps them to gain and maintain confidence, to absorb and retain information and generally to develop and grow.

According to Dr Comrie, ADHD medication works by delivering the missing stimulants, dopamine or noradrenaline, to the brain.

The more common type of medication used helps with the delivery of dopamine and works quickly, sometimes within 20 minutes. It also leaves the system quickly – within four to eight hours.

Adults usually require long-acting medicine because their workday is typically longer than a school day.

She says it is important to weigh up the cost of meds versus how difficult your life would be without the help.

“Fortunately, generics have become available in recent years so medication is more affordable now,” she says.

If untreated, ADHD can lead to a serious lack of confidence as well as low academic or career performance, says Dr Comrie.

“Some individuals are afraid of addiction to ADHD medication. However, by not having the clinical support they need, people with ADHD may seek out the stimulants their brains need elsewhere, such as in certain illegal and seriously addictive drugs.”

Used properly, ADHD medication can instead help to avoid substance addiction into adulthood, she says.

Dr Comrie says that when receiving an ADHD diagnosis, it is important to fully discuss both medication and psychotherapy treatment options with a psychiatrist.

Other symptoms often expressed with ADHD are anxiety and depression, and these need to be taken into account in creating the right treatment programme.

“The medical management of ADHD can only be improved with a healthy lifestyle such as avoiding stimulants like caffeine, eating a balanced diet, exercising regularly, getting enough sleep and practising daily mindfulness. This approach, along with understanding and support from family and colleagues, can go a long way to positively impacting the life of someone with ADHD,” Dr Comrie says.

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