People with Attention Deficit Hyperactivity Disorder (ADHD) are often thought of as simply being hyperactive, distracted or generally disorganised.
However, there is much more than meets the eye to this attention disorder, which is usually associated with children but, interestingly, is also common in adults.
Dr Laura Comrie, a psychiatrist practicing at Netcare Akeso in Kenilworth, said there are many misconceptions around ADHD. It is a very real and legitimate problem with regulating attention.
“This largely hereditary neuro-developmental disorder has to do with the wiring of the brain during development,” she explained. “The research indicates that ADHD has persisted since childhood in 25% to 50% of adults who have it. While current figures for adults with ADHD are at around 4% in the general population, it is suspected this number is much higher, but that due to a lack of awareness it often goes undiagnosed.”
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Comrie noted there are three different sub-types of ADHD, each of which present differently:. Hyperactive or impulsive
– fidgety, unable to sit still or wait patiently;
– talking too much, interrupting others; or
– highly active, as though there is a motor constantly running inside.. Inattentive:
– easily distracted and often day dreaming, seemingly avoiding dislikes;
– problems with completing or remembering tasks, making mistakes; or
– losing things often and difficulty in being organised.. Combined:
– a combination of the above types of symptoms.
“ADHD tends to present more commonly in men, with the hyperactive or impulsive type being most prevalent in that sex,” explained Comrie. “These individuals will often choose a line of work that involves physical activity rather than sitting at a desk. Inattentive ADHD is more common in women. It is possible that because inattentive ADHD is less of a visible concern; it is more undiagnosed than hyperactive or impulsive, or combined ADHD.
“The disorder occurs on a spectrum, so it is more severe in some than in others. Many people 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 an errand, for example.”
She said this behaviour can be frustrating for others but is out of the control of the person with ADHD. As it’s a neurological disorder it often requires medical intervention to regulate it. “It is most certainly not the case that these individuals lack discipline or are lazy. In fact, they have the potential to make valuable contributions to society, provided they receive the medication, psychotherapy and societal support that they need.
ADHD affects the delivery of two neurotransmitters – dopamine and noradrenaline, also known as norepinephrine – to the front of the brain that controls planning, organisation, focus and similar neural processes.
“These neurotransmitters are important for ensuring that such processes in the brain take place effectively,” Comries explained. “In people with ADHD, dopamine and noradrenaline are not being properly delivered to the front of the brain, affecting 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. Medication is important for these individuals to function in a neurotypical or ‘normal’ world. This helps them gain and maintain confidence, absorb and retain information, and develop and grow.”
ADHD medication delivers the missing stimulants to the brain, with the more common medication delivering dopamine within 20 minutes. It also leaves the system in four to eight hours. The dosage and type depends on whether short acting or long acting medicine is needed. Adults usually require long acting medicine, as a workday is typically longer.
“This type of medication is not a huge commitment, as the person is able to try it out and see fairly quickly if it works for them,” said Comrie. “Many adults choose to take it only when they need it. It can, however, make you feel wired and over-stimulated, in which case the other form of medication should be explored.”
The second type of ADHD medication works on noradrenaline, she added, which requires you to gradually build up towards the full dosage daily over 10 weeks to build and maintain efficacy. “This is often seen as the second line in treatment as it is a bigger commitment,” Comrie related. “The medicines are costly, but it is important to weigh-up cost-versus-benefit in terms of how difficult one’s life can be without the help.”