Adult ADHD or Attention Deficit Hyperactivity Disorder is a mental health disorder often characterised by impulsive behaviour, difficulty paying attention, disorganisation, poor time management, frequent mood swings, short temper, poor planning skills, difficulty managing or prioritising thoughts and actions and memory difficulties – amongst others.
ADHD has its roots in childhood and Adult ADHD is only diagnosed if its symptoms can be traced back to childhood. Most core symptoms develop early in childhood – normally before the age of 12. For many, ADHD may not have been diagnosed as a child, but the symptoms have been there, and it is only later in life that ADHD becomes a possible explanation for certain types of behaviour in adulthood.
ADHD is only diagnosed if five or more recognised symptoms are present and if these symptoms are having too much an untoward influence on one or more areas of everyday life and for a significant period of time. A diagnosis will therefore be based on the number, severity, frequency and duration of the symptoms. Symptoms in adults can manifest themselves as, for example, underachieving at work or in education, difficulty with relationships and/or forming and maintaining friendships, difficulty concentrating on or completing tasks, dangerous driving, impatience or risk taking, frequent outbursts of anger, regularly missing deadlines or forgetting appointments.
ADHD rarely occurs alone. Research has shown that more than two thirds of patients with a diagnosis of ADHD are also suffering from another mental health condition such as depression, anxiety, substance misuse or a learning disability. As many of these conditions present with the same symptoms as ADHD, it can be tricky to give an accurate diagnosis of ADHD. It is important therefore that a thorough evaluation is done by a qualified mental health professional with experience in recognising and treating ADHD, and that any other contributory mental health condition is also treated.
An accurate diagnosis of Adult ADHD will involve a face to face evaluation with a mental health professional. There are many online tests available, but which cannot enable a full, accurate and all-round view of the patient’s life, circumstances and mental health history. It is only by interviewing a patient that the full picture can be gained.
As well as interviewing the patient, it may also be appropriate for those closest to the patient – partner or other next of kin – who know the patient and their past well to be interviewed. Some practitioners may also ask to see school reports to ascertain whether any symptoms existed earlier in life. Others may also ask the patient to complete an evaluation questionnaire prior to their appointment with them. The DIVA (Diagnostic Interview for ADHD) form helps the practitioner to determine the extent and severity of any behaviour which may be an indication of ADHD. The patient is then scored on a rating scale. The score however should not be considered in isolation but in conjunction with a face to face evaluation.
At evaluation, the patient will also be asked whether they suffer from other medical problems, whether they take any medications or abuse substances such as alcohol or drugs. All these may cause symptoms which can be mistaken for the ADHD, so are important to rule out before giving a diagnosis of ADHD.
The causes of ADHD are not clear and treating it is not straightforward. Some believe that the causes may be genetic – it can run in families; or environmental factors – such as exposure to lead paint as a child – may play a role. The risk of ADHD may also increase if your mother smoked, drank alcohol or used drugs during pregnancy, or if you were born prematurely.
There are treatments available which can alleviate some of the symptoms, but there is no cure for ADHD. These treatments usually involve one or a combination of medication, psychological counselling, peer support and practical organisation and coping techniques.
The medications most frequently prescribed depending on the patient include either stimulants such as methylphenidate or amphetamine, or alternatively slower acting non-stimulants such as atomoxetine or certain ant-depressants. Cognitive Behavioural Therapy (CBT) is also helpful for some patients, and as ADHD can have far-reaching impacts on the family, marital and/or family counselling may also be appropriate. Some people with ADHD find mindfulness therapy helpful, or simple, practical measures such as list making, following a routine or breaking down tasks into more manageable parts, useful in coping with life’s day to day challenges. An important step is to inform others – family, friends, teachers, employer and work colleagues – so that they too can offer support by perhaps making small changes and accommodations to help make life a bit easier.
Further information on Adult ADHD can be viewed in our series of videos in which Dr Winbow explains how ADHD is diagnosed and treated.
At Private Psychiatry, we frequently see adults who think they may have been suffering from ADHD since childhood and were never diagnosed, or who were given a diagnosis of ADHD in childhood and need further help with their condition. An ADHD assessment with one of our consultant psychiatrists takes 1 ½ hours. We will ask you to complete the DIVA assessment form in advance of your appointment so that the psychiatrist can gain a full picture of any symptoms you may have and of your circumstances. If you have any relevant school reports or other documents which may demonstrate you have some of the symptoms of ADHD, please bring those to your appointment. Or if a family member or close friend would like to attend the appointment with you to help explain your symptoms, they will be most welcome. The evaluation is followed up with a written report from the consultant psychiatrist indicating whether you are suffering from ADHD and any recommended treatment or medication which may alleviate the symptoms and help you to cope with the day to day effects. To make an appointment, please get in touch.