ADHD

What is ADHD?

ADHD is a neurological condition people are born with and it often runs in families. It seems likely that 5% of the population has ADHD, which means in the UK there are some 3,5 million people living with it, most of them not realising they have it.

If you have it, you are born with it, which means your symptoms will have been there from a very young age. Not all children with ADHD get diagnosed as such, so often the diagnosis gets delayed until someone is an adult.

It is not caused by bad parenting or eating too much sugar or junk food or playing videogames all the time. This is a functional MRI scan, which shows that the brain of the person with ADHD looks quite different from the one who hasn’t:

(the purple border around the brain is caused by the scanner and not real)

One researcher (Dr M. Hoogman) from the Radboud University in Holland, who carried out a large study with 81 other international researchers, was quoted in Science Daily (feb 16, 2017) as stating:

  • "The results from our study confirm that people with ADHD have differences in their brain structure and therefore suggest that ADHD is a disorder of the brain," added Dr Hoogman. "We hope that this will help to reduce stigma that ADHD is 'just a label' for difficult children or caused by poor parenting. This is definitely not the case, and we hope that this work will contribute to a better understanding of the disorder."

It often runs in families (often with autism, Asperger’s Syndrome and other conditions) so in that sense you could call it hereditary and it is genetic. We are not clear yet which genes are involved but it is clear that there are lots, so it is impossible to predict if someone who has ADHD will pass it on to any children.

How is it diagnosed?

There is no blood test for ADHD and scans (such as used by some ‘entrepreneurial’ doctors in the USA) are not precise enough and are not of any use when diagnosing someone. We diagnose by asking about a range of symptoms, how severe they are and how long you have had them. For instance, if all your symptoms started when you were 20 and you never had them before, then whatever it is, it is not ADHD.

There are specific internationally agreed criteria and symptom thresholds: if you have enough symptoms, they are severe enough, they impact in more than one area of daily functioning and they were present in childhood as well, then you will wind up above the diagnostic threshold and that means you have ADHD. If you are below the thresholds, then your symptoms are likely to be part of the normal variations we see in the general population.

What are the symptoms?

The main symptoms are problems with attention, concentration and keeping focus and being restless and impulsive. However, the situation is complicated: here is a picture that shows what brain areas are involved, leading to the symptoms:

So, for instance, attention drifts when doing something, you start a task and then don’t finish it and often people procrastinate endlessly, only being able to produce something at the very last minute or you wind up starting lots of tasks and not finishing any.
You may be disorganised, forgetful, missing appointments, forgetting friends’ birthdays and so on. That in turn may lead people to ‘give up’ on you and quite a few people with ADHD have lost friends as a result.
You may be impulsive and that can manifest itself by:

  • flying off the handle for no reason (often called rejection sensitive dysphoria)
  • buying stuff you don’t need and can’t afford
  • binge eating or drinking
  • and doing things you think of afterwards: why did I do that?

You may be physically restless, not being able to sit through a movie or a show or waiting your turn in a queue and sometimes that restlessness (aka hyperactivity) is ‘internalised’, which means you may have lots of thoughts crowding in on each other in your head and you can’t stop them, even to the point where you can’t get off to sleep.

Very often people are tired all the time and sometimes they even get diagnosed with ME or Chronic Fatigue Syndrome. Once they are treated fully for their ADHD, all or most of that vanishes (unless it is a separate condition in one individual, which would be exceedingly rare).

People say the symptoms are different if you are male or female: whilst there might be a difference in what it looks like, in fact when we probe there is no clear difference, although females may be less boisterous and males more aggressive. But that is a general difference anyway.

How is it treated?

A lot of people try to manage their ADHD in all sorts of ways. For instance, if someone is very disorganised and forgetful, they may use lots of reminders, diaries, agendas, post-it notes and lists. Sometimes there are so many lists, they wind up having lists of lists. And they then still forget to look at the lists, so it is often still not efficient.

ADHD is eminently treatable with medication and this approach has been used since the late sixties, early seventies, with very good results. The medication works primarily on the prefrontal cortex, which is the main ‘management system’ that organises your brain activity:

(Some problems originate in the Amygdala, leading to problems with emotion.)

There are around 5 different medications, but it is unpredictable what will work for a particular individual and at what dosage. So usually some time is spent finding the right medication for someone. This is called the titration period.

The medication is not addictive. In fact, many people stop their tablets occasionally or even regularly for all sorts of reasons. If you stop the medication, you won’t get withdrawal symptoms, but your ADHD symptoms will come back. So in that sense, you are dependent on the medication to keep the symptoms at bay, a bit like insulin and diabetes: if you are insulin dependent, it does not mean you are addicted to insulin; it means you need the insulin to keep the symptoms of diabetes away.

The general mode of action of the medication is by addressing some shortcomings that can be seen in this picture:

 

Once it is clear what medication at what dosage is the correct one for you, we produce a so-called Shared Care Agreement, asking your GP to take over prescribing. Most GPs will not be able to start you off on medication, as NICE guidelines demand this is done by a specialist.