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ADHD in Adult - Attention Deficit Hyperactivity Disorder in Adult
ADHD is a behavioural disorder that affects people of all levels of intelligence and all walks of life. If you think you might have ADHD, the first step to getting treatment is to seek a professional assessment. Once diagnosed, there are many safe and effective treatments that can help you take control and move forward with your life.
Common ADHD Symptoms in Adult
The effects of ADHD can be far reaching and impact on many aspects of an individual’s life. It may be hard for someone with ADHD / ADD to have stable, lasting relationships or to progress at work, to manage their finances well and to feel on top of everyday mundane tasks. There is also an increased risk of criminality or substance abuse in adults with ADHD.
1. Concentration
Problems of concentration are common in adult ADHD and are exacerbated as the pressures of life increase and more demands are made on the individual to remain calm, organised and focused.
Invariably, there is a tipping point where the level of the complexity and demands of life cannot be overcome by the adaptive coping strategies and natural intelligence levels. Difficulties can arise as those with adult ADHD try to manage life and their difficulties concentrating, possibly leading to the development of anxiety and depressive symptoms.
2. Hyperactivity
The ADHD symptom of hyperactivity that is often seen in children, can be experienced differently in adults. In adults, hyperactivity is often more internalised – resulting in a strong sense of dissatisfaction and restlessness. Again, this can add to feelings of worthlessness, unhappiness and low mood which if not understand, can result in anxiety or depression developing.
Types of ADHD in Adult
There are three main subtypes of ADHD which can be diagnosed which is key to making sure that you have the right support.
ADHD – Inattentive
Inattentive ADHD – commonly known as ADD accounts for about 33% of all ADHD in adults. ADD or inattentive ADHD is characterised with difficulties staying focused and attending to daily, mundane tasks. Individuals may be easily distracted by irrelevant sights and sounds, bouncing from one activity to another or becoming bored quickly.
ADHD – Hyperactive & Impulsive
Hyperactive and impulsive ADHD accounts for 7% of all ADHD in adults. The main symptoms are related to impulsivity and hyperactivity, whilst inattention may be secondary and not as much of a problem.
ADHD – Combined
Combined ADHD accounts for about 60% of all ADHD in adults and, as the name suggests, is acombination of inattention and hyperactivity/impulsivity.
Causes of ADHD in Adult
Biological
MRI scans have shown that the brain functions differently in someone with ADHD. For instance, children with ADHD show a delay (of about three years) in the development of the part of the brain that is involved in thinking, paying attention and planning. There are also overall delays in the maturation of the outermost layer of the brain, known as the cortex and some abnormal growth in the corpus callosum, which is the brain structure that is important for the communication between the two halves of the brain.
Hereditary causes of ADHD
The genetic makeup of an individual can make someone more susceptible to ADHD. Research has shown that ADHD / ADD can run in families.
Environmental causes of ADHD
It is thought that a mother who smokes, drinks or takes drugs during pregnancy may increase the risk of her child developing ADHD. There have also been studies showing a link between ADHD development and exposure to lead. Both of these factors impact on the way the brain develops as an embryo and in infancy. There are also thoughts that early childhood trauma, such as a chaotic family life, neglect or abuse can impact on the way a child’s brain develops and this can increase the likelihood of ADHD developing.
Integrative Medicine
There is a growing body of evidence that microbiota /microbiome, the bacteria that we all have in our guts plays an important role in mental health disorders and ADHD / ADD in particular. An imbalance of the microbiota affects, among other things, the levels of essential nutrients such as minerals and vitamins and as a consequence the production of neurotransmitters involved in our normal functioning, which can then result in impaired attention, hyperactivity and impulsivity.
Brain Injuries
A very small percentage of ADHD cases are linked to brain injuries.
ADHD Diagnosis
For many adults with undiagnosed ADHD, everyday tasks, maintaining successful employment and relationships can be more difficult. It is common for people who have ADHD / ADD, but do not know it, to have very low self-esteem as they are not sure why they find some things difficult when others do not.
Untreated ADHD can also be dangerous and have serious implications for individual and research shows adults with undiagnosed ADHD are more likely to have car accidents or get involved in criminal activity.
A Psychiatrist is needed to diagnose ADHD. They will need detailed information about your experiences in childhood and as an adult, teamed with information gathered in evidence-based questionnaires. Psychiatrists will also assess you for other common mental health conditions, such as depression, anxiety or Bipolar Disorder to ensure that they are able to recommend the right treatment
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Frequently Asked Questions
What does an ADHD assessment look like and what can you expect?
You will be asked to complete a few questionnaires on relevant issues which you will need to return at least 48 hours prior to the assessment.
The assessment consists of a semi-structured interview probing the main areas of functioning that are usually involved in ADHD; this is called the DIVA (the Diagnostic Interview for ADHD in Adults and Children and Adolescents). This interview yields scores for attention deficit and for hyperactivity and impulsivity and these scores are mapped against internationally agreed diagnostic thresholds, above which it is highly likely someone has ADHD and below which it is clear they do not. This information is merged with the information elicited in the general assessment with the specialist, during which relevant issues are explored which are having an impact on someone’s life. All assessments are currently conducted in video consultation format. Patients / Parents receive a Video Appointment Confirmation Email after a booking is made.
Ultimately the specialist establishes the diagnosis: he can overrule any scores from the DIVA if there are sound clinical grounds to do so.
All the findings will be summarised in a report, which is held securely in our practice system: the report will be sent by secure email, which will enable you to download the report in pdf format and save or print it. The report is your property: you can choose to share it with others (e.g. your GP), but you don’t have to. Before the final version is shared with you, you can ask for amendments if you think something important is forgotten or a detail is wrong.
The assessment concludes with deciding a treatment plan: ADHD is eminently treatable with
medication, although there is sometimes also a role for other approaches, such as ADHD coaching or psychotherapeutic interventions.
The prescription is £75 if it is only prescription. The cost of medication is naturally not included and will need to be paid extra to the pharmacy. It concludes with a Shared Care Agreement.
We normally recommend using a pharmacy that delivers the medication to you, as it is more secure. They are called Pharmacierge, and we can arrange for the prescription to be sent to them directly: you will get a payment link from them on your mobile phone and once you have paid, they will deliver the medication to you: within 24hrs if you are within the London area and within 48hrs anywhere else in the UK.
Once a treatment plan is agreed, a so-called titration period starts. As it is largely unpredictable what medication and what dose is the right one for a particular individual, it is a matter of trial and error to establish it. The titration period involves regular, half-hour, reviews to monitor response and adjust the treatment accordingly.
The main medications are controlled drugs, which means prescribing is subject to legal restrictions, so prescriptions are for a maximum of 30 days.
It is unpredictable how many reviews are needed in an individual case before it is clear a sustained and optimal improvement has been achieved. When that happens, a shared care agreement is put together to invite the GP to take over prescribing on the NHS, after which we review the patient once every 6 months. These various components of the treatment plan follow the relevant NICE guidelines. Follow up appointments cost ££225, shared care proposals cost £100. Briarbridge Psychiatrists provides a direct communication service to all of its patients after their assessments. This is free of charge and patients are able to communicate with their doctors via email.