Its 30 years since the condition was recognised. It is most often associated with children, but more and more grownups are now being diagnosed. Does this help?
Michelle Beckett, a 44 -year-old entrepreneur from Harrogate, always knew she was different. But, like many women who suffer from attention deficit hyperactivity disorder( ADHD ), she did not fit the stereotypical profile of a child with the condition. Beckett’s difficulties would come later in life, when she failed to live up to her academic potential, experienced two failed matrimonies and had mental health problems.
At 36, Beckett decided to seek help. A neuroscientist in York told her that the results of an EEG- a recording of brain activity- indicated she had ADHD.” I rejected his diagnosis as rubbish ,” she says.” How could I have ADHD? I was just[ being] crap and needed to kind myself out .”
Beckett’s problems escalated from there. She experienced mood swingings so dramatic that any criticism could cause her to go from feeling happy to contemplating suicide. After a failed business venture, she ended up in the care of a local mental health crisis team, believing that her” family and the world would be far better off without me “.
It was then that ADHD was mentioned again by a psychiatrist, and, at the age of 44, she decided to seek a private diagnosis; one that is not merely transformed her life but saved it:” Everything fell into place. I wasn’t crap because I find VAT returns painful, blurted out stuff and was messy. I wasn’t crap at all. I have a neuro change, which gives me many advantages .” Beckett is just one of many people who slipped through the diagnostic net as children and were left to cope with their ADHD into adulthood.
It’s now 30 years since the American Psychiatric Association agreed that ADHD was the best word to describe this condition. It has long been viewed as something that predominantly affects children- mostly young sons- but increasing numbers of adults are now being diagnosed. According to the Royal College of Psychiatrists , ADHD is indeed more common in boys than in girls- surveys of children between the ages of five and 15 years have found that 3.62% of boys and 0.85% of girls had ADHD. As many people get older, however, the condition improves and around 1% of adults continue to have the condition, with about 2-4% showing partial symptoms.
ADHD in adults has come for the purposes of the spotlight this year with new advances in clinical research. A BBC Horizon programme featured comedian Rory Bremner’s personal journey to understand the science behind the condition. And the thinktank Demos has started a research project exploring the social and fiscal impact of undiagnosed ADHD in adults. It is due to be completed this year.
Even though ADHD is considered to be an modern condition, it was being discussed as early as the Edwardian period, probably for the purposes of theadvent of compulsory schooling in Britain.
I was diagnosed with ADHD when I was six. I doubt my psychiatrist felt much ambivalence when he was diagnosing me. During one of the assessments, instead of focusing on arranging a series of images into chronological order, I thought it would be more productive to climb to the top of the bookshelves in its term of office. I was easy to diagnose, but many children with ADHD aren’t ricochetting off the walls or scaling bookshelves and are therefore much less likely to receive a diagnosis in childhood. This is especially true for women, whose ADHD tends to manifest in less overt ways than it does in boys.
Dr Ashok Roy, head of the Royal College of Psychiatrists’ intellectual disability faculty, says the core symptoms are the same in men and women, but that” female patients’ inattention problems often are combined with daydreaming, whereas humen have more hyperactivity and behavioural problems, which are more noticeable during childhood “. Roy has also observed that women with ADHD also tend to suffer from other disorders that can affect their mood and behaviour.
Arielle, a 27 -year-old writer from Boston, was diagnosed with ADHD when she was 19. She remembers always being a quiet child:” I didn’t indicate the classic signs people think of when they hear about hyperactivity. Instead of bouncing off the walls, I simply fidget constantly. I slept through most of school, but, if I was awake, I never was an attentive listener ,” she says.
Arielle says her grades suffered throughout school because she was unable to focus on her homework. Her teachers told her that if she simply did her homework, remained awake in class and became organised, she could be a straight-A student.” Over the years, I started to assume I was just lazy. Instead of supposing there might be something wrong biologically, I assumed it was all my fault. And, every time I’d resolve to be better at being attentive in class, or neat or diligent about homework, I’d inevitably fail .”
Arielle feels that going undiagnosed until adulthood was ” pretty harmful” for her, and sometimes tells herself that if she actually had ADHD, someone would have noticed it sooner:” I still often doubt that I have ADHD and sometimes believe I’m just fooling everyone in an attempt to excuse my forgetfulness, messy nature, issues with planning ahead and problems completing projects .”
It’s not surprising that Arielle feels this way, as there is a prevailing scepticism about the condition, even among psychiatrists. The most frequent criticism levelled at the diagnosis of ADHD is that it pathologises normal behaviours. The neurologist Dr Richard Saul promoted this idea in his 2014 book, ADHD Does Not Exist. At the same period, in an article for Time magazine, Saul expressed concern over the stimulants used to treat ADHD- most commonly methylphenidate- and argued that, under the criteria employed to diagnose the condition,” the entire US population could potentially qualify. We have all had these moments and, in moderate quantities, they’re a normal part of the human condition .”
These arguments tend to come as a reaction to the recent detonation of ADHD diagnoses in children, particularly in the US. However, Roy argues that” untreated populations fare worse on academic, social and occupational outcomes as well as contact with the law “. He argues that practitioners should” guard against overdiagnosis by the use of systematic appraisals using internationally agreed criteria “.
In April this year, the Lancetpublished a report that indicates the condition is a valid pathology. Researchers from nine countries scanned the brains of people aged between four and 63 years old, 1,713 with ADHD and 1,529 without. The report discovered small differences in brain size between those with the condition and those without it. These changes were more pronounced in children, and the differences were still apparent in unmedicated subjects.
If we accept that ADHD is real, then we might want to address the lack of awareness that exists within our society, as undiagnosed adults are often left to live dysfunctional lives. According to Roy, part of their own problems when diagnosing adults is that they are more likely to” internalise their inner restlessness rather than act it out as children do “. Roy adds:” This may show as mood swingings, difficulty getting along with others, problems holding down a undertaking, substance-abuse problems, and a pattern of being irresponsible and stimulating poor decisions. These behaviours may be incorrectly attributed to personality problems, nervousnes or depression rather than ADHD .”