Disorders

Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder manifesting as a behavioural syndrome characterised by 3 main symptoms: inattention, hyperactivity and impulsivity. As with any developmental disorders, a diagnosis of ADHD reflects an extreme of, or delay in, the rate that a normal trait is developing by comparison to same age peers rather than an absolute loss of function, failure to develop or pathological fixed state.

The primary problem in ADHD seems to be in executive function, which is hypothesized to contribute a shift in the source of control over human behaviour from: external events to mental representations related to those events; control by others to control by self; immediate reinforcement to delayed gratification; and the temporal now to the conjectured social future.

The prevalence of ADHD ranges between 2-6% of children and the male:female ratio is approximately 3:1. 80% of the risk burden for the disorder is inherited. Approximately 20-40% of children continue to experience problems in the late adolescence and early adulthood, particularly with impulsivity and inattention, although hyperactivity symptoms typically decline is severity.

Symptoms

Inattention

• Fails to give close attention to detail
• Difficulty sustaining attention
• Does not listen when spoken to
• Fails to follow through on instructions and complete tasks
• Difficulty organising tasks or activities
• Avoids or dislikes sustained mental effort
• Loses things needed for tasks
• Easily distracted by extraneous stimuli
• Forgetful in daily activities

Hyperactivity

• Fidgets with hands or feet
• Socially inappropriate behaviour
• Wanders or runs excessively / subjective feelings of restlessness
• Difficulty engaging in leisure activities quietly
• 'On the go' or acts as if driven by a motor
• Talks excessively

Impulsivity

• Blurts out answers before questions completed
• Difficulty in waiting turn
• Interrupting or intruding on others

Treatment

If these symptoms continue to interfere with vocational, social, marital or family functioning in adulthood, treatment is recommended.

• Medical – medication is the first-line intervention for adult ADHD and the same drugs prescribed in childhood are used in adults, namely methylphenidate or amphetamine compounds, or if these are not tolerated, desipramine (an antidepressant) or atomoxetine.
• Psychological – psychological interventions are aimed to help patients and their partners, families and work colleagues learn and adapt to their deficits. There are a number of interventions that might be helpful including: CBT, self-management skills training, environmental restructuring, psycho-education, individual psychotherapy, family therapy, marital or couples therapy, vocational counselling, or ADHD Coaching.