What is ADHD?
ADHD, or
attention deficit hyperactivity disorder is the current term used in DSM-5 (The
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition which was
published in May 2013 by the American Psychiatric Association) which describes a life long
pattern of inattention, hyperactivity and impulsivity of a severity that is
causing impairment . Subtypes include ADHD inattentive subtype where symptoms are predominantly inattentive; ADHD, hyperactive/impulsive subtype, where
predominantly hyperactive/impulsive symptoms occur and ADHD, combined subtype where
inattentive, hyperactive and impulsive symptoms are all present. You may come
across the term ADD or attention deficit disorder which is an older term used
particularly in US to describe ADHD, inattentive subtype. Hyperkinetic disorder
is described in ICD-10 (WHO 1992) is broadly equivalent to ADHD combined
subtype, so a more severe form of ADHD.
Diagnosing ADHD
ADHD is a neurodevelopmental disorder, present in about 5% of children. It continues into adulthood to present with symptoms and associated impairment in up to 50% of cases. There is under diagnosis of ADHD in adults for a variety of reasons including a lack of awareness and expertise in NHS services and a lack of specialist services and ADHD can be tricky to detect in adults as the physical restlessness and hyperactivity which can be marked in children may be less prominent, adults may have developed coping strategies so that symptoms are hidden and symptom of ADHD may be thought to be caused by other conditions such as depression, anxiety or personality disorder.
Treating ADHD in adults
If ADHD is
confirmed in an adult, treatment should be offered and this can take the form of
medication or psychotherapy. The National Institute for Health and Care
Excellence (NICE) recommends that medication, including stimulants
(methylphenidate, dexamfetamine and lisdexamfetamine) and non stimulants
(atomoxetine), should be used where clinical appropriate in adults with ADHD and
there is evidence that medication can improve quality of life, reduce symptoms
burden and reduce functional impairment.
Cognitive behavioural therapy (CBT) has a growing evidence base for effectiveness in ADHD in adults and it can be vital to develop skills and tools to reduce impairment secondary to ADHD.