ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental condition arising since birth.
ADHD is characterised by 3 main sets of symptoms:
- INATTENTIVE symptoms are characterised by poor concentration, distractibility, forgetfulness and a difficulty sticking to tasks resulting in many tasks being undertaken at once with none reaching completion. Disorganisation and carelessness are other features of inattention as is difficulty listening and carrying out instructions.
- HYPERACTIVE symptoms are characterised by being overly active, difficulty sitting still, restlessness, fidgeting, excessive movement and an inability to relax.
- IMPULSIVE symptoms are characterised by difficulty sitting still, fidgeting, excessive movement and an inability to relax. Other features include excessive talking, interrupting, impatience and speaking or acting without thinking through the consequences. People with hyperactive and impulsive symptoms often appear to have little sense of danger.
Most people with ADHD have all 3 sets of symptoms, but some may exhibit more inattentive symptoms and others may exhibit more hyperactive / impulsive symptoms.
The hyperactive and impulsive symptoms in ADHD may also lead to emotional dysregulation characterised by poor temper control (feelings of irritability and short outbursts of temper), over-reactive emotions (difficulty handling stress and feelings of being overwhelmed) and lability in mood (unpredictable and quick shifts in mood from normality to depression or anger or excitement).
All of these symptoms of ADHD are experienced by everybody at some point in their lives but in ADHD these symptoms are extreme, persistent and have a marked impact on day to day functioning:
As a result of these symptoms, adults with ADHD often experience:-
- Underachievement in education
- Poor work performance
- Financial difficulties
- Relationship difficulties
- Road traffic accidents
- Involvement in law breaking
Up to 66% of adults with ADHD also suffer additional mental health problems including:-
- Drug and alcohol misuse
- Bipolar affective disorder
- Personality disorder
Treatment of ADHD can bring about improvement in all of these areas and make treatment of other mental health problems much more straightforward.
The National Institute for Health and Care Excellence (NICE; March 2018) recommend medication as first-line treatment for adults with ADHD. Medication is effective in reducing the symptoms of ADHD in up to 80% of patients.
There are 2 main types of drug used to treat ADHD:
Stimulants: Methylphenidate (well known as Ritalin) group and Dexamfetamine group.
Stimulant drugs work quickly, usually within half an hour and are available in different forms: immediate release, intermediate and sustained release. Immediate release stimulants usually last for around 4 hours, whereas sustained release stimulants can last from 8 to 14 hours. Sustained release stimulants have the advantage of once daily dosing for adult lifestyle.
Stimulants are ‘controlled’ drugs. This means that you will need to provide proof of identity when collecting from the pharmacy.
Non-stimulants: Atomoxetine and Guanfacine
Non-stimulant drugs take a long time to work, often up to 1 month. They have the advantage of a much longer duration of action than stimulant drugs and they are not ‘controlled’ drugs.
There are many other medication which are not within the above categories.
The decision about which medication to use will be based on several factors including what you hope to achieve with treatment, presence of other conditions (physical and mental) and your personal preference based on information provided by the doctor.
At follow-up appointments the dose of the chosen medication will be adjusted according to your response to the treatment and presence of any side effects.
Medication will be started after a review of your physical health and checking your blood pressure and heart rate.
Like all medications, ADHD medication may cause side-effects although not everybody gets them. Different side effects can occur with the different types of medication.
Dr Tint and team will talk to you about which side-effects may occur with your treatment. They will review your treatment regularly and check your weight,heart rate and blood pressure before and during treatment.
Sometimes side-effects get better once you have settled on the medication or you may learn to manage them. The dose of the medication may be adjusted or it may be necessary to change to a different medication.
Non -medical treatments include psychological therapies, ADHD coaching and other forms of support. Information to employers and education establishments are also part of such support.
These can be discussed within the consultation with your doctor.