What is attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) and how common are they really?
They are both lifelong conditions, in which patients experience inattention symptoms (eg difficulty staying focused, forgetfulness, losing things, poor time keeping, brain fog) and impulsivity symptoms (interrupting, making quick decisions without thought, difficulty relaxing, risk taking). Some patients are also hyperactive and in a child this manifests as fidgetiness and excessive energy whereas in adults it may manifest as talking excessively or feeling restless. If hyperactivity is also present a diagnosis of ADHD is made instead of ADD.
There are often other associated symptoms such as mood swings, difficulty in sleeping, oppositional defiance, procrastination and a low tolerance to frustration but every patient is different and in girls and women symptoms may be harder to spot. A teenage girl will often try to hide her symptoms, which may make her feel anxious or low.
ADD and ADHD are common conditions and highly heritable, affecting between 3-4 people per hundred people. For some the challenges are apparent from a very early age, but for others their challenges only become apparent in adulthood when the structure of school or university goes, and life becomes more complicated. Increasingly, now that more is written about it, adults are being diagnosed after many years of difficulties that were not spotted. Remember also, that some patients enjoy their symptoms, are highly successful and need no treatment. There are many well-known high achievers who recognise their own attention deficit and have adapted their lives accordingly.
How do you diagnose attention deficit disorder?
Diagnosing attention deficit is a complex process and although it is often easy to see or experience symptoms in yourself or your child an evaluation has to be thorough and comprehensive. It usually involves a face-to-face appointment with a consultant psychiatrist and he or she will rule out other causes of difficulty in focusing and determine the presence or absence of other mental health conditions that may complicate the diagnosis. They will look at collateral information from school reports, employers etc and will do their own clinical evaluation before making a formal diagnosis. We all have times in which our focus is lessened and we recognise many of the symptoms in our everyday lives but in order to be diagnosed with attention deficit those symptoms have to have been present in childhood, they have to persist long term and they have to be greater than that those which any other person faces.
Should I medicate my child or myself?
Medication is only a small part of the treatment for attention deficit, and although it can often by extremely effective, it is a big decision and needs careful thought and discussion. There is stimulant and non-stimulant medication, and most patients start with stimulant medication. Not everyone benefits from medication, and the stimulant medication has significant side effects. A diagnosis can be disappointing and sad, but usually there is also relief and understanding, and learning more about how your brain or your child’s works is enlightening and confirming.
Lifestyle changes can make a huge difference. There is good evidence for nutritional changes and also for exercise. Strict elimination diets are probably not necessary for most, but the role of omega 3, magnesium, zinc, Vitamin C and B Vitamins is interesting and regular exercise benefits patients with ADHD even more than patients without. Some foods can trigger symptoms and some nutritional deficiencies can amplify symptoms.
How can Sloane Street Surgery help?
If you are wondering about yourself or your child, do make an appointment to come in and discuss your symptoms. It may be that you are anxious, stressed or depressed, as anxiety and stress can also destroy focus. It may be that you have poor sleep, and by improving your sleep, diet or exercise some of your symptoms will lessen. We work with several different adult and child psychiatrists with an interest in diagnosing and treating ADHD and we also work with several different psychologists and executive function coaches. There are educational psychologists that can help, and great podcasts, books and apps.