Imagine being born like this, unable to sustain focus, being easily distracted by stimuli that provide your brain with what it needs to feel OK. Feeling constantly restless, as if on the go, your body literally won’t sit still.
Name tags on your shirts drive you crazy and need to be cut off.
You seem to always be told off because you forgot something, because once you do find something that is very rewarding, you lock onto it with hyper-focus, and the rest of the world doesn’t even register.
Scolding causes you to be emotionally flooded as it is too much to process, and patterns of stress in response to feedback begin, alongside lowering self-esteem.
This drives you to seek more stimulation, making you less able to complete mundane tasks.
Your teacher even says you are bright, but you perform under your potential because you never pay attention and are disruptive in class. Your natural intelligence and creativity manage to get you through school, and you may have been labelled “lazy” by some.
More scolding, more flooding, less self-esteem and achievement. Exercise seems to help, but you get frustrated at sports because even though you have the ability, you underperform under pressure, making simple mistakes.
However, online gaming or playing music are areas where you can excel, due to the high levels of stimulation. Your parents worry because you don’t seem to be doing anything else.
Getting to sleep is impossible and you become dog tired during class.
The risk-taking period of adolescence begins. Experimentation with drugs is engaging for your brain, putting you at risk of becoming addicted.
Your attention, behaviour and sleep patterns get worse, so maturity and achievement are further diminished. Struggling with confidence in social situations is stressful as you often interrupt people and finish their sentences.
You can’t seem to follow conversations and often make gaffs. You are impulsive and at times you break the law.
Typically, in your early 20s, you seek counselling to discuss your anxiety and depression, which does not seem to have responded to anti-depressant medication. Stopping cannabis did not help at all.
You are tearful, as your frustration tolerance is always low but worse when you are down. You lament recurring thoughts of suicide despite wanting to live a good life.
The counsellor enquires about school progress, hyperactivity and distractibility and wonders if you have Attention Deficit Hyperactivity Disorder. Online tests indicate a high probability of ADHD.
This explains why you are having problems in your relationships, including sexually. Previous failures now make sense, and energy and hope for the future set in.
Your partner now understands that your forgetfulness and poor listening are not about them, but about you. After trying your mate’s Ritalin, suddenly all the noise is gone.
You can focus clearly, and you get all your bills and washing done. Your boss noticed how productive you were that day but wondered why it didn’t last.
Your GP advises that a psychiatrist must diagnose this neurodevelopmental disorder, but there is no option to be seen in our public system. You work in a minimum-wage job and cannot afford the large fee to be seen privately. The waiting list for this may be months anyway.
There was a GP who specialised in ADHD and made it possible for people to access this type of treatment. The New Zealand Health Practitioners Disciplinary Tribunal last month found him guilty of professional misconduct for incorrectly prescribing Ritalin and other ADHD drugs.
He faces being sanctioned.
In my view, he may know more about ADHD than a number of psychiatrists but he broke the rules for prescribing to keep patients’ treatment continuous.
I feel for this doctor and, in my opinion, this situation highlights the lack of resources available for an issue that can affect 2 to 5 per cent of the population.
It is frustrating for a practitioner to diagnose a patient, with limited access to treatment even though it is indicated and available. We need to develop capacity in the system for accurate diagnosis, treatment and monitoring.
Not all ADHD patients need medication, but they need diagnosis and support. In my view, general practices could do this, with adequate support from their specialist colleagues.
We could at least pay attention to that.
Tony Farrell has been a general practitioner for 30 years. He is a Mount Medical Centre director and a Fellow of the Royal New Zealand College of General Practitioners. Tony has a special interest in mental health and addiction and is a trustee of Hanmer Clinic and medical spokesperson for Alcohol Action NZ.
