There has been a 20-fold increase in the number of people being diagnosed with ADHD between 2000 and 2018. Photo / 123rf
There has been a 20-fold increase in the number of people being diagnosed with ADHD between 2000 and 2018. Photo / 123rf
There has been an explosion in ADHD cases over recent years. Here’s how to know if you have the condition and what you can do about it.
From high-profile celebrities to midlifers waking up to a condition they never knew they had, it feels as if everywhere you look you can find somebody who has attention deficit hyperactivity disorder, known as ADHD.
The numbers certainly point that way. According to the National Institute for Health and Care Research (NIHR), there has been a 20-fold increase in the number of people being diagnosed with ADHD between 2000 and 2018. Post-pandemic numbers have climbed even faster. Since 2020, The ADHD Foundation has reported a 400 per cent increase in the number of adults seeking a diagnosis.
According to experts, the explosion in cases is partly because we’re playing catch-up with a condition we’ve only recently recognised.
“ADHD has been largely misunderstood. Initially, it was thought to be a condition of childhood, and that we grew out of it. It was only towards the end of the last millennium that was proved not to be the case. What you see in adulthood is that people can disguise it to some extent, but that if not treated a lot of other problems like anxiety and depression can develop,” says Dr Mike Smith, a consultant psychiatrist and the clinical lead at the Adult ADHD Service in Leeds.
Read on for everything you need to know about ADHD.
ADHD can lead to problems with sleep, attention and focus. Photo / 123rf
What exactly is ADHD?
ADHD is a neurodevelopmental disorder in which the connections or neurotransmitters between different brain regions work differently, leading to issues with inattention, impulsivity and hyperactivity.
“The current consensus is that there is a difference in certain neurotransmitters in people who have a diagnosis of ADHD, and the transmitters dopamine and noradrenaline are most affected,” says Dr Smith.
This can lead to problems with sleep, attention and focus as well as what is known as executive function – planning and organising your life. Researchers have also found that the brains of some people with ADHD have quieter frontal lobes, which is the area in charge of impulse control and inhibition.
ADHD is common, affecting around one in 20 people, and although the number of people getting diagnosed has risen dramatically in recent years, most experts believe the lengthy NHS waitlists mean the disorder is still underdiagnosed.
ADHD symptoms start in childhood, usually at primary school before the age of 12, which sets it apart from other conditions like bipolar disorder. That said, people often don’t realise they have ADHD, as symptoms in childhood are often missed, particularly in girls and introverted people who don’t present with the classic symptoms.
“People are looking for that prototype of a young boy bouncing around the classroom, but it’s a gross oversimplification and there are many more subtle forms of ADHD,” Dr Smith says. Fortunately for most people, ADHD is very treatable.
What does living with ADHD feel like?
The classic symptom of ADHD, which most people associate with the condition, is hyperactivity - which can manifest in an inability to sit still and listen in class. As adults, this might manifest as fidgeting or being unable to stay seated during meetings.
Children with ADHD also struggle to focus on certain tasks, so they often find themselves getting in trouble for not doing homework or revising for tests and can end up being branded lazy by teachers and parents.
Children with ADHD may find themselves in constant trouble at school and home. Photo / 123rf
“Imagine growing up and you are in constant trouble at school and home and you start to think you’re stupid because you can’t concentrate on your schoolwork. People start to internalise that and this can lead to them feeling very deficient. As adults, the hyperactivity can get a little calmer, but what stays is the mental restlessness, the mind is constantly whirring, and that can be exhausting,” says Dr Thilo Beck, an ADHD specialist and consultant psychiatrist at the exclusive Swiss clinic, Paracelsus Recovery.
“How I describe it to my patients is that they have fewer mental filters, so all the input from the outside world comes in and they can’t process it. We recommend that people with ADHD should choose jobs that are more active, or which have a lot of variety to fight off boredom, however, they also have to watch for getting easily overwhelmed.”
How does ADHD affect everyday life?
Sleep is often an issue as the brain won’t shut down at night. “Part of it is the anxiety and worry that often accompanies ADHD, or it’s down to mental activity. People get into bed, the head hits the pillow and it takes them a couple of hours looking at the ceiling before they can fall asleep,” explains Dr Smith.
Navigating relationships can also be tough as people with ADHD can struggle to listen to what others say, and people might interpret this as a lack of interest. Or they can annoy people by being overly chatty and interrupting them, or find they are quick to anger and can’t control their temper.
“This is known as emotional dysregulation and is controlled by the frontal lobe in your brain. In people with ADHD, it is quieter and this can lead to tremendous problems in intimate relationships and the workplace,” says Dr Smith.
Although inattentiveness and struggling to focus are key symptoms, people with ADHD can “hyperfocus” on some things. “It’s not that the person can’t concentrate, it’s that they can’t control where they put their attention,” Dr Smith adds.
As a result, people with ADHD are often thrill-seekers and may abuse substances like alcohol and drugs to soothe their constant restlessness. They may also struggle with “executive function” – planning and organising their lives.
ADHD often exists alongside other conditions, including dyslexia, dyspraxia, autism, Tourette’s, anxiety and depression. For a diagnosis, clinicians are typically looking for major impairment across two domains, such as work and home life and relationships with other people.
Inattentive ADHD refers to people who struggle to focus, listen to others and are easily distracted. Photo / 123rf
What are the types of ADHD?
When you are diagnosed with ADHD you are divided into one of two types, or a combination of the two. The combined type is the most common.
Impulsive/Hyperactive: People with this type might have excessive energy, struggle to sit down, fidget often, interrupt others and talk excessively.
Inattentive: These people are the dreamers who struggle to focus, listen to others and are easily distracted. They have trouble with attention to detail and organising tasks and activities. They may lose things, forget things and easily make mistakes.
Combined: Most people find they have a combination of inattentive and hyperactive ADHD – at Dr Smith’s clinic, 70 per cent of his patients have combined ADHD. It’s also the case that as people get older they might look less hyperactive as they learn to disguise it. “Some people might judge themselves to be the inattentive type, but often when I do the reassessment I find a hyperactive internal restlessness. These are the people who always find things to busy themselves with, like helping out at a dinner party, or crocheting during a meeting, or using fidget devices, it helps to quieten the mind,” says Dr Smith.
What causes ADHD?
ADHD is a genetic condition which tends to run in families, so there is a high chance that if you have ADHD a relative will also have a diagnosis. However, environmental factors also seem to play a part, including experience of trauma, birth complications, brain injury and exposure to toxins.
“We don’t yet understand how these triggers influence ADHD, we have 60 years of research, but there’s a lot of variability, what we don’t have are neat, consistent findings,” says Dr Smith.
Many experts believe that because ADHD is so common there must be an evolutionary explanation. Intriguing recent research has suggested the ADHD brain may have evolved in hunter-gatherer societies where their impulsivity and risk-taking traits would have been an advantage when it came to foraging for food.
ADHD will usually present in primary school before the age of 12. Photo / 123rf
ADHD commonly starts in childhood
ADHD will usually present in primary school before the age of 12, although some children, particularly girls who are dreamy and inattentive rather than hyperactive, may be missed.
A red flag might be a child who is bright but is underperforming at school or a child that a family can find quite exhausting to be around.
“It’s difficult as a lot of children are exhausting, so it has to be at another level, or behaviour that the child doesn’t grow out of,” Dr Smith states.
Dr Helen Read is a consultant psychiatrist who worked for many years in the NHS running an ADHD service, and now runs a private practice, The ADHD Consultancy. She says many children with undiagnosed ADHD can manage to get through their GCSEs but that most of them struggle when it comes to A-levels.
“You need ‘executive function’ to do A-levels, and by this stage, if they have undiagnosed ADHD almost all of them fall off a cliff.”
If you think your child may have ADHD, you should speak to your GP. Your GP can refer you to a specialist for an assessment, but as with adults, there are lengthy waiting lists. You can also speak to your child’s teacher or the school’s special education needs co-ordinator.
Why is ADHD often missed in girls and women?
In recent years there have been many high-profile stories of women who have only realised they have ADHD later in life, as their symptoms had been missed as children.
“We don’t know why it sometimes manifests differently between the sexes, but it could be to do with how males and females are socialised – it’s more acceptable for boys to be hyperactive. Girls are more likely to be daydreaming in class and not paying attention, but as long as they sit quietly and don’t move they don’t disturb the class so nobody notices,” says Dr Beck.
Women might also be better able to mask their symptoms. “Women may feel more obliged to mask their behaviour and develop compensatory behaviours, like anxiety for example, and then it’s the anxiety that is treated rather than the underlying ADHD,” Dr Smith adds.
Visit your GP if you think you have ADHD. Photo / 123rf
What should you do if you think you have ADHD?
First, visit your GP. They will refer you for an assessment on the national health system. However, waiting lists on the system are lengthy and in many cases getting worse, with the worst-affected trusts citing wait lists of up to 10 years.
It’s not surprising that many opt for a private assessment, and that many private clinics also have long waiting lists.
If you do choose to go private, make sure you choose a reputable clinic as you may want to get back into the national system to be prescribed your medication.
Speaking about the National Health System (NHS) in the United Kingdom, Dr Smith says, “Medication is expensive and you may need it for life. But if you do go back into the NHS, your GP will need to be sure they can rely on the validity of your report before they can safely prescribe medication, and if the report isn’t comprehensive, you may find yourself waiting to have your diagnosis confirmed by the NHS.
“Talk to your GP about the private clinic you’ve chosen, they may have worked with them before. Speak to a local charity that may be in contact with local reputable private providers, and seek out recommendations from peers. Around 80 per cent of adults with ADHD have another condition as well so if someone isn’t correctly trained, there is a risk ADHD might be incorrectly diagnosed or missed.”
What medication is available for ADHD?
ADHD is highly treatable and medications are effective for most people.
Stimulants: The first line of treatment is stimulant medications, such as methylphenidate, dexamfetamine or the lesser-known lisdexamfetamine. According to Dr Smith these work in 80 per cent of his patients. However, for some people, the stimulants either don’t work or aren’t tolerated. Side effects can include insomnia, appetite loss and jaw clenching. In this case, doctors might try a non-stimulant medication.
Non-stimulants: The main second-line, non-stimulant treatments are atomoxetine and guanfacine, which increase the amount of a chemical in the brain called noradrenaline, which boosts concentration and helps control impulses. These can be an effective alternative for some patients.
What psychotherapeutic treatments are there for ADHD?
Medication isn’t necessary for everyone with ADHD. “The condition exists on a spectrum and for less severe cases we try coaching to help people be more self-aware about their impulse traits, to help them interact differently with others, and to learn to organise themselves,” says Dr Beck.
Cognitive behavioural therapy (CBT) and mindfulness training can also be useful. “People tend to be impulsive and have a problem thinking about consequences. With mindfulness and CBT they can learn to be more grounded, and not to act immediately,” Dr Beck adds.
Consistent exercise can be a very useful way to manage ADHD symptoms. Photo / 123rf
How can lifestyle changes help with ADHD?
Many simple daily strategies can help with managing ADHD symptoms. “We help them with little things like advice on writing lists, packing your bag the night before, having a place to leave keys, setting a series of alarms on your phones for reminders, paying your bills by direct debits, that sort of thing,” says Dr Read. However, Dr Beck also uses melatonin supplements to help treat people with sleep problems.
Exercise
Consistent exercise can be a really useful way to manage symptoms. “People with ADHD need dopamine and physical exercise will give you dopamine, a better body and help your brain work better. Many high-functioning people with ADHD exercise quite excessively to manage their brains,” Dr Read explains.
Diet
There’s a lot of discussion about diet and nutrition but so far the research is inconclusive beyond the usual advice to eat a healthy, balanced diet.
“Supplementing Vitamin D is helpful if you are deficient, so that’s an easy win. Non-pharmacological options are not going to be individual game-changers, but when you stack them together they can have an impact,” says Dr Smith.
What is behind the rise in ADHD cases?
“If you look at the trajectory of the numbers of referrals of ADHD you see a steep rise around 2021 during the pandemic, at the same time you can see that the revenue of TikTok follows the same curve,” says Dr Smith. “I think social media reached a lot of people and acted as a sort of catalyst to spread awareness and recognition of the condition and alongside the pandemic, it just started to snowball,” says Dr Smith.
Yet the growing numbers of diagnoses have also led to scepticism from some doctors and the public, and charges of unreliable and not sufficiently rigorous diagnoses in the private sector.
Part of the reason for this is that the symptoms of ADHD are so universal – we can all relate to struggling to concentrate, motivate or focus. Yet if you have ADHD these symptoms are of a different order of magnitude.
“People look for simple solutions and it’s easier to label people as lazy or unmotivated,” Dr Smith explains. “It’s not like psychosis, many of us have experienced these ADHD symptoms. But most people I see are majorly impacted by the condition, they are often unable to hold down a job or a relationship and are feeling terrible about themselves.”
People with ADHD have higher divorce rates and are more likely to be unemployed or in a car accident, and 25 per cent of adults being treated for alcohol or substance abuse also have ADHD.
“I think we are more likely to spot it now in children, but I see a lot of adults in my practice who have been diagnosed in middle age, and often they realise that their lives would have been so much easier if they had been supported earlier, and it’s devastating. I don’t see any reason to be sceptical, on the contrary, we should do everything we can to get everybody diagnosed,” says Dr Beck.
