ADHD: More Attention Needed

ADHD: More Attention Needed

A 400% increase. The figure for adults seeking a diagnosis in ADHD since 2020, according to Dr Tony Lloyd, chief executive of the ADHD foundation.

First, what exactly is ADHD and how is it diagnosed?

It’s categorised as a “neurodevelopmental disorder,” typically one that is diagnosed in childhood and can last throughout life.

The next part’s a bit of a mouthful, but stay with us.

In the UK, for an adult to be diagnosed, the person must have “at least five symptoms of inattention” such as poor organisation or being easily distracted, “and/ or at least five symptoms of hyperactivity/ impulsivity” like struggling to engage in quiet, leisurely activities, for six months or more, “to a degree that is inconsistent with [their] developmental level and negatively impacts social and academic/occupational activities.” (Diagnostic and Statistical Manual of Mental Disorders)

Most symptoms should also have been present before the age of 12. This is because, according to the NHS website, “it’s currently thought that ADHD cannot develop for the first time in adults.”

There’s no real debate as to whether or not ADHD is real. Proto-diagnoses began in the late 1700s – before diabetes and MS – and there are countless individuals who struggle with the heft of symptoms.

With that said, a 2016 review of existing literature posited that ADHD is less of an end diagnosis, and more of an admission of a place on a sliding scale (McLennan, 2016). That is to say that there is no one size fits all for the disorder and the burden can feel more weighty at certain times in our life than at others.

A line must be drawn at some point, where symptoms that arise from overactivity and restlessness coagulate, developing from mere proclivity and becoming labelled as a condition, to paraphrase Paul Bloom.

The simple binary decision as to having it, or not, and the possible subsequent medication, can be a problem.

Chiefly because of many of the stimulant effects of the medication, the addictive nature that some of them can create, and the generally understood position that there is no “cure,” meaning that you could, if you so choose, continue to medicate yourself with stimulants for the rest of your life.

Whilst one person may need medication perpetually, another may only need it for a short period of time, whilst another may not need it at all. These gradations of severity make it difficult to understand how best to tackle the disorder.

Again, to be clear, there’s no element of this piece that argues that ADHD isn’t real. Neurodiversity must continue to be lauded. For many, its propensity to change the way they live their lives is unarguable.

But there are almost certainly many more people for whom the (often private) diagnosis is being sought out as a means to categorise, and consequently medicate to address, somewhat common behaviour.

Knowing that you struggle more to focus, that you interrupt others, that you’re easily distracted (to use a few examples) doesn’t necessarily mean that you need to *fix* anything.

Further, the flipside of these character traits include creativity and “outside the box thinking.” Which highlights how being diagnosed with ADHD, for some, can be nothing more than an acceptance of a proclivity, as opposed to a foghorn for intervention.

That is to say, turning to addictive, mood altering medication shouldn't be seen as a first port of call.

The guidelines state
that medication should only be offered to adults if their symptoms are “still causing a significant impairment in at least one domain after environmental modifications have been implemented and reviewed.” With the NHS in its current state, these predeterminants are likely not being taken as seriously as they should.
Recent figures show that there has been an 85% increase in the number of identified patients prescribed drugs for ADHD since 2017 (The Pharmacist, 2023).

This, coupled with a 2023 BBC investigation, which found “50 percent of diagnoses from private clinics turned out to be incorrect when they were checked by [a] specialist ADHD service…" highlights that there's clearly a wider discussion necessary about how we evolve our approach in the future.

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