Understanding ADHD: Signs, diagnosis, and treatment

In his latest online article, Dr Vitantonio Di Fabio gives us his insights into ADHD. He talks about the signs and symptoms, how its diagnosed, the assessment process and treatment options available.

What are the symptoms and signs of ADHD in children and adults?

The symptoms, which can be broadly categorised into two main areas. The first category is inattention, encompassing a variety of issues. Within this category, there's a tendency to consistently overlook details and make careless errors in schoolwork. Difficulty in maintaining focus on tasks, particularly those that are repetitive or disliked, is common. This may result in misplacing or forgetting items crucial for school-related activities, such as books or necessary tools. Additionally, individuals might face challenges in organising and prioritising tasks, leading to a generally messy environment. They may also avoid activities they dislike.

Moving on to the second category, we encounter hyperactivity and impulsivity. Unlike adults, where hyperactivity tends to diminish, it is more prevalent in children. Issues related to hyperactivity include fidgeting, restlessness, and difficulty staying seated during lessons. Children with these symptoms may engage in loud and disruptive behaviours, interrupting conversations and participating in potentially dangerous activities. They may struggle to play or engage quietly in leisure activities and often exhibit impulsive decision-making.

It's essential to note that these symptoms should be present before the age of 12 for a diagnosis in both categories. In terms of impulsivity, individuals may struggle with impulse control, leading to impulsive decisions and potentially dangerous behaviours. This impulsivity can persist into adulthood, where coping mechanisms might be developed, but situations may still arise where potential is not fully realised.

In the diagnostic process for adults, a questionnaire about childhood symptoms filled out by those who knew the individual as a child is often required. Symptoms may vary slightly in adults, and coping mechanisms may mask the extent of the condition. While some adults with ADHD may excel in certain areas, there can still be instances where they fall short of their potential.

Additionally, ADHD may coexist with other conditions. Substance misuse is a common comorbidity, and in females, depression and anxiety are frequently diagnosed together. Post-traumatic stress disorder may also be linked to ADHD, especially when impulsive behaviours lead to traumatic experiences.

How is ADHD diagnosed and what is the assessment process?

The diagnosis of ADHD involves a comprehensive process, and while I am not directly involved in assessing children, my focus is on adult assessments. The procedure encompasses a thorough mental assessment, along with the administration of the Diva questionnaire. This questionnaire requires patients to identify symptoms in two distinct areas of ADHD: inattention and hyperactivity. Additionally, there is a child-specific questionnaire, known as the Adult ADHD Parent or Adult Questionnaire, completed by parents or relatives familiar with the patient's childhood.

The Diva 5, now recognised as the diagnostic interview for ADHD, is filled out by the patient after a complete assessment. The patient's journey at the clinic begins with triage, during which a preliminary medical review is conducted. Subsequently, patients undergo a full mental assessment, including discussions about the results of the Diva questionnaire and the questionnaire for parents. This entire process, from triage to questionnaire completion and the psychiatrist-conducted mental assessment, culminates in a comprehensive review of the findings.

Following the guidelines of international standards such as DSM-5 or ICD-10, which serve as recognised manuals for mental disorders, the psychiatrist, during the full mental assessment, evaluates whether the patient meets the criteria for ADHD. It's important to note that numerous other potential diagnoses are considered and ruled out within the comprehensive mental assessment, utilising various tools and processes.

What treatment options are available for managing ADHD?

Treatment options for managing ADHD include both pharmacological and non-pharmacological approaches. On the non-pharmacological side, various talking therapies and supportive applications have been developed. Peer-to-peer support, often provided by different patient groups in the UK, is also valuable. As for the pharmacological aspect, the NICE guidance recommends medication as the first-line treatment for ADHD. Methylphenidate, commonly known as Ritalin, is often the initial medication prescribed, especially for adults. Extended-release formulations are commonly used, ensuring a sustained release of the medication throughout the day. In children, there may be a preference for extended-release formulations compared to adults.

Regarding the lifelong nature of ADHD, unfortunately, it is a neurodevelopmental disorder that persists throughout an individual's life. This characteristic poses challenges with health insurance companies, as the condition is not always recognised post-diagnosis due to its developmental nature. However, there is evidence that after two years of continuous medication, some individuals can maintain improvements in symptomatology even if they discontinue treatment. Another group may experience a return of symptoms under stress but can resume medication as needed. Lastly, approximately one-third of patients may find that discontinuing medication results in a complete return of symptoms to pre-treatment levels.

Dr Vitantonio Di Fabio is an esteemed psychiatrist with over 15 years of experience. You can schedule an appointment with Dr Di Fabio on his Top Doctors profile.