The UK is experiencing dramatic increases in requests for a diagnosis of attention deficit hyperactivity disorder (ADHD) in adults. But what is ADHD, and why is it suddenly becoming something the general public and medical professionals need to know about? In this feature, Dr. James Brown and Dr. Alex Conner provide some context.
National Teaching Scholar doctor conner is a reader in communication of biomedical sciences in the Faculty of Medical and Dental Sciences of the university of birminghamUNITED KINGDOM dr brown She is a professor of biomedical sciences in the Faculty of Health and Life Sciences of the aston universityUNITED KINGDOM
Together, they co-founded the charity ADHDadultUnited Kingdom in 2021 to improve the lives of adults with ADHD through psychoeducation, advocacy, and peer support.
ADHD it is a lifelong neurodevelopmental disorder in which the brain grows differently. This leads to poor action of the chemicals involved in pleasure and reward.
The name ADHD is a bit of a misnomer since people with the disorder do not have an attention deficit, but rather a lack of ability to control what they pay attention to. Even the hyperactivity part isn’t always obvious, at least externally.
ADHD is commonly associated with “executive function” problems. These are higher thinking skills such as planning, task management, cognitive inhibition, and working memory.
Although often considered a “new” disorder predominantly in children, ADHD was first described in medical texts dating back to the 1920s. 18th century. And although it is usually diagnosed during childhood, most people continue to live with ADHD throughout their adult lives.
Recently, a growing number of people reported ADHD symptoms for the first time as adults, in part due to high-profile cases or the impact of social media.
In fact, somewhere around 2.8% Adults are believed to be living with ADHD, and the vast majority of these go undiagnosed.
Despite this growing awareness, problems with health care resources, misunderstanding among health professionals, and the stigma surrounding the disorder means that many adults have difficulty obtaining a diagnosis.
The neurological basis of the disorder means that ADHD brains often look for ways to stimulate chemicals that are underactive, which is why people with the disorder may experience some or all of the main traits: inattention, hyperactivity, and impulsivity .
These core traits can manifest in a number of ways, including:
- Not being able to get on with longer tasks or not being able to start them.
- Being easily distracted by other tasks or thoughts.
- Look for activities, which sometimes include risky behaviors, that provide an immediate reward.
- Restlessness, either externally or internally.
- Interrupt other people unintentionally.
The symptoms of ADHD are very similar for both adults and children, although ADHD can present itself differently as we age. For example, inattention is the most persistent symptom in adults, and hyperactivity is less apparent.
ADHD can be extremely debilitating if left untreated. Has been associated with a greater likelihood of reduced quality of life, increased risk of substance use problems, unemployment or underemployment, accidental injury, suicide, and premature death, among other problems.
Furthermore, untreated ADHD is believed to have significant costs to society, with estimates of around £18,000 —about $24,400— each year per adult with untreated ADHD. This is due to things like health care and unemployment costs.
Beyond the core traits of ADHD, a variety of commonly associated coexisting conditions are reported in adults with ADHD.
These coexisting conditions include a greater than triple risk of mood disorders compared to adults without ADHD, a twofold increased risk of having an anxiety disorder, and an increased risk of eating disorders and obesity.
In addition, about 70% of adults with ADHD also experience emotional dysregulation, making it difficult to control emotional responses. Almost all adults with ADHD are thought to have rejection sensitive dysphoria (RSD)a condition in which real or even perceived rejection or criticism can cause extreme emotional pain or sensitivity.
As public awareness of adult ADHD increases, it has become apparent that receiving an ADHD diagnosis as an adult in the UK can be particularly difficult.
There have been reports in some areas of referral times of up to 5 years or more. These long waiting times are due to the requirement of a specialist psychiatric diagnosis.
Even with a referral to a specialist, there are still challenges. The individual has to show clear evidence of a significant number of ADHD traits, evidence that these traits are present from childhood, Y evidence that the disorder has a moderate impact on two separate areas of a person’s life, such as causing problems with work, education, or maintaining relationships.
The increase in people seeking referrals means that even private clinics have long waiting periods for diagnosis.
While there is now a growing recognition of adult ADHD, many people still live with it undiagnosed for various reasons: lack of awareness that adult ADHD is a real thing, poor management by health professionals, or hesitancy in diagnosis: the fear of being labeled with something that carries a stigma in society.
Understanding the condition in adults, taking it more seriously as a disorder, raising awareness both in society in general and among health professionals, and investing in services to improve diagnosis times are essential to address this growing problem.
Improving access to diagnosis and reducing the stigma associated with ADHD would open the door to treatment, which can have a marked impact on living with the disorder, such as improving self-esteem, productivity, and quality of life.
