Oliver Nagaya

We’re moving into a space now where ADHD is becoming far less stigmatised, let’s say, and people are talking about it a lot more.  Our team recently discussed the topic of adult ADHD with educational psychologist Dayne Williams and tried to understand more about this topic. Our purpose in this discussion was to get a better understanding of what ADHD is and how it is treated.

What ADHD Means?

According to the NHS, Attention deficit hyperactivity disorder (ADHD) is a condition that affects people’s behaviour. People with ADHD can seem restless, may have trouble concentrating and in some cases may act on impulse.

Symptoms of ADHD are normally noticed at an early age and may become more noticeable as a child develops and their circumstances change, such as when they start school. The majority of cases are diagnosed when children are between 3 & 7 years old. Sometimes though ADHD was not recognised when someone was a child, and they are diagnosed later as an adult.

ADHD in Adults

ADHD is neurological in nature, it’s not something that just pops into existence, right. So if you have it as an adult, you would have had it as a child. And, the signs of ADHD are often related to executive functioning. Executive functioning essentially is a term that we use to describe mental skills that help us navigate through life. Things like organising and planning are examples of executive functioning. Adults with ADHD, often have a lot of executive function deficits.

As an adult working in a corporate environment, if you feel like you’re unable to meet deadlines, even though you have every intention of doing that. However, you end up procrastinating significantly and leaving it until the last minute all the time. Then that crippling anxiety builds up and that process repeats consistently. Or you feel like actually, you’re capable of so much more, but you’re not being recognised for that, because you just can’t seem to work with some sense of efficiency. It could be that you are having meetings and you staring at someone and are trying to have a conversation, but you’re not taking in what people are saying, because your mind is wandering everywhere else.

These are all aspects that build up and you can imagine if this is happening consistently, it’s going to cause an increase in anxiety and frustration. And what a lot of adults don’t realise is that it might be ADHD. But they tend to internalise these things believing that there’s something wrong with them, or that they are just lazy, not intelligent enough, or just can’t listen to people. This often leads to what is called an ADHD meltdown.

What is an ADHD Meltdown?

When we have emotions and feelings that build up so extremely, there’s this outpouring or acting out in some way. But I think, you know, with kids, it’s very easy to see that kind of thing and often sort of resembles a tantrum of some sort. But with adults that can really manifest in different ways. These manifestations could be frustration, significant crying, anxiety, anxiety, and a real sense of hopelessness. Even self-loathing can be a form of an ADHD meltdown, where you just feel like, oh, there’s so much wrong with me, and I just can’t deal with life right now. 

If we use the metaphor of the pressure cooker, living with the challenges of ADHD can be unrelenting. And if it’s not managed, well, then they’re bound to build up over time and explode. So it’s just like a pressure cooker, if you don’t maintain and release the pressure it can be dangerous. But if we work on our self-awareness, and we laid off some of that pressure cooker steam gradually we can reduce the intensity of it and prevent the meltdown or explosion.

How Adult ADHD is Diagnosed?

The only difference between a childhood diagnosis and being diagnosed as an adult from a clinical perspective is that slightly fewer symptoms are required to be present to make a diagnosis in a child. But as an adult, there can be very different manifestations of ADHD, even though the symptoms are at their core, the same. The external factors are different.

So as an adult, you’re going to have the pressure to succeed in a career one day, manage a romantic relationship with a spouse or, significant other, or even parenthood. These are all aspects, of course, that children don’t deal with, but adults do and ADHD is going to have an impact on an adult, so clinically, not much difference, but of course in manifestation, it has a big difference.

When it comes to a diagnosis the psychologist or psychiatrist needs to find out about that patient’s history. They look at the developmental history, family history and medical history of the patient as ADHD is something that has to be present before the age of 12.

It’s important to have a combination of both qualitative and quantitative information. So the qualitative information comes from the conversation and the stories and hearing about the symptoms and how they affect the patient’s life and every aspect of it. The quantitative comes in the form of an actual assessment. Most practitioners use the Connors Adult ADHA Rating Scales (CAARS), as it gives us nice quantitative information, that gives us an idea as to the probability that the patient meets the criteria for ADHD. This assessment also helps with the specific areas that are affected by ADHD and we can develop a treatment plan from that. 

Using the CAARS assessment give the practitioner a more holistic idea of what that patient might be going through, and then they can make a definitive diagnosis, and therefore have a good treatment plan.

Adult ADHD Treatment

And so when people aren’t diagnosed, and move into adulthood, ADHD doesn’t miraculously disappear. If they haven’t had a diagnosis, then those symptoms are still going to be there, and they are still going to impact their lives.

If a patient is diagnosed with ADHD, then the practitioner has to have a conversation about treatment and medication. As you can imagine when it comes to medication, there are polarised views as to whether the medication works or not. There are options to follow a more homoeopathic route or go with more traditional medicine routes. Medication can only be prescribed by a psychiatrist and thus the psychologist will refer the patient to a psychiatrist for prescription purposes. In terms of the actual prescriptions for children and adults with ADHD are the same, but the dosages are different. So you won’t find a lot of adults on short-acting Ritalin but rather the long-acting Concerta.

Adult ADHD :: Further Resources

In this article, we referenced much of the information from the Moulding Health Episode that we had with Dayne Williams an Educational Psychologist based in South Africa. If you would like to watch the full episode, we included it for you here.

If you would like to view other areas related to health and insight from health practitioners, you can view our current list here: list of good health-related resources.

Adult ADHD :: Looking for Help from a Healthcare Practitioner. 

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