Page 27 - IDF Journal 2023

patients that we need to get up to speed with ADHD.17
And what about the social comorbidities? Untreated ADHD is a disorder associated with serious distress and/or impairments in living. The emotional, behavioural, school, and social consequences of
our collective blindness to ADHD are catastrophic18, as is totting up the millions spent treating the consequences. For adults, finally getting a diagnosis of ADHD is often bittersweet, as they look back on their lives, and those of family members and reflect ‘it didn’t have to be this way’.
Again, in my NHS general adult psychiatry outpatient clinic, I recall two of my ADHD patients over a four year period losing (undiagnosed) children to hit and run accidents.19 That really brings home the human cost of our societal unwillingness to open our eyes to this.
And let’s also remember the women. We know now that women with ADHD often present with symptoms that are different from men and because of this, they are frequently missed or misdiagnosed with other health conditions and given the wrong treatment.20 Why?
While the true rate of ADHD in boys is thought to be higher than in girls, it is also true that boys are diagnosed with ADHD more often. The average age of diagnosis for boys is 8, for girls it is 9 years later at 17. A lot of damage has often been done by then.
Boys are more likely to present with the hyperactive/impulsive or combined type of ADHD, which tends to produce externalising symptoms which are obvious and fit the stereotype.
Girls more often present with inattentive or internalising symptoms, such as forgetfulness and difficulty sustaining attention, which are easier to mask. Girls often mature a bit sooner than boys and often work hard to hide their emotional dysregulation, poor concentration and memory, and impulsivity. Girls are more likely to be perceived in childhood and adolescence as overly talkative, scatty daydreamers.20
And don’t forget that our diagnostic guidelines were written about children, and we know that presentations of ADHD generally mature and change across the lifespan. Because males have always been diagnosed far more often than females, many female presentations are missed, or sent to therapy.20, 21
And of course, female hormones
don’t help! From exacerbations
in difficulties with menarche, to menopause and perimenopause linked drastic deteriorations, higher levels of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are all frequently seen in the ADHD clinic and improve greatly when ADHD is treated.22 Sadly, the majority of women with ADHD are being left behind. It is imperative that we address the lack
of health services and support that is affecting women’s health, family life, and careers.21
What would the impact be on deluged GP colleagues if we screened all these people for ADHD?23 If you have ADHD, studies show there’s a 70-80% chance that you are going to respond to medication.24
So what can we do for our patients and society? As doctors and leaders, we need to get ahead of the curve here.
We need to recognise the overwhelming evidence that we are letting society and our patients down and do some research. We are all so busy; “where can I start?” I hear you say.
There is no better way to get up to speed and avoid ruining our patients’ lives than reading this paper by Prof Steven Faraone et al which is a fantastic international consensus study about ADHD.10 Some of you may have seen my webinar last year about this paper.
Faraone comes with great credentials which you can check out online.10
Now we all now know that unfortunately we can’t blindly trust research, since too often there are flaws or biases. This meta- analysis excludes flawed research and gives us 208 evidence-based conclusions about ADHD which I think are excellent.
I like it so much, I now send it to all my new patients to reassure them that there is no good evidence supporting the widespread guidance and beliefs that ADHD medication is addictive or can cause cardiovascular problems. I know this as I have been treating ADHD for a long time. I also send them a list of the physical symptoms of anxiety which unfortunately for our patients are exactly the same as the first half of the side effects leaflet, quite a problem when you are treating an anxious population who don’t tend to trust medication.
Let’s all learn that ADHD medications are safe and highly effective, people. We can expect 70-80% of our patients to respond to the right ADHD treatment, done right. The most common adjective used by my patients is “life changing”. And if you want happy, grateful patients, read my patient feedback.25
So, the take home from this article is that despite all the stigma, ADHD diagnosis is highly valid as a predictor of treatment response, family history of ADHD, many clinical features, measures of brain structure and function, and adverse outcomes. When done right. Treatment is safe, highly effective, and often life changing. ADHD is a valid and useful diagnosis that can be used around the world to improve the lives of the many people who suffer from the disorder and its complications.
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