By: Antoinette Stafford Cloete (Health Systems Trust Communication Manager)
October is Attention Deficit Hyperactivity Disorder (ADHD) Month in South Africa. According to a South Coast Herald article published in September 2018 the condition affects approximately 1 in 20 children and over 1 million adults. These figures may be grossly underestimated since many argue that the condition may be severely mis- or under-diagnosed.
Drs Renata Schoeman and Rykie Liebenberg are experts in the field and have developed guidelines to assist with a proper diagnosis. Dr Schoeman, the convenor of the ADHD Special Interest Group (SIG), part of the South African Society of Psychiatrists (SASOP) says it is critical that we 'shed light on this condition which [can] hamper sufferers' educational performance, self-esteem, relationships and work productivity.'
A correct diagnosis by a properly qualified clinician such as a paediatrician or psychiatrist is thus key and takes an effective multi-modal treatment plan, which may include drug- and psychotherapy, into account.
ADHD Symptoms
ADHD is usually characterised by a core triad of symptoms:
- Inattentiveness: being easily distracted or forgetful, failing to follow instructions or finish tasks, lack of attention to detail or careless mistakes, being disorganised, procrastinating.
- Hyperactivity: fidgeting, tapping, talkativeness.
- Impulsivity: has difficulty waiting their turn, often intrudes on others or butts into conversations; short temper or low tolerance for frustration; makes snap decisions without considering consequences; addictive behaviour.
These symptoms must be viewed in conjunction with other conditions such as anxiety- and mood disorders and usually over time (about six months).
For many years the focus has also been on children and adolescents, but increasingly research and treatment has shifted to adults since it has become widely accepted that children don't necessarily outgrow ADHD.
What exactly is ADHD?
'Mental restlessness' was first described by Sir Alexander Crichton in 1798, while 'Fidgety Philip' (a popular storybook character and now also an allegory for children with attention-deficit/hyperactivity disorder [ADHD]) was created by Heinrich Hoffmann in 1844. Sir George Still's Goulstonian Lectures, describing children with restlessness, inattention and impulsiveness, can be considered the starting point of the description 'attention-deficit/hyperactivity disorder' (ADHD) as we know it. (From The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder).
For many years (until the 1990s) ADHD was considered a childhood disorder, but longitudinal studies and public awareness highlighted the presence of ongoing symptoms in adult patients. Adult ADHD is now a recognised condition. It is a costly chronic disorder since many adults who suffer from it also have comorbid medical and psychiatric disorders such as unplanned pregnancies, sexually transmitted diseases, substance abuse disorders, mood disorders, anxiety disorders and behavioural disorders.
Untreated ADHD is a huge problem in that many people end up spiralling out of control because of substance abuse, accidents, and inability to cope with life and work demands, which is caused by lowered self-esteem, and the lack of support friends and family would bring.
Paying for ADHD is costly and probably the largest expense for private patients.
Access to healthcare and treatment is a challenge for those wishing to do so through the public health system due to the 'identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited … [and] the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines' (as set out by Schoeman and Liebenberg).
However, with the launch of the ADHD SIG in 2015 the objective was to make the overall 'basket of care' more readily available to patients with ADHD wishing to access treatment and care via the public sector.
The sex difference when it comes to ADHD
Keath Low, a Therapist and Clinical Scientist at the Carolina Institute for Developmental Disabilities at the University of North Carolina focuses specifically on women at the ADHD interface. She offers a number of insights into what ADHD looks like in women to help them get a proper diagnosis and treatment. She argues that women tend to live with undiagnosed ADHD mainly because this was traditionally thought of as a condition that affects mainly boys/men because women do not necessarily manifest the same way men do.
How Symptoms Differ in Women and Men
ADHD in Women
| ADHD in Men
|
- Less likely to be diagnosed
- Low self-esteem and anxiety
- More symptoms of inattention
- Verbal aggression
| - More likely to be diagnosed
- Disruptive behaviours and acting out
- More hyperactivity and impulsiveness
- Physical aggression
|
Why ADHD in Women Is Often Misdiagnosed
ADHD symptoms in girls are often viewed as character traits rather than symptoms of a condition. For example, a girl might be described as spacey, forgetful, or chatty. Later in life, a woman might reach out for help for her symptoms, only to be diagnosed with depression or anxiety instead.
According to Low, 'Women with ADHD face the same feelings of being overwhelmed and exhausted as men with ADHD commonly feel … Our culture commonly expects women to fill the caretaker role. When things feel out of control and it's difficult to organize and plan because of ADHD, taking care of others can feel nearly impossible. This societal pressure also may greatly increase a woman's feelings of inadequacy.'
What are Common Signs of ADHD in Women?
Relationships: You may wish you were able to be a better friend, partner, or mom, and that you could do the things that other people do. Because you're not able to do the things that society expects women to do, people may think you don't care.
Social Life: While you may be talkative, you may dislike going to parties and other social gatherings because they make you feel overwhelmed and shy. Your mind drifts during conversations unless you're the one talking or it's a topic you find very interesting.
Work: Being at the office feels difficult. The noise and people make it hard to get work done. Your desk at work is piled high with papers. Even when you make a big effort to tidy it, it only stays clear for a day or two.
Daily Life: With ADHD, it may feel like each day is spent responding to requests and limiting disasters rather than moving forward with your goals. You may feel crushing sadness and frustration that you haven't met your potential.
Relaxing is often difficult for people with ADHD. Little things can push you over the top and you may become emotional.
Where to get help?
You could reach out to ADHASA, a registered non-profit organisation (Section 21) that has been assisting people living with and/or affected by ADHD for over 20 years. They offer information, advice, support and guidance as well as referrals to other professionals to further assist you.
T: +27-11-8887655
Website Address: http://www.adhasa.co.za