A neglected condition with significant consequences for patients and societies

Attention Deficit Hyperactivity Disorder (ADHD) in adults is a psychiatric condition which affects 3-5% of adults (more common than Schizophrenia or Bipolar Disorder). However, it is estimated that over 80% of adults with ADHD do not have a diagnosis nor receive treatment.  Once it was considered to be a disorder of childhood and adolescence. Nevertheless, studies have shown that ADHD continues into adulthood in more than half of adolescents with this condition.

Dr. Behzad Basit

I have experience in diagnosis, treatment and management of functional mental illnesses such as depression, mood disorders, anxiety, OCD, bipolar affective disorder and psychosis; in particular the interaction between physical illnesses and mental health problems. I am also experienced in assessment, diagnosis and management of cognitive disorders and matters relevant to these conditions including capacity assessment. In addition, I have epicene in diagnosis and treatment of Adult ADHD.

There are some reasons why Adult-ADHD is not diagnosed or treated sufficiently.

• There is a universal lack of training/knowledge about Adult-ADHD amongst professionals which lead to missing the diagnosis or misdiagnosis. Many healthcare professionals are still sceptical about Adult-ADHD being a genuine illness. 

• Also, the pattern of symptoms changes as the patients grow up. While hyperactivity symptoms are more prominent in children, inattention tends to be the most common reason for referral in adults. 

• In addition, as children with ADHD grow up, they develop strategies to cope with symptoms and making their symptoms less visible. These strategies vary in their success, but they usually cause ongoing stress, anxiety and exhaustion for the patient. 

• Last but not least, Adult-ADHD is comorbid with other mental health problems. Autism spectrum disorder, depression, substance misuse, anxiety and bipolar disorder are several times more common in adults with ADHD than in adults without it. They can change the clinical presentation of ADHD. 

• Adult-ADHD is even less diagnosed in women. Although ADHD is 1.6 times more common in boys and men, it is far less diagnosed in women and girls. Women with Adult-ADHD are less likely referred for an assessment, even less likely to get a diagnosis and far likely to be misdiagnosed.

ADHD affects the patients and people around them throughout life span. 

• In early childhood, they show behavioural problems and challenges in interaction with parents and siblings (who may also have ADHD). They are also more prone to have injuries. 

• At school age (primary school), these children are more likely to have poorer grades. The more behavioural disturbances, more likely to be aggressive and more problems interacting with other children. They have a higher risk of accidents. 

• As children with ADHD grow into adolescence, their grades are likely to become poorer and their behaviour is likely to deteriorate even further with a higher risk of antisocial behaviour and illegal activities. They are more likely to smoke or to misuse drugs and alcohol. Their accidents tend to be more serious (e.g. driving under influence of alcohol) and they are less accepted/tolerated by their peers. They tend to have low self-esteem. 

• Adults with ADHD fail more commonly in their academic progress (less chance of finishing secondary school and entering higher education, higher risk of drop-out). They struggle to get a job and find it even more difficult keeping it. Poor employment and reckless behaviours usually lead to financial problems. There is a similar pattern of problems in starting and maintaining relationships. They continue to have a higher risk of smoking, substance misuse and accidents/injuries. They struggle emotionally and have low self-esteem. Finally, they face difficulties raising children of their own. 

Adults with ADHD are shown to be several times more likely to have a number of complications which affect their own life, lives of their families and society. These complications are poor education, poor employment, smoking, drugs and alcohol misuse, occupational and road accidents, domestic violence and divorce, obesity and other psychiatric illnesses (more likely to have psychiatric admissions). People with ADHD have a higher mortality rate comparing to people without ADHD (more than twice). The mortality rate is even much higher if ADHD is diagnosed as an adult.

adult adhd clinic london

Causes of ADHD

Like other mental illnesses, ADHD is a multifactorial condition caused by a combination of genetic and environmental factors. 

Unlike conditions like haemophilia, there is not a single gene which causes ADHD. Instead, there are several genes that collectively increase the risk (i.e. the more of genes one has, the higher risk of ADHD). In the case of Adult-ADHD, hereditability is estimated to be approximately 72%. This indicates that role of genes in Adult-ADHD is higher than depression or anxiety but lower than Schizophrenia or bipolar disorder. 

ADHD is also linked to environmental risk factors. The known risk factors in early life are more biological in nature; premature birth, low birth weight, maternal smoking during pregnancy. The other risk factors are more socioeconomic in nature and they are unstable families, single-parent households, paternal history of antisocial behaviour, maternal depression, lower education of mother, lower socioeconomic status of the family.

Symptoms of ADHD

Symptoms of Adult-ADHD can be put together in clusters. None of the symptoms on its own confirms the diagnosis of ADHD; patients present with several symptoms, but the nature of symptoms varies from patient to patient. The symptoms are present from a young age, but patients may be able to mask some symptoms to a degree by developing strategies (e.g. using audiobooks instead of written books). Symptoms are present in different life settings; i.e. work, education and relationship. Due to negative feedback from others and from their own opinion, patients commonly have low self-esteem and feel they have not reached their full potentials.

adult adhd

Symptoms

Poor attention 

  • Difficulty focusing in classroom, lectures or meeting (tend to daydream) 
  • Feeling overwhelmed when dealing with detailed tasks 
  • The problem in informal conversation, usually noticed by others 
  • Easily distracted 
  • Problem keeping with deadlines, procrastinate to the last minute or missing deadline 
  • Poor time management; missing or being late for appointments, need to set multiple reminders 
  • Repeated accidents; e.g. losing/misplacing items, dropping items, injuries, car accidents 
  • Poor attention while driving or poor road safety when walking 
  • Difficulty reading books or watching a movie, losing track of the story. 
  • Doing more than one task at the same time.

Hyperactivity

  • Fidgety and difficulty sitting still for a long time (e.g. long ceremonies). 
  • Interest in extreme sports, driving fast (not physically hyperactive like children with ADHD) 
  • Talkative and chatty, rather fast speech and difficult to interrupt 
  • So many thoughts at the same time can make it difficult to sleep

Impulsivity 

  • Random decisions (going on holiday) without proper planning 
  • Interrupting others in conversation and finishing their sentences 
  • Starting new hobbies and activities then leaving them unfinished 
  • Difficulty managing finances and impulsive spending 
  • Frequent job changes 
  • Multiple and usually short-term relationships 
  • Reckless behaviour; gambling, drug and alcohol misuse, unprotected sex and promiscuity.
 

Patient Focused Quality Care

Dr Behzad Basit can help patients with ADHD. If you are concerned or feeling vulnerable, we can help.

Management of Adult ADHD

Management of Adult-ADHD There is no cure for ADHD; nevertheless, a significant number of patients experience report benefit from treatment. Medications are the most effective approach in the management of Adult-ADHD. Still, like all other mental health problems, there are benefits in combining treatment with psychological and social support when indicated:

Biological

Before starting medications, a few crucial points should be explained to patients: 

1) Medications only manage symptoms of ADHD and do not cure it. The symptoms recur after treatment is stopped. 

2) Like any other treatment, response to treatment varies from patient to patient. Some patients respond better, and some may not see much benefit. 

3) There is always a possibility that patients experience side effects although side effects are usually mild and limited to the first few days of treatment. Even if side effects persist, they will disappear when treatment is discontinued. 

4) Patients with ADHD have problems with organisation, time management and keeping deadlines as long as they can remember. ADHD medications will enable them to change their lifestyle and habits, but mediations will not automatically modify those habits. It is up to patients to make effort in order to establish new habits. 

5) It is important to diagnose and treat comorbid conditions alongside ADHD (sometimes even before ADHD) in order to provide a better quality of life for patients. 

6) ADHD medications can interact dangerously with alcohol and some illicit drugs. It is vital that patients address the harmful use of those substances before starting ADHD medications. 

Stimulants: (e.g. Concerta XL, Medikinet, Elvanse)They are the first line of treatment for ADHD.  They are generally well-tolerated and effective. Stimulant medications are from two main groups of amphetamine (e.g. Elvanse) and methylphenidate (e.g. Concerta XL). Patients respond very individually to each group in terms of therapeutic benefits and side effects. Both groups are available in immediate-release and slow-release forms. It is strongly advised to treat adults with ADHD using slow-release preparations because i) they do not induce euphoria and less potential for abuse ii) they need to be taken only once a day and iii) they provide a rather steady level in the brain which causes steady feeling for the patient. Side effects are usually mild and limited to the first few days of treatment and include poor appetite, headache, feeling of heaviness in the chest, and poor sleep. However, they can have ongoing side effects which are mainly poor appetite (which can lead to weight loss and physical weakness) and poor sleep (usually if medication is taken late in the morning). In a very small minority of patients, stimulant medications can cause irritability and anxiety. Stimulant medications leave the body rather quickly and hence, any side effect is expected to disappear within a day or two after stopping the medication. It is of note that (in contrasts to a general belief), stimulant medications are not addictive because they do not induce tolerance (no need to constantly increase the dose), they do not cause withdrawal symptoms (they can be stopped immediately and patients only notice a return of ADHD symptoms) and they do not cause craving. 

Non-stimulants: There is only one medication in this category, Atomoxetine. Atomoxetine is similar in the molecule to one of the new antidepressants (Vortioxetine) and acts differently from stimulants, therefore, it can be used if a patient is unable to take stimulants due to their pre-existing medical conditions of side effects. Unlike stimulants, Atomoxetine has a more gradual and build up effects. It is also well-tolerated by most patients. The side effects are uncommon; the main ones are reduction in appetite, fatigue, anxiety and low mood, menstrual irregularities and sexual dysfunction.

Psychological

While children and adolescents with ADHS and their families tend to benefit from psychological interventions (groups or individual therapy), the benefit of therapy for adults with ADHD is controversial and at best minimal. Many adults with ADHD have already developed strategies (with different rates of success) to cope with symptoms when they are diagnosed. Therapies like counselling and CBT can be beneficial in addressing mental health problems which can be comorbid with Adult-ADHD; e.g. depression, anxiety, harmful use of drugs and alcohol.

Social

Adults with ADHD are affected in many aspects of their personal and professional life. Recognition of ADHD and applying appropriate modifications can lead to significant benefit for patients and can prevent many adverse outcomes like dropping out of education and unemployment.

Central london ADHD Clinic

Face to face appointments at our medical clinic can be booked by visiting our contact page here. Dr Basit also offers virtual appointments.

Yes, Dr Basit has admission privilege with Nightingale Hospital. During office hours, admissions are through his secretary or directly contacting Patient Services (Nightingale switchboard). If someone needs to be admitted under his care out of hours (in particular known patients), they can contact Nurse Coordinator via switchboard.

Yes, BUPA, AXA, Aviva, Vitality, Cigna, Healix.

Address

Nightingale Hospital 11-19 Lisson Grove, Marylebone, London NW1 6SH

VIRTUAL Appointments

Virtual Appointments are available with Dr Basit

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