The young adult female talks to the counselor about her ADHD.

ADHD: Complexities in Diagnosis and Treatment

Attention-Deficit/Hyperactivity Disorder (ADHD) has garnered significant attention over the past few decades, sparking debates, controversies, and concerns regarding its diagnosis, prevalence, and treatment. Initially perceived as a childhood disorder characterized by inattentiveness, impulsivity, and hyperactivity, our understanding of ADHD has evolved, shedding light on the challenges and complexities surrounding its diagnosis and treatment.

 

History

The diagnostic history of ADHD dates back to early 20th century paediatrician, Dr Frederic Still, whose work helped establish paediatrics as a separate field of medicine. It wasn’t until the 1960s that the term “hyperkinetic disorder” emerged, encompassing symptoms similar to what is now known as ADHD.

 

Fast forward to the 21st century and ADHD as a medical condition has evolved from what was thought of as a mental disorder affecting mainly children to a complex neuro-developmental disorder affecting not only children, but more than 366 million adults worldwide, according to research published in the Journal of Global Health in 2021. Today, ADHD is characterised by 3 groups of behaviour symptoms, including inattention, hyperactivity, and impulsivity. The number of individuals diagnosed with ADHD has skyrocketed since it was first included (as ADD with and without hyperactivity) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980.

Contemporary understanding

The criteria for diagnosing ADHD have undergone several revisions, broadening the spectrum of symptoms and allowing for a more comprehensive understanding of the disorder. However, the subjective nature of these criteria poses challenges. Symptoms like inattention and hyperactivity, while prevalent in ADHD, can also be attributed to various other factors, such as trauma, environmental influences, such as diet and exercise, or even normal developmental phases.

 

According to the Australian Institute of Health and Wellbeing, ADHD affects approximately 8.2% of Australian children and adolescents. Many parents may recognise the diagnostic symptoms of ADHD, inattention, hyperactivity and impulsivity, as normal childhood behaviours. A diagnosis of ADHD may occur when these behaviours are severe enough to interfere with everyday activities in life such as school and relationships.

One of the contentious issues surrounding ADHD is the potential for overdiagnosis, particularly in children. Social and cultural factors, along with increased awareness and screening, have contributed to a rise in reported cases. The pressure to excel academically, coupled with expectations of conformity in behaviour, might lead to hasty diagnoses, overlooking other underlying issues or misinterpreting developmental variances as ADHD symptoms.

 

ADHD isn’t confined to childhood; it persists into adulthood for many individuals. Yet, diagnosing ADHD in adults poses unique challenges. Symptoms may manifest differently in adulthood, often resembling other mental health conditions like anxiety or depression. This complicates the diagnostic process and increases the risk of underdiagnosis or misdiagnosis.

 

“Unwinding ADHD from other mental health conditions poses its challenges,” says Raindrum psychologist Samantha Molineux. “Symptoms often overlap and intertwine, requiring a comprehensive and nuanced approach for effective treatment. Moving towards targeted intervention requires a thorough and careful understanding of each unique person and their intricacies.”

 

To Medicate or Not to Medicate

Medications used for treating ADHD are Schedule 8 drugs known as psychostimulants and include brands such as Ritalin, Concerta and Artige. While these drugs have many therapeutic benefits, they also have potentially serious side effects, including increased heart rate and blood pressure, problems sleeping, decreased appetite, headaches, irritability and addiction, and therefore can only be prescribed by a recognised specialist medical practitioner such as a paediatrician, psychiatrist, or neurologist.

The overmedication of individuals diagnosed with ADHD remains a complex issue and a critical point of contention. Stimulant medications like methylphenidate (Ritalin) and amphetamines (Adderall) are commonly prescribed to manage symptoms. While these medications can be highly effective in alleviating ADHD symptoms, their over-prescription raises concerns about potential long-term side effects, abuse, and dependency.

 

Addressing the multifaceted challenges surrounding ADHD requires a comprehensive approach. Improving diagnostic accuracy is crucial, involving thorough assessments by multidisciplinary teams to rule out other potential causes of symptoms. Additionally, promoting awareness and education among healthcare professionals, educators, and the public can mitigate misconceptions and reduce the likelihood of hasty or inaccurate diagnoses.

 

Medication isn’t the sole answer to managing ADHD. Behavioural therapies, such as cognitive-behavioural therapy (CBT) and mindfulness practices, have shown promising results in managing symptoms and improving overall well-being. Creating a more holistic treatment approach that combines medication with behavioural interventions and environmental factors such as diet and exercise could yield more effective and sustainable outcomes.

 

We are here to help

At Raindrum, we believe in the uniqueness of each individual and in employing an approach that accommodates the complexity of each individual’s life story. If you think you may have ADHD, it’s important to seek advice from your doctor or specialist. For clients of Raindrum, the team can create a program that emphasises comprehensive assessments utilising multiple modalities, exploring non-pharmaceutical interventions, and promoting a nuanced understanding of ADHD. We believe this is pivotal in ensuring proper care and support for individuals grappling with this disorder.

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