ADD/ADHD in Adults

Our approach to treating ADHD

The first step in treating ADHD is receiving a diagnosis to understand what type of symptoms are causing the most difficulty.

We believe that psychoeducation should always be the first approach in treating symptoms, regardless of severity, as per the guidelines set out by England’s National Institute for Health and Care Excellence (NICE). Psychoeducation involves your psychiatrist providing information about your specific ADHD symptoms so that you can better understand and cope with them.

We will also recommend talking therapy as a way to better understand and take control of many symptoms of ADHD. Therapy for ADHD can be incredibly effective for many people, and its results are often long-lasting.

If you have been diagnosed with ADHD, your London-based psychiatrist will discuss with you the possibility of taking medication. Taking medication for ADHD is completely optional, and the role of the psychiatrist is to provide professional advice while taking into account your personal preferences to help you through your journey.

We take the view that some lifestyle interventions, such as stress relief techniques, nutrition or exercise, can be very helpful for a lot of people with ADHD and we take these into account when developing your personalised treatment plan.

What is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is a condition that can affect people’s behaviour in many different ways. Somebody with ADHD may experience any of the following issues:

• Finding it hard to focus on tasks that they dislike, and avoiding them
• On the other hand, being able to hyperfocus and spend lots of time on tasks that they Enjoy (to the point of often overdoing it)
• Making careless mistakes unless they are deliberately paying a lot of attention
• Having a tendency to start tasks and not finish them, because they are easily sidetracked
• Difficulty finishing schoolwork, chores, or duties in the workplace or start tasks due to a loss of focus
• Struggling with organisation or failing to keep a diary
• Leaving things to the last minute
• Procrastinating
• Being easily distracted (for example by their own thoughts)
• Problems organising tasks and activities, such as what to do in sequence
• Keeping materials and belongings in order, having messy work and poor time management
• Failing to meet deadlines
• Finding it hard to pay attention in conversations
• Feeling restless inside (too much mind wandering)
• Fidgeting or finding it hard to sit still for long periods of time (tendency to move around more than other people)
• Feeling a need to be constantly “doing something” (even if it is just checking the phone)
• Talking most of the time, interrupting other people or finishing their sentences
• Being quite impatient, finding it hard to wait for their turn

How frequent is ADHD?

ADHD is surprisingly common in adults. In the UK alone, 1.5 million adults are estimated to have ADHD, yet only 200,000 are officially diagnosed.

The number of adults who receive treatment for their ADHD symptoms is even less. So even though it is a common condition it is widely underdiagnosed, especially in females.

Can I have ADHD even if I’m high-functioning?

Many people with ADHD are very high-functioning, which means they may have developed strategies to mask their symptoms, or they might be able to perform very well in their careers despite struggling with their symptoms.

Even if you are high-functioning, you will likely still benefit from an official diagnosis such as a private ADHD assessment and further support so that you can better understand the reason for any difficulties.

What are the symptoms of ADHD?

Symptoms of ADHD typically fall under three main categories of hyperactivity, impulsiveness and inattention. Although everyone demonstrates this behaviour on occasion, people with ADHD will constantly struggle with these tendencies despite their best intentions.

ADHD is a condition that exists across a spectrum or continuum in the general population. This means that while many people will display some of these tendencies, people with ADHD will display the extreme of these tendencies.

If others aren’t aware of your symptoms, they may think you are lazy or unfocused. This can lead to arguments and fights, or people might perceive your behaviour as ‘inconsiderate’ or ‘rude’ at times.

People with undiagnosed ADHD may feel frustrated and ashamed of their symptoms, which can sometimes lead to anxiety, depression or addiction problems if untreated. ADHD symptoms fall under several broad categories.

Inattention

Difficulty concentrating, listening or following instructions, becoming distracted quickly, procrastinate easily, struggling to meet deadlines, zoning out of conversations or daydreaming often, having to start a task multiple times before you can finish it, and difficulty planning ahead and organising your time.

Physical hyperactivity

Fidgeting, being unable to sit still, feeling restless, always moving around. You might struggle in environments that require you to sit still for long periods of time without disturbing others (such as libraries, offices and during flights).

Brain hyperactivity

Feeling either completely uninterested or completely obsessed with a topic. These extremes will influence whether you struggle to concentrate on something or whether you become completely focused on it, either because you find it interesting or because you are trying to cram for a deadline.

Impulsiveness

Not thinking about consequences or risks, impatient or snappy with people, impulsive purchases, reckless decisions that you later regret, interrupting conversations or completing other people’s sentences.

These symptoms can become problematic if they occur very often and interfere with your ability to maintain relationships or meet deadlines. If you feel that your ADHD symptoms negatively impact your career or academic performance, it’s appropriate to seek help and support by first getting a private ADHD assessment.

Is ADHD associated with sleep problems?

Insomnia is not a specific symptom of ADHD, but many people with ADHD suffer from sleep-onset insomnia. Generally, they tend to be night owls and function best at night when there are no interruptions, no distractions, or when they have an upcoming deadline. At nighttime, they may struggle to relax and fall asleep because their brains do not stop thinking about all sorts of stuff – sometimes just random things.

Many people with ADHD have developed coping mechanisms to deal with their sleeping problems. Some take alcohol or sleeping tablets, while others find that if they keep their brains entertained by watching TV, listening to a podcast or an audiobook they find it easier to relax and fall asleep. Often they might fall asleep with the TV on!

What are the different types of ADHD?

There are three main subtypes of ADHD that are classified according to the person’s symptoms:

Inattentive ADD

Predominantly characterised by problems with attention and concentration (which is actually known as Attention Deficit Disorder).

Hyperactive-impulsive ADHD

Predominantly characterised by problems with impulsive behaviour and hyperactivity.

Combined ADHD

This is the most frequent type and involves problems with attention/concentrations and problems with impulsive behaviour/hyperactivity. Symptoms of combined ADHD are usually more severe than the two other subtypes.

What conditions are associated with ADHD?

People with ADHD may also have other coexisting mental health conditions. Common issues that typically co-occur with ADHD include:

• Addiction
• Anxiety
• Depression
• Borderline Personality Disorder (BPD)
• Sleep problems
• Physical health conditions (epilepsy, allergies, gastrointestinal problems)

The reason for this is that the genes that increase the risk for ADHD also increase the risk for these other mental conditions, mainly depression, anxiety and Borderline Personality Disorder.

While the presence of these other conditions can make it more challenging to diagnose and treat ADHD, we often find that a holistic treatment approach can make an enormously positive impact. Once other conditions are treated, the symptoms of ADHD become much more manageable.

Is ADHD genetic?

ADHD is a complex neurodevelopmental disorder that is caused by a combination of genetic, environmental and biological factors. The heritability of ADHD is relatively high, at 74%, meaning that someone’s genetics will significantly influence whether they develop ADHD or not.

However, it’s not a simple case of genetic inheritance. Researchers have identified that the genetic risk comes from small mutations in thousands of different genes, with each of these genes contributing a small amount of risk (known as polygenic risk). Due to the vast number of genes involved, scientists still don’t understand precisely why some people develop ADHD, while others don’t.

Some environmental factors can increase the risk for ADHD, including smoking, alcohol or drug use in pregnancy, exposure to environmental toxins and premature birth. These environmental factors can place a degree of biological stress on the individual, which then increases their risk of developing ADHD, particularly if they already have an increased genetic risk

Does inflammation cause ADHD?

Several biological factors could be associated with ADHD, such as inflammation. Specifically, people with ADHD can have lower amounts of the anti-inflammatory hormone cortisol. Cortisol helps our body to absorb nutrients and is involved in regulating cognitive function and reward-seeking behaviour.

Neuroimaging studies have also shown that people with ADHD have altered patterns of brain activity, compared to people without ADHD.

Although it might be scary to learn about these biological factors involved with ADHD, the good news is that many of the treatments for ADHD help to regulate these biological mechanisms (such as cortisol and brain activity). Receiving a diagnosis and treatment for ADHD often leads to a considerable reduction in stress as you understand there is a concrete reason for your symptoms and difficulties. Stress reduction leads to a host of positive health benefits, from reducing inflammation to improving cognition. By focusing on your overall health holistically, this could even lead to an improvement in your ADHD symptoms!

Can ADHD cause addiction?

People with ADHD are at an increased risk of developing a drug addiction, as the genes that underlie the risk for developing ADHD are very similar to the genes underlying the risk for drug addiction. People with ADHD might have used or developed a drug addiction at a much younger age compared with their friends.

New genetic studies show that people with ADHD have a particularly strong predisposition to cannabis use. Meaning that the same genes that increase the risk for ADHD also increase the risk that someone will use cannabis. The study used a technique called Mendelian randomisation, which essentially demonstrated that it was the underlying genetic risk that was associated with ADHD and cannabis use, rather than the ADHD itself causing the cannabis use.

Nearly half of the risk associated with being a regular cannabis user is explained by our genetic make-up. Many of the genes are also involved in ADHD, which explains why people with ADHD are more likely to also smoke or vape cannabis.

Untreated ADHD can, in some cases, lead to serious problems later in life as it is associated with a high risk of addiction and other impulsive behaviours.

As ADHD can underlie many addictions, you should have a private ADHD assessment before treatment for any addiction begins.

While ADHD symptoms may not require targeted treatment itself, a diagnosis will be crucial for designing an effective addiction treatment.

How do you treat ADHD?

Every individual will have a unique set of symptoms and circumstances contributing to their ADHD symptoms. Once ADHD is diagnosed, as well as any other potential conditions, we will develop a personalised treatment plan specifically for you. We will develop this with your input, based on your needs and unique circumstances.

A treatment plan for ADHD may combine any of the following evidence-based approaches:

Psychotherapy (psychological therapy or talking therapies)

• Cognitive behavioural therapy (CBT)
• Psychodynamic therapy
• Interpersonal therapy
• Mindfulness-based cognitive therapy

Psychoeducation

• Information and support so that you can better understand and cope with your ADHD symptoms.

Medication (if required)

• Commonly prescribed ADHD medications include Ritalin, Adderall, Concerta, Medikinet, Elvanse, Dexamfetamine, Modafinil (Provigil), Atomoxetine (Strattera), Guanfacine (Intuniv)

Stress reduction approaches

• Mindfulness techniques
• Mind-body exercises

Diet and lifestyle interventions

• Exercise
• Nutritional and dietary changes
• Supplements
• Sleep therapy

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