ADHD and ADD

What is ADHD and ADD?

ADHD is a congenital developmental disorder with the typical symptoms: difficulty concentrating, hyperactivity and impulsivity.

ADHD is also called hyperkinetic disorder. The subtype ADD (Attention Deficit Disorder) has the aforementioned difficulties with concentration and impulsivity, but not or to a lesser extent hyperactivity.

The acronym ADHD is an abbreviation of Attention-Deficit-Hyperactivity Disorder, which translates to "Attention-Deficit Hyperactivity Disorder". The term covers a group of several different types of difficulties that begin in childhood and often cause problems at home, at school, socially and later in studies, workplaces and social interaction with other people.

• "Attention-deficit" stands for attention and concentration problems. In other words, you have trouble focussing on what you need to do.
• "Hyperactivity disorder" means that you have a tendency to over-activity. This means that you can't stay calm and can't control your impulsivity - it can be both physical and mental hyperactivity (racing thoughts)

What are the challenges of having ADHD?

Children, adolescents and adults with ADHD have a disorder in the brain functions we use when trying to understand and solve problems, plan and get an overview. It presents various challenges such as:

• Difficulty creating an overview and structure
• Difficulty planning activities
• impaired working memory
• poor sense of time
• sleep disturbances

It makes it difficult to plan your daily life. It often leads to severe learning disabilities and social problems. Adolescents and adults with ADHD/ADD have difficulty enrolling in education and staying in a job. Without support and treatment, there will often be unfinished education programmes and frequent job changes.

The problems affect almost every aspect of life. Many people with ADHD often struggle with low self-esteem, difficult relationships with other people, including relationships, mood swings, sleep problems and poor performance at school or work.

Adult ADHD

Many people with ADHD have never been psychiatrically examined and diagnosed during childhood and adolescence. Either because their environment was unaware of it or because they compensated for it with extra work in school and the education system. Only later in life do they become aware that they have limitations, for example because they read about ADHD/ADD, meet people who recognise the symptoms or have children who are assessed and diagnosed with ADHD/ADD. 

The symptoms of ADHD usually become milder with age. However, in around 50 %, symptoms continue to be severe, even into adulthood

Impaired functioning in adults with ADHD can lead to stress, anxiety and depression. Sleep problems can lead to substance abuse, such as overuse of alcohol, cannabis and sleeping pills.

In most people with ADHD, there is a development of function with age. This means that the number of people who fulfil all the criteria for ADHD decreases with age. However, many still have symptoms that persist into adulthood. So even if an adult no longer fulfils all the criteria for a diagnosis of ADHD, they may still have many symptoms.

ADHD symptoms in adults

• The main symptoms of ADHD in adults are concentration problems, hyperactivity and impulsivity:
• Hyperactivity usually subsides somewhat in the early years
• You may continue to have problems organising your daily life and often your work or studies. This tendency continues into adulthood

Adults are treated with medication, supplemented with education, support and guidance, and possibly cognitive behavioural therapy individually or in groups.

Concentration problems in particular, and to some extent impulsivity, are usually more prominent than restlessness and hyperactivity in adults with ADHD. Hyperactivity, which is very pronounced in childhood and adolescence, is often replaced with age by inner turmoil and restlessness with a tendency towards racing thoughts and brooding, for example when comparing one's level of functioning with others.

ADHD can cause problems with:

• Retention in the labour market, i.e. being able to stay in a job
• impulsive behaviour with increased risk of accidents
• substance abuse
• Development of co-morbidities such as stress, anxiety and depression 

There are various reasons why adults may be assessed for ADHD:

• The person or those around them may have recognised the symptoms themselves and want to know if they may have ADHD
• In some cases, a diagnostic assessment of the parents of children who have been diagnosed is appropriate because it may be hereditary and it may help the child to get support/treatment from parents if they have ADHD
• You may also want to find out if you have ADHD if you are being treated for drug addiction or other mental illnesses other than ADHD

Assessment of ADHD/ADD by a specialist in psychiatry typically consists of the following elements:

• A self-completed questionnaire, e.g. ASRS v 1.1 (Adult Self-report Scale)
• Interview with the specialist - possibly with the participation of a partner or relative. Information is gathered about the person's development, psychiatric symptoms, difficulties from early childhood to adulthood and any past and current substance abuse. Information is also gathered about the person's health, social and financial situation, educational and occupational background and daily functioning.
• The specialist will often give you a more detailed questionnaire to fill out at home for the next appointment. The person can benefit from involving parents, siblings or others who have known the person for a long time
• A feedback to the person with education and explanation of the significant findings, what treatment options appear, including whether the examination gives reason or need for further investigations.

Treatment of ADHD in adults

Private psychiatrists follow the recommendations of the National Board of Health, which is that adults with ADHD receive:

• Psychoeducation, i.e. education about the disease and its consequences
• Guidance on how to manage ADHD difficulties yourself
• Indication of where to get further information
• Cognitive behavioural therapy if symptoms such as anxiety and depression are also present
• Medication is recommended as a supplement if the above measures are not sufficient (which they often are not)

Treating adults with medication

When adults start treatment with medication for ADHD, it must be done by a psychiatrist. Subsequent checks can be carried out by the general practitioner as long as the medical treatment of ADHD is not changed. If there is a need to change ADHD medication, this must be done by a psychiatrist.

Benefits of treatment with medication

• Studies show that adults with moderate to severe ADHD benefit from methylphenidate (MPH), a stimulant that is the most commonly used medication in the treatment of ADHD
• Methylphenidate has beneficial effects on ADHD core symptoms and level of functioning
• Alternatively, another stimulant, lisdexamfetamine, can be used,
• The third drug that has shown moderate efficacy is atomoxetine, which is often used to alleviate ADHD symptoms in people who also have symptoms of anxiety and have been unable to tolerate treatment with methylphenidate or lisdexamfetamine
• In addition to medications with a direct effect on ADHD/ADD, there may be a need to treat accompanying symptoms such as sleep problems, anxiety or depressive symptoms

Side effects of treatment with medication

• Studies show that the treatment can have side effects for some, such as increased heart rate and blood pressure (although rarely of clinical significance), reduced appetite and sleep problems
• Adults with ADHD who benefit from medication are recommended to continue treatment for several years. If at some point you feel ready and want to come off the medication (possibly due to doubts about the effect or side effects), you should consult with your doctor to agree on a tapering programme.