“Doctor, I have never completed anything in my life, I always jump from pole to branch, I start a thousand things and I don’t finish one, I have a huge effort to concentrate, to keep my attention and this has always been the case. I’ve always had to work hard to reach a goal, work twice as hard as the others. Reading a newspaper page weighs me down, I can’t get to the bottom of it. What is wrong with me
”
This is often the desperate appeal of those who come to our clinic and present the ” Attention Deficit and Hyperactivity Disorder “ , better known by the acronym ADHD. It is not easy to diagnose it because it is an age-related disorder: ADHD is born, it is not made. These people have always been like that. We might think of ADHD as an Axis II disorder, according to the old distinction in axes that existed in previous classifications of psychiatric disorders.
ADHD is a complex disorder, it often occurs in comorbidity, often those who have it do not go to a psychiatrist, or if they do and for other matters. Very often the psychiatrist does not recognize it as ADHD, because in the adult some components of childhood ADHD improve, eg. hyperactivity, and the disorder in adulthood is complicated with other things we go to see.
What are the symptoms
Here is one of the fundamental problems. The symptoms present in ADHD are nonspecific.There is not a symptom that can tell us here, it is ADHD. Hyperactivity, for example, can be found in some phases of bipolar disorder; inattention is common in depression etc .; we find disorganization in psychotic, deteriorative pictures …
In preschool and school age it can be seen how these children are extremely hyperactive, they never stand still. It is not the frisky little boy, but the plague! As teenagers it is very likely they do a lot of motorbike accidents, rear-end collisions … Not at all scary, often a little aggressive, emotionally unstable, it can happen that they have sleep problems; and they are very likely to have academic difficulties, even if over the years they can develop some strategies that tend to compensate or mask their deficit.
There are ADHD graduating degrees (albeit hardly in math!). Over the years, these difficulties feed self-esteem problems; patients feel they have a handicap: “I feel incapable, stupid” they often begin.
Over time, hyperactivity often diminishes, but inattention remains, as does the disorganization component. They are unable to organize anything, even very simple tasks. They forget about everything: from the keys, to the wallet to anything else. They are unable to manage time. They are very messy. Entering a room of a patient with ADHD can make us diagnose: we find not a normal disorder, but a frightening chaos: dishes under the bed; the computer on the closet; the shower gel in the bedside table …
In adults with ADHD it is very common to find in association mood disorders, emotional difficulties, substance use (e.g. cocaine, alcohol), impulse control disorders, antisocial behaviors … hence the complexity of the disorder in adulthood and the multiplicity of its presentations, with the consequent partial possibility of recognition. Having ADHD anticipates most of these disorders in onset. For example, finding a kid who starts drinking alcohol at 13 must raise the suspicion that he may be ADHD. Recently, Atomoxetine
was approved for adult ADHD, a drug in some ways similar to SNRI antidepressants such as venlafaxine and duloxetine, also in the side effect profile. In childhood it is possible to use psychostimulants such as the famous Methylphenidate (Ritalin®) which, having a short half-life defect, exists in various prolonged-release formulations.
It is important to diagnose ADHD even in adulthood for many reasons. Primarily because there are first-line treatments. I remember that often these patients come to the psychiatrist’s attention for a different problem such as substances, or mood disorders. But these pathologies in people with ADHD respond poorly to classic treatments if the ADHD is not promptly recognized and treated.
