What are the types of ADHD? 

 

When you are diagnosed with ADHD you are divided into one of two types, or a combination of the two. The combined type is the most common. 

• Impulsive/Hyperactive: People with this type might have excessive energy, struggle to sit down, fidget often, interrupt others and talk excessively.
• Inattentive: These people are the dreamers who struggle to focus, listen to others and are easily distracted. They have trouble with attention to detail and organising tasks and activities. They may lose things, forget things and easily make mistakes.
• Combined: Most people find they have a combination of inattentive and hyperactive ADHD – at Dr Smith’s clinic, 70 per cent of his patients have combined ADHD. It’s also the case that as people get older they might look less hyperactive as they learn to disguise it. “Some people might judge themselves to be the inattentive type, but often when I do the reassessment I find a hyperactive internal restlessness. These are the people who always find things to busy themselves with, like helping out at a dinner party, or crocheting during a meeting, or using fidget devices, it helps to quieten the mind,” says Dr Smith.

What causes ADHD?

ADHD is a genetic condition which tends to run in families, so there is a high chance that if you have ADHD a relative will also have a diagnosis. However environmental factors also seem to play a part including experience of trauma, birth complications, brain injury and exposure to toxins. 

“We don’t yet understand how these triggers influence ADHD, we have 60 years of research, but there’s a lot of variability, what we don’t have are neat, consistent findings,” says Dr Smith. 

Many experts believe that because ADHD is so common there must be an evolutionary explanation. Intriguing recent research has suggested that the ADHD brain may have evolved in hunter-gatherer societies where their impulsivity and risk-taking traits would have been an advantage when it came to foraging for food.  

ADHD commonly starts in childhood 

ADHD will usually present in primary school before the age of 12, although some children, particularly girls who are dreamy and inattentive rather than hyperactive, may be missed. 

A red flag might be a child who is bright but is underperforming at school or a child that a family can find quite exhausting to be around. “It’s difficult as a lot of children are exhausting, so it has to be at another level, or behaviour that the child doesn’t grow out of,” Dr Smith states. 

Dr Helen Read is a consultant psychiatrist who worked for many years in the NHS running an ADHD service, and now runs a private practice, The ADHD Consultancy. She says many children with undiagnosed ADHD can manage to get through their GCSEs but that most of them struggle when it comes to A-levels. “You need ‘executive function’ to do A-levels, and by this stage, if they have undiagnosed ADHD almost all of them fall off a cliff.” 

If you think your child may have ADHD, you should speak to your GP. Your GP can refer you to a specialist for an assessment, but as with adults, there are lengthy waiting lists. You can also speak to your child’s teacher or the school’s special education needs coordinator (SENCO). 

Why is ADHD often missed in girls and women? 

In recent years there have been many high-profile stories of women who have only realised they have ADHD later in life, as their symptoms had been missed as children. 

“We don’t know why it sometimes manifests differently between the sexes, but it could be to do with how males and females are socialised – it’s more acceptable for boys to be hyperactive. Girls are more likely to be daydreaming in class and not paying attention, but as long as they sit quietly and don’t move they don’t disturb the class so nobody notices,” explains Dr Beck. 

Women might also be better able to mask their symptoms. “Women may feel more obliged to mask their behaviour and develop compensatory behaviours, like anxiety for example, and then it’s the anxiety that is treated rather than the underlying ADHD,” Dr Smith adds. 

What should you do if you think you have ADHD?

First, visit your GP. They will refer you for an assessment on the NHS. However, waiting lists are lengthy on the NHS and in many cases getting worse with the worst affected trusts citing wait lists of up to 10 years. 

It’s not surprising then that many opt for a private assessment, and that many private clinics also have long waiting lists. 

If you do choose to go private make sure you choose a reputable clinic, as you may want to get back into the NHS to be prescribed your medication. 

“Medication is expensive and you may need it for life. But if you do go back into the NHS, your GP will need to be sure they can rely on the validity of your report before they can safely prescribe medication, and if the report isn’t comprehensive, you may find yourself waiting to have your diagnosis confirmed by the NHS,” says Dr Smith.

“Talk to your GP about the private clinic you’ve chosen, they may have worked with them before. Speak to a local charity that may be in contact with local reputable private providers, and seek out recommendations from peers. Around 80 per cent of adults with ADHD have another condition as well so if someone isn’t correctly trained there is a risk that ADHD might be incorrectly diagnosed or missed.”

 

What medication is available for ADHD? 

 

ADHD is highly treatable and medications are effective for most people. 

• Stimulants: The first line of treatment is stimulant medications, such as methylphenidate, dexamfetamine or the lesser-known lisdexamfetamine. According to Dr Smith these work in 80 per cent of his patients. However, for some people, the stimulants either don’t work or aren’t tolerated. Side effects can include insomnia, appetite loss and jaw clenching. In this case, doctors might try a non-stimulant medication.
• Non-stimulants: The main second-line non-stimulant treatments are atomoxetine and guanfacine which increase the amount of a chemical in the brain called noradrenaline, which boosts concentration and helps control impulses. These can be an effective alternative for some patients.

 

What psychotherapeutic treatments are there for ADHD? 

 

Medication isn’t necessary for everyone with ADHD. “The condition exists on a spectrum and for less severe cases we try coaching to help people be more self-aware about their impulse traits, to help them interact differently with others, and to learn to organise themselves,” says Dr Beck.

Cognitive behavioural therapy (CBT) and mindfulness training can also be useful. “People tend to be impulsive and have a problem thinking about consequences. With mindfulness and CBT they can learn to be more grounded, and not to act immediately,” Dr Beck adds. 

How can lifestyle changes help with ADHD? 

Many simple daily strategies can help with managing ADHD symptoms. “We help them with little things like advice on writing lists, packing your bag the night before, having a place to leave keys, setting a series of alarms on your phones for reminders, paying your bills by direct debits, that sort of thing,” says Dr Read. However, Dr Beck also uses melatonin supplements to help treat people with sleep problems. 

Exercise 

Consistent exercise can be a really useful way to manage symptoms. “People with ADHD need dopamine and physical exercise will give you dopamine, a better body and help your brain work better. Many high-functioning people with ADHD exercise quite excessively to manage their brains,” Dr Read explains.

Diet

There’s a lot of discussion about diet and nutrition but so far the research is inconclusive beyond the usual advice to eat a healthy, balanced diet. “Supplementing Vitamin D is helpful if you are deficient, so that’s an easy win. Non-pharmacological options are not going to be individual game-changers, but when you stack them together they can have an impact,” says Dr Smith. 

What is behind the rise in ADHD cases?

“If you look at the trajectory of the numbers of referrals of ADHD you see a steep rise around 2021 during the pandemic, at the same time you can see that the revenue of TikTok follows the same curve. I think that social media reached a lot of people and acted as a sort of catalyst to spreading awareness and recognition of the condition and alongside the pandemic, it just started to snowball,” says Dr Smith. 

Yet the growing numbers of diagnoses have also led to scepticism from some doctors and the public, and charges of unreliable and not sufficiently rigorous diagnoses in the private sector. 

Part of the reason for this is that the symptoms of ADHD are so universal – we can all relate to struggling to concentrate, motivate or focus. Yet if you have ADHD these symptoms are of a different order of magnitude. 

“People look for simple solutions and it’s easier to label people as lazy or unmotivated,” Dr Smith explains. “It’s not like psychosis, many of us have experienced these ADHD symptoms. But most people I see are majorly impacted by the condition, they are often unable to hold down a job or a relationship and are feeling terrible about themselves.” 

People with ADHD have higher divorce rates and are more likely to be unemployed or in a car accident, and 25 per cent of adults being treated for alcohol or substance abuse also have ADHD. 

“I think we are more likely to spot it now in children, but I see a lot of adults in my practice who have been diagnosed in middle age, and often they realise that their lives would have been so much easier if they had been supported earlier, and it’s devastating. I don’t see any reason to be sceptical, on the contrary, we should do everything we can to get everybody diagnosed,” says Dr Beck.