adult ADHD – what’s the buzz?
Jacinta: So this is a commissioned piece, sort of, by someone who wants us to look into this disorder (attention deficit hyperactivity disorder, in full), for our sakes and of course for the sake of humanity.
Canto: Sounds like a first world issue to me.
Jacinta: Okay consider yourself lucky you don’t have to scrounge around rubbish heaps for a living, or travel miles on a half-dead donkey to see a medico, or dodge government bullets because you’re an outspoken female…
Canto: Okay okay. So we know that diagnoses of adult ADHD have risen substantially in recent years, in the WEIRD* world, along with autism spectrum disorder (ASD), bipolar disorder, major depressive disorder, PTSD, chronic fatigue syndrome, and others. A lot of work is being created for clinical psychologists, and the waiting lists are getting longer.
Jacinta: So we’ve started by watching a couple of videos, one from CNBC in the US, another from the ABC in Australia. And a few points here about research and reliable info. Avoid social media! And for the most part avoid commercial news and info networks, which are privately owned and often have a commercial-financial agenda. The most reliable sources in the WEIRD world are generally government subsidised and mandated sites (the ABC in Australia, the BBC in Britain, PBS and NPR in the USA, DW (Deutsche Welle) in Germany, France TV and Radio France, for example).
Canto: Well, we’ve broken that rule by starting with this video from CNBC, but it does give a good overview of the symptoms, via field professionals such as Dr Leonard Adler, director of an adult ADHD programme at NYU. The symptoms are divided into two types, those associated with inattentiveness and with hyperactivity, though there are obvious crossovers. Under each type heading, nine more or less connected symptoms are described. For example, symptoms of inattentiveness include ‘forgetfulness in daily activities’, ‘failure to finish tasks’ and ‘losing important things’, and under hyperactivity comes ‘interrupting others’ or ‘trouble with turn-taking’, and ‘being always ‘on the go”. Apparently you need at least five of the nine symptoms in either category to be diagnosed with ADHD, at least in the USA. Personally, I can relate to all of the symptoms some of the time. All of this, by the way, comes from the famous, or infamous, DSM-5, the 5th edition of the diagnostic and statistical manual of mental disorders.
Jacinta: So you may be skeptical, but on the question posed throughout this video: ‘Is ADHD on the rise or is there simply a rise in diagnoses?’, my answer would be ‘yes there is a rise in diagnoses’, but not for the cynical reason you seem to favour – that it’s all about lining the pockets of psychiatrists. Remember we’ve been studying Freud and the post-Freudians, who pioneered the uncovering of disorders due to childhood trauma, sexual repression, unconscious guilt and the like, all in a groping, hit-and-miss sort of way, before anything much was known of neurology, endocrinology or genetics. Now in the 21st century, we can make connections between genetics, family and personal histories and brain processes in a more scientific way – at least slightly. There’s a long way to go. And this has led us to the reality of ongoing behavioural disorders, where previously people were just considered in vague terms as oddballs, eccentrics, psychos, losers or pains in the arse.
Canto: Steady on. I understand that it’s not about having some symptoms sometimes, which we all do, it’s about having a number of them to a degree that it becomes debilitating. And, as more than one expert has said, what’s frustrating to these sufferers is that sometimes, with certain specific tasks, or aspects of their professional lives, they perform perfectly well on a regular basis, while the rest of their lives are a mess of procrastination, disorganisation, impulsivity and the like. But the more I learn about the disorder, the more I wonder about treatment. These symptoms seem so multi-faceted, I can’t imagine how they can be dealt with though drugs. I can’t even begin to imagine the brain chemistry behind such varied behaviour. Surely there’s no medication that’s going to make you more organised or a better listener – never mind both at the same time.
Jacinta: Well, and yet it all has to be about brain chemistry and signalling. What else can it be? And patterns of behaviour – that’s to say, patterns of brain signalling, that have become habitual since childhood. In response to family dynamics and such. No free will, remember. Much that I’ve heard so far indicates that it runs in families. And of course there are prescription medications for the disorder. So we have to look at effectiveness (method of action), cost, availability and any side-effects or downsides. And then there are other treatments such as cognitive behavioural therapy.
Canto: Yeah I’ve heard that medications are expensive, and I doubt that therapy comes cheaply either. But let’s look at the brain of ADHD sufferers and what can be done medically, if anything, to alter it.
Jacinta: Well Britain’s National Health Service has this to say:
Research has identified a number of possible differences in the brains of people with ADHD from those without the condition, although the exact significance of these is not clear. For example, studies involving brain scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger. Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly.
Canto: Wow, that’s really informative. I like the bit about smaller or larger. Are they talking about brains or dicks? I mean, really…
Jacinta: Hmm. We need to look at research papers. And one thing I note is that researchers don’t readily distinguish ‘Adult ADHD’ because it’s understood to have emerged in childhood, though symptoms might have changed over time. In fact many children may ‘get over it’. Dr Judy Ho, in an interview on ADHD in the USA, quoted that childhood ADHD affects some 5% of the population but the adult version affects some 2.5%, which seems to make sense.
Canto: Well, having checked Google Scholar, I don’t see much in the way of recent research that jumps out. Sheeting home the various symptoms of the disorder to brain chemistry is really difficult…
Jacinta: Well since they do have medications on the market – the NHS describes 5 types- methylphenidate, lisdexamfetamine, dexamfetamine, atomoxetine and guanfacine – and these presumably work on brain chemistry, they must have some idea. ..
Canto: Well these are generally amfetamines, which act as stimulants, speeding up brain functions through the release of hormones and monoamine neurotransmitters such as dopamine and norepinephrine, and this kind of ‘upper’ activity would help with the disorder most associated with ADHD, which is depression, though there are definite downsides related to prolonged use or overuse. Combining, and possibly replacing, such medications with more behavioural-analytical treatments such as Cognitive Behavioural Therapy might be an idea, if there were enough decent therapists around, and if it was affordable, but it’s all a bit hit and miss.
Jacinta: You have to distinguish between proximal causes and ultimate causes. The proximal causes of most of these conditions is hormone levels and neurotransmitter activity, but that says nothing about why those levels are higher in some people than in others. If you don’t know the underlying causes, you’re just treating symptoms – drugging people to behave ‘normally’. But those underlying causes are generally fiendishly difficult to deal with – for example how can you cure an abused childhood, or damage done in the womb?
Canto: But many people with ADHD may just want to be ‘normalised’, to a degree. They know that what’s been done to them can’t be undone, but they just might want those symptoms reduced, to concentrate better, to be more organised, to calm down, whatever.
Jacinta: And given that we’re not that good at tolerating differences, why not give people drugs so they can all be the same, at least tolerably so….
*western ,educated,industrial,rich,democratic
References
ADD/ADHD – What is Attention Deficit Hyperactivity Disorder? (video)
https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/
https://www.cdc.gov/ncbddd/adhd/index.html
Leave a Reply