Understanding ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) affects 1 in 20 children, and an estimated one million South African adults, yet it is a condition often misdiagnosed, and plagued by myths and misunderstandings, particularly with regard to treatment.

When undiagnosed or not effectively treated, ADHD often sees children being unfairly labelled as naughty, delinquent, unteachable, and adults as lazy, lacking focus or incompetent.

Dr Renata Schoeman, co-convenor of the ADHD Special Interest Group of the South African Society of Psychiatrists (SASOP) says it’s important to shed light on this condition which hampers sufferers’ educational performance, self-esteem, relationships and work productivity, and leads to increased risk of other psychiatric disorders, reduced social functioning, delinquency, and substance abuse.

According to Dr Schoeman, registered and approved medication for ADHD in combination with psychotherapy, remains the mainstay of treatment.

“Psychotherapy, whether individual, family or group, and particularly cognitive behavioural therapy (CBT) has the most definitive evidence for its benefit to ADHD patients.

“Therapy provides support to the patient and their family, assists in developing acceptance of the disorder and coping skills, and helps in treating other (co-morbid) conditions that can accompany ADHD such as anxiety, depression, learning disabilities and substance abuse, and benefits organisational and social skills.”

A healthy diet and regular exercise have many benefits for physical, mental and emotional health, and there is some evidence that physical activity benefits ADHD symptoms, she said. While a multi-modal approach (the combination of pharmacological and psycho-social intervention) is the most widely proven and accepted treatment for ADHD, there are also a host of other treatments including diet and supplements, complementary and alternative medicine (CAM), exercise, and “brain training” methods such as neurofeedback.

But Dr Schoeman warns that many of these require more research to scientifically prove their effectiveness and safety.

ADHD is characterised by a persistent pattern of the “core triad” of symptoms of inattention, hyperactivity and impulsivity that impair development and functioning, and are often coupled with behavioural, cognitive and social problems.

Hyperactivity refers to excessive, inappropriate activity such as constantly fidgeting, talking or leaving their seat in class, is often “on the go” and has difficulty playing quietly; while impulsivity shows in poor self-control such as a short temper, social intrusiveness, and making spur-of-the-moment decisions without considering the consequences.

Dr Schoeman said although some children appear to “outgrow” ADHD, the condition does continue into adolescence in most cases and is more a case of some becoming more skilled in managing the symptoms and, as adults, compensating for their ADHD-related impairment through lifestyle and career choices.

Where to get help?

The child’s school, a clinic doctor or general practitioner should be able to assist with referral to specialist help.

What treatments have been proven effective?

For children under 5 years, and those with mild ADHD symptoms, the initial focus is likely to be on psycho-social interventions such as educating the parents, individual and group therapy and training in social skills. With moderate and severe ADHD, medication (stimulants and non-stimulants) go hand-in-hand with psychotherapy, behaviour training and social and educational support.

A healthy diet and regular physical activity are recommended in addition to medication and psycho-social interventions.

Dr Schoeman co-authored the first South African guidelines on the assessment and treatment of adult ADHD, published in the South African Journal of Psychiatry in 2017.

What to look out for?

A persistent pattern combining:

Inattentiveness – easily distracted or forgetful, failing to follow instructions or finish tasks, and wanders off task or topic.

Hyperactivity – fidgeting, tapping, talkativeness, especially in inappropriate situations such as during class.

Impulsivity – has difficulty waiting their turn; often intrudes on others or butts into conversations; short temper or low tolerance for frustration.

The pattern needs to have persisted for at least six months, be inappropriate for age or developmental level, and/or impact negatively on the person’s social functioning and work or school activities.