It's a condition associated with
children, but Nicola, 36, is one of many adults who blame it for their problems.
But are they actually ill? BARBARA ROWLANDS investigates:
Like many working mothers, Nicola
Hasan is a busy woman. With two daughters at different schools, she also has a
demanding job as a senior social worker, and has just finished a course that
means she can teach other social workers.
Her spare time is spent mainly with her family, but she also squeezes in
voluntary work for ADDISS, the national support group for those with
attention-deficit hyperactivity disorder (ADHD). Nicola started the Greenwich
branch last year because her daughter, Lauren, 14, was diagnosed with ADHD ten
years ago.
However, it is not Lauren with whom she battles every day, but herself:
"I was never aggressive like some people with ADHD, but I would talk too
much, flip from one thing to another and get very easily distracted," says
Nicola, 36, who lives with her family in South-East London.
"I'd go to the kitchen, walk past the washing basket, put the washing on, and
see the dishes, but not do them, and forget what I came in to do."
The only way she could cope was by writing a "to do" list that "even Superman
couldn't have finished".
This inability to focus meant she didn't take any exams and left school at
15. "It seems I've had ADHD all my life, but it was only diagnosed last
September," says Nicola. She is now taking Concerta, which contains the
stimulant methylphenidate, and says her life "has improved tenfold".
ADHD is the name given to a collection of behavioural problems linked to poor
attention span. The symptoms include impulsiveness, restlessness and
hyperactivity.
Most people associate ADHD with children - as many as one in 30 in Britain
has it. It was once thought that they grew out of the condition, but some
scientists say ADHD is a genetic disorder which doesn't disappear with
adulthood.
One in five children with the more extreme forms of ADHD still has the same
problems in adulthood: if these figures are translated into the adult
population, this means around 460,000 adults - one in 100 - have ADHD.
Addiss puts the figure higher. "I would say ten per cent of the adult
population have ADHD but don't have a diagnosis. I think it's one of the biggest
public health problems there is," says Andrea Bilbow, the charity's chairperson.
Some sceptics question the existence of ADHD, as well as the numbers
affected. However, adult ADHD has already prompted a number of studies, ranging
from its effect on older sufferers (up to 55) to what it is like for sufferers'
families and partners.
It was announced recently that the prestigious University of Kentucky is
going to study the reaction time and decision-making of drivers with ADHD.
By the time those with ADHD, nicknamed 'adders', have reached adulthood, many
will have learned to control their hyperactivity, but may still find it
difficult to concentrate, for instance, and will still be impulsive. They can be
inattentive, fidgety and restless, and are prone to abuse alcohol and drugs.
"They have very unfocused thoughts that flip from one thing to another,"
explains Professor Philip Asherson, professor of molecular psychiatry at the
Institute of Psychiatry, and the UK's leading expert on adult ADHD.
He runs one of two adult ADHD clinics in the UK, at the Maudsley Hospital,
South London. "Some people say it's like having a whirlwind in your head, or a
fog. It's a constant distracting mental process. Adders tend to procrastinate,
have problems starting things and are easily distracted when eventually they do
start," he says.
"We all put off the boring and mundane things - but for them it's almost like
a disability. They can play a computer game all day long, but if there is
something important they have to do, they just can't do it.
"They also tend to be impatient. In queues, they'll either explode in
irritability or just walk out."
But they can also be highly creative, according to some American experts, who
claim ADHD is common among high-powered executives - their rapid-fire thinking
is suited to multi-tasking, while their army of assistants is left to deal with
the organisational side.
Most adults discover they have ADHD when their children are diagnosed; others
notice they have a problem when they are promoted into a job that requires the
organisational skills they don't possess.
Prof Eric Taylor, a child psychiatrist specialising in childhood ADHD at the
Institute of Psychiatry, says: "People with ADHD may be very good ideas people,
but to be a successful manager you have to combine the creative side with a
systematic and analytical mind."
"We all have the symptoms to some degree - it's where you draw the line
that's important," explains Prof Asherson. "If those with ADHD find the symptoms
distressing, that seems a good place to draw the line."
But sceptics such as Dr Sami Timimi, of the Ash Villa Child & Adolescent Unit
in Sleaford, Lincolnshire, see ADHD as 'biobabble'.
The hallmarks of ADHD - restlessness, impatience, mood swings - are
experienced by everyone to some degree, he says and are a result of our
"hyperactive, fast-paced, soundbite culture". He is concerned about the risk of
heart damage from long-term use of drugs to treat ADHD.
He also believes drug companies will make a sizeable profit from the sale of
newer medication to a new, hugely expanded market.
The main form of drug treatment for ADHD is stimulants; methylphenidates
(sold as Ritalin and Concerta), which boost levels of the brain chemical
dopamine, associated with focus and pleasure, and amphetamines (Adderall and
Dexedrine).
A new drug, Strattera, is not a stimulant, but works on norepinephrine, a
brain chemical linked to attention and activity levels.
Last year, 359,100 prescriptions were written for Ritalin (ten per cent of
which were for adults), four times as many as in 1997.
Disquiet
There has been growing disquiet about the increasing number of ADHD
prescriptions, against the background of the experience in the US, where the
market is worth more than $2billion.
"There's a potential for prescribing to get out of control, so it's important
to focus on the really serious cases - and there's plenty of them," says Prof
Asherson.
But, in fact, doctors in the UK under-diagnose adult ADHD, says Dr Jonathan
Dowson, a consultant psychiatrist who runs the NHS adult ADHD clinic at
Addenbrooke's Hospital, Cambridge.
He says he would prescribe medication for less serious cases: "If someone has
a high-powered job and wants to do a bit better, I don't see why you can't use
methylphenidate if it's useful to the individual.
"It isn't a drug you have to take all the time. If they have significant
problems and are functioning way below their IQ level, I think it's reasonable."
Dr Timimi believe stimulants have no long-term benefits in terms of behaviour
or academic achievement.
Instead of opting for a 'quick fix', he says psychiatrists should apply a
multitude of different approaches, which they should tailor to individuals - for
instance, working with schools or families or weaning a child off junk food.
But for Nicola Hasan, whose life is "under control" thanks to medication,
there is no argument.
"I'm the same person - but for the first time in my life, I can focus and
concentrate. I'm far more productive," she says.
Could you have it, too?
The following are classic signs. For a diagnosis of ADHD, you must agree with
most of the following - and have demonstrated these characteristics from before
the age of seven - as well as having significant problems at home and work.
Do you:
• Find it hard to focus on things?
• Often make careless mistakes?
• Have difficulty paying attention?
• Talk too much and blurt out answers before questions have been completed?
• Hate queues?
• Butt into conversations?
• Don't listen when spoken to directly?
• Have difficulty following through duties at work? Have difficulty organising
yourself?
• Put off tasks that require concentration? Lose important things, such as keys?
• Become easily distracted? Forget things?
• Have thoughts that jump around? Fidget incessantly? Feel restless? Have
difficulty playing or engaging in leisure activities quietly?
Attention Deficit Disorder Information and Support Service (ADDISS). Tel:
020 8906 9068. www.addiss.co.uk
