June 19, 2022 • 47 mins
FIrstly about 1 in 10 children have ADHD and about half will grow out of it leaving 1 in 20 adults with ADHD. The long term studies in adults have not been done but the oldest patient I have diagnosed and treated with ADHD was 68.
There is a strong genetic component and it is almost certain that other members of the family will have symptoms of ADHD. There is also a greater than average association of ADHD with bipolar disorder and dyslexia.
People with ADHD often present with an inexplicable failure to succeed in life. In other words they are intelligent and affable and try to apply themselves but they fail.
ADHD can make is so difficult to function that there is a high incidence of depression and anxiety alcohol and substance use.
It is also not an uncommon cause of relationship problems amongst couples as the ADHD person will be impatient and irritable and impulsive and difficult to communicate with.often appearing not to listen.
Notably of patients diagnosed with clinical depression then 25% will have ADHD and unless it is treated the depression will not resolve.
As a child ADHD can have severe direct and indirect consequences on self esteem, socialisation and general ability to function and be consistent which are all hugely involved in success in life.
One can imagine a child with ADHD being relentlessly hyperactive impulsive and inattentive will be hard to manage for the parents who typically chastise verbally and physically. This negativity erodes the green shoots of self esteem . The child gets used to criticism, and also gets used to failure and comes to expect both. One patient was so out of control that his father used to take him out into the garden and hose him down with cold water. They will have difficulty with socialisation and will tend misbehave as a consequence of the ADHD at school and be punished.
There are two issues as far as schools are concerned.
ADHD -unless it is very mild- is a disability and is covered under the Disablity discrimination act 2010. Additionally even if the child is treated with medication the disability criterion applies as if the child is not on medication. Therefore if the school is sanctioning a child for behaviour as a result of disability or if they are insisting on behavioural targets such as a behavioural contract then they are setting up the child to fail.
Not making reasonable adjustments is part of disability discrimination and is illegal.
The second is abuse by neglect. If either parent or school knowingly do not take steps to help their child once they know they have ADHD then that is abuse by neglect.
Parents should be wary of the paradoxical reinforcement of shouting or physical punishment. Either may arouse the child so much that their dopamine goes up producing a compliant calm child. The parent in desperation learns this is an effective way of curbing unruly ADHD behaviour and the child gets used to being scolded criticised and punished and absorbs that into their self esteem and personality. One of my patients as a child was so hyperactive the only way his father could get him to calm down was to take him out and turn the high pressure water hose on him. That raised his dopamine.
This is also the rational when an occupational therapist recommends ‘Play breaks’ at school if an ADHD is getting unrully or for quiter play ‘hard putty’. All these provide physical stimulation hence raising dopamine.
Far preferable of course to take a simple tablet rather than treating the child differently to the others.
Medication for ADHD:
Stimulants: Methylphenidate and different types of preparation of this. They come is standard release or sustained release (modified release)
In the USA there is also Dexedrine (adderall) which is a mixture of standard and slow release salts.
All these are Class B drugs and have to be prescribed with a CD Pad (controlled drug pad)
National Institute of Clinical Excellence Guidlines state that one a consultant psychiatrist has made the diagnosis and continues supervision of the patient then the GP can prescribe it. Many GPs however do not. Either because they dont understand it, or they are anxious about a class B drug or they don’t believe in ADHD.
Unlicensed stimulant : Modafanil (Provigil) is a histaminergic agent which at high dose has been shown to treat ADHD. note that antihistamines sedtate so histaminergic agents will stimulate.
Non stimulant medications:
Atomoxetine (Strattera) : this raises dopamine and noradrenaline but it is a cumulative effect similar to an antidepressant and needs to be taken constantly . Stimulant medication can be taken according to the requirements and then not taken if not required.
Guanfacine: a central alpha 2 receptor agonist which raises
There is a strong genetic component and it is almost certain that other members of the family will have symptoms of ADHD. There is also a greater than average association of ADHD with bipolar disorder and dyslexia.
People with ADHD often present with an inexplicable failure to succeed in life. In other words they are intelligent and affable and try to apply themselves but they fail.
ADHD can make is so difficult to function that there is a high incidence of depression and anxiety alcohol and substance use.
It is also not an uncommon cause of relationship problems amongst couples as the ADHD person will be impatient and irritable and impulsive and difficult to communicate with.often appearing not to listen.
Notably of patients diagnosed with clinical depression then 25% will have ADHD and unless it is treated the depression will not resolve.
As a child ADHD can have severe direct and indirect consequences on self esteem, socialisation and general ability to function and be consistent which are all hugely involved in success in life.
One can imagine a child with ADHD being relentlessly hyperactive impulsive and inattentive will be hard to manage for the parents who typically chastise verbally and physically. This negativity erodes the green shoots of self esteem . The child gets used to criticism, and also gets used to failure and comes to expect both. One patient was so out of control that his father used to take him out into the garden and hose him down with cold water. They will have difficulty with socialisation and will tend misbehave as a consequence of the ADHD at school and be punished.
There are two issues as far as schools are concerned.
ADHD -unless it is very mild- is a disability and is covered under the Disablity discrimination act 2010. Additionally even if the child is treated with medication the disability criterion applies as if the child is not on medication. Therefore if the school is sanctioning a child for behaviour as a result of disability or if they are insisting on behavioural targets such as a behavioural contract then they are setting up the child to fail.
Not making reasonable adjustments is part of disability discrimination and is illegal.
The second is abuse by neglect. If either parent or school knowingly do not take steps to help their child once they know they have ADHD then that is abuse by neglect.
Parents should be wary of the paradoxical reinforcement of shouting or physical punishment. Either may arouse the child so much that their dopamine goes up producing a compliant calm child. The parent in desperation learns this is an effective way of curbing unruly ADHD behaviour and the child gets used to being scolded criticised and punished and absorbs that into their self esteem and personality. One of my patients as a child was so hyperactive the only way his father could get him to calm down was to take him out and turn the high pressure water hose on him. That raised his dopamine.
This is also the rational when an occupational therapist recommends ‘Play breaks’ at school if an ADHD is getting unrully or for quiter play ‘hard putty’. All these provide physical stimulation hence raising dopamine.
Far preferable of course to take a simple tablet rather than treating the child differently to the others.
Medication for ADHD:
Stimulants: Methylphenidate and different types of preparation of this. They come is standard release or sustained release (modified release)
In the USA there is also Dexedrine (adderall) which is a mixture of standard and slow release salts.
All these are Class B drugs and have to be prescribed with a CD Pad (controlled drug pad)
National Institute of Clinical Excellence Guidlines state that one a consultant psychiatrist has made the diagnosis and continues supervision of the patient then the GP can prescribe it. Many GPs however do not. Either because they dont understand it, or they are anxious about a class B drug or they don’t believe in ADHD.
Unlicensed stimulant : Modafanil (Provigil) is a histaminergic agent which at high dose has been shown to treat ADHD. note that antihistamines sedtate so histaminergic agents will stimulate.
Non stimulant medications:
Atomoxetine (Strattera) : this raises dopamine and noradrenaline but it is a cumulative effect similar to an antidepressant and needs to be taken constantly . Stimulant medication can be taken according to the requirements and then not taken if not required.
Guanfacine: a central alpha 2 receptor agonist which raises
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