What is ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that first emerges in childhood, and may continue into adolescence and adulthood. It is characterised by inattention and/or hyperactivity and impulsivity. It was previously known as Attention Deficit Disorder (ADD), but from 2000 the name Attention Deficit Hyperactivity Disorder (ADHD) is now used as it is recognises that there are three main presentations of this disorder.

  1. Predominantly Inattentive Presentation. This presentation is characterised by symptoms that are predominantly from the inattention category. However, the individual may also have some symptoms from the hyperactive-impulsive category. To meet criteria for ADHD- Predominantly Inattentive Presentation 6 (5 in adults) out of a minimum of 9 of the criteria must be met.
  2. Predominantly hyperactive-impulsive Presentation. This presentation is characterised by symptoms that are predominantly from the hyperactive-impulsive category. However, the individual may also have some symptoms from the inattention category. Again, to meet criteria for ADHD- Predominantly Hyperactive-Impulsive Presentation 6 (5 in adults) out of a minimum of 9 of the criteria must be met.
  3. Combined Presentation. This subtype is characterised by a significant number of symptoms from both the inattentive and hyperactive–impulsive categories as specified above (ie. meeting criteria for both of the above subtypes).

Symptoms of inattention may include:

  1. Lack of attention to detail or makes careless errors in study, work and other activities.
  2. Has difficulty sustaining attention in activities or tasks.
  3. Appears not to be listening when others are speaking to him or her.
  4. Has trouble completing tasks such as study, work or chores.
  5. Has difficulty organising tasks or activities.
  6. Avoids or dislikes tasks that require sustained mental effort (e.g. homework).
  7. Loses items frequently (e.g. phone, bag, jumpers).
  8. Easily distracted.
  9. Often forgetful.

Symptoms of hyperactive/impulsive behaviour may include:

  1. Fidgets or squirms frequently.
  2. Struggles to remain seated when required.
  3. Moved around excessively when it is not appropriate, or feels the need to move or is restless
  4. Has difficulty playing or engaging in activities quietly.
  5. Talks excessively.
  6. Always seems to be on the go.
  7. Difficulty waiting for their turn in activities or groups situations.
  8. Blurts out the answer to questions before they have been completed.
  9. Often interrupts others.

How to Get Assessed for ADHD

In Australia there are three main types of mental health professionals who assess for ADHD. Below is a summary and their differences:

(1) A paediatrician/ developmental paediatrician (Only under age 18). In Australia we have a subspecialty of paediatrics called Developmental Paediatricians who have additional training in issues that affect development such as ADHD. There are many types of paediatricians and not all have experience in diagnosing ADHD. It is important to ask when trying to book an appointment whether the paediatrician is experienced in diagnosis or will refer out for diagnosis. Likewise, it will be important to ask whether they can prescribe medication or will refer elsewhere. It can be easier to find a paediatrician who has a team who can assess and medicate without needing to go elsewhere. One disadvantage of seeing a paediatrician is that once they reach adulthood they will need to find a new doctor to receive ongoing care (although some paediatricians may agree to see a adult for a few extra years). In addition, if there are learning concerns or mood concerns they will also need to refer to a psychologist for assessment. Paediatricians tend to look at the symptoms using a more medical model, going through the behaviours and ruling out any medical issues that might be causing it (eg. genetic disorders, low iron, thyroid issues, sleep apnoea etc).

(2) A psychologist (Any age). In Australia there are numerous types of training you can receive in psychology. In psychology areas of speciality are called endorsements and are usually awarded based on the types of Masters program completed after the 4 year undergraduate training. Two of the common endorsements that are often specifically trained to diagnose ADHD are the “Developmental & Educational Psychologists” and “Clinical Neuropsychologists”. However, many other clinical and generally registered psychologists have experience in diagnosis and having one of these endorsements does not guarantee that the psychologist has experience diagnosing. It is important to ask when making an appointment whether the psychologist is experienced in diagnosis, and if so what therapies they offer to help people with ADHD. Psychologists cannot prescribe medication but can provide parenting, behaviour management at home and in schools, and psychological therapy to help with any mood issues that may be present. Often psychologists will refer to psychiatrists/paediatricians for medications, and likewise, these doctors will refer back for behaviour management, psychological therapy, and assessment of any co-occurring disorders like learning issues or mood disorders. Psychologist usually have a different, longer process to assessing ADHD, often including IQ tests, academic tests and even attention and executive testing. This is is addition to the clinical interviews looking at behavioural issues that all three clinicians in this list will conduct. If a psychologist has concerns about any medical issues they will need to refer to a doctor for further testing.

(3) A psychiatrist (Any age): Some psychiatrists are also trained in assessing ADHD. As described above, not all psychiatrists may be trained so it is important to ask when making an appointment, as well as checking whether they can prescribe medication. As noted above not all medical professional have an Authority to prescribe medication as they are a restricted Scheduled 8 Drug. If an adult wants to trial medication for ADHD they will need to see a psychiatrist, and it is recommended that they see a psychiatrist before seeing a psychologist, as a psychologist cannot prescribe. Most psychiatrists in Australia do not tend to be trained in behavioural management or attention/executive management, so if further help is needed in these areas they can refer on to a psychologist. Also, psychiatrists do not tend to do school visits or have lengthy contact with schools, and this is usually left to psychologists to do the more day-to-day management. If there are any medical conditions that may be associated with the ADHD, typically the psychiatrist will work with other medical professionals. A psychiatrist that sees both children and adults can be good if one wants medication and prefers not to have to change doctors.

Strengths & Weaknesses in ADHD

People with ADHD are often characterised by their weakness and issues, however there are some characteristics of ADHD that can actually for some people be seen as strengths.

  • Due to distractibility may ruminate less on negative things and get over them more quickly
  • Due to less linear thinking, may be more creative and make connections and see things in different and new ways
  • Due to lack of inhibition may be spontaneous which can open up new opportunities
  • Can have high energy that can be funnelled into projects and tasks
  • Some people with ADHD can hyper-focus, which can result in incredible achievements
  • Willingness to take risks can result in people with ADHD not being afraid to chase the things they want

Of course all these strengths come at a cost, and ADHD is ultimately a disorder and the impacts on quality of life can be very significant. People with ADHD can often suffer from the following:

  • Low self-esteem due to living with a sense of underachievement, and being frustrated they can’t meet their potential.
  • Depression due to ongoing failure and underperformance, resulting in wanting to give up and not feeling like it is worth trying
  • Sleep issues can be due to having a racing mind making it hard to fall asleep, or waking in the night, making one more drowsy and worsening attention problems
  • Disorganisation due to being forgetful, not planning tasks well, struggling to start tasks, and then getting distracted and not completing them
  • Anxiety due to repeated failure and the desire then avoid further tasks that may be failed. Social phobia can be common due to issues ADHD can create socially, with the social issues and possible bullying in childhood leading to a fear of being judged by others.
  • Social issues and relationship problems may occur due to inattention and people feeling disrespected when the person with ADHD gets distracted. Planning and organisation issues can also result in problems with running late or not completing requests made by partners/friends. Impulsivity, saying things which are inappropriate, can also further degrade relationships.