Attention Deficit Hyperactivity Disorder (ADHD ) is the term used to identify a neurodevelopmental condition characterised by symptoms of inattention and/or hyperactivity/impulsivity
There are three possible diagnoses according to what symptoms are mainly present:
- ADHD inattentive presentation (inattentive ADD)
- ADHD hyperactive/impulsive presentation
- ADHD combined presentation.
The aim of treating ADHD is to optimise an individual's effectiveness with
- Sustained focus
- Reduced distractibility
- Less impulsivity
- Improved mood
- Improved productivity and fewer social challenges
- Greater attention to detail
- Better memory
- Better sleep
- Reduced hyperactivity
Overfocused ADD is a type of ADD characterized by inflexible cognitive thinking and an inability to appropriately shift one's attention from task to task
Overfocused ADD patients can experience the following symptoms
- Inattentive behaviour
- Trouble shifting behaviour
- Inflexible cognitive thinking
- May or may not be hyperactive
- Stuck in a negative thought loop
- Excessive worrying
- Difficulty adjusting to changing conditions
Many ADHD patients only show inattentive symptoms(predominantly Inattentive presentation), exhibiting no signs of behavioural problems nor disruptiveness.
In fact, the child with ADHD may be extremely well behaved, but have noticeable difficulty with sustaining effective concentration on non-preferred tasks, such as academic studies or homework. Unless there is a very good organisational structure in place.
Untreated ADHD can result in dopaminergic and executive dysfunction, which can have an impact on the following:
- Self-directed attention
- Self-restraint (poor inhibition)
- Increased impulsivity
- Non-verbal working memory - one's visual imagery and ability to picture things mentally
- Verbal working memory - internal speech or 'inner monologue'
- Emotional self-regulation
- Self-motivation to complete tasks when there is no immediate external consequence
- Planning and problem solving.
There may be both serotonergic and dopaminergic dysfunction in ADHD, which is important to identify as it determines medication options and which one to introduce first
A comorbid or co-occuring condition is a separate condition that exists alongside ADHD, compounding an individual's cognitive, psychological, and social impairment. These conditions, when found alongside ADHD, warrant special consideration and a unique treatment plan.
For this reason, it is important to complete a general psychiatric assessment to enquire about commonly co-occurring symptoms, syndromes, and disorders. The most common mental health problems that accompany ADHD include anxiety, Autistic Spectrum Disorder (ASD), OCD, depression, bipolar disorder, substance abuse disorders and addiction, sleep problems and personality disorders. These should be investigated and treated accordingly. It is also imperative to assess for any trauma, be it PTSD or cPTSD.
Adult ADHD treatment should be holistic and focus on nutrition, exercise, supplements, medication options, self-care routines and targeted ADHD coaching,
Addressing destructive negative lifestyle choices (addictions) and treatment for any comorbid mental health conditions that occur along with ADHD is crucial.
This is invariably with medication and/or specific forms of therapy.
Autism Spectrum Disorder (ASD)
Autism Spectrum Disorder is a complex neurobiological developmental disorder that is characterized by difficulty communicating verbally and relating socially to others, alongside a need to engage in repetitive behaviours or language.
ASD is typically a lifelong condition, though a small percentage of children outgrow the diagnosis.
Adults with ASD may:
- Have difficulty interpreting what others are thinking or feeling
- Have trouble interpreting facial expressions, body language, or social cues
- Have difficulty regulating emotion
- Have trouble keeping up a conversation
- Have inflection that does not reflect feelings
- Exhibit repetitive behaviours and have specific, extreme interests which may border on obsessions.
ASD can be a stand-alone disorder, or it may coexist with other disorders
To differentiate ADHD from ASD, many clinicians work to determine whether weak social skills derive from an executive-function impairment or from a developmental issue.
Common symptoms of autism in adults include:
- Difficulty interpreting what others are thinking or feeling
- Trouble interpreting facial expressions, body language, or social cues
- Difficulty regulating emotion
- Trouble keeping up a conversation
- Inflection that does not reflect feelings
- Difficulty maintaining the natural give-and-take of a conversation; prone to monologues on a favourite subject
- Tendency to engage in repetitive or routine behaviours
- Only participates in a restricted range of activities
- Strict consistency to daily routines; outbursts when changes occur
- Exhibiting strong, special interests
Autism in women Is often misunderstood and is commonly misdiagnosed or missed altogether in the presence of an existing condition like ADHD.
Women with autism spectrum disorder (ASD) often display symptoms differently than do autistic men. They may be better able to mimic social standards better than some autistic men — they often describe taking on personas or mimicking other people to fit in.
A woman with autism may show a larger range of emotion in her face and voice. She may be able to adopt social standards fairly well but find it exhausting and stressful. The drama of female peer relationships can feel really overwhelming and not enjoyable — she might even gravitate toward male friendships for this reason.
Women with ASD may fixate on more socially relevant hobbies and as such, their autism may be missed because of the mainstream nature of these interests, despite how obsessive their interest actually is.
Autism in women can present with an eating disorder and women with autism who are diagnosed with anorexia benefit less from treatment than do non-autistic patients.
The fixation for these women might be nutrition, or they might have really restricted, repetitive eating profiles because of sensory issues or because they crave repetition. Since the eating disorder is the most critical and evident condition, the autism spectrum disorder often gets overlooked. A significant risk for women with autism is being taken advantage of in relationships with a high incidence of sexual abuse.
If you think you may have undiagnosed or untreated Adult ADHD/ADD or ASC, then contact me for a more detailed assessment and overview of treatment options
Please note that I do not offer stand alone ASD assessments - they form parts of my comprehensive ADHD Assessment. You should seek a stand alone ASD assessment elsewhere if that is specifically what you are looking for.