What is ADHD?

For those who don’t know (or remember!) what ADHD stands for - it is attention deficit hyperactivity disorder. It is a chronic disorder present from birth and characterised by inappropriate levels of attention, impulsivity and hyperactivity. A neurodevelopmental condition, not a mental health condition and also not influenced by environment or behaviour. People with ADHD often experience the condition quite differently from one another and this can be because each individual’s condition is a little varied but also because there are the 3 different types. I will go into this more below.

Did you know?

•  In 1798 a Scottish doctor Sir Alexander Crichton reported symptoms beginning early in life of people easily distracted and unable to focus on activities to the same level as others. It wasn’t until 1968 a form of ADHD was recognised in the DSM (Diagnostic and Statistical Manual of Mental Disorders), then in 1980 named ADD, and finally in 1994 listed as ADHD.

• Statistically the condition makes it more likely for those with ADHD to have issues at school, family / relationship problems, suffer from depression, substance abuse and increased risk of self-harm.

• ADHD and the lesser-known comorbidities (Comorbidity can occur when a person has more than one disease or condition at the same time. Conditions described as comorbidities are often chronic or long-term conditions) are Alexithymia, Aphantasia, Central Auditory Processing Disorder, Dyscalculia, Dysgraphia, Dyspraxia, Oppositional Defiance Disorder, Pre-menstrual dysphoric disorder, Prosopagnosia, Rejection Sensitivity Dysphoria (one I often see with my clients), Sensory Processing Disorder, Synesthesia, and Tourette Syndrome. Not easy to real off the tongue that sentence.

• That it is diagnosed in around 3 times as many males as females?!

• Genetics has shown 70% of people with ADHD will have an immediate relative with the condition.

Types

There are 3 types of ADHD primarily hyperactive and impulsive type, primarily inattentive type and then the combined type.

Hyperactive

According to the DSM-V, the majority of people with the hyperactive-impulsive type of ADHD tend to have the urge to be constantly on the go, have struggles in controlling impulses, or make decisions rashly. Struggles to sit still for prolonged periods of time is a common symptom, but the symptoms are more defined as hyperactivity-impulsivity behaviours.

Hyperactive Indicators

• Often leaves the seat when they are expected to stay seated

• The feeling of restlessness, like climbing something, or pacing back and forth

• Fidgeting, wriggling about on the seat constantly, tapping hands or feet

• Have the tendency not do things quietly

• Feeling constantly on the go and having other people feel challenging to keep up with

• Talking excessively

Impulsive Indicators

• Impulse control difficulty and blurting out answers even if questions aren't directed to them

• May struggle to wait for long periods 

• Interrupting conversations and the need almost always to tell something that isn't necessary

‍To be diagnosed with this type of ADHD People 17 years old and upwards, must have at least 5 symptoms, and the symptoms must be present for a minimum of 6 months and they must be disruptive in some form to the person’s daily life. 

‍Inattentive

Those on the side of the inattentive type ADHD tend to have difficulty organising and finishing tasks, following instructions, paying attention to detail and focusing. The other symptoms may include some of the below

Predominantly Inattentive ADHD Indicators

• Difficulty sustaining attention in tasks or conversations (like someone has a remote control in your brain and keeps changing the channel!)

• Does not seem to listen when spoken directly or can get distracted easily

• Usually start tasks with enthusiasm but has a hard time completing them

• Can struggle to following instructions

• Difficulty organising tasks, activities, thoughts, or schedule

• Trouble paying attention to details and often makes careless mistakes

• Dislikes doing things or activities that require sustained mental effort or getting reluctant to do paperwork/ forms

• Generally forgetful in managing or arranging tasks

• Forgetting and misplacing important things on a regular basis

• Distracted with external stimuli or sensory overload

• Finds activities like home chores, to do lists, and meeting deadlines a struggle

‍As per the DSM, People aged 17 and up must again have at least 5 symptoms, for at least 6 months. ‍Inattentive Presentation symptoms often will create difficulties in social, academic, or work life. It's important to understand that people with this type of ADHD might not show any hyperactive and impulsive behaviours as they are only on the inattentive side.

‍Combined

As the name describes, combined type ADHD is when a person persistently presents with symptoms of both inattention and hyperactivity-impulsivity. A person's behavior may indicate this subtype if they meet sufficient criteria for both the inattentive and hyperactive-impulsive subtypes.  According to statistics, this type of ADHD is the most common presentation and diagnosis among children and adults (American Psychiatric Association).

What it is and is Not

‘Yes but aren’t we all a bit ADHD sometimes?’ – Worst question to ask….. Yes, some times you may feel you have some of the ADHD symptoms but that doesn’t mean you have ADHD. 'You Only Focus on What You Want To', also can be very upsetting and invalidating.

ADHD is not a result of bad parenting, diet, sugar, TV or video games, is not related to intelligence or laziness. It is not actually over diagnosed (which seems to be a thing in the news just now) as only around 20% will actually get a diagnosis. It is also not the sufferers’ fault and is certainly not to do with a lack of effort or motivation (its really hard work for that person on a daily basis!).

ADHD and the brain

ADHD is associated with abnormally low levels of the neurotransmitters transmitting between the prefrontal cortical area and the basal ganglia i.e., dopamine (pleasure, motivation) and noradrenaline (mood, concentration, alertness as a response to stress). Due to this lack of dopamine, people with ADHD are "chemically wired" to seek more. And often can be drawn to risk taking activities in order to feel that ‘rush’.

 Diagnosis – to obtain one or not!

This is entirely up to you. How do you feel about a label? Would it feel uncomfortable, pigeon holed or would it be a relief to finally understand yourself and your struggles? Do you need some additional support in your studies, or workplace where a diagnosis might be helpful or beneficial? There are lots of questions you will need to ask yourself before you can take that first step. If you have decided against it, then that is fine - you can then decide what you do need. For example, practical support with organisation skills, doing some research, self-help strategies etc. If you have decided you would like a diagnosis, then there are essentially two avenues.

1. Go to your GP and let them know you would like this and take as much information with you as you can, - when you first noticed things, what you struggle with, what symptoms resonate with you, what feedback you have had from those around you etc. All going well, they will put you on a waiting list which varies depending on your area you live in. In can be months or even years which is very unfortunate as a diagnosis can make an enormous difference to some people’s lives.  

2. Alternatively, you can go privately which involves finding a psychiatrist / psychologist or assessment centre.  Again, you may have to join a waiting list which can be weeks to months, then you can receive an assessment and as a result possible medication and receive a shared care agreement between the medical practitioners involved. At this point the psychiatrist or psychologist will then write to your GP to update them of your diagnosis and medication. There can however be some issues at this point – GPs may refuse or be unwilling to agree to the agreement, medication may be impossible they feel due to it being ‘too expensive’. So even if you do go private, it’s still worth having a conversation with your GP to suss out their views on the process and after care of a diagnosis!

Medication -V- No Medication – the big debate

I won’t spend much time on this mainly because it could be a whole other blog but basically there are two options or routes someone can take after a diagnosis. Medical route or alternatives route.

The medication route you can see below in this simple diagram. All of these can be discussed with your GP or psychiatrist/psychologist who provided you with your diagnosis. Some clients have said things like ‘finally found some peace’, ‘if felt life changing’ whereas others struggled to see a difference or may have just experienced some side effects. This is a very personal thing, and the best thing you can do is to research the pros and cons and ask all the questions you can think of to give to your GP or psychiatrist – e.g. what side effects might there be, how long till the medication takes effect, are there any long term effects, if I want to come off it how do I go about that.. etc

However, if you would prefer not to take the medical route – Joseph Pack is a great advocate for no medication. You can visit his website or follow his social media. Leanne Maskell is another knowledgeable author (law graduate and activist) who I would suggest you might visit her social media or read her book ‘ADHD and A-Z’.

So, what are some of the natural treatments or remedies if the medication route is not taken:

·       Therapy! (Aberdeen Bespoke Counselling – which I believe would be more than happy to support you before, throughout or after a diagnosis and to help you find easier ways to cope with day to day life).

·       Meditation

·       Mindfulness

·       Breathing exercises

·       Supplements:

Numerous studies have shown that iron levels tend to be lower in people with ADHD and I have personally come across this in the therapy room. So, eat up - Liver, red meat, kidney beans, spinach and broccoli!

Iron, zinc and magnesium are required in the production of neurotransmitters (I mentioned these above) and are linked to inattention and focus. Magnesium is also known for its calming effect which can be helpful for the hyperactivity side of ADHD.

·       Healthy eating - avoid processed foods and watch out for stimulants

·       Drink lots of water - yes water! We can lose focus when we are dehydrated and therefore good hydration helps to improve memory, critical thinking and cognitive function.

·       Try to have regular and controlled sleep patterns

·       Ensure you get the right amount of healthy exercise

ADHD and the Counselling Room

At Aberdeen Bespoke Counselling I quite often find myself with a client who suspects they might have ADHD, would like to have a diagnosis, or have just had a diagnosis or are perhaps unsure if they would like a diagnosis. So, what can counselling do? Where to begin…..

Counselling can help support you to obtain or go through a diagnosis or support you following a diagnosis. The whole process of this, is not to underestimate the time, effort or the emotional toll it can take on you and those around you.

It can also help you to cope with your feelings throughout this process. Feelings such as loss, regret, fear, sadness, excitement, failure, etc. It can also help you work on self-esteem – which often has been chipped away at over the years through possible struggles, tribulations and judgements.

Counselling can also assist you in adjusting to and accepting this new part of you and most importantly look at what might feel like a sense of loss – which could be whole host of things. Loss of support that you missed out on, missed opportunities, relationships that were damaged or ended, regrets, failures felt, etc.

Most importantly a client can feel the benefits of the therapeutic relationship of a space where you can really be yourself, in a safe, non-judgemental and supportive environment. As the client you can have your emotional needs supported, and your practical needs met through prioritisation, organisation and building of healthy relationships.

Summary

I hope you have taken something away from todays blog about ADHD – whether it’s a fact, information or you simply learned a little about what it would be like to come to Aberdeen Bespoke Counselling. It is important to share knowledge re ADHD so that others can be more accepting, work places more accommodating and help relationships become more understanding.

I hope I have provided a little insight into how the brain works, how diagnosis works and a brief synopsis of medication v no medication.

If you do think you might be ADHD, then whether you want a diagnosis or not, you still deserve some emotional and practical support. Aberdeen Bespoke Counselling is here for you and you do not have to experience the difficulties alone.