In this article we talk about Attention Deficit Hyperactivity Disorder (ADHD) in general with special emphasis on the ADHD treatment in our clinic in Dubai.
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder. Individuals with ADHD display symptoms of inattentiveness, over-activity, impulsivity, or combination of both. These symptoms start before age seven, however, ADHD can continue through adolescence and adulthood.
The original concept of ADHD (Attention Deficit Hyperactivity Disorder) understood the condition as a childhood developmental disorder. For this reason, scientists used to believe that ADHD was “outgrown” during the later stages of life.
First later research proved that ADHD symptoms last lifelong. Based on this finding scientists recognized ADHD in adults as a psychiatric diagnosis including the development of treatment protocols.
Adult ADHD. Change of Paradigm
Initially the ADHD diagnosis was restricted only to children and adolescents younger than eighteen. First in the past twenty years genetic, neuroimaging, and psychological studies have demonstrated that ADHD symptoms persist life-long. In addition to that the researchers found that ADHD in adulthood impairs individual’s neurocognitive functions not less than in the childhood leading to professional and social difficulties.
Frequency of ADHD in the Mature Population
The estimated global prevalence (the number of cases per 100 individuals) of ADHD is 4% to 6%. Despite the evidence that ADHD symptoms continue lifelong, until today very few adults receive adequate treatment. One study conducted in the United States estimated that only 10% of adults suffering from ADHD received treatment. This means that up to nine million adult Americans remain untreated.
ADHD, Signs and Symptoms
Many untreated ADHD patients have histories of negative academic and professional performance often falsely attributed to their low intelligence. However, the scientific data proved that people with ADHD are smarter than average.
ADHD symptoms include difficulty staying focused and paying attention, difficulty controlling behaviour, hyperactivity (over-activity) and impulsivity. It is hard to draw the line between normal and hyperactive behaviour and to identify a clinically significant level requiring intervention. Because other mental health disorders cause symptoms similar to ADHD, it easy to misdiagnose such conditions as ADHD. Therefore, it’s important to secure the diagnosis by an experienced psychiatrist who identifies whether a patient has ADHD, or psychiatric disorder with similar symptoms.
Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) at CHMC in Dubai
ADHD is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. In order to secure the ADHD diagnosis, we cooperate closely with the patient himself as well as his parents, caregivers or fiends. At our psychiatric clinic in Dubai we diagnose ADHD based on the DSM-5 guidelines.
ADHD diagnosis in adults has the following five or more symptoms of inattention and/or 5 or more symptoms of hyperactivity/impulsivity. They must have persisted for more than 6 months.
– Several symptoms (inattentive or hyperactive/impulsive) were present before the age of 12 years.
– Several symptoms (inattentive or hyperactive/impulsive) must be present in 2 or more settings (eg, at home, school, or work; with friends or relatives; in other activities).
– Clear evidence that the symptoms reduce the quality of social, academic, or occupational functioning.
– Symptoms do not occur exclusively during other mental disorder.
– Several inattentive or hyperactive-impulsive symptoms present prior to age 12 years.
– Several inattentive or hyperactive-impulsive symptoms present in two or more settings (e.g. at home, in the school or with friends).
– Clear evidence that the symptoms reduce the quality of, social, academic or occupational functioning
– Symptoms do not occur exclusively during the course
The diagnosis of ADHD includes the specification of its severity
Mild – few, if any, symptoms in excess of those required to make the diagnosis are present. The symptoms result in no more than minor impairments in social or occupational functioning.
Moderate – symptoms or functional impairment between ‘mild’ and ‘severe’ are present.
Severe – many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe.
Diagnostic Problems in ADHD
In adults ADHD the signs and symptoms may differ from those during childhood due to the adaptive processes and avoidance mechanisms learned during the process of socialization. Many adults with ADHD are even not aware that they have the condition. An in-depth clinical interview of such individuals will uncover history of failure at school, problems at work, failed relationships, or multiple traffic accidents.
Misdiagnosing ADHD with Other Conditions
Another barrier to the diagnosis of ADHD in adulthood is the blurring of the boundaries between ADHD and other psychiatric disorders. Mood and anxiety disorders are often misdiagnosed as ADHD.
Adults-ADHD and Psychiatric Co-Morbidities
People with Attention Deficit Hyperactivity Disorder often have other overlapping mental conditions called “comorbidities”. That’s why, a thorough clinical examination is required to confirm the diagnosis of ADHD, differentiating it from other psychiatric disorders. This helps to exclude overlapping comorbidities, such as depression or anxiety, which also impairs the performance of ADHD individuals.
Clinical investigation of Adults-ADHD
Diagnosis of ADHD in adults based on testing alone is not sufficient. The clinical investigation can detect the causes restricting the person’s limitation. Is it a mental health disorder that impairs functioning, or is it ADHD, or a combination of both? ADHD test results in patients with depression, anxiety, bipolar disorder, will default to false-positive results for ADHD.
Psychometric tests for Adults-ADHD
Professional psychometric testing for ADHD is a useful tool to secure the diagnosis and to quantify the degree of disability. However, the psychometric testing makes sense first after ruling out other psychiatric disorders which affect the concentration. Neuropsychological tests show differences between groups of adults with and without ADHD. The tests measure the executive function, memory, processing speed, and concentration.
CHMC patients are offered the psychometric test, Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV). It is a professional, evidence-based, and practical test. The test measures not only general intelligence, but also intellectual deficiencies spotting the ADHD symptoms in adults.
ADHD Treatment in Dubai for Adults
Patients usually come to us because they have difficulties completing tasks, missing deadlines, or underperforming professionally. A proper diagnosis of ADHD requires a detailed investigation that includes the patient’s medical history, mental health assessment, and level of functioning.
The entire process of ADHD treatment usually involves combination of medications, psychotherapy, behaviour modifications and lifestyle changes. Multiple studies proved that the best ADHD treatment results are achieved using combination of medication and psychotherapy.
After confirming the diagnosis, our psychiatrist prescribes medications tailored to the adult ADHD symptoms. In case of co-morbid psychiatric disorders, such as depression or anxiety treatment follows in the correct order. For instance, if a patient suffers of both depression and ADHD, depression should be treated before ADHD.
ADHD Treatment in Dubai with Medication
The medication is one of the main pillars for the ADHD treatment. Psychiatrists prescribe this medication under conditions of strict documentation and close patient monitoring. Medication called “stimulants” is the first-line pharmacological treatment for ADHD. In the UAE just like in other countries stimulants have the status of “narcotic medication”. The medication available for treatment of ADHD in Dubai is: Methylphenidate in fast and extended-release form, and Atomoxetine.
It may seem unusual to treat hyperactivity with stimulating medication. However, this medication has actually a calming effect on ADHD patients.
In order to reduce the risk of habit-forming behaviour the medication of choice in treatment of adults ADHD are slow-release stimulants. Patients with ADHD and symptoms of depression also can be treated with Bupropion, a dopaminerg antidepressant.
The discussion of attention deficit hyperactivity disorder diagnosis and treatment would not be complete without a few words on the role of a psychologist.
ADHD treatment in Dubai with Psychotherapy
ADHD can be treated by various forms of psychotherapy. The most effective evidenced based method is behavioral therapy. It focuses on patient’s behaviour to improve concentration and to reduce the hyperactivity.
Behavioural therapy includes practical help by organizing tasks or dealing with emotionally challenging events working through positive reinforcement for desired behaviours. It helps to control the anger trough thinking before acting. It helps the patient and his family to understand and to gain control of the stressful feelings related to ADHD.
Our psychologists are using customer focused, evidence-based therapeutic methods, including the mentioned CBT as well as mindfulness and Life-Skills training.
ADHD treatment in Dubai. Summary
ADHD in adulthood is recognized psychiatric disorder. Adulthood ADHD symptoms cause significant neurocognitive deficits associated with academic, social, and occupational difficulties limiting patient’s ability to reach the full potential.
Despite considerable scientific progress in field of Adult ADHD most adults suffering of the condition remain undiagnosed and untreated.
A detailed examination supported by psychometric tests secures the diagnosis of ADHD in adulthood. As the adult ADHD began in childhood the diagnostic requires careful evaluation of past social and academic performance.
The most effective treatment for adult ADHD is the combination of pharmacotherapy (medication) and psychotherapy. Our psychologists use customer focused, evidence-based therapeutic methods, including CBT as well as mindfulness and Life-Skills training.
The use of stimulating medication such as Methylphenidate requires meticulous documentation of the prescribed dosage. ADHD patients respond “paradoxically” to stimulating medication, which in their case has calming and focus increasing effect. That’s why the risk of dependency in accurately diagnosed ADHD patient using the stimulants is negligible.
A careful titration of the medication used for ADHD treatment, helps to exclude potential side effects. Regular laboratory and ECG checks eliminate the possibility of adverse effects. If these criteria are met, the benefits of treatment far outweigh the possible risks.
Read more about ADHD
ADHD. Types and Behavioural Problems
Multimodal Treatment Study of ADHD
DR. GREGOR KOWAL
Senior Consultant in Psychiatry,
Psychotherapy And Family Medicine
(German Board)
Call +971 4 457 4240
References
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