Neurodiversity 101-challenging ADHD myths and... presenting some of the facts
Prof. Amanda Kirby MBBS MRCGP PhD FCGI
Honorary/Emeritus Professor; Doctor | PhD, Multi award winning;Neurodivergent; CEO of tech/good company
I am irritated and saddened this week that there is an rise in ADHD-bashing going on. I am sending my newsletter early this week because of this.
ADHD has always seemed to stimulate a lot of feelings both positively and negatively. It is almost a fear from some that if we discuss it enough we will open Pandora's box.
A headline in one paper in the last week or so suggests that too many people are being diagnosed with ADHD.
Another one states...
and this one...
I have been around long enough to see this happening again and again...
ADHD has been around a while
Why is it that something that was first described in 1775 evoke such differences of opinions?Melchior Adam Weikard, a German physician, wrote the first textbook description of a 'disorder' with the hallmarks of ADHD.
Since then there has been a lot and a lot and a lot of work done....
In the UK we have NICE guidelines for ADHD recognising not only the prevalence rates, but also those who have higher rates than in the general population.Misconceptions about ADHD stigmatize people, preventing and delaying support.
There are also international guidelines and metanalyses presenting hundreds of papers relating to ADHD.A recent review published in 2021.They emphasise that ADHD is caused by the combined effects of many genetic and environmental interactions. Many of these people are valued and critical investigators.
ADHD symptoms include inattention (and hyper focus as well) and/or hyperactivity ( more seen in young children) and acting impulsively.
Lawson in the Times says:
"when I cast my eye down the list of ADHD characteristics on the NHS website, I suppose that at least half the population could make a persuasive application to join this burgeoning club: constant fidgeting, poor concentration, acting without thinking, careless mistakes, forgetfulness, difficulty organising tasks, inability to listen or carry out instructions ..."
The impact for more than one in twenty (5.3%) children, and two-thirds of those who continue to experience challenges as adults is much more than a little bit of difficulty focusing. Lawson's also commented:
?"But then it was only in 2008 that the British medical establishment decided that?ADHD affected adults .?"
This shows a lack of understanding.Thapar and colleagues looked at the changes in presentation in ADHD in childhood and adulthood and published this work in 2021. They noted that some people present later with their challenges and for this reason may have been missed in childhood. We know more today than we did yesterday. It doesn't mean we are making it up now.In the past I think we naively thought ADHD was a childhood condition. We would never think this about Diabetes would we?
Females and ADHD were missed and misunderstood. You could look back and say how come they are only popping up now? Is it really just the vapours those silly women have...
We know more today....In 2020 there was an expert consensus relating to this.
Lawson also implies that awareness is no good as it drives higher rates of demand which we can't cope with . I agree awareness drives demand but I don't think the opposite of this is no awareness is what we should be doing either.
Having ADHD is not an easy pass or golden ticket
I look back on my early teens and twenties and I would have been assisted greatly if I had known why despite being able to get into medical school I had to work harder and longer to retain information and focus on learning long tracts of information. It took me years to understand how I learned my best and what helped me to focus. In my late teens I had eating challenges which were driven by anxiety to be my best and uncertainty how to do so. Today my grandchild and child thrive with because they have been identified early and have had help to do so. They do still have challenges. A diagnosis is not a panacea for all!
ADHD and strengths
I know too well ADHD comes with strengths. I am a magpie collecting and grouping all sorts of random facts together and making sense of them. I also know for many people it brings challenges it brings can impact on day to day functioning. One study from 2006 showed increased rates of creativity but in a further exploration a paper in 2017 showed that ?goal-directed motivation may drive the enhanced real-world creative achievements of people with ADHD. Importantly that people with ADHD do better when we can selectively engage and excel in creative domains that fit their skills and preferences.
As a parent, grandparent and one of those individuals with ADHD I see the damaging impact of headlines disputing that ADHD exists and that too many people are now being diagnosed.
ADHD certainly runs in families. One large study showed that ADHD were five and a half times more likely to have a sibling with ADHD than controls.
It seems ADHD has always generated a variety of negative, shaming and blaming views including being associated with 'bad parenting' This is stigmatising and has been a real reason why people did not stand up and say:
" Look at me I have a deficit and a disorder!"
Disclosure or sharing this information doesn't always end well.
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Too many people are being diagnosed - this is not true
In one meta-analysis they provided the evidence for substantial undertreatment of children and adolescents affected by ADHD in different countries. This is a relevant public health issue worldwide since ADHD under treatment is associated with known negative outcomes in education, healthcare, and productivity systems. In the UK there is caution on who gains a diagnosis and we still under diagnose.
There is good evidence that when made by an appropriately trained professional with training then the diagnosis of ADHD is well-defined and valid at all ages, even in the presence of other mental health conditions which may be more common.
Impact of ADHD - it is not trivial
In ADHD, rates of depression range from 0% to 44.5% and are more than 5 times higher compared to individuals without ADHD (Angold, Costello, & Erkanli, 1999 ). The cumulative incidence of depression in individuals with ADHD followed up to age 19 has been estimated at 23% (Yoshimasu et?al., 2012 ), and 44% of individuals with ADHD have experienced a depressive episode before age 30 (Meinzer, Pettit, & Viswesvaran, 2014 ).
ADHD can have an impact day to day... and night to night
In the largest meta-analysis , covering eight studies and 1,713 participants, adults with ADHD took longer to fall asleep than those with our ADHD traits. In meta-analyses of five studies with between 834 and 1,130 participants, they also reported moderately poorer sleep quality, more frequent night awakenings, being moderately less rested upon awakening in the morning, and moderate-to-strongly greater daytime sleepiness.
ADHD can impact on other areas of a person's wellbeing
A Swedish national register study of over 1.5 million people found that those with asthma were 45 % more likely to have ADHD even after adjustment for relevant variables (Cortese et al., 2018b ).A cohort study of almost a million births using the Danish national registers found that children born to asthmatic mothers were 40 % more likely to develop ADHD (Liu et al., 2019b ).
A population-based cohort study of over 900,000 Danish children found that epilepsy was associated with a 2.7-fold increased risk for ADHD (Bertelsen et al., 2016 ). Another population-based cohort study, of over 12,000 Taiwanese, reported that epilepsy was associated with a 2.5-fold increased risk for ADHD. Conversely, a linked cohort study of over 18,000 Taiwanese found ADHD was associated with a fourfold increase in epilepsy (Chou et al., 2013 ).
?A U.S. study of over 8000 high school and collegiate athletes (predominantly male football players) found that those with ADHD were three times as likely to have had three or more reported concussions (Nelson et al., 2016 ).
Intervention can make a difference and can save a lot of money too!
Lawson suggests that a dose of compassion is all we need. I am not sure that will quite do it really. His father may have been more interested in the cost savings than Lawson perhaps?
Impact of interventions
Persons with ADHD are about a fifth (19%)more likely to be in traffic crashes. Research has shown that treatment with methylphenidate reduces that risk of traffic accidents .
By diagnosing and supporting people we can save money and have lasting impact on people's lives and even the economy.
A systematic review of seven European studies of hundreds of thousands of participants estimated total ADHD-related costs in the Netherlands as €9860 to €14,483 per patient per year, with annual national costs more than €1 billion (Le et al., 2014 ).
Over 5000 adults with a diagnosis of ADHD in adulthood in a Danish study who had not received a diagnosis in childhood were identified. On average, adults with ADHD had an annual economic burden of just over €20,000 compared with their normally developing siblings (Daley et al., 2019 ).
I do think self - diagnosis can be problematic. ADHD can if you don't know enough mimic other challenges. Loss of focus can happen when you are very anxious or depressed too. Traumatic brain injury and ADHD can show similar challenges.
As a professional working in this space for quite a long time we come to the conclusion that someone has ADHD when we also consider what it is not ....as well as what it could be... We take a history to find out more about impact over time and not just in one moment. If you are a good clinician you will also consider how other conditions such as Autism and Developmental Coordination Disorder co-occur and take a person centred approach. This is a considered diagnosis.
As a parent and grandparent I want a world where there is less stigma and shame and we can say I have ADHD without the other person casting their eyes to the sky!
I have only mentioned some of the evidence as this is a blog.
Read more.
Also if you are going to write about ADHD at least gain some knowledge about the topic. Clearly some of the journalists writing these articles don't have any experience of someone in their family or themselves. Do your research.
Start talking to others and listening too and you may learn a lot!
( NB The next newsletter will be in 2 weeks time)
The blog author
I am Amanda Kirby, CEO of?Do-IT Solutions ?a tech-for-good company that delivers web-based screening tools and training that help 1000s of people deliver person-centered solutions relating to neurodiversity and wellbeing.
I am a mixed bag of experiences and skills and have 25+ years of working in the field of neurodiversity. I am a medical doctor, Professor, and have a Ph.D. in the field of neurodiversity.
I have very personal multi-generational experiences of being neurodivergent with my wonderful family.
Theo Smith and I wrote the UK award-winning book?Neurodiversity at Work?Drive Innovation, Performance, and Productivity with a Neurodiverse Workforce . I have my 10th book coming out called?Neurodiversity and Education ?coming out in March 2023. I was also voted one of the top 20 Thinkers by?HR magazine for 2022 !
References:
ADHD Foundation:https://www.adhdfoundation.org.uk/
International guidelines for ADHD https://www.sciencedirect.com/science/article/pii/S014976342100049X
NICE guidelines:https://www.nice.org.uk/guidance/ng87
A systematic review and meta-analysis,”?Neuroscience &Biobehavioral Reviews(2021), Vol. 128, 64-73, published online ahead of print,?https://doi.org/10.1016/j.neubiorev.2021.06.001 .
Females and ADHD - consensus review.https://pubmed.ncbi.nlm.nih.gov/32787804/
Senior Ecologist at Appletons
1 年As a daydreamy girl raised in Norfolk in the 80s and 90s, I wasn't a problem in class and I was never, ever going to get diagnosed until later in life due to where and more specifically when I was as a child. I saw that article earlier this week, got angry, and then had the same reaction -- it has always been around, but it's been underdiagnosed. Worse, I already question myself all the time because my organisational skills are terrible and I forget everything all the time without my medication. When a person is used to questioning themselves all the time, they begin to question "do I really have this neurodiversity that has impacted my life in so many ways?". External sources for that don't help. Thankfully, I'm very aware of the improvements to my life I've had since diagnosis. Not only has the medication helped massively, but it's allowed me the space to find better coping mechanisms than some of the less helpful ones I've accrued over the years. I guess what I'm trying to say in a long winded way is thank you for writing this. External validation from experts also helps.
Digital Media Officer | Westminster
1 年A very insightful read! Thank you ????
What baffles me about this is how given that techniques to assist in many cases are known and inexpensive and unintrusive, why do children have to wait for a diagnosis to have access to some adaption and support? It might be that they don't have a neurodiverse condition, or have a different condition than they suspect; simply being adaptive in the classroom and school grounds might provide the necessary support for many who have more mild symptoms. My child has waited from 3yo to 13 before being diagnosed with ADHD. The symptoms early on were judged to be within the scope of typical development. I also suspect dyslexia. I was 51 when I was diagnosed with dyslexia. It makes sense of so many issues I faced, which now seem familiar with those experienced by my child.
Founder & Director at AJ Recruitment Ltd & turro and Founder & Director at Temp Rewards call me on 03305 552233 @andrewbrindley
1 年My enabled me to find Dominic Lawton’s email address I’m going to be sending him a message about his article, anyone else want to do that just DM me I’ll share it, I’m not going to be rude or unpleasant just direct. ??
Founder & Director at AJ Recruitment Ltd & turro and Founder & Director at Temp Rewards call me on 03305 552233 @andrewbrindley
1 年As someone who’s a parent of a 19 year old with ADHD whom discovered they have it too last year after 55 years this is really annoying. I don’t want a label, I just wanted to understand why I did things and why my brain never switches off (like never unless asleep) I honestly thought everyone was like this. Also my relationship with risk, I was convinced that almost everyone else was so cautious and as I thought boring. Why midway thinking about something I forget what I was thinking about, how I miss out words, my 1 to 10 happens in a flash. All things I now understand much more and OMG how during my life I been attracted to people who also probably also have ADHD. For me because also I can do something’s well, ask me to think of 3 new ways to do something I’ll give you 6 plus 3 new ways to record them and another 2 ways you didn’t ask me about, I’m never going to write the, down, or if I do I’ll forget where or forget them totally. I’ll need a sidekick someone who can help me in the chaos, give me some order and structure that’s why I love working with people like Paige Hawley, she’s my green person whom I totally need (we use HBDI profiles and Green people are those really useful people who remember you had a meeting)