We’ve known about ADHD for over 200 years – it’s time to move the conversation forward

This blog post is by Dr Dietmar Hank an expert contributor to the Royal College of Psychiatrists’ ADHD in adults resource for patients and carers, and clinical lead for the Adult ADHD Service with the Avon & Wiltshire Mental Health Partnership Trust.

Sir Alexander Crichton described the symptoms we now associate with attention deficit hyperactivity disorder, otherwise known as ADHD, as early as 1798. He reported some children were “incapable of attending with constancy to any one object of education”. 

More than 200 years later, some still doubt whether ADHD exists or should be treated, despite an ever-growing body of evidence that it both exists and is treatable. 

The sheer volume of information that is available online, in the media, and from various care providers can be overwhelming.  That’s why the Royal College of Psychiatrists has updated its ADHD in adults resource for patients and carers, which outlines how ADHD can present, be diagnosed and treated. 

It aims to put the needs of patients at the heart of the conversation by giving clear and simple information on how to progress with seeking assessment and treatment and ways to care for themselves. 

As the clinical lead for an Adult ADHD Service, I see first-hand how disruptive and devastating this disorder can be when left untreated. 

Patients report struggling across many areas of life, including managing work-related tasks,  maintaining relationships, budgeting, and taking risks impulsively, to name a few. Many patients are exhausted by the extra effort they must put in on a daily basis in order to keep going. Their struggles with inattention and/or hyperactivity/impulsivity usually date back to childhood but had gone undetected – for decades in some cases. 

Progress is being made, however, and many more people in the UK are being diagnosed with ADHD. Celebrities like Rory Bremner, for example, are open about their experiences and helping to educate people about the nature of the condition. 

Of course, some recent media coverage has shone a light on practices of assessing for ADHD and treating the condition. I understand that this has left some patients unsure as to whether they were given a valid diagnosis and the treatment they were offered was justified. I am aware that some patients have written to their local NHS service in the matter. We very much welcome the rise in public interest and awareness of ADHD. 

The National Institute for Health and Care Excellence (NICE) sets out standards for the assessment and treatment of ADHD. The College’s updated resource outlines what you should look for when seeking an assessment, including a discussion of symptoms and whether these meet the criteria for a diagnosis. 

You should also check with their local NHS ADHD service what criteria they look for if you are considering using an alternative assessment provider. Some patients can find themselves out of pocket and no longer able to afford the support, including private prescriptions, they require.  When they turn to their local NHS service with the request to take over care, they may have to join the queue to be assessed again if the preceding work doesn’t meet adequate standards. 

I cannot overemphasise the importance of a good initial assessment that leads to a diagnosis of Adult ADHD, which in most cases is a diagnosis for life, or provide the person with an alternative formulation if diagnostic criteria are not met.  

The process involves so much more than ticking off a checklist of symptoms or difficulties. It’s about understanding how a person has negotiated life so far, the many set-backs they have had to overcome including other conditions such as anxiety, depression, alcohol and/or substance use.

I am particularly interested in how patients describe and communicate their inner experience of living with ADHD. I hear metaphors such as my brain is like “a Ferrari with bicycle breaks…a box of frogs…scrambled egg...guns going off…”. 

Not only are such descriptors quite unique in my professional experience of mental health conditions but they provide an insight into the ceaseless mental activity or noise patients must overcome to engage with the word around them. They allow me to better empathise with an experience I personally don’t share. Time and again, I am impressed by the resilience patients with ADHD demonstrate and how they keep going.   

Patients frequently tell our assessment team they felt someone listened to their life story for the first time. This is where the foundations of a therapeutic alliance and relationship are built.  

Once people have received a diagnosis, they may benefit from reasonable adjustments at work or advice and support to better manage home life, relationships, finances etc. Cognitive behaviour therapy-based approaches can also help them to develop strategies to improve their attention and impulsivity management. 

Medications for ADHD are amongst the most effective treatments of all mental health conditions. There is strong evidence that these drugs are safe and effective, provided they are prescribed for the correct condition and by a practitioner with expertise and experience in the field of ADHD. As with all medications, prescribing should only follow a comprehensive discussion of potential adverse effects and how to manage these.  

We desperately need more funding for ADHD services and investment in our workforce so everyone can benefit from a comprehensive assessment and treatment programme. The evidence is overwhelming that timely assessment, diagnosis and interventions make sense on a personal, health economical and wider societal level. People with ADHD deserve access to good services that support them to achieve their potential and to flourish.

The College’s updated resource is a good starting point for anyone who is interested in learning more about ADHD. It can also easily be shared with friends and family so that they can develop a better understanding of what it’s like to live with the condition. 

Find out more

The College’s ADHD in adults resource for patients and carers can be accessed online and for free. See also our news story about the release of this new resource.