Exploring Adult ADHD

Commonly categorized by hyperactivity and impulsivity, Adult Attention Deficit Hyperactivity Disorder (ADHD) is one that many underestimate. Moneybags journalist, Danielle Van Wyk, explores Adult ADHD, its effects and treatments, which can evidently cost you quite a penny.

What is Adult ADHD?

“Adult ADHD is a genetically determined and chronic disorder, first apparent in very early years, and persisting throughout life. The problem can be diagnosed as early as three years of age, or later.  The disorder could be characterised as a disorder of impaired self-control,” says clinical psychologist and ADHD specialist, Peter Collis.

It is diagnosed according to a specific diagnostic criteria. This criteria is inclusive of a substantial amount of symptoms in three different aspects, known as the core triad.

These aspects include, “inattention, hyperactivity and impulsivity. And usually presents across different domains of life (e.g. social and occupational), and cause significant functional impairment,” adds Dr Renata Schoeman, psychiatrist and University of Stellenbosch Business School (USB) top MBA student for 2015.

Impact of ADHD

Individuals who typically suffer from the disorder experience difficulties with ability to concentrate, impulsivity, impatience, hyperactivity, motor coordination and social anxiety.

“It can cause major disruption to both their work environment, and social relationships.  This can mean many job changes, loss of work, or broken marriages.  In some instances it can lead to drug abuse, aggressive behaviour, and sometimes even suicide,” states Collis.

It further impacts on spheres of concentration, learning and memory.

The ability to “plan and execute tasks as well as one’s sense of organization and concept of time.  The individual may also often feel overloaded by multiple stimuli in their environment and need to withdraw and refocus. They may miss certain critical details or may be forgetful or easily distracted. Should the individual struggle with hyperactivity they may find it difficult to sit still for long periods of time, may talk excessively or may interrupt or intrude on others conversations,” says clinical psychologist, Liane Lurie.

Struggling with poor concentration and distractibility is not uncommon for most. However, many other reasons could be the cause for this.

“Some individuals with ADHD function when without medication (due to coping skills they have learned through their lives, or the careers they have chosen), while others cannot function without medication. There is definitely a continuum of symptom severity.

“Individuals with ADHD are often highly intelligent, very creative with lateral and analytical thinking – yet they often lead a life of underachievement and perpetual failure, manifested as poor academic and work performance, interpersonal conflict, marital disorder and experience of financial difficulties,” Schoeman notes.

The challenge then stems from these feelings of failure and often develops destructively from there.

“These negative experiences can lead to negative thoughts and beliefs that further decrease motivation and performance and increase avoidance behaviour and emotional problems,” Schoeman states.

Diagnosis

There is an unfortunate social stigma around neuropsychological disorder. This disorder primarily is neurological in cause and psychological in outcome.

“The Stigma emanates from a failure of many people to comprehend the nature of the disorder, and consequences for both the person themselves and their associates.  The problem often is attributed to simply a lack of discipline, or consideration for others. Neither of which is valid,” highlights Collis.

Lurie added that when diagnosing someone with any condition, “we always have to exclude the possibility that the difficulties may not be better accounted for by another disorder such as depression, anxiety or a general medical condition. Hence the importance of taking a full history is imperative.”

Sadly many adults are only diagnosed much later in life, but the likelihood that they struggled with the same class of issues as a child. For many this was probably put down to rebellion or disruptiveness.

“They may have been punished for behaviours that were not in their control and as a result have had a very poor self-concept,” advises Lurie.

Treatment

The ideal basket of care for patients with ADHD should include a comprehensive diagnostic assessment and the establishment of a multidisciplinary treatment plan which includes access to medication, psychotherapy, occupational therapists, and work intervention, advises Schoeman.

“Medication options in South Africa are limited with the mainstay of treatment being the stimulants (i.e. methylphenidate) and atomoxetine (a non-stimulant). Psychiatrist may also prescribe other medication (such as bupropion or other antidepressants) which have proven to improve concentration, even if not specifically registered in South Africa for the treatment of ADHD. Many overseas products are not available here. Psychotherapy (both individual and family therapy), life coaching and assistance with time management, organisational skills, and support within the work environment (e.g. by liaison between an occupational therapist and the employee) should also form part of the intervention,” Schoeman notes.

There are unfortunately very limited “centres of excellence” for (adult) ADHD in South Africa – although we are driving hard to establish these. Psychiatrists are mainly located in the bigger cities and rural areas are currently underserved.

Cost of ADHD

The costs of ADHD can be divided in direct costs (e.g. healthcare and out-of-pocket expenses related to consultations and medication), indirect costs (e.g. the time of patients and their families consumed by ADHD and loss of productivity) and intangible costs (i.e. those consequences which are difficult to measure and value, e.g. the value of improved health or the reduction of suffering), explains Schoeman.

Should this disorder go untreated, the potential costs could double in the long run.

“However, medication used for the treatment of ADHD contributed merely 7% to all direct and indirect costs. This is in agreement with international studies. It is difficult to give a specific figure for medication costs per month as treatment is individualised according to efficacy and tolerability and type of medication and the dose thereof will vary from patient to patient. However, depending on which medication regime the patient uses, it can range from R500 to even R2000 per month,” remarks Schoeman.

It should also be said that the comorbidity associated with (undiagnosed or untreated) ADHD such as depression, anxiety, substance abuse and accidents can be very expensive.

“There is no South African studies yet on the specific economics around it, but the bottom line is that treating ADHD is cheaper, than not treating it,” says Schoeman.

One of the significant barriers in South Africa, however, still remains the lack of funding.

ADHD is also not considered a prescribed minimum benefit (PMB) condition. Medical schemes are therefore not legally obliged to pay for treatment and only a limited number of medical schemes provide some funding for the treatment of ADHD.

Schoeman further found that, ‘’the funding for psychiatric consultations were more or less similarly divided between out of pocket expense (OOP) to the patient, from their medical savings account (MSA) or from acute or chronic benefits. Medication for the treatment of (adult) ADHD was predominantly an OOP expense for beneficiaries, although medical savings accounts (MSAa) were also utilised. These savings accounts are usually insufficient to cover medication for more than a few months – which contributes to interrupted and inadequate treatment.  Funding for services by allied healthcare professionals is extremely limited (predominantly an OOP expense), which impairs the likelihood of access to the comprehensive care these patients need. This restricted funding which limits access to optimal treatment, escalates long-term direct, indirect, and intangible costs and the burden of disease.”

The most helpful thing you can do for someone who presents with the before mentioned symptoms would be to assist them in seeking a professional evaluation.

Ultimately improved outcomes are very possible if patients receive an accurate and timely diagnosis, coupled with the appropriate care.

“It is time to pay attention to the plight of adults with ADHD – and to embark on a collaborative approach between stakeholders to improve the treatment of adult ADHD in the South African context,” says Schoeman.