Not just a childhood malady

When Ajinkya Surve (name changed), a 30-year-old media professional, visited counselling psychologist Divya Nerurkar Saudagar, he had quit his job abruptly. Being out of work and not knowing what to do next had caused him anxiety and stress, which led him to the latter’s office. The signs and his past history brought to light that his was a case of Adult ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder). Divya states, “Patients of this condition are indecisive and they do not have control over impulses. This makes them switch the places of employment frequently and there is no such thing as job satisfaction for them.” Case in point Ajinkya, who was bored of his vocation in a few days of joining, and impetuously resigned.

Usually undiagnosed

ADD/ADHD is considered a childhood disorder and makes one think of kids who are hyperactive and impulsive and have difficulty paying attention. But, even if symptoms begin when one is young, they can continue through teenage years as well as adulthood. Sadly, though, it’s largely under-diagnosed in grown-ups, according to Dr Pavan Sonar, Consultant Psychiatrist, Belle Vue Multispeciality Hospital, Andheri. “That’s because of an overlap of symptoms typical to other disorders. Even psychiatrists first suspect anxiety and depression, which are more common and also present in adults with ADD/ADHD,” says he, adding, “Anger and impulsiveness are also mutual to syndromes such as mood, anti-social and borderline personality disorder.” So, unless one goes deep into the history of the patient, the disorder remains undiagnosed or misdiagnosed. There are also no definitive tests for the issue. In his practice of 12 years, Dr Pavan says that the number of adults visiting him for ADD/ADHD is the same.

Patients don’t see the treatment through

Unlike in the case of kids, there’s often no objective data for Adult ADD/ADHD. Meaning, patients are seldom accompanied by someone who can appraise the doctor of their behaviour at work or home, Dr Pavan explains. He points out that since leaving tasks incomplete and procrastination are typical behavioural patterns with sufferers, they often postpone, forget or miss appointments, don’t follow up or even swap doctors midway. Divya concurs that counselling is a prolonged process, too, and requires a lot of patience, which people with ADD/ADHD lack.

Undesirable effects

Since adults with the condition are unable to organise, plan, manage time and remember things, the repercussion on their work is enormous. And given the highly-structured nature of organisations these days, they usually struggle professionally.  “They are also often seen as defiant if they cannot keep up to the requirements of the company,” Dr Pavan says. Moreover, he tells us that males are likelier to have this condition compared to females. And the ailment adversely affects interpersonal relationships.  

Michael Phelps suffers from the condition

How it can be handled

According to Dr Pavan, the mainstay of the treatment is medication, which psychiatrists prescribe after multiple sessions and determining the condition, because these drugs can be addictive. Divya says, “We work on their belief system, concepts, confusion and other unhealthy emotions like stress as well as anger.” Dr Manan J Shah, MD, Sheppard Pratt Hospital, Baltimore, USA, informs that the condition is best treated by using a combination of medication, if appropriate, and behavioural strategies. He says, “Stimulants are usually first-line treatment but there are many non-stimulant meds available. Adults with ADD/ADHD often struggle with low self-esteem, time management, planning and organising. Life coaching to address these can be extremely beneficial.” 

Dr Manan emphasises that the earlier one gets help the better it is as it takes more effort to form new habits the older you get. “Therapies like CBT (Cognitive Behavioural Therapy) can be helpful especially to address co-morbidities like anxiety and depression, which a person with ADHD is likelier to have,” he adds.

Let’s talk about it

While Divya observes that media has played a vital role in reducing the stigma on mental disorders, Dr Pavan says that more Indians need to talk about Adult ADD/ADHD. “Many international celebrities like athlete Michael Phelps have opened up about being afflicted by it. When Deepika Padukone spoke about depression, more people sought help,” Dr Pavan says. He and Divya are both of the opinion that of late, more individuals have been reaching out to them for help when suffering from a mental disorder.

SYMPTOMS OF ADULT ADD/ADHD

Signs of the disorder are more subtle in adults, with inattentiveness, procrastination and impulsivity being the biggest ones. Here are some more:

• Disorganisation and inability to prioritise — spending more time doing unimportant things
• Poor time management or losing track of time
• Being unable to focus
• Trouble multitasking
• Restlessness and fidgetiness
• Poor planning
• Low tolerance level
• Frequent mood swings
• Problems in completing tasks
• Hot temper
• Inefficiency at coping with stress
• Missing deadlines all the time
• Inability to keep a job
• Poor self-esteem
• Unstable relationships