Voices Anand Neelakantan S Vaidhyasubramaniam Ravi Shankar Preeti Shenoy Dinesh Singh Swami Sukhabodhananda MAGAZINE Buffet People Wellness Books Food Art & Culture Entertainment NEW DELHI march 3 2024 SUNDAY PAGES 12 Pay Attention Attention Deficit Hyperactivity Disorder is a silent disabler, affecting millions around the world. It’s not the end of any road, however. This is why. What is ADHD? ADHD is a chronic condition characterised by symptoms of inattention and/or hyperactivity/impulsivity that lead to impairments in many aspects of living. The disorder, which starts in childhood or early adolescence, and is more commonly diagnosed in boys than girls. People diagnosed with ADHD have an elevated risk for school failure, antisocial behavior, other psychiatric problems, somatic disorders, drug and alcohol abuse, accidental injuries, and premature death, including attempted and completed suicide. SOURCE- The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder - ScienceDirect 5.9% of youth worldwide are affected by ADHD, which starts in childhood or early adolescence 2.8 % of adults worldwide have ADHD 56.25% of people with substance use disorder screened positive for “likely ADHD” in a 2017 study of outpatients at NIMHANS, Bengaluru J By Menaka Rao ust days before her wedding in Chennai, Varshaa Narayanan was overcome by the need to see a therapist. The 30-year-old was convinced of “depressive” episodes in her adolescence and college days, even though there had been no such diagnosis. As she approached a major life event, Narayanan’s past—the constant bullying, the inability to do well in exams, and very low self-confidence—rose within to confront her yet again. Narayanan—she lives in California now—did go to a therapist. During the conversation, she mentioned her experiences in school. The therapist zeroed in, suspecting Attention Deficit Hyperactivity Disorder, or ADHD, and investigating it till there could be no doubt. “I just brushed it off. I mean, what is this new thing? I did not want to come to terms with this,” says Narayanan, recalling her diagnosis of April 2021. It involved long interviews along with psychometric assessment. Such diagnoses are based on criteria detailed in the holy book of psychiatry the Diagnostic and Statistical Manual of Mental Disorders , (DSM) which is published by American Psychiatric Association. The disorder is associated mostly with children, but increasingly adults are being diagnosed with, and “coming out”, as ADHD-ers. Often these are people like Narayanan who seek psychological care after experiencing distress, or come with other kinds of conditions such as depression, trauma, anxiety or even substance abuse issues. Some even seek diagnosis suspecting they have this condition, and to seek validation. ADHD is a chronic condition characterised by symptoms of inattention and/or hyperactivity/ impulsivity that impair many aspects of living. The disorder, which usually starts in childhood or early adolescence, and is more commonly diagnosed in boys than girls, affects 5.9 per cent young people and 2.8 per cent adults worldwide. ADHD is a neuro-developmental disorder that results from the interaction of both genetic and environmental risk factors. Many studies, including a major one in 2019 with scientists all over the world that was published in Nature Genetics, identified biomarkers. The latest version of DSM published in 2022, however, states that there is no biological marker for ADHD and that metaanalyses of all neuroimaging studies do not show differences between individuals with ADHD and control subjects, a critique of the DSM-2022 in the Frontiers in Psychiatry has said. “These conditions are multifactorial. Some children may have traits that are similar to those who have ADHD, but their environment may help them cope with it better,” says Porrselvi AP, a Chennai-based cognitive neuropsychologist, adding, “Besides, why are we looking at it as a disorder? You do not talk about why someone is short or tall for instance. These are individual differences we should accommodate as a society.” Left out as children Mental health professionals say that there are hardly any systems in place for systematic diagnosis of children with ADHD. Dr Nidhi Singhal, director for Research and Training at Action for Autism, Delhi says, “Children do not have the vocabulary to say they are not able to concentrate. We assume that they are being difficult; the responsibility is put on the individual. It is dismissed as bad behaviour or bad parenting.” Psychologists say that it’s easier to diagnose ADHD in children. “It can be confused with personality disorders (such as bipolar disorder) or depression and anxiety or , trauma. Diagnostic criteria overlap with many conditions. There are many co-morbidities in adults because of the amount of emotional damage as children,” says Porrselvi. For an accurate diagnosis, a mental health professional looks at patterns of behaviour that are pervasive in nature. “Your symptoms cannot occur only in the workplace, but also at home or in your relationships. We look at the whole picture,” she says. “It is not like systems in the UK and US where teachers and nurses can refer children for an ADHD diagnosis,” says Porrselvi who was trained in the UK. She says that ideally at least paediatricians and teachers should be trained to look for red flags that can help early diagnosis of such ailments. “Parents here may ask a paediatrician, and possibly a diagnosis may happen. We have had clients who said that their parents were given some indication that the child may have ADHD, but that was not followed through.” Porrselvi speaks of a recent case she had when they suspected a developmental condition in a two-year-old which was not followed up by the parents. “The parents stopped coming to us. They blamed us for everything. And they still have not taken any help from a mental health professional. Now the child is about four or five years old.” Needless to say there is a , “Children do not have the vocabulary to say they are not able to concentrate on anything. We assume that they are being difficult… It is dismissed as bad behaviour or bad parenting.” Dr Nidhi Singhal, Director for Research and Training at Action for Autism, Delhi huge lack of awareness about neurodivergence among both parents and teachers. “My parents are staunch believers in astrology When I was born . an astrologer said that my moon star is weak. They accepted that I may not do well in studies. They did not stress on studies as a result,” says Narayanan. In fact many studies, including a 2023 Canada-based study published in Research on Child and Adult Psychopathology, says that early diagnosis and intervention and involved parenting can help stabilise ADHD. An expert consensus document, published in BMC Medicine, says that ADHD is often associated with co-occurring conditions, which can complicate diagnosis, such as Autism Spectrum Disorder. A meta-analysis done in the UK and published in BMC Medicine showed that among those diagnosed with ADHD, over a fifth reported coexisting conditions of autism. Apart from this, many who come for diagnosis as adults could also have depression, anxiety personality disorders , such as bipolar disorder, trauma, post-traumatic stress disorder as well as addictions, which complicate the diagnosis. By the time they turn up as adults seeking care, they come with emotional baggage, says Porrselvi, adding, “These adults would have lived a life full of shame, often wondering what’s wrong with them and why they are not able to do what others are able to.” Take 26-year-old Preethi Srinivasan, for whom life before diagnosis of ADHD and autism in 2021 is “like a blur”. “I hardly remember anything that happened in school and college... But I can say it was not pleasant. As an undiagnosed neurodivergent girl, life was hell for me throughout school and college, as I was seen as an outcast or just a laughing stock for my classmates,” says the Chennai resident, now training to be a mental health counsellor. Inattention and sensitivity Adults with ADHD seek help during transition phases of their lives. For example, when they move from school to college, or had just had a baby or got married: when , their life moves from structured to unstructured, when there is a need to multitask or make decisions on their own. “Some people come in mid-adulthood on their own. They have been high-functioning all their lives, but believe that they can do more and are not able to. They feel a holistic achievement is not there. They are either not able to manage their family or work,” says Dr Arun Kandaswamy , Professor of Psychiatry at Turn to page 2