In a competitive city like Hong Kong, people have become more concerned about their intellectual ability and qualifications. Attention deficit and hyperactive disorder (ADHD), a psychiatric condition, is notorious for affecting the learning abilities of children.  Previously it was thought to be a condition that affected only children and would remit spontaneously when the children grew into adulthood. Indeed, we seldom see adults jump up and down like a monkey. Does it mean children with ADHD have recovered? The answer is no. According to the National Comorbidity Survey Replication in the United States in 2001-02, 4.4% of 18- to 44-year-old adults suffered from adult ADHD. Comorbidity is also very common with this disorder, including mood disorders, anxiety disorders, substance use disorders and intermittent explosive disorders, etc.  Although hyperactivity gradually lessens with time, the problem of attention deficit does not cease completely.

One of my patients told me his story. It was the time when people had no idea about ADHD. He was noted as a “naughty” child when he was young. He never sat still or concentrated in class. As a result, he was not a favoured student of the teachers. He was also disliked by his classmates for he was disturbing all the time. His school results were not good either.  The headmaster of his school suggested him to transfer to another school for better “adjustment”.

His parents wanted to give him a second chance and sent him abroad to a high school in the United States. Despite all the efforts he made, his academic results did not improve much. Whenever there was noise during lessons, he was distracted. He frequently committed careless mistakes and had difficulties wrapping up his projects. It was also socially embarrassing that he kept fidgeting or squirming and talked like a chatterbox during gatherings.  Finally, many of his classmates got admitted to their ideal universities, but he returned to Hong Kong in disappointment.

In the end, he completed some distance learning courses and started working. He hoped things would work out finally. However, he still struggled quite a lot. He could not follow the instructions given by his supervisors and his mind drifted away during their conversations. His desk was chaotic and his schedule was so packed that he found it difficult to finish all the tasks on time. His colleagues commented that he was absent-minded and disorganised.  He needed almost double the time of others to finish a task. Therefore, his boss didn’t give a good evaluation on his performance.

He was not popular among his colleagues either, as he had delayed their projects many times. He had the bad habit of deferring until he had the time to think in detail, which was quite annoying to his work partners as he kept everyone waiting all the time. Discussions were also hard as he always interrupted others and did not seem to follow the line of thought of others. As a result, people found it difficult to collaborate with him.

Having worked under high pressure for many years, he gradually started to have anxiety symptoms. He complained of restlessness and apprehension from time to time. On and off he suffered from shortness of breath and palpitation. The symptoms persisted despite that he was treated by his family doctor repeatedly. His sleep was superficial and he had many dreams. His mood was low and he started to see things more negatively. His concentration and work abilities further declined. His depressed mood affected other aspects of his life that he no longer enjoyed his hobbies or social gatherings. He felt he was a failure and could not see his future.

His family suspected him to be suffering from depression and suggested him see a psychiatrist for treatment. Eventually, he came to me for an assessment.

We had a long discussion about his problems and struggles. He realised that his problems did not start in recent years but surfaced when he was young. He was diagnosed to be suffering from depression with an underlying long-standing, untreated ADHD.

It was quite common for individuals who suffered from ADHD remained undiagnosed in their childhood and adulthood due to the lack of knowledge about this condition decades ago. These individuals might eventually develop comorbidities such as anxiety or depression, due to hindrance caused by ADHD in their earlier lives. In order to cure these patients, doctors should put ADHD high on the list of potential underlying causes.

Core symptoms of adult attention deficit and hyperactive disorder (ADHD)

Deficit in Executive Function

·         Suboptimal working memory

·         Poor ability in task shifting

·         Ineffectiveness in self-monitoring and response inhibition

Problems of Inattention

·         Difficulty in focusing, especially for a long period

·         Inability to organise activities and prioritise tasks

·         Forgetfulness

·         Trouble in managing time

Hyperactivity

·         Feeling fidgety or restless

·         Talking too much and/or interrupting others

·         Being impulsive

from <<CONNECT>> Winter Issue 2017