T.Prevalence of attention-deficit/hyperactivity disorder (ADHD) Since the outbreak of the pandemic, diagnoses have increased significantly in Australia, paving the way for new world-leading clinical guidelines and renewed interest in the condition long thought to be ‘naughty boy disorder’. became.
Australian experts say prolonged lockdowns in cities such as Melbourne and Sydney may have “brought to the brink” people with undiagnosed ADHD.
“The other day [COVID-19]A lot of people hit a wall and have since started looking for a diagnosis,” said John Kramer, Ph.D., RACGP Chair of Special Interest ADHD, ASD and Neurodiversity and member of the new ADHD guideline development group. increase.
Social media is also having an impact, with platforms such as TikTok, Instagram and YouTube shining a light on this state by popularizing ADHD-related content on channels such as the tags #adhdtiktok and How to ADHD. Experts argue that this has spurred an increased demand for ADHD assessment and treatment services for her adult, highlighting significant gaps in Australia’s healthcare delivery.
“Social media has played a role in spreading awareness, making information much faster to access. Not all information is of high quality, but it is still there,” says Kramer. says Mr.
Despite the relatively recent focus on ADHD, most health professionals such as physicians, speech pathologists, psychologists, nurses, psychiatrists and occupational therapists are learning in the workplace. , Kramer adds, not much is known about the disorder in both the medical community and the wider community.
“ADHD is under-taught in health courses and medical schools,” he says. “It is difficult to teach when it is barely included in the curriculum because the knowledge base is not sufficient.”
I hope this will change soon. Experts hope the new guidelines will not only demystify the condition, but also help clinicians identify symptoms early.
What is ADHD?
Like many neurodevelopmental disorders, ADHD exists on a spectrum and presents differently in everyone. ADHD includes problems with attention span, resistance to distraction, and adjusting activity levels to the environment (such as sitting in a classroom). There are three main types of ADHD: hyperactive-impulsive, inattentive, and a combination of both.
Although we don’t know exactly why some people have ADHD (scans show no brain biomarkers and studies show a genetic link, ADHD risk genes may be developing). It is not known exactly how it affects the brain inside.) The association between brain neurochemicals such as dopamine and norepinephrine and his development of ADHD.
Dopamine is a type of neurotransmitter that has several important functions in the brain and body. Its levels can affect a person’s mood, attention, motivation, and movement. Dopamine also regulates the brain’s reward system, and its levels rise in the brain when a person experiences something pleasurable. Noradrenaline, on the other hand, is particularly important for alertness and concentration.
It was long thought that people with ADHD may have lower levels of dopamine and norepinephrine because drugs such as psychostimulants work to increase the levels of dopamine and norepinephrine in the brain. However, it has been very difficult to find firm evidence for differences in these chemical signaling systems with and without ADHD.
However, modern genetics now provide important clues, as some of the most recent genes identified appear to be involved in dopamine signaling. There is a lot of work to be done to understand the complex interactions between , and the environment.
So far, symptoms of hyperactivity, such as being fidgety, writhing, or disruptive, tend to be more common in boys and have been recognized by more people. Common in girls and easy to overlook – relatively little attention.
There are also suggestions that more boys will be diagnosed because the current diagnostic framework developed on male-dominated samples is not suitable for girls.
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“There are two to three boys with ADHD for every girl, but roughly equal numbers of men and women have ADHD in adulthood,” says Melbourne psychologist Tamara May. “What this means is that many girls with ADHD go unrecognized in childhood, and some boys with ADHD have reduced symptoms and may not meet ADHD criteria in adulthood. May adds that women are more likely than men to seek help.
To make things even more complicated, ADHD in adults looks different than ADHD in children.
Beth Johnson, Ph.D., a senior researcher at the Turner Institute for Brain and Mental Health, who has a particular interest in autism and ADHD, says it doesn’t really start after age 12. When it first occurs in adulthood, it is usually due to something else, such as trauma or anxiety.
Many adults with undiagnosed childhood ADHD grew up in supportive environments with many structures around them, or were interested in and motivated by academic topics, so they focused on their academic work. could have persisted.
“According to more recent data, the prevalence of ADHD is 2.5% among adults who also meet childhood ADHD criteria, whereas among adults who meet adult criteria only (not childhood criteria), the prevalence is 2.5%. The prevalence is as high as almost 7%,” May said. “This means that these adults did not meet her ADHD symptom count in childhood.”
May points to recent reports on stimulant use among children, adolescents and adults in Australia, suggesting that between 2013 and 2020, between 0.5% and about 1% of the population will be exposed to stimulants and non-stimulant ADHD medications. found to have increased.
“This is well below the prevalence of ADHD in children (around 6% to 8%) and ADHD in adults (2.5%), with many people receiving evidence-based treatment for ADHD. It suggests not,” she says.
“Conservative estimates put the number of Australians with ADHD at 1.5 million, and perhaps only a quarter have been formally identified,” Kramer believes.
Australia’s new ADHD guidelines
Enter the new guidelines, which are currently the most up-to-date in the world, according to a group of experts in the field. Professor Mark Bellgrove, president of his ADHD Professional Association in Australia, says he is part of a team of clinical experts, researchers and experienced people who have developed the Australian guidelines for more than two years. A set of clinical practice guidelines for ADHD approved by the NHMRC in Australia.
“Clinical practice guidelines are very important to ensure uniformity in diagnosis, treatment, and condition support,” says Bellgrove. “The approval of his ADHD guidelines by the NHMRC, the premier medical research institution, is a landmark moment not only for Australian clinicians, but for people with ADHD.”
Based on the 2018 UK guidelines (which were previously the latest), Bellgrove said the team looked at thousands of clinical trials to derive 111 clinical recommendations and 450 pages of evidence.
“I see it as the bible and the best way to diagnose, treat, and manage ADHD,” he says. “The guidelines also have elements that highlight areas where more knowledge is needed, such as the effects of puberty on girls, clinical symptoms before puberty, and whether it is a trigger point.”
Little is known about the effects on all women, including older women, because women and girls were not actually included in ADHD research. Bellgrove said it is equally important to study how an older woman’s menopause affects her ADHD, as well as the effectiveness of menopausal treatments.
Little is also known about the coexistence of ADHD and autism, which occurs together in up to 40% of ADHD cases, according to Johnson.
“We know that children with ADHD and autism have a high rate of coexistence, and we know that they have more impairments and higher symptoms,” she said. says. “Generally, they are double loaded for both risks.”
What is the treatment?
Treatment for ADHD consists of stimulants that increase the availability of dopamine in the brain, as well as psychiatrists, psychologists, allied health professionals, occupational therapists, and increasingly ADHD coaches (who are especially trained to help). It is a multi-layered approach that includes support from Helping adults, teens and children with ADHD take better control of their lives).
In Australia, medications primarily used to treat ADHD include dexamphetamine, methylphenidate and lisdexamphetamine, doses and combinations should be discussed with a professional ADHD practitioner, physician or trained professional. determined jointly.
The line between neurodiversity and ADHD
In a highly distracting world where smartphones dominate, many workplaces are open-plan designed, and content streams are available 24/7, the line between normal human neurodiversity and ADHD is drawn. Pulling can be difficult.
However, it is clear that there is a line that experts define as the point at which symptoms begin to significantly affect daily functioning.
“It’s up to the individual,” says Johnson. “Not all descriptions of the behaviors and symptoms that characterize ADHD affect us negatively. There are also things.”
To receive a diagnosis, you must feel that you can no longer cope with daily life. It’s often at this point that they come for a diagnosis, he added, Johnson. “Even if it has its characteristics, it often causes some degree of disability or difficulty at some point and affects daily life.”
Perhaps more than any other condition, ADHD can be considered a “continuing trait” that everyone in the general population can have, says Bellgrove. The portion of the disorder is the “extreme part of the bell curve”, and symptoms must severely affect a person to be diagnosed.
“They also need to be pervasive across multiple settings,” he adds.
“What is often overlooked in the general public’s understanding of ADHD is that living with the disorder has a significant level of functional impact on a daily basis in a variety of settings. ”