World – Attention Deficit/Hyperactivity Disorder (ADHD) is a mental health condition that is widely misunderstood. According to Children and Adults with Attention Deficit Disorder (CHADD) it affects 1 in 20 children, and an estimated 1 million South African adults. While so many people live with it, it is still plagued by myths and misunderstandings.
Those who have ADHD are often classified as “lazy” or are even told ADHD is not a bona fide medical condition. According to Zakiyah Hoosen, a registered counsellor, ADHD is a neurodevelopmental disorder and while it is not known what causes it, it is very much a real thing.
“ADHD typically refers to a neurodevelopmental disorder that results in a severe lack of attention or awareness in most or all functional areas, and/or exists on a spectrum of inactivity and hyperactivity. The exact causes of the disorder are unknown, but genetics play a significant role. Alongside genetics, researchers believe that possible causes could also include brain injury, exposure to environmental risks during pregnancy, substance use during pregnancy, premature birth and a low birth weight.”
Symptoms of ADHD
Symptoms of ADHD can be broken down into two different behavioural categories, inattentiveness and hyperactivity and impulsiveness. People with ADHD usually fall into both of these categories but it is not always the case. Around two to three in 10 people have problems with concentrating and focusing, but not with hyperactivity or impulsiveness. The criteria for inattentiveness and hyperactivity are different and should be present prior to the age of 12, said Hoosen.
“Criteria for inattention could include lack of attention to detail, difficulty in sustaining tasks, difficulty to follow instructions, difficulty with organising tasks, avoidance of tasks that require sustained mental effort, often forgetful and is easily distracted by external stimuli. Criteria for hyperactivity-impulsivity could include often fidgeting/tapping/squirming, runs or climbs when it is inappropriate, unable to engage in leisure activities quietly, talks excessively, often interrupts others and has difficulty waiting their turn.”
At least six symptoms from each characteristic of these criteria must be present and persistent for six months or longer, and must be present in two or more settings like home, work, school etc, added Hoosen.
The different types of ADHD and their differences
Contrary to popular belief, there is not just one type of ADHD. ADHD can manifest itself into three ways and can be further broken down into several others. The three ways are called inattentive, hyperactive-impulsive or combined presentation, explained Hoosen.
“Predominantly Inattentive Presentation is when an individual finds it hard to organise or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines. Predominantly Hyperactive-Impulsive Presentation is when an individual fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while completing a task) and the individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. Combined Presentation is when the symptoms of the above two types are equally present in the person. It is important to remember that symptoms can manifest differently since individuals are unique, and these symptoms may also manifest differently between adults and children.”
ADHD is found in both genders
For a long time it was believed that ADHD was associated with boys. This is because the symptoms for boys and girls manifest differently, explained Hoosen. The symptoms in boys most often reflect hyperactive-impulsive presentation while girls present with inattentive presentation.
“Often, the symptoms for boys and girls manifested differently for various environmental and physiological reasons e.g. since boys were believed to be more “active/sporty/louder” the symptoms were often “seen” more in boys, whereas girls may have been more quiet and inactive playing with dolls or keeping to themselves, and thus believed to be functioning normally. Research has since corrected its views on this matter, and ADHD can be present amongst both genders.”
Ahmed, a grade nine student, was diagnosed with ADHD hyperactive disorder when he was just 12 years old. Growing up he was a very playful and disruptive child. Something which is common amongst boys. His parents, after being called in to school many times, decided to take him to a psychologist which led to a visit to a paediatrician who diagnosed him.
“I have been very playful and disruptive since I started school. I’ve always struggled with concentration both at school and at home. I’ve been hyper my entire life and have been told I “can’t sit still” and I “talk too much”. Because of these ‘behavioural issues’, my parents were called to school many times. My behaviour didn’t improve despite this, and then in grade six I visited a psychologist who referred me to a paediatrician who specialises in ADHD. He diagnosed me.”
On the other hand you have Humayra, an occupational therapist, who wasn’t diagnosed with ADHD until well into her young adult years. Due to girls being seen as quiet and shy, her ADHD went undiagnosed for a significant amount of time. It was only when she entered university did the symptoms finally make themselves known.
“I was only diagnosed at 24. I have ADHD inattentive type. I was diagnosed last year, around this time. So exactly a year ago. My parents never suspected it and neither did I. At least not when I was younger. I was a high achiever at school & university so there really wasn’t a reason for me or my parents to suspect. I also have GAD (generalised anxiety disorder). My doctor explained that my anxiety probably pushed me to achieve. Almost balanced out whatever symptoms I had of ADHD. Looking back, university was probably when ADHD started catching up to me. I would compare myself with my peers and always felt it took me much longer to do everything. It was very frustrating to have to spend more time studying, less time doing other things. Once I started working and moved away from home, that’s when my symptoms became even more prominent as life demands increased beyond my existing coping skills.”
Having the disorder does not mean a child is lazy or stupid
Sadly, it is often the case children with ADHD are labelled as being stupid or lazy. In actuality this is far from the truth. ADHD has nothing to do with intelligence. It does not hamper one’s ability to do work but it impacts the individual’s ability to function at full capacity for long periods of times, stressed Hoosen.
“Inattention or hyperactivity impairs the individual’s capability to function at full capacity for long periods of times, and in a school or work setting, this may cause them to shut down, not follow or carry out instructions, space out etc. Intelligence is determined in a different manner and it is possible that an individual may perform poorly due to the manifestation or their symptoms.”
Humayra was an overachiever in school but struggled to compete with her peers in university. While she didn’t feel less intelligent, she often found herself taking more time to study than her peers.
“I felt like we were in a race and I just couldn’t keep up with their pace. I felt hurried. I could learn what was in the course, and well. But I knew it would take me longer than them. Obviously, this was exacerbated by my anxiety too.”
Ahmed, having ADHD hyperactive and anxiety, made it harder for him to concentrate. Even attending extra lessons had little to no benefit as he struggled to maintain concentration.
“Since I struggled to concentrate, understanding my schoolwork was a challenge. Going to private tutors was a little helpful but didn’t make a major difference because I would lose focus in those sessions too. I would be shouted at during class because of this.”
Therapy is helpful but it isn’t the only remedy
ADHD tends to be an invisible condition and as such, our society generally stigmatises medication taking. However, taking medication has proven to help many. While medication isn’t the first option, it is still a beneficial option, said Hoosen.
“Behavioural therapy is the first line of treatment. Medication for children only becomes an option if the therapy is found to be inefficient or requires more intervention with a combined approach. ADHD is also present in adults, and that medication alongside therapy serves a purpose to assist individuals to correct their concentration levels and to limit impulsivity, as well as to improve overall capacity for functioning in multiple areas.”
Ahmed and Humayra have both benefited from taking medication. Ahmed has found that while on medication his “concentration is a lot better” and it makes going to school better. It has also helped him control his moods and he now feels much calmer than before.
The difference in being on medication and not is vast, explained Humayra. At first, it didn’t feel like there was a difference but once she stopped taking it, it became very apparent just how much help the medication was providing her.
“I think many people don’t know that there is so much more than Ritalin and Concerta which are stimulants. I’m on non-stimulant meds. I noticed when I was compliant, my thoughts were less disorganised. I was less tangential in my speech and my efficiency was much better. I had more psychological endurance to get stuff done, personal chores and work. It’s usually one or the other. And with that, I obviously was a lot less anxious and much happier. I’m a sucker for ticking things off a checklist. So, the more things ticked off, the more constructive I felt.”
Having a social life isn’t as hard as one thinks
There is a notion that exists which makes it seem as if people with ADHD struggle to have any real friendships or even have a large number of friends. Ahmed believes he leads a good social life. He has a lot of friends at school.
Having a social life at school and having a social life outside of your schooling are two different things. Most adults expect you to commit a certain amount of time to them. Humayra admits that while she struggles to maintain long distance friendships, having understanding people in your life makes a world of difference.
“I definitely struggle to maintain friendships with people who I may not see on a daily basis. Especially since I’ve moved away from home. I’m really fortunate to have wonderful people in my life who are really understanding. If I don’t respond to a message or don’t call in a while, people know it’s not because I don’t care. It’s just that I’m busy or I forgot or I’m procrastinating doing it.”
Challenges of living with ADHD and coming to terms with it
A child can face a lot of struggles before they are diagnosed with ADHD. That is not to say those struggles disappear after they are diagnosed. For Ahmed, the way people treated him was one of his biggest challenges. Coming to terms and understanding what ADHD is was another obstacle he had to climb.
“The biggest challenge was the way people treated me. I would always be in trouble both at school and home. I was seen as naughty and badly behaved. Another challenge for me was also accepting that there was “something wrong with me” and having to take medication to change the way I am but I realised it was a good change because it really helped with my concentration and mood.”
Adults have a whole lot more to worry about. There are certain responsibilities they have that children do not. Maintaining a job, friendships and a household is tough enough without living with ADHD. Humayra has found various ways to cope with the daily tasks and stress that comes with ADHD. It is all about writing things down and having adequate support from those around, she explained.
“When things become too much, I always ask for help and ask people for what I need. Especially at work. It really eases my anxiety. My co-workers are a big source of support. I also try to just prevent the overwhelm. Writing things everywhere really helps. Google calendar is my best friend. I’ve now made it a habit to use it daily. I also write the stuff in my diary. Plus, we have a huge communal schedule for the OT practice at work and I have a white board on my fridge. So really, there’s no way for me to mess up. Repetition and putting things on paper really helps.”
Other stereotypes associated with ADHD
There is a common misconception that ADHD is only found in children. Adult ADHD is a real and valid manifestation of this disorder, said Hoosen. Her views are backed up by Humayra who feels that most people forget that children grow up and become adults.
“There is a common misconception that ADHD only presents in children. Many people fail to realise that those children grow up into adults. And that growing up doesn’t mean you grow out of the condition. It’s still there and it’s chronic.”
Hoosen has also noticed people believe that ADHD is caused by certain environmental and social factors. While these factors can worsen ADHD, it does not cause it, she explained.
“Another myth that exists is that ADHD is caused by watching too much television or eating too much sugar – these are largely myths. While some environmental and social factors could worsen the symptoms, these do not directly cause ADHD among children or even adults.”
How parents and teachers can help
A child spends most of their time around their parents and teachers. It is then vital for them to get proper support from these two structures. It is important they recognise techniques to help children as well as methods to help keep their concentration, said Hoosen.
“It is important to identify other ways to keep the individual with ADHD stimulated based on their age. Parents can help to manage this better by limiting screen time and incorporating exercise or activity outside on a daily basis, as well as maintaining a healthy diet and sleep routine. Teachers can assist in the school setting by incorporating accommodations in their teaching procedures such as scheduled breaks or scheduled activity (stand up, stretch, take a walk, come back into class), or by allowing fidget toys in class, and by extending remedial intervention to learners with ADHD. There are also courses on understanding and integrating appropriate teaching methods for teachers to adopt and it would be beneficial if teachers are equipped with these skills through professional development and training.”
There needs to be conversations held with parents, teachers and society at large. Such stigmas and stereotypes make it difficult for one who has ADHD to talk about it or even seek help. The easiest way to destigmatise it is by talking about it and explaining it, said Humayra. In her experience, once these disorders are explained to a person, it becomes easier for them to understand what it is and helps to remove any stereotypes about it from their minds.
“I think there’s a need for education regarding the condition. In my experience as a health professional working in psychiatry, the moment you explain the factual, physiological aspect of any condition be it depression, bipolar or ADHD, people are able to understand it so much better. I think education needs to happen for parents, teachers and health professionals to help younger individuals. Also workplace education so that people can be accommodated adequately.”