It has long been accepted that some children have attention deficit hyperactivity disorder (ADHD), although they are not all hyperactive, so then it gets called attention deficit disorder (ADD). They disrupt classrooms, cannot concentrate, get low grades, upset their families, and often run into trouble with drugs or jail. The 1 to 2 per cent of British children affected are meant to grow out of it in their late teens, but about 10 per cent do not. This has caused considerable angst amid psychiatric units; what to do about adult ADD?
The dilemma is that otherwise healthy young people are asking for stimulants such as methylphenidate and dexamphetamine, which speed you up mentally. Given the hurly-burly nature of modern life, it is not surprising that everyone wants to think a bit faster, focus better and get on. But when I saw Jack, now aged 35, I wondered what to do. Despite difficulties in school, he got a degree. He had worked in various roles in the computer industry, but had a tendency to move jobs every year or two and did not know why.
As the nature of the medication requires careful assessment, we often check symptom histories by getting school reports and family corroboration. We also use a standard ADD questionnaire. From this, it was quite clear that Jack was easily distracted. He said he found it hard to start boring tasks, could not focus on more difficult ones, could not wait in queues and tended to interrupt people. He binge-drank, and felt buzzed up by cocaine. (As in the song, people with ADHD/ADD do not generally get a kick from cocaine.)
We asked Jack why he kept losing jobs, and he said he just wanted to quit and often had arguments beforehand. Previously, he had been smart enough to get another job, but now, and here was the rub, he had been out of work for two years.
Did Jack have adult ADD? We had no idea, since there are currently no diagnostic brain scans, blood tests or more specific questionnaires than the one we had used. Was this just someone with poor social skills, who drank too much, and who had burnt his bridges on the work circuit? Then his girlfriend came in and told us more of what was happening: that he lost his mobile phone two or three times a week, did not remember appointments, and got depressed and anxious as a result. He wanted therapy, but apart from “problem-solving” there is no specific therapy for ADD.
The cynic in me felt this was just special pleading from the girlfriend, and that, like so many, both of them had been reading up on ADD on the internet. But it was worth trying a few methylphenidate to see if we could put Jack right.
I never saw him again. I wrote to his GP and advised that it would be worth giving him a trial of medication. There were concerns about alcohol use, and we advised this should be checked out as well. A year later the letter arrived from New Zealand. He and his girlfriend had settled down, he had a regular job, he was taking medication, was able to work most of the day, and his mobile phone was safe. Like so many sufferers – for it now seemed clear he was an adult ADD case – he had struggled with a substantial brain handicap as well as the associated stigma and doctors’ assumptions of “druggie” driven requests for medications. Fortunately brain-scanning and genetics research are starting to detail the hard-wiring of this condition, so medication could soon be seen as a kind of vitamin that some people do need – like iron tablets for anaemia.
Trevor Turner is a consultant psychiatrist working in east London. Some details have been changed to protect identity. Sophie Harrison is on maternity leave