Managing ADHD

Persons with ADHD pointed out that there are some fundamental problems in the approach of mental health professionals. It starts with the diagnosis itself. Srinivasan says, “Even the assessment questionnaire I was given was not ADHD-friendly. It had a bunch of questions that I found extremely hard due to the lack of challenge in the task, and due to the large number of questions that wasn’t helping me maintain my already tiny attention span.”

Kundu points to the pathologisation of neurodivergence in the training of mental health professionals. “In our entire training to be mental health professionals, we are not taught about neurodiversity from an affirmative lens at all. We are taught about a set of traits from the DSM and not about actual lives and what are the access needs for neurodiverse folks in therapy,” she says.

Doctors offer treatment by way of medicines. Two classes of medicines are prescribed usually: stimulants and non-stimulants. “These medicines primarily work on releasing dopamine or norepinephrine and trying to improve upon non-function. Stimulants are more effective than non stimulants,” says Dr Agarwal, adding that while the drugs are safe, they screen persons with heart conditions and offer non-stimulants instead of a stimulant.

It’s agreed on that medicine alone is not effective without therapy.

Kundu explains that historically therapy has been used to “fix” neurotypes to make the person “fit’ into a neurotypical world. “When we view something as a disorder, it prohibits us from developing a relationship and understanding its presence in our lives. It is a reductive way of looking at something that’s just us. Therapists need to learn and include a neuro-affirmative approach with their clients.”

A neuro-affirmative approach to therapy starts with believing that ADHD experiences are different for different people. The use of deficit-based medical language in the diagnostic manuals is now only contrasted with the increasing number of blogs, vlogs and social media posts by neurodivergent persons. The activism of adult ADHD-ers and other neurodivergent persons has changed the narrative around these conditions, earlier dominated by parents.

“The literature in social media describing neurodivergence in words that can be understood is an eye-opener. They are talking about their personal experiences, and how the condition has impacted their lives. They are also saying that we are great at many things, while significantly being challenged by others. Many parents have also told me that they feel they can now relate to their neurodivergent kids after reading these accounts,” says Singhal.

Neurofeedback is one therapeutic approach that’s working. Chetna Punia, Neurofeedback and Biofeedback Trainer, Maatram Center of Mental Health Development and Support, Puducherry, explains: “We map the brain’s electrical signals with an EEG-based device, and zero in on the frequencies that can point out various markers. With ADHD, it helps to manage mood regulation, tension span, sleep pattern, etc.” Punia emphasises that this is a way of training the brain, not curing it. “In a typical neurofeedback session, the client comes in and after we have zeroed in on the areas or issues and brain functions we want to work on, we can feed all that into the system. The person wears the EEG cap, and the brain activity is recorded. Each time the brain activity is in the optimal range, s/he gets a reward, in an audiovisual format. Once the brain is wired to the reward mechanisation, it wants to repeat the activity. The brain starts to rewire and the change begins to settle in.”

Life with ADHD

Narayanan used to do poorly in her school and college exams. She recalls that about 10 years ago, she was casually sitting with her father when he asked her a question about what she was studying. “When I explained, I started to develop some confidence. I understood how to study and started clearing my papers finally. After my diagnosis (in 2021), I read up that this is called ‘body doubling’ where touching someone helps get the stimulation to remain motivated,” she says.

Narayanan enrolled in an online ADHD coaching class in the US, and found camaraderie among the adults who were late diagnosed ADHD persons. She started an Instagram and Youtube channel about ADHD for Indians.

As a child, Gangrade flitted from one interest to another. “Parents feel that their children should focus on one thing. I loved writing, drawing and colouring, shooting from my father’s phone, all of which apply in my current job as a filmmaker,” she explains in a vlog.

This feeling has some validation in evolutionary studies done abroad. A US-based study by neuroscientists published in Proceedings of Royal Society B: Biological Sciences showed that traits common to ADHD such as impulsivity may have been an evolutionary advantage for our ancestors.

Rathish was 22 when he was diagnosed with ADHD. The 33-year-old had struggled with reading all his life, his mother used to read out his textbooks to him. “The diagnosis gave me validation that I am not dumb. What happened over time is that I got the confidence to do whatever I wanted,” he says.

After finishing his Bachelors in Business Administration, he worked in nine different professions including insurance, filmmaking, chef, advertising, landscape procurement and design. He is now focusing on children’s education. Rathish says that the label of ADHD comes with the word “disorder”, which makes him uncomfortable. He says, “Though the label helped me recognising the condition, I do not focus on it. I want to instead build on my way of looking at the world.”

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.

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

When to Seek Diagnosis in Adults

● Underachieving at work or in education

● Driving dangerously

● Difficulty making or keeping friends

● Difficulty in relationships with partners

Symptoms in adults

● Carelessness and lack of attention to detail

● Continually starting new tasks before finishing old ones

● Poor organisational skills

● Inability to focus or prioritise

● Continually losing or misplacing things

● Forgetfulness

● Restlessness and edginess

● Difficulty keeping quiet, and speaking out of turn

● Blurting out responses and often interrupting others

● Mood swings, irritability and a quick temper

● Inability to deal with stress

● Extreme impatience

● Taking risks in activities, often with little or no regard for personal or others’ safety

Symptoms in Kids and Teens

Inattentiveness

● Short attention span; easily distracted

● Making careless mistakes

● Appearing forgetful or losing things

● Being unable to stick to tasks that are tedious or time-consuming

● Unable to listen to or carry out instructions

● Constantly changing activity or task

● Having difficulty organising tasks

Hyperactivity and Impulsiveness

● Unable to sit still, especially in calm or quiet surroundings

● Constantly fidgeting

● Being unable to concentrate on tasks

● Excessive physical movement

● Excessive talking

● Being unable to wait their turn

● Acting without thinking

● Interrupting conversations

● Little or no sense of danger

When to Seek Diagnosis in Kids

● Been displaying symptoms continuously for at least 6 months

● Started to show symptoms before the age of 12

● Been showing symptoms in at least 2 different settings – for example, at home and at school

● Symptoms that make their lives considerably more difficult on a social, academic or occupational level

● Symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition

Common Medication

● Methylphenidate

● Lisdexamfetamine

● Dexamfetamine

● Atomoxetine

● Guanfacine

Therapy

● Psychoeducation

● Behaviour therapy

● Parent training and education programmes

● Social skills training

● Cognitive behavioural therapy