Adult ADHD: problems and pitfalls

The controversy surrounding adult attention-deficit hyperactivity disorder (ADHD) is intellectually interesting in terms of what it says about the distinction between pathology and normality and our moral response to this. However, the role of psychiatrists is to provide impartial advice to patients about what intervention is likely to be more useful than harmful. The individual then decides whether the intervention is useful for them or not. This applies to any intervention, not only pharmacological.

Considering data may help to inform the debate. I have run a National Health Service adult ADHD clinic for the past 3.5 years, during which time we have received 350 referrals, about half for adults who believe they may have ADHD, but who have not been assessed for this before. Of those who were ultimately identified as having significant ADHD traits and offered pharmacological intervention: (a) 70% were unemployed or had dropped out of education, (b) 15% had been in trouble with the police previously, (c) 72% had had previous contact with mental health services (and no consideration given to the possibility of ADHD), (d) 30% had two other mental health problems apart from ADHD, (e) 70% of those prescribed medication (stimulant on non-stimulant) returned to work or education.

It is the last finding that is most telling. These are individuals who are, and have always been, struggling significantly. Medication can help them to successfully complete ordinary but important tasks like hold down a job, stick to a course or maintain personal relationships. It is not a cure, but a powerful tool that can empower the individual.

The psychiatrist has a critical role in diagnosing and prescribing a substance that can have such profound effects (both positive and negative). Perhaps we should focus more on trying to identify who would benefit from intervention, and less on the intellectual exercise involved in ‘pathologicising normality’.