Symptoms of attention deficit hyperactivity
disorder often persist into adulthood
Increased
awareness of attention deficit hyperactivity disorder, or ADHD, has led to more
new cases being identified in recent years, but misconceptions about it persist
.
Reach
(Response, Early Intervention and Assessment in Community Mental Health),
Institute of Mental Health (IMH) and National University Hospital (NUH) have
continued to report new cases each year.
ADHD is a
neurobiological condition that affects one's academic learning and social
behavioural development in varying degrees of severity. About 5 to 8 per cent
of children and young people, and 2 to 3 per cent of adults have it, said
Associate Professor John Wong, the head and senior consultant of NUH's
department of psychological medicine.
ADHD can
also occur with other problems such as anxiety and learning difficulties such
as dyslexia, which tend to affect structured learning and its outcome. This
then catches the parents and teachers' attention, said Prof Wong.
ADHD is
the top mental health condition seen at IMH's Child Guidance Clinic. From 2012
to last year, the clinic saw an average of 645 new cases with ADHD a year.
It is the
top mental health condition picked up in schoolchildren aged six to 19, under
Reach, a mental healthcare service that works closely with schools, voluntary
welfare organisations and doctors to help students with emotional, social and
behavioural issues. It is a collaborative effort between the IMH's Child
Guidance Clinic, KK Women's and Children's Hospital, NUH and the Ministry of
Education. It helped identify 242 cases last year, up from five cases in 2007
when it started.
In the
west zone, the number of new ADHD cases reached 43 last year, up from 26 to 32
cases a year in the previous three years, said Prof Wong, who is also programme
director, Reach (West), at NUH.
He
estimates that the Neuroscience Clinic and Paediatric Psychiatry Clinic at NUH
sees about 40 new ADHD cases each a year. There would also be new cases seen in
the private sector.
Dr Lim
Boon Leng, a psychiatrist at Gleneagles Hospital, said he has seen a rise in
ADHD cases, especially in adults. He saw about 100 adult and children's cases
last year, compared with about 10 in 2012.
Adjunct
Associate Professor Ong Say How, chief and senior consultant at IMH's
department of child and adolescent psychiatry, described an ADHD child as one
who is often disorganised, forgetful and lacking the ability to focus or obey
instructions. He behaves impulsively and is constantly restless.
Some people
think the ADHD child will outgrow it. But the symptoms often persist into
adulthood.
Dr Lim
said: "It is common for ADHD symptoms to be misconstrued as
"naughty" behaviour. Even after diagnosis, parents and teachers often
need plenty of convincing before realising the symptoms are not wilful or
deliberate."
There are
three types of ADHD - those who are predominantly inattentive, those who are
predominantly hyperactive-impulsive and those with a combination of the two.
Dr Lim
said those who are predominantly in the attention deficit domain do not display
hyperactive behaviour and are often well behaved in school.
Adults
may not realise that they are having problems concentrating in class and are
not fulfilling their potential academically.
Dr Ong said
ADHD is highly treatable. Those with mild ADHD may just require behavioural
therapy and environmental adjustments.
Adjustments
could include having a timetable to remind them to do things. In school, these
children can sit in front of the class and not near the window where they may
look out.
Dr Ong
said if the child is so hyperactive that he cannot learn in school, medication
may be needed.
Prof Wong
said: "When left untreated, a child tends to under- achieve in his
academic learning, leading to poor self-esteem from negative attention and
scolding from parents and teachers."
The lack
of control in impulsivity may evolve into risk-taking and anti-social
behaviour, frequent aggressive outbursts and violent behaviour, and lack of
friends and social support, he said.
A child
or teenager with ADHD may also miss out on opportunities at critical streaming
milestones in the education system, he added.
Dr Ong
said ADHD is caused by a delay in maturation involving parts of the brain
responsible for attention control and behaviour inhibition. These are in the
pre-frontal cortex, which is the last brain area to develop fully. "This
is why some ADHD symptoms may decline slightly with age. But the biological
deficits largely remain."
Hyperactivity,
for instance, tends to improve with age but the ADHD person may still have
problems focusing on tasks. Those with ADHD like to multi-task, he said.
The good
news is, many people with ADHD learn to cope well. Some even go on to achieve
greatness. American swimmer Michael Phelps, who has won 22 Olympic medals,
including 18 golds, is one such person.
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