Inside Health

Q I am interested to find out more about ADHD and how you get diagnosed. Some people I work with have asked me if I have it and my boss says I may have some of the traits. I also have some mental health conditions; PTSD, adjustment disorder and anxiety which I have been told can co-exist with ADHD.

A Hello and thank you for your question about ADHD, this is something we as GPs get asked frequently working in prison. In this article we will explore what ADHD is, how it is diagnosed, and what the treatment options are, although this may vary across the UK. Hopefully by the end of this article you will understand a bit more about it and how to explore getting assessed. 

ADHD or Attention Deficit Hyperactivity Disorder is a common condition in the community but actually much more common in prisons. Approximately 3 in 100 people are said to have ADHD in the community. However one academic paper suggests as many as 25 in 100 people in prison may have it.

ADHD – what is it?

ADHD is a developmental condition that starts in childhood – symptoms become noticeable in young children as they cannot focus or settle and are very easily distracted both at school and at home. There are three main groups of symptoms that make up ADHD. These are:

1. Inattention – difficulty concentrating for any length of time and very easily distracted.

2. Hyperactivity – inability to sit still or focus on a task easily.

3. Impulsivity – a tendency to act on a whim without considering the consequences.

People who have ADHD can have a combination or all of the above symptoms which can be very debilitating for both them and their families. It is at least twice as common in boys as girls.

ADHD begins in childhood but around 60 per cent of those affected will continue to have some symptoms into adulthood. These can reduce in severity but anxiety or stress can trigger it and make the symptoms periodically worse. In adulthood, ADHD can lead to social and education difficulties and can also increase contacts with the justice system.

Causes

The exact cause of ADHD is unknown; however the condition has been shown to run in families. It is more common in people with learning difficulties and in people whose mothers smoked during pregnancy.

Diagnosis

ADHD diagnosis is not straightforward and requires referral by your GP to a specialist mental health service. At the clinic you will be examined physically and psychologically and the specialist will complete a very comprehensive rating scale. You may also be asked to complete a self-rating questionnaire. It takes a number of visits to establish a diagnosis – it is estimated that completion of an assessment and diagnosis of ADHD takes over 3 hours of clinical time.

Treatment

Treatment for ADHD depends on the age of diagnosis and the severity of symptoms. In children it can be managed with educational support and advice for parents as well as medicine to help manage the symptoms. In adults medicine is often the first line, however some psychological therapies such as CBT (cognitive behavioural therapy) can also help.

There are a number of medications to help treat ADHD. These are mostly stimulant medications (Methylph-enidate, Dexamfetamine) and are not a cure but may help a person with the condition concentrate and be less impulsive so that they can get on with their daily lives more effectively. There are obviously concerns about using stimulant medications in prison; hence some practitioners may choose treatments that have less risk in a prison setting, such as Atomoxetine which is a non-stimulant treatment.

As you have stated in the question, ADHD can be associated with other mental health conditions and there is often cross over of symptoms – for example, anxiety can cause hyperactivity and agitation, so it is important that you discuss your mental health with the GP and specialist in detail, to help them plan your treatment.

The good news is that ADHD symptoms (especially hyperactivity and impulsiveness) tend to ease over time. Medical treatment can be very successful and enable people to function in a more acceptable way such as by reducing impulsive behaviour. Several academic studies show that treatment for ADHD can reduce offending by up to 32 per cent and also help people stay in employment.

Hopefully this has answered some of your questions but if not, your local GP or mental health service will be able to point you in the right direction.

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