Liv­ing with adult ADHD

Many adults un­know­ingly suf­fer from ADHD – and the cor­rect di­ag­no­sis and treat­ment can change their lives


THEY’RE eas­ily dis­tracted, have lit­tle tol­er­ance for frus­tra­tion or bore­dom, and tend to say and do what­ever pops into their head. If you know some­one like this, it’s pos­si­ble they have at­ten­tion-deficit hy­per­ac­tiv­ity disor­der (ADHD) – and there’s a pretty good chance they don’t even know it.

The con­di­tion is un­di­ag­nosed in many South African adults, says Cape Town­based in­dus­trial psy­chol­o­gist Hil­ton Calder, who has the con­di­tion but failed to recog­nise his own symp­toms un­til a col­league gave him a book about ADHD in the early ’90s. Un­til then he hadn’t re­alised his in­abil­ity to sit still while on the phone and his short at­ten­tion span were signs of a brain con­di­tion that’s chronic and for which treat­ment was avail­able.

That was also when Calder re­alised he’s dyslexic – one of the many co­ex­ist­ing con­di­tions associated with ADHD. “I never re­ally read at school,” he says. “I lis­tened well in class and mem­o­rised stuff.”

It was once thought that ADHD symp­toms dis­ap­pear af­ter ado­les­cence. But it’s now known that 50% of chil­dren with ADHD carry their symp­toms into adult­hood.

Guide­lines for the di­ag­no­sis and treat­ment of adult ADHD in South Africa were pub­lished for the first time this year in the SA Jour­nal of Psy­chi­a­try.

It’s es­ti­mated at least a mil­lion South Africans in their twen­ties to fifties have adult ADHD.

“Be­cause most adults with ADHD func­tion so well with it and hide it from oth­ers, it’s re­mained largely un­di­ag­nosed un­til re­cently,” Calder says. “It’s of­ten con­sid­ered a prob­lem only if your col­leagues or loved ones strug­gle to cope with your be­hav­iour.”

He’s been help­ing other adults with

ADHD to man­age their con­di­tion for the past 30 years. His pa­tients are mostly suc­cess­ful pro­fes­sion­als – such as the woman in her early for­ties who was re­cently re­ferred to him be­cause of “stress” and was on the verge of burnout by the time she came to see him.

When he spoke to her, Calder re­alised she has ADHD. “She strug­gles to stand still and think. Her Du­ra­cell-bunny en­ergy knows no lim­its.”

Many prom­i­nent ath­letes and per­form­ers have ADHD, says Dave PugheParry, who also has the con­di­tion and is an on­line coach for adults with ADHD at Liv­ing ADDven­ture. “This is be­cause of their dom­i­nant right brain,” he says, adding that fa­mous peo­ple with ADHD in­clude Richard Bran­son, Win­ston Churchill, Michael Phelps, Justin Tim­ber­lake, Brit­ney Spears and Lady Gaga.

SOUTH Africa’s re­cently pub­lished guide­lines for adult ADHD, for­mu­lated by Dr Renata Schoe­man and Dr Rykie Lieben­berg of the fo­cus group for adult ADHD at the SA So­ci­ety of Psy­chi­a­trists (Sopa), are the first to con­cen­trate on adults ex­clu­sively and are aimed at help­ing suf­fer­ers get the right treat­ment.

Schoe­man and Lieben­berg hope the guide­lines will also give pa­tients ne­go­ti­at­ing power with med­i­cal aid schemes with re­gard to pay­ing for the treat­ment of this chronic con­di­tion.

The guide­lines are for med­i­cal prac­ti­tion­ers and in­clude assess­ment pro­ce­dures for di­ag­no­sis and choices re­gard­ing treat­ment with med­i­ca­tion and/or ther­apy.

Be­ing di­ag­nosed and get­ting the cor­rect treat­ment can be life-chang­ing – just ask Cyril Many­oni (41), a suc­cess­ful en­tre­pre­neur from Brak­pan in Gaut­eng’s East Rand.

He’s a busy man. He owns two busi­nesses – one lo­cates dan­ger­ous gas leaks in fac­to­ries, the other har­vests alien plants from Hart­beespoort Dam and turns them into fer­tiliser – and pro­duces a handy­man TV pro­gramme that’s soon to be broad­cast. Many­oni says his life changed in 2010 af­ter he watched a TV show about ADHD. “I’d al­ways thought I was dis­or­gan­ised and lazy. The lack of fo­cus and short at­ten­tion span they men­tioned in the TV pro­gramme – that was me.”

He did more re­search into the con­di­tion, con­sulted a doc­tor and was pre­scribed Ri­talin. The med­i­ca­tion has helped, but he adds that treat­ment also in­volves an on­go­ing process of learn­ing new cop­ing skills.

“My par­ents don’t un­der­stand this thing [ADHD]. In African cul­ture it’s con­sid­ered witchcraft; some­thing to be ex­or­cised with a ri­tual,” he says. That’s why Many­oni now raises aware­ness about ADHD in Soweto and other town­ships.

Di­ag­no­sis of ADHD in adults is com­plex, Schoe­man says, as the symp­toms are of­ten dif­fer­ent to those ex­hib­ited by chil­dren, and more sub­tle. Adults also don’t re­spond to med­i­ca­tion in the same way as chil­dren and are ex­posed to a dif­fer­ent set of daily de­mands.

“Once a di­ag­no­sis is made, peo­ple are of­ten re­lieved be­cause it ex­plains their ‘ bad’ be­hav­iour and ac­tions to­wards oth­ers,” Pughe-Parry says. Of­ten those with ADHD are told they are rude, lazy, dis­re­spect­ful or gen­er­ally high main­te­nance, Pughe-Parry ex­plains. “The di­ag­no­sis pro­vides a rea­son for the be­hav­iour, and they can then do some­thing about it. I al­ways say to teach­ers and par­ents that no ADHD child gets up in the morn­ing and plots how to make your life a mis­ery. They’ll prob­a­bly make you mis­er­able, but it’s not in­ten­tional.” The same ap­plies to adults with ADHD. One thing that got Pughe-Parry into trou­ble with his wife was his ten­dency to zone out while she spoke to him. “But I don’t do it on pur­pose. Dis­trac­tion isn’t an in­ten­tional ac­tion. To un­der­stand it, look in a mir­ror and try not to blink – it’s im­pos­si­ble,” he says. “Peo­ple with ADHD are dis­tracted by six things – our five senses and our own thought pro­cesses.” Adults also of­ten ex­pe­ri­ence frus­tra­tion when they’re di­ag­nosed only later in life, es­pe­cially if they feel they haven’t reached their full po­ten­tial due to the im­pact the con­di­tion has had on their lives. The strug­gle to fo­cus can lead to dif­fi­culty hold­ing down a job. Im­pul­siv­ity and im­pa­tience can cause fric­tion with oth­ers and lead to prob­lems in work and per­sonal re­la­tion­ships. Here’s how to spot adult ADHD and tips on how to deal with it. SYMP­TOMS OF ADULT ADHD

Trou­ble con­cen­trat­ing and stay­ing fo­cused This plays out in many ways – be­ing eas­ily dis­tracted, not fin­ish­ing tasks, “zon­ing out”, day­dream­ing and poor lis­ten­ing skills.

Disor­gan­i­sa­tion and for­get­ful­ness Adults with ADHD tend to have poor or­gan­i­sa­tional skills, un­der­es­ti­mate how long it will take to com­plete tasks, pro­cras­ti­nate, of­ten lose or mis­place things, fre­quently for­get ap­point­ments or com­mit­ments and are of­ten late. Im­pul­siv­ity Suf­fer­ers are of­ten im­pa­tient, un­able to wait their turn, tend to in­ter­rupt, re­act with­out con­sid­er­ing the

con­se­quences and be­have reck­lessly. They some­times be­have in so­cially in­ap­pro­pri­ate ways.

Emo­tional dif­fi­cul­ties Suf­fer­ers can be moody, prickly, ir­ri­ta­ble and have a short tem­per – all of which makes it dif­fi­cult to sus­tain re­la­tion­ships and friend­ships. Some­times poor self-im­age is hid­den be­hind false bravado. Hy­per­ac­tiv­ity Rest­less­ness, fid­get­ing, rac­ing thoughts, ex­ces­sive talk­ing and a need to be per­pet­u­ally on the go are typ­i­cal. These symp­toms can be­come more sub­tle with age. Adults with ADHD of­ten have an ac­tive life­style and strug­gle with sleep, Schoe­man says. HOW TO MAN­AGE IT

It can feel over­whelm­ing to be di­ag­nosed with ADHD but there are ways to man­age the symp­toms.

The aim of in­ter­ven­tion is to con­trol im­pul­sive be­hav­iours, man­age stress and emo­tions, man­age time bet­ter, get and stay or­gan­ised, boost pro­duc­tiv­ity and im­prove re­la­tion­ships.

Adults with ADHD can ben­e­fit from med­i­ca­tion that im­proves the brain’s abil­ity to fo­cus, which helps to de­crease symp­toms. These med­i­ca­tions, which in­clude Ri­talin, Con­certa and Strat­tera, are avail­able only on pre­scrip­tion, as us­ing them in­cor­rectly or with­out guid­ance can lead to de­pen­dancy is­sues. Pughe- Parry be­lieves med­i­ca­tion on its own isn’t enough though. A healthy life­style is im­por­tant – that means nu­tri­tious food, reg­u­lar ex­er­cise and plenty of sleep. It’s also a good idea to avoid al­co­hol.

Ther­apy can help to deal with anx­i­ety and de­pres­sion, which are com­mon co­ex­ist­ing con­di­tions. It might also be ben­e­fi­cial for cou­ples or fam­i­lies to man­age the im­pact ADHD can have on re­la­tion­ships. Find tools to help you to be more or­gan­ised, whether it’s mak­ing lists or us­ing a colour-coded sys­tem. Look for apps that can help you and use re­minders on your phone to keep track of things. IF A LOVED ONE HAS ADHD

ADHD is a con­di­tion that af­fects the whole fam­ily. Here’s what loved ones can do to help.

Read about ADHD to un­der­stand the symp­toms so you can un­der­stand your loved one’s con­di­tion bet­ter. Talk about how it af­fects your re­la­tion­ship and what can be done to im­prove things as well as how you com­mu­ni­cate about it.

Don’t give some­one with ADHD too much in­for­ma­tion or too many tasks at one time – they won’t re­mem­ber all of it. Make a list of every­thing they need to get or do and give it to them, or send it on What­sApp, rather than ex­pect­ing them to re­mem­ber every­thing.

Don’t ex­pect them to con­form. They can’t. Al­low them to be who they are.

Make sure they’re pay­ing at­ten­tion to you be­fore talk­ing to them. It might help to touch them to draw their at­ten­tion.

If you need help, con­tact the At­ten­tion Deficit and Hy­per­ac­tiv­ity Sup­port Group of South­ern Africa (Ad­hasa). It’s a non­profit or­gan­i­sa­tion that pro­vides in­for­ma­tion and sup­port for those with ADHD and their fam­i­lies. Go to ad­ for more in­for­ma­tion.

Find tools to help you to be more or­gan­ised, whether it’s mak­ing lists or us­ing a colour-coded sys­tem

ABOVE LEFT: Psy­chol­o­gist Hil­ton Calder suf­fers from ADHD but didn’t know it. ABOVE RIGHT: Di­ag­no­sis and treat­ment changed en­tre­pre­neur Cyril Many­oni’s life.

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