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 adhasa.co.za 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.