Adults with ADHD: finding the source of the pain

“Sometimes I would leave in the middle of a conversation because intrusive thoughts made me forget that someone was talking to me.” Nicknamed “Cloud” for being a bit of an airhead, Éric, 33, remembers being a young adult oscillating between trouble managing his day-to-day life and excessive behaviour. “I was never the first one home from a party and sometimes put myself in danger while practising sports. Professionally, I could be all over the place by doing six tasks at once, or I’d work myself to exhaustion when I was interested in a project.”

Everyone struggles to a slight degree with impulsivity, concentration, procrastination or, the opposite, hyperactivity. But these challenges can qualify as attention deficit disorder with or without hyperactivity (ADHD) when they become too debilitating in a person’s social, academic or professional life.

According to the Revue médicale suisse, between 3% and 7% of children and adolescents in Switzerland have ADHD. In 60% of cases, symptoms persist into adulthood. “Until now, adult ADHD has been diagnosed too rarely,” says Caroline Menache Starobinski, a paediatric neurologist at the ADHD Consultation Centre at the Clinique des Grangettes in Geneva. “Improved knowledge of the different forms of ADHD and how it develops after adolescence means that it can now be detected earlier.”

COMPENSATORY MECHANISMS

If ADHD is not identified in childhood, it is even more difficult to detect in adulthood. Many people try to conceal their symptoms to comply with social and professional norms and rules, sometimes even choosing a less repetitive job that will not be affected as much by their disorder. “Around the age of 20, I wanted to fit into the mould, to ‘become normal’,” Éric says. “I tried to contain myself, especially at work, for fear of emotions or reactions that would be too strong or inappropriate.”

However, holding these symptoms back requires constant effort, which can have major repercussions on the individual’s mental health. “These compensatory mechanisms eventually lead to psychological exhaustion,” says François Candaux, head of the Adult ADHD Specialised Consultation and associate physician at Lausanne University Hospital (CHUV).

COMORBIDITIES AND HERITABILITY

In 80% of cases, patients with ADHD present other psychiatric disorders during their lives, such as depression, bipolar disorder, anxiety and borderline personality disorder. These individuals are also at greater risk of burnout and substance abuse. “Genetic predisposition probably increases the prevalence of these disorders,” Caroline Menache Starobinski says. “However, because of the comorbidities, ADHD symptoms are often attributed to another disorder, which can delay diagnosis by several years.”

Genetic factors also play an important role in the onset of ADHD. Rarely does only one person in a family have the disorder. “I thought that my hyperactive side came from my family background, that it was normal to have 30,000 ideas in my head and to do everything at the last minute, under the pressure of an imminent deadline,” says Clara*, who was diagnosed at the age of 34, after going through a burnout. Paediatric neurologist Caroline Menache Starobinski notes that many parents realise that they have ADHD once their child is diagnosed with it. “Interpretations of certain behaviours are not the same in a family where members have ADHD, compared with other families,” François Candaux says.

EVOLVING TREATMENT

Two years ago, the CHUV’s Service of General Psychiatry opened a specialised ADHD Consultation Centre for adults. “As a result, formal investigation procedures could be laid down for the admissions and brief intervention unit,” the head of the centre says. Patients are referred by their psychiatrist or psychotherapist. Most come here in a crisis situation because an event – starting university, getting their first job, becoming a parent, going through divorce, etc. – has exacerbated their symptoms. CHUV experts can then make a diagnosis and begin appropriate treatment.

Psychostimulant medications such as methylphenidate can alleviate attention and hyperactivity-impulsivity disorders. “It can take some time to work out the right dosage, but these drugs work well in 75% of cases,” François Candaux says. “After being diagnosed two years ago, Éric was able to follow a discussion from A to Z for the first time after taking Ritalin and ‘had tears in his eyes’.”

However, treatment does not mean taking these drugs for life. “New habits need to be developed at the same time through psychotherapy,” François Candaux says. For example, cognitive-behavioural therapy can be used to build new strategies. “This therapy has given me real solutions for managing my attention deficit,” Clara says. “For example, by dividing a task like tidying a room into several smaller objectives, I reduce the risk of losing my concentration.” 

^{*Not her real name}