First clinic for ADHD adults poised to open

ADHD, which is treated with drugs such as Ritalin, is more commonly associated with children having problems in school. More than 4,500 Scots children have been diagnosed with the condition.

But mental health experts estimate that there are thousands of adults who have either not been previously diagnosed with the condition or who still suffer continuing problems from childhood and will benefit from a dedicated service.

Charity helplines dealing with the condition also report that 25 per cent of their calls now involve adults seeking help compared to just a few per cent four years ago.

Studies suggest that up to 3 per cent of adults could be affected by some form of ADHD, with symptoms such as difficulty concentrating on tasks, impulsive behaviour and relationship problems.

Some experts believe many habitual offenders are suffering from ADHD and that better recognition and treatment could help to cut crime levels.

The first clinic is being set up in Edinburgh by NHS Lothian, but, if successful, it is likely to be a model for other services across Scotland.

Dr Fiona Forbes, the consultant child and adolescent psychiatrist at NHS Lothian, said her team had been giving funding for two years.

Forbes said: "ADHD in adults is being increasingly recognised. Whereas previously it was recognised that it does exist within children and adolescents and is seen as a developmental disorder, people are now realising that children don't necessarily 'grow out of it' and some adults continue to have problems associated with ADHD.

"We are estimating that there will be an average of 80 adolescents who, once they reach the age of 18, will continue to require input from such a service. In terms of new referrals, coming in to general adult psychiatry colleagues across Lothian, we would expect there to be up to 180."

Gordon Brown, a child and adolescent mental health nurse, works full-time in the NHS in Falkirk, but in his spare time runs a service helping adults and children with ADHD.

"The generic adult services aren't currently equipped to deal with the large numbers that could be coming their way," he said. "So we need to be developing dedicated adult services to meet the demand."

Brown said many adults with ADHD had other problems, such as depression and anxiety disorder. He said they may also be abusing drugs and alcohol, as well as suffering relationship and financial difficulties.

In extreme cases, ADHD could lead them into criminal behaviour. "Within the criminal justice system, there are huge numbers of adults with ADHD. I see them all the time," Brown said. While ADHD was not an excuse for crime, it may explain some of the reasons why people find themselves offending, he added. "That's because they are so easily led," he said.

"They are using drugs and alcohol. The environments they grow up in may be harsh and traditionally they are exposed to many adverse events early on in life which shapes who they are as they grow up."

Dave Boyd, a musician living in Airdrie, North Lanarkshire, was diagnosed with ADHD at the end of last year, aged 46.

Boyd says he passed through school with his ADHD unnoticed. "I was just one of those people in school who could have done better. It was always 'David could do really well if only he could concentrate; if he could see things through to the end'.

"What that comes across as when you are a teenager is that you're really just lazy and you lack the focus to complete things. You become a person who is, to a lot of people, not fulfilling their potential."

As an adult, Boyd looked back on the problems he had had and realised they needed to be properly investigated. But he faced a long journey to eventual diagnosis.

"Many of the behaviours that you have as a person with ADHD are normal. You lose things. You're messy. You're late. You're spontaneous and impulsive and forget things. The difference between what is in the normal range of these behaviours and what is ADHD is that they are impacting on your life to the extent that you can't function."

But Boyd believes his ADHD also led him into a creative career: "For me, it drove me to become a musician and I developed a performance style and a way of working that was about stepping into a room of complete strangers and working with them there on the spot."

He has been helped by using Ritalin to manage his symptoms. Describing the effects of the tablets, he said: "You take them and 30 minutes after it kicks in and you get put down on the ground. My great sense with the medication is 'so this is how other people see the world'."

Controversial condition

Attention deficit hyperactivity disorder is the most commonly diagnosed psychiatric disorder in children, affecting about 3 to 5 per cent of children globally. Up to half of those diagnosed in childhood continue to have symptoms into adulthood, although adolescents and adults tend to develop coping mechanisms to compensate for some or all of their impairments. Inattention, hyperactivity and impulsivity are the key behavioural symptoms of ADHD.

The disorder affects twice as many boys as girls. Management of the condition usually involves some combination of medications, behaviour modifications and counselling.

Opinions regarding ADHD range from not believing it exists at all to believing there are genetic and physiological bases for the condition.

Most healthcare experts accept it is a genuine disorder, with scientific debate centring mainly around how it is diagnosed and treated. A study found that about 70 per cent of children improve after being treated with stimulant drugs such as Ritalin.