Could an epidemic of attention deficit hyperactivity disorder (ADHD) be affecting the UK’s elderly population?
Or are many instead being overdiagnosed with the condition and even taking drugs that in the long term can reduce their mental abilities and increase their risk of serious illnesses such as brain disorders?
The spotlight was thrown on ADHD this month after comedian Johnny Vegas, 52, became the latest in a wave of celebrities to announce they have been diagnosed with ADHD (others include comedian Rory Bremner, chef Heston Blumenthal and TV hosts Ant McPartlin and Sue Perkins).
Johnny Vegas told BBC Breakfast: “Everyone has an element of ADHD. But it’s about how strong your filter is. When you have no filter at all, simple things take a long time.
The spotlight has been thrown on ADHD this month after comedian Johnny Vegas, 52, became the latest in a wave of celebrities to announce they have been diagnosed with ADHD
Other celebrities who have ADHD include comedian Rory Bremner
“I’ll think, I’ll move that cup, and then you have ten other ideas and you haven’t moved that cup. Three weeks later, it turned into this monumental task.
In yesterday’s Mail, Inspire columnist Dr Clare Bailey described her own experience with ADHD.
ADHD is a serious, complex neurobiological condition characterized by inattention — such as a short attention span, being easily distracted, appearing forgetful or losing things — and impulsivity, such as an inability to sit still and concentrate.
One in 20 adults in Britain has the condition, according to the charity ADHD Foundation, but only 120,000 have had an official diagnosis – the charity said this was due to ‘a combination of poor understanding of the condition, stigma and delays in diagnosis’.
Former Great British Bake Off host Sue Perkins also revealed she has ADHD this month
Yet rising rates of diagnosis among adults are causing alarm among some British experts. Joanna Moncrieff, professor of critical and social psychiatry at University College London, told Good Health: “Diagnoses of ADHD in adults are on the rise at the moment.”
She is particularly concerned that screening tools for ADHD are too weak, meaning that too many people simply “diagnose” themselves.
As an illustration, the ADHD Foundation’s online self-assessment includes questions such as: “How often do you have difficulty maintaining your attention when doing boring or repetitive work?” and “How often do you make careless mistakes when you have to work on a boring or difficult project? ” Many of us could easily answer “Yes, often” to them.
Other questions suggest that people may have ADHD in adulthood if they often “lose or have trouble finding things at home or at work,” “get distracted by noise or activity,” or “have difficulty completing the final details of project after the challenging parts are done’. Again, these may seem like everyday experiences for many of us.
Meanwhile, there’s also been a surge in videos and posts on social media websites claiming to help people spot the signs of ADHD, again with wide-ranging symptoms so anyone can think they have ADHD — and if you have ADHD, then you can sign up for “support” or perhaps pay for an online course.
Joanna Moncrieff, professor of critical and social psychiatry at University College London, told Good Health: “Diagnoses of ADHD in adults are on the rise at the moment.”
TikTok videos with the hashtag #ADHD, which have been viewed 20.2 billion times, include one that lays out “six signs you may have ADHD in adulthood” — these include losing interest in hobbies, being constantly late and “scrolling TikTok and Ignoring Texts’.
Meanwhile, on Instagram, an ADHD expert describes how chronic constipation can be a symptom. Someone commented, “I would never make that connection.” This is probably because none of these symptoms appear in the official diagnostic criteria.
ADHD is defined in psychiatrists’ bible, the Diagnostic and Statistical Manual (DSM), quite strictly.
For an adult to be diagnosed with ADHD, the DSM dictates that they must have at least five symptoms of inattention (such as poor organization and being easily distracted) and/or at least five symptoms of hyperactivity/impulsivity (such as difficulty participating in quiet, recreational activities , verbalizing responses) for six months or more “to a degree that is inconsistent with developmental level and negatively impacts social and academic/vocational activities.”
The DSM also says that several symptoms of ADHD should have been noted as being present before age 12.
Johnny Vegas told BBC Breakfast: “Everyone has an element of ADHD. But it’s about how strong your filter is. When you have no filter at all, simple things take a long time
Professor Moncrief worries that celebrities who say they have ADHD are effectively acting as a modern endorsement for the condition, and that people see others with the condition and simply decide they have it too.
She says, “If you have to ask for a diagnosis, you can get a diagnosis. The diagnostic questionnaires are so simplistically obvious that people know the correct answers to give in order to receive a diagnosis of ADHD in adults.
Her concern was echoed by a 2015 study in the Canadian Journal of Psychiatry from McGill University. It warns that the condition is seriously overdiagnosed, not least because of the use of simplistic symptom checklists, and says that ‘overdiagnosis leads to overtreatment and the dramatic increase in ADHD prescriptions in adults over the past decade should be cause for concern’ .
Professor Moncrieff adds that there are concerns about the drugs used to treat ADHD – in particular, increasing numbers of British adults are being put on amphetamine-type drugs as first-line treatment.
Four stimulants are licensed in the UK to reduce ADHD symptoms: methylphenidate, lisdexamfetamine, dexamfetamine and guanfacine.
These drugs are designed to increase the ability of adults to concentrate and focus on completing tasks.
Giving a stimulant drug to someone who is feeling impulsive and irritable may seem odd, but the NHS says stimulants work “by increasing activity in the brain, particularly in areas that play a role in controlling attention and behaviour”.
Four stimulants are licensed in the UK to reduce ADHD symptoms: methylphenidate, lisdexamfetamine, dexamfetamine and guanfacine. These drugs are designed to increase the ability of adults to concentrate and focus on completing tasks
Professor Moncrief is skeptical. “Stimulants are quite pleasant to take, so people will think they feel and function better when they take them,” she says.
“But that doesn’t mean people actually are. There is no evidence that taking these stimulants actually makes you perform better on exams or drive.
Indeed, a 2010 review in the journal Neuroscience & Biobehavioral Reviews concluded that students who took the stimulants did not show improved learning or academic achievement.
Lead researcher Claire Advocate, a professor of psychology at Louisiana State University, warned that drugs like methylphenidate could instead dull people’s mental impulses and reduce their cognitive flexibility. Heston Blumenthal was prescribed the amphetamine-based ADHD drug Adderall when he was diagnosed three years ago, but said last week he stopped taking it because he was “constantly worried that the drugs would cloud my imagination.”
Other people complain of other drug-related problems. Last September, a survey of nearly 600 adults with ADHD found that nearly half said their medications caused sleep disturbances, depressed mood and panic attacks, the journal Current Medical Research and Opinion reported. And 45 percent said the drugs increased their emotional impulsivity and mood swings.
The report concluded that “Symptoms related to the side effects of ADHD treatment are common and have a significant negative impact on quality of life and reduce the chances of finding work.”
Harmful physical side effects have also been reported after long-term use. For example, a report on the expert website WebMD states that ADHD medications “may increase blood pressure and increase heart rate.” If you already have a problem with your heart, these drugs can be risky.
Professor Moncrief fears the drugs could also cause neurological damage. “The long-term effects of stimulants prescribed for ADHD in adults are understudied,” she says. “But alarming evidence is emerging that taking prescription stimulants increases the risk of developing Parkinson’s disease.”
A 2015 study in the journal Frontiers In Human Neuroscience warned that taking the drugs at levels commonly prescribed for ADHD could lead to the development of Parkinson’s disease symptoms in humans — after animal studies showed that the drugs can have a toxic effect on brain cells.
Additionally, a 2008 study of animals given prescribed levels of these stimulants showed disruptions in their brains’ dopamine systems after just four weeks of the drug.
The study in the journal Molecular Psychiatry warns that “dopamine dysfunction plays a role in Parkinson’s disease and mental disorders such as schizophrenia,” not least because it is associated with a loss of emotional regulation.
Long-term use of ADHD medications can even, ironically, make it harder to concentrate, according to a 2016 review in the journal Neuropsychiatric Disease and Treatment.
The researchers said that methylphenidate prompts the human brain to effectively resist the drug’s effects and “results in increased inattention and the need to increase the dose administered.”
Professor Moncrief says: “It’s really worrying that we’re giving these stimulants without knowing what the consequences are for people who take them for…
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