ADHD: Assessment and Support for Children and Adults

Some of us have a hard time focusing our attention and coping with our emotions. At times this causes real distress and makes life heavier. But when a person can improve their peace of mind, their self-confidence and their relationships with the people around them, life can become a great deal better. That is why therapy helps, and science tells us so. What matters is building resilience and having the courage to seek support.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that makes it harder to sustain attention, control impulses, and regulate activity and emotions. Attention difficulties and emotional strain, which in most cases begin to appear in childhood, can change with age: especially from the mid-twenties on, hyperactivity turns inward and can become a mind that won’t quiet down, while difficulty starting important tasks, procrastination, losing track of time (time blindness) and a heightened sensitivity to rejection can come to the fore.

In girls and women, ADHD was overlooked for a long time. A picture that doesn’t fit the image of the restless boy, where inattention dominates and symptoms are masked, is often recognized only years later, alongside anxiety or depression.

Heritability in ADHD is high; estimates based on twin studies put it at around 70–80 percent. But the methods behind these estimates are debated, and ADHD does not come from a single gene or group of genes: the cause is the combination of genes and the environment a person is born into and grows up in. Exposure in pregnancy to toxins such as heavy metals, pesticides and some plastics chemicals, to smoking and alcohol, premature birth, low birth weight, and adverse or traumatic experiences in early childhood are all associated with ADHD.

In my doctoral dissertation, while studying the effects of industrial pollution and social collapse on mental health, I also looked at ADHD in this context. ADHD is more common among children growing up in low-income and industrial areas; toxin exposure, chronic stress, poor nutrition, chaos at home and how schools work all contribute. Access to diagnosis is unequal too: a five-minute appointment and an hour-long assessment do not lead to the same result.

I treat an ADHD diagnosis as a hypothesis. Assessment is less about collecting evidence to confirm that hypothesis than about putting the claim to the test:

• Information from more than one source. We are not the only ones who notice our differences: the views of the people close to us, family members, teachers and (where there have been any) other mental health professionals matter too.
• Neuropsychological tests that measure the sub-areas of attention and executive functions. These tests do not diagnose on their own, but they draw a profile.
• Separating out conditions that can resemble or accompany ADHD: anxiety, depression, trauma, sleep problems, substance use, thyroid problems, B12 and iron deficiency.

In children under six, sleep patterns, screen exposure, the home environment and developmental characteristics can create pictures that look like ADHD, so great caution is needed at this age. An adolescent who says “I can’t focus” before exams is often anxious. In adults, memories of childhood are not always reliable, so information from people close to them matters.

Diagnosis is made by a psychiatrist. What I do is prepare an assessment report that supports the differential diagnosis; sometimes recommending observation and waiting, rather than a diagnosis, is part of the work.