Being unable to read a book, not retaining information in meetings, always being late, constantly losing your mobile phone, getting lost in the street on a regular route, suffering from anxiety, procrastinating… Some of these things can happen to us all once, or even several times. But when these situations color everyday life and deeply affect a person’s social, work and personal life, they can be symptoms of ADHD, attention deficit hyperactivity disorder.
According to the latest scientific research, between 2.58% and 6.76% of the world’s adult population suffers from ADHD, often without a clear diagnosis and with great uncertainty.
Doctor Juncal Sevilla, psychiatrist, co-founder of the first association of adults with ADHD in Spain, has just published ADHD in the adult: la respuesta a muchas de estas preguntas. Science and rigor for skeptics and unbelievers (Universo de Letras).
There is a gap between scientific knowledge and popular knowledge of the disorder. ADHD, for many people, is still a legend, something that is not clear if it exists at all. Is it like that?
Little is known about it. There is a lot of talk about hyperactive children, rebellious children, children “who are ill-mannered and the problem is the parents”… There are many myths: the symptoms of the disorder are seen as social problems.
Being lazy, lacking concentration, living in a sense of chaos, anxiety, always being late, constantly losing things, having drastic mood swings… Lived continuously are symptoms of ADHD?
Brothers-in-law, neighbors, siblings, relatives and especially parents must understand that the behaviors of people with ADHD, often incomprehensible, are symptoms. They are the symptomatic expression of the disorder itself. What should be very clear is that the symptoms can manifest themselves in anyone at any time in their life. 12 years is considered the age before which they must have manifested. This is a problem because sometimes it is difficult for adults to remember if they had the symptoms before that age or they may not have fully expressed them depending on multiple variables.
Attention deficit has different characteristics that originate in the brain. You talk about dysfunction in executive functions. What is it about?
The executive functions are the capacities that humans have to achieve goals, they are processes included within the set of cognition and at the same time they are responsible for ensuring that the rest of the cognitive processes (language, memory, attention, etc.) are properly related to achieve the self regulation In people with ADHD these functions are affected.
Lack of motivation is another major symptom or characteristic. How is it explained on a cerebral scale?
The lack of motivation is the so-called (in these cases) laziness, which can lead to difficulties even to extend a washing machine for days. It stems from a lack of regulation in the dopamine pathways, which command the desire to do something. Patients have physical difficulty doing things as simple as picking up a pencil from the floor. This happens because there is a dysregulation in some brain structures, in the reward circuit, which makes them need much more intense rewards. That’s why they always get bored, look for something new and then give up.
What are the causes of ADHD?
The main cause is genetic, although genetic expression is conditioned by multiple environmental factors.
What other factors influence this gene expression?
Being premature, being born by caesarean section… everything to do with pregnancy and the birth process. There are also factors that make the symptomatic expression more serious, such as having adverse experiences in childhood, having been bullied, having suffered violence, even the divorce of the parents.
He says that ADHD usually doesn’t go away on its own…
It can be accompanied by other neurodevelopmental disorders such as dyslexia, reading comprehension problems or autism. A brain that has developed abnormally will involve other affects. They are neurodevelopmental disorders that are closely linked, in fact, in the genetic field. But in addition, and in adults it is the norm and not the exception, these people develop throughout their lives problems such as anxiety, depression, addictions or personality changes. They can be broken people.
When should you go to the doctor?
When symptoms affect all areas of your life. When they talk to you and you think about something else. When you see that you haven’t learned about something that just happened to you. When you get lost 20 times going to work the same way. When you’re distracted in the car and run a red light, when you have difficulty controlling the urge to eat or scream. When you are very temperamental. When everything affects you very emotionally. When you leave your obligations. When you leave everything for the end. If all this happens together in your life, then go to the doctor.
How is the diagnosis made?
It is clinical: they are officially validated questionnaires, structured and very long interviews in which the specialists check whether the current symptoms were also present in childhood or adolescence. We cannot do an MRI because ADHD is not seen in static neuroimaging, it is seen in functional neuroimaging, that is, in imaging tests that are not routinely done.
What are the most recommended drugs for ADHD?
The first line of treatment is drugs known as “stimulants”. Methylphenidate and lis- dextroamphetamine. They are safe drugs.
