Being unable to read a book, not retaining information in meetings, always arriving late, constantly losing your mobile phone, getting lost on the street while making a regular trip, suffering from anxiety, procrastinating… Some of these things can happen to all of us at some point. , or even several. 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. The feeling of loneliness and social maladjustment is aggravated by stigma and social ignorance. Because understanding the ins and outs of the brain with ADHD is not easy, and overcoming the judgment of being a “lazy”, “clueless” or “unstable” person is not easy either.
To resolve doubts about this disorder, Dr. Juncal Sevilla, psychiatrist, co-founder of the first association of adults with this condition in Spain, has just published ADHD in adults: the answer to all your questions (Universo de Letras). Sevilla is also a psychiatrist judicial expert and has been an associate professor at the Autonomous University of Madrid, directing research work focused on adult ADHD.
There is a great 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… Is that right?
Little is known and it is poorly known. There is a lot of talk about hyperactive children, unruly children, children “who are poorly educated and the problem lies with the parents”… There are many myths. Furthermore, a very serious problem with this disorder is that it generates a lot of debate and a lot of division, both in the medical field and in society itself.
Some doctors doubt that the disorder exists… How is it explained?
It is one of the cases in medicine where the debate is absurd. You can doubt whether a pathology has a specific origin or not, how you treat it, how it has evolved. But questioning one’s own existence is something that really happens very little in medicine. Psychiatry is a specialty that in certain aspects is not advanced. Serious mental illnesses (schizophrenia, bipolar disorder, depression…) are well known, the pharmaceutical industry, medical research and society are very aware of the need for help for these patients. The paradox of ADHD is that the symptoms of the disorder themselves are seen as social problems.
Being lazy, lack of concentration, living in a feeling of chaos, anxiety, always being late, constantly losing things, having drastic mood swings… Are all of these, experienced continuously, symptoms of ADHD?
Brothers-in-law, neighbors, siblings, partners and, above all, parents must understand that the behaviors of people with ADHD, often incomprehensible, are symptoms. They are the symptomatic expression of the disorder itself. What must be very clear is that symptoms can manifest in anyone at any time in their life. You can lose your keys one day, I can be in a meeting with my boss and disconnect. On the other hand, for people with ADHD these symptoms are not an exception, but the norm, and they affect all areas of their life, personal, social, and work.
To receive the diagnosis, therefore, all facets of life must be affected. What other factors can affect the diagnosis of ADHD?
Consensus has been developed by experts from all over the world with the diagnostic criteria and to begin to propose the diagnosis, a specific number of them must manifest for at least six months and these symptoms must have a significant impact on all areas of the person’s life. a person. Currently, 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 symptoms before this age or they may not even have been fully expressed based on multiple variables.
You compare the view of ADHD with the seven deadly sins… Are patients seen as sinful, angry and lazy, instead of as sick?
Yes. Imagine a patient who is angry, who has a lack of impulse control, who is always late, who does not listen to you, who loses an iPhone four times, who also has a high risk of falling into addictions… He is not a pleasant patient for patients. psychiatrists, because mental illness usually consists of symptoms that we can see and that we can treat, to which the patient has a response that we expect and that we know. ADHD is purely neurological, but the ins and outs of the neurology underlying this disorder are completely unknown to many psychiatrists.
Attention deficit has several characteristics and these have their origin in the brain. To start, talk about dysfunction in executive functions. What is it about?
Executive functions are the abilities that humans have to achieve objectives, they are processes included within the set of cognition and at the same time they ensure that the rest of the cognitive processes (language, memory, attention, etc.) are properly related. to achieve self-regulation. In people with ADHD these functions are seriously affected. Executive functions emanate from the prefrontal cortex, which is like the control tower of the human being, from where other brain structures (limbic system or emotional brain or reward circuits) are connected to memorize, plan times, maintain attention, regulate motivation or emotions… In the brain with ADHD these areas and connections have a deregulation of both dopamine and norepinephrine.
Lack of motivation is another great symptom or characteristic. How is it explained at the brain level?
Lack of motivation is the so-called (in these cases) laziness, which can lead to difficulty even hanging a washing machine for days. It derives from a lack of regulation in the dopamine pathways, which control 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 deregulation 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 novelty and then give up.
It speaks of severe lack of emotional regulation or “emotional dysregulation” in patients. Up to what point?
They are very reactive people. When something happens to us, normally the limbic system, which is the emotional brain, tells us “now you can’t scream”, “now you can’t cry”, “now you have to be quiet”, depending on the situation. People with ADHD do not have this regulation. If your emotional brain receives a stimulus and your prefrontal cortex, which decides whether or not that stimulus is relevant to having a reaction, is not well regulated, your emotional brain is in charge. With which, you have an explosion of anger, a crying attack or continuous irritability.
What are the causes of ADHD?
The main cause is genetic, although genetic expression is conditioned by multiple environmental factors. For example, if you have genetics to inherit ADHD, some of these factors will determine a greater symptomatic expression of the disorder. In other cases, which are a smaller percentage, ADHD can be “acquired” by factors that already affect neurodevelopment from pregnancy and for which there is already scientific evidence, such as your mother smoking during pregnancy or being very premature.
What other factors influence this genetic expression?
Being premature, being born by cesarean section… everything that has 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, being bullied, having suffered violence, even the parents’ divorce itself.
He says that ADHD normally does not go alone… What pathologies or other problems can it be accompanied by?
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 effects. They are neurodevelopmental disorders that are closely linked, in fact, at the genetic level. But in addition, and in adults it is the norm and not the exception, these people develop problems such as anxiety, depression, addictions or personality alterations throughout their lives.
ADHD symptoms are associated with poor education in childhood. A big mistake?
It’s never because of bad education, ever. Imagine that you can’t sit still and you are continually penalized for it. You can’t help it, even if you try, and you suffer. You want to please and please your teacher, your father or your mother, but you can’t. This is like asking a lame person to run a marathon and also penalizing him because he is not capable.
When do we have to go to the doctor?
When the 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 found out about something that just happened to you. When you get lost 20 times going to work on the same road. When you are distracted in the car and you run a red light, when you have difficulty controlling the impulse to eat or scream. When you are very temperamental. When everything affects you a lot on an emotional level. When you leave your obligations. When you leave everything for last. If all of this happens together in your life, then go to the doctor.
The diagnosis, how is it done?
The diagnosis is clinical: they are questions to the patient, officially validated questionnaires, structured and very long interviews in which specialists check whether the current symptoms were also in childhood or adolescence. From this we make the diagnosis. 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.
The treatment for ADHD, he says in the book, is drugs. Does this generate a lot of reluctance among patients and the medical community?
There is a double standard within psychiatry because the treatment for this disorder is amphetamines, and this is alarming. On the other hand, other types of substances that also have great addictive potential are used for other diseases, such as benzodiazepines (such as Lexatin or Orfidal), and are prescribed by the family doctor calmly, without any shame. Anesthetists or doctors in pain units use drugs derived from opioids, such as tramadol, oxycodone, or morphine patches. When older women have pain due to osteoarthritis or bone fractures, they are given a morphine patch and since you do not change the patch, it will generate an opioid withdrawal syndrome. On the other hand, you tell a family or an ADHD patient that you are going to give them a drug that is clearly going to improve their functionality and quality of life and everyone shakes their head.
What are the most recommended drugs now to treat ADHD? Is there safety about its use?
The first line of treatment is drugs known as “stimulants.” Methylphenidate and lis-dextroamphetamine, which is the latest drug that has been developed and has been worked with in the United States for years, with different formulations. These two names are already scary, but the amphetamines for ADHD that we have on the market are very safe drugs. The side effects that antipsychotics that are given – in low doses – for some behavioral problems in children and disruptive adults can produce are much worse, and there is also great scientific evidence that they are very beneficial with correct doses.
Many adults who surely have ADHD, but don’t know it…
Many people have ADHD and don’t know it, it is a very unknown neurodevelopmental disorder.
Now it is said that “it seems like everyone has ADHD.” Another myth?
There is no more ADHD, it’s just that we diagnose it now. When did celiac disease begin to be diagnosed? Well, relatively recently. 40 years ago, you had a stomach ache all day, diarrhea and a feeling of discomfort that made you die every time you ate gluten or wheat and that’s it. And you didn’t know why, until it was discovered that there is a disease that is celiac disease. Stomach ulcer, until recently we thought it was due to stress!
Life suffering from ADHD without a diagnosis, what consequences can it have?
It’s awful. I dedicate myself to adults, who were not diagnosed as children. They come to consultation with symptoms of trauma, many fears, a lot of anxiety, personality disorders… I see broken adults because they don’t know why all this has happened to them. They have grown up all their lives with the label of lazy people, bad guys, many of them with addictions. Society sees them as misfits. Now there is more attention to neurodiversity and if a kid fails, does poorly or has problems, you take him to the doctor, you take him to the psychiatrist and he focuses in another way.
There are adults with ADHD who have managed to complete university studies, they may be lawyers or engineers…
Nobody understands how a medical doctor or a minister can have ADHD, but the truth is that there are people with this disorder in all spheres of society, although incomprehensibly having a job of great responsibility, they are then unable to know what time they leave. tomorrow your AVE. People with great success at work and with ADHD normally have a lot of intellectual capacity or a very structured family network, the financial capacity to pay for private teachers or medical professionals, a support network in general that helps them compensate for their symptoms. When they grow up they go to the doctor and they are told, “if you have a career you can’t have ADHD,” and that is not true. They may have a career, having put in many hours, having overexerted themselves, and having a lot of anxiety, perhaps with resulting health problems, such as headaches or stress. And the most serious thing, a very low self-esteem.
