Should we say lazy, stupid and sloppy or instead bright, hardworking and creative? There are some people who perceive the world a little differently and find it difficult to cope with everyday routines. They are often labelled as lazy, stupid and lazy, but this is far from the truth. It could instead be a diagnosis of ADHD. Dr Katre Pääso, a psychiatrist at the Ülemiste Psychiatric Centre, explains how to recognise these people and how to support in bringing out their best qualities.
“I personally probably find ADHD more interesting than the average Estonian and psychiatrist, because I have a closer connection with ADHD than just in a professional sense. Because of this, ADHD diagnosis, spreading information on the topic and making school and workplaces environments more ADHD-friendly is very important to me,” says Dr Pääso. Until about 10-15 years ago, at least in Estonia, we were only talking about ADHD in children, where today we have come to understand that this neurobiological disorder cannot disappear completely and continues to manifest in adulthood.
Already present at birth
First of all, any doctor will explain that ADHD is not a disease. “ADHD cannot be named a disease, it is instead a neurodevelopmental disorder. To put it simply, we divide people into ‘neurotypical’ and ‘non-neurotypical’, the latter including autism spectrum disorder, which sometimes has overlapping symptoms with ADHD. The difference is that while illnesses develop during life for a triggering reason or reasons, ADHD is already present in a child from birth,” he says, adding that ADHD could be called a special trait, not a disease or disorder, despite the fact that the International Classification of Diseases (ICD) has long referred to it as an activity and attention disorder.
There is a lot that the closest ones can do to make a person with ADHD feel as comfortable as possible. First of all, Dr Pääso recommends taking ADHD as it is. “ADHD is often not taken seriously, which causes a lot of suffering for the person trying to deal with it. ADHD is also hard on loved ones who don’t understand it and for whatever reason refuse to accept it as a special condition, but it is even more difficult for the person who has ADHD and whose loved ones refuse to believe it.” According to the doctor, ADHD is hereditary in 60-80% of cases, and so in addition it is present in some other family members, either in a more severe or milder form. “On the one hand, this may be a factor that helps to understand the person with ADHD better, but on the other hand, it is also quite common for people of the older generation to question the diagnosis of a child or grandchild, brother or sister, saying that they have the same thing and that it is all normal.”
Not just weaknesses
As an interesting fact, Dr Pääso points out that no two people with ADHD are alike. “ADHD is a ‘spectrum disorder’, which means that it has a huge number of different manifestations. There is both high-functioning ADHD and more severe, problematic ADHD. It has been suggested that people with ADHD have a higher than average intellect, but no conclusive link has been found. It is certain, however, that people with ADHD have many strengths alongside their weaknesses, and how well we cope depends to a large extent on how well our brains are able to compensate for so-called deficits such as poor attention, lack of focus, impulsivity, hyperactivity, etc.”. The environment in which we grow up certainly plays a big role in this, and one of the most important influences, according to the doctor, is a supportive and understanding attitude.
A person with ADHD could also be seen as having some kind of different brain, which, under the right conditions, can surprise us with its special abilities. People with ADHD are often very bright, hard-working and creative. “They include entrepreneurs, creatives, athletes, scientists, doctors, teachers, etc. This ‘out of the box’ thinking, creativity, big picture vision, courage, spontaneity and high energy are qualities that are, after all, driving forces in life and tend to be more endowed with ADHD.” One of these typical figures in Estonian literature is, for example, Joosep Toots. However, according to the doctor, one must bear in mind that everything always comes at the cost of something else. “At the same time, we must not forget that because it all comes at the expense of something (the plasticity of the brain and compensatory mechanisms), people with ADHD also have a high risk of burnout. Most of them end up seeing a psychiatrist for other reasons such as depression, anxiety, sleep disorders, etc.”
More treatable than depression
One of the biggest myths about people with ADHD, according to Dr Pääso, is that such people are simply considered lazy, stupid and lazy. “However, if we get to know the peculiarities of the brain of a person with ADHD, we will come to understand where these symptoms, which unfortunately create such misconceptions, stem from.” The good news is that nearly 80% of ADHD is treatable. “Compared to depression, for example, this is a very good indicator,” she says. In adults, treatment raises dopamine levels in certain areas of the brain in order to improve concentration and reduce signs of hyperactivity and impulsivity. “The main drugs used for this purpose falls under the category of stimulants, which are considered the most effective in the treatment of ADHD worldwide.” According to Dr Pääso, it is very important to start the treatment in childhood. “In children whose treatment is started early enough, at the beginning of their school years, studies show that the brain can be ‘retrained’ and in some cases treatment is no longer necessary in adulthood.
Unfortunately, about two thirds of ADHD cases left untreated in childhood will continue to show symptoms, to a greater or lesser extent, in adulthood.” According to Katre, there has been a lot of talk about ADHD in adults lately, but even despite the fact that about 1/3 of children with ADHD have symptoms that subside as they mature into adulthood, and it is estimated that about 2/3 of children with ADHD have persistent symptoms, we cannot yet speak of overdiagnosis. It is rather so that ATH is still underdiagnosed. Worldwide, the prevalence of ADHD in adults is estimated to be around 5%. On average ADHD is diagnosed by a psychiatrist. “ADHD diagnosis is based on the life history. ADHD is a neurodevelopmental trait, which means that symptoms must have started in childhood. The clinical findings, i.e. the observations made during the admission in the patient’s behaviour, state and other characteristics, are certainly important. The diagnosis is further supported by psychological tests, of which there are various types,” she explains.
In addition, Dr Pääso is keen to stress that ADHD is not a new-age disease. “ADHD has always existed, but it officially emerged as a diagnosis in the 1960s as a childhood hyperkinetic disorder, and in the 1980s its name was changed to ADHD, as we know it now (attention deficit disorder with or without hyperactivity).”
Dr Katre Pääso, psychiatrist at the Ülemiste Psychiatric Clinic Dr Katre Pääso
In case of ATH problems, please contact the Ülemiste Psychiatric Centre of Ülemiste Health Centre (Valukoja 7).