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Psychiatrist at the Upper Psychiatric Clinic explains ATH diagnosis

Is it really lazy, stupid and sloppy or 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 be a diagnosis of ATH. Dr Katre Pääso, a psychiatrist at the Ülemiste Psychiatric Centre, explains how to recognise such people and how to support them to bring out their best qualities.

“Personally, ATH speaks to me perhaps more than to the average Estonian and psychiatrist, because I have closer contact with ATH than just in a professional sense. Accordingly, ATH diagnosis, information on ATH and making the environment in schools and workplaces more ATH-friendly is very important to me,” says Dr Pääso. Whereas about 10-15 years ago, at least in Estonia, we were only talking about ATD in children, today we have come to understand that this neurobiological disorder cannot disappear completely and continues to occur in adulthood.

Already present at birth

First of all, your doctor will want to explain that ATH is not a disease. “ATH is not a disease, it is 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 ATH. The difference is that while illnesses develop during life for a triggering reason or reasons, ATH is present in a child from birth,” he says, adding that ATH could be called a 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 loved ones can do to make a person with ATH feel as comfortable as possible. First of all, Dr Pääso recommends taking ATH as it is. “ATH is often not taken seriously, which causes a lot of suffering for the person trying to cope. ATH is hard for loved ones who don’t understand it and for whatever reason refuse to accept it as a special condition, but even harder for the person who has ATH and whose loved ones refuse to believe it.” According to the doctor, ATH is hereditary in 60-80% of cases, and so it is present in addition to some other family member, either in a more severe or milder form. “On the one hand, this may be a factor that helps to understand the person with ATH 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 ATH are alike. “ATH is a ‘spectrum disorder’, which means that it has a huge number of different manifestations. There is both high-functioning ATH and more severe ATH. It has been suggested that people with ATH have a higher than average intellect, but no clear link has been found. Certainly, however, people with ATH 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 poorer attention, inattention, impulsivity, hyperactivity, etc.”. The growing environment certainly plays a big role in this, and one of the most important influences, according to the doctor, is a supportive and understanding attitude.

The ATH could also be seen as a kind of different brain, which, under the right conditions, can surprise us with its special abilities. People with ATH are often very bright, hard-working and creative. “They include entrepreneurs, creatives, athletes, scientists, doctors, teachers, etc. This ‘out of the box’ thinking, creativity and 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 ATH.” 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. “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 ATH are also at 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 ATH, 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 ATH, we will understand where these symptoms come from, which unfortunately create such misconceptions.” The good news is that nearly 80% of ATH is treatable. “Compared to depression, for example, this is a very good indicator,” he says. In adults, treatment raises dopamine levels in certain areas of the brain to improve concentration and reduce signs of hyperactivity and impulsivity. “The main drugs used for this purpose fall under the category of stimulants, which are considered the most effective in the treatment of ATH worldwide.” According to Dr Pääso, it is very important to start 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 ATHs 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 ATH in adults lately, but given the fact that although about 1/3 of children with ATH have symptoms that subside as they mature into adulthood, and it is estimated that about 2/3 of children with ATH have persistent symptoms, we cannot yet speak of overdiagnosis, but rather that ATH is still underdiagnosed. Worldwide, the prevalence of ATH in adults is estimated to be around 5% on average ATH is diagnosed by a psychiatrist. “ATH diagnosis is based on the life history. ATH 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,” he explains.

In addition, Dr Pääso is keen to stress that ATH is not a new-age disease. “ATH 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 ATH as we know it, known in English as ADHD (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).