Child and Adult ADHD
(Attention Deficit Hyperactivity Disorder)
In Singapore, Attention Deficit Hyperactivity Disorder (ADHD) or its attention deficit only subtype Attention Deficit Disorder (ADD) has often been traditionally thought to be a disorder occurring only in childhood.
Simplistically speaking, scientists once believed that ADHD is a disorder resulting from a delay in neurodevelopment of the child and as the child grows older, the brain matures and the symptoms of ADHD will stop.
However, research has consistently showed that it is a chronic illness and 6 in 10 children will continue to have symptoms of attention deficit and poor concentration in adulthood. As the child matures, his or her symptoms may change. Symptoms of hyperactivity will decrease with maturity while symptoms of attention deficit often persist.
In adulthood, patients may no longer be fidgety or noisy. Instead they complain mainly about having a hard time concentrating on what is going on and being easily distracted. They may have under-achieved in almost every part of their life, and even in relationships. Their life is in chaos and they may lose track of time and end up running late for appointments. They are forgetful and constantly forget to complete tasks.
Adult ADHD
Adult ADHD
If your spouse or partner has this condition, you may notice the following symptoms:
Inattention
- Disorganization, forgetfulness
- Poor time management
- Misses part of conversation
Hyperactivity
- Inner restlessness
- Inability to relax
- Feeling down when inactive and happy when stimulated
Impulsivity
- Interrupting, impatient
- Recklessness, impulsive decision making
- Switching tasks rapidly
Despite the seemingly less serious behavioural symptoms in adults, adult sufferers can continue to be afflicted with serious functional difficulties in their lives which can significantly impair their work and family relationships if not treated.
Check if you have symptoms of Adult ADHD here.
Management and Treatment of ADHD
Medications are effective in the treatment of Adult ADHD. There are two main type of medications:
- Stimulants: In Singapore, methylphenidate is used in the treatment of Adult ADHD. Two third of adults given medications show significant improvement in their symptoms following medications. Shorter acting stimulants (eg. Ritalin) wear off quickly, and adults with ADHD may be forgetful and have difficulty with giving themselves multiple doses throughout the day. As such, most adult patients prefer the long acting version of methlyphenidate (eg. Concerta LA).
- Non-stimulant: Atomoxetine (Strattera) is a non-stimulant medication used for the treatment of ADHD for adults as well as children and adolescents. It is a nordrenagic reuptake inhibitor and works by increasing the level of neurotransmitter responsible for concentration and focus.
Childhood ADHD
Childhood ADHD
If your child has this condition, he or she may have the following symptoms:
Inattention
- Fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
- Has difficulty sustaining attention in tasks or play activities
- Does not seem to listen when spoken to directly
- Does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- Has difficulty organizing tasks and activities
- Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
- Easily distracted by extraneous stimuli
- Forgetful in daily activities
Hyperactivity
- Fidgets with hands or feet or squirms in seat
- Leaves seat in classroom or in other situations in which remaining seated is expected
- Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- Has difficulty playing or engaging in leisure activities quietly
- Is often “on the go” or often acts as if “driven by a motor”
- Talks excessively
Impulsivity
- Blurts out answers before questions have been completed
- Difficulty awaiting turn
- Interrupts or intrudes on others (e.g., butts into conversations or games)
Management and Treatment of ADHD
In children, the first line of treatment is often therapy with behavioural modifications. Medications may be recommended by the child psychiatrist / medical doctors to enable the child to cope with the ADHD symptoms especially when he or she is not coping well at home and in school. This will help prevent the child with ADHD from being labelled as a naughty or lazy child by his teachers and parents. Punitive actions from adults and ostracization from peers due to their impulsive behaviours are factors leading to alienation of ADHD children and worsening of their behaviour.
Medications
Medications are part of best practices required in the treatment of ADHD / ADD by psychiatrists. These are some medications available in Singapore.
Stimulants:
Stimulants are the most commonly prescribed medications for ADHD. They work by increasing the levels of dopamine and norepinephrine in the brain, which can improve focus, attention, and impulse control. Stimulants are available in short-acting and long-acting forms.
a. Methylphenidate (Ritalin, Concerta):
- Short-acting stimulant that can be taken multiple times a day, usually 2-3 hours apart.
- Available in immediate-release (IR) and extended-release (ER) forms.
- IR formulations typically last 3-4 hours, while ER formulations can last up to 12 hours.
- Side effects may include loss of appetite, insomnia, stomach upset, tics, and mood changes.
b. Lisdexamfetamine (Vyvanse):
- Prodrug that is metabolized into dextroamphetamine in the body.
- Available in capsules that can be taken once a day.
- Typically lasts 10-12 hours.
- Side effects may include loss of appetite, insomnia, stomach upset, tics, and mood changes.
Non-stimulants:
Non-stimulant medications are sometimes prescribed for people who cannot tolerate stimulant medications or who have certain medical conditions that make stimulant use risky. Non-stimulants work by increasing the levels of norepinephrine in the brain, which can improve focus, attention, and impulse control.
a. Atomoxetine (Strattera):
- Non-stimulant that is taken once or twice a day.
- Typically takes several weeks to reach full effectiveness.
- Side effects may include nausea, dry mouth, dizziness, and mood changes.
b. Guanfacine (Intuniv):
- Non-stimulant that is taken once a day.
- Typically takes several weeks to reach full effectiveness.
- Side effects may include drowsiness, dizziness, and low blood pressure.
c. Bupropion (Wellbutrin):
- Bupropion is an atypical antidepressant that is sometimes prescribed off-label for ADHD treatment.
- It is thought to work by increasing the levels of dopamine and norepinephrine in the brain.
- Bupropion is typically taken once or twice a day, and may take several weeks to reach full effectiveness.
- It is available in immediate-release (IR) and extended-release (ER) formulations.
- Side effects may include insomnia, dry mouth, headache, and nausea.
- Bupropion may also increase the risk of seizures, especially at higher doses.
It is important to note that medication alone may not be sufficient for managing ADHD and that other treatments such as therapy and lifestyle changes may be necessary. Additionally, the above medications may have different side effects and efficacy for each individual, and a medical professional should always be consulted before starting any medication.
