What is ADD?

Dr Wian Meintjes a Psychiatrist at Busamed Harrismith Private Hospital explains more about ADD.

1. What is ADD?

ADD (Attention Deficiency Disorder) or formally ADHD (Attention Disorder; Hypo activity Disorder) is an illness which is present from birth (a neuro-developmental disorder) in 3-5% of children.
60 – 70% of children carry symptoms on into adulthood.

The ADD term started being used for adult patients as the hyperactivity aspect of the illness minimize with

• Inattention
• Impulsion

Being the dominant dysfunction in the adult group.

The precise causes of ADHD is still unclear, but genetic heritability of ADHD is estimated to be between 70-80%.
Parents & siblings of children with ADHD have 2-8% X higher incidence than the general population.

The ADD patient has impaired executive functions.

2. What are executive functions? (EF)

EF refers to brain functions that

• activate
• organize
• integrate
• manage other functions of brain integration

EF enables a person to

• Account for short- & long-term consequences of their actions & plan for those results
• Help people to make real time evaluations of their actions & make the necessary adjustments if those actions are not achieving the desired results.

How does ADD impact EF:

1. Diminished attention
2. Increased impulsivity

These 2 aspects are involved in every aspect of EF. With the ADD brain, pervasively dysfunction of EF, leads to various clinical symptoms of the illness.
Leading to difficulty in

• Behavioral
• Cognitive
• Social
• Planning
• Task Completion
• Impulsion

3. How is ADD diagnosed?

There is no test i.e. blood test, brain scan or any other diagnostic test to make the diagnosis. It is a clinical diagnosis.

Other diseases that can mimic ADD (i.e. overactive thyroid gland; substances; seizures; sleep apnea).
A questionnaire with 6 questions can help in guiding diagnosis.

The clinical presentation can include:

• Inattention
• Forgetfulness
• Distractibility
• Chaotic presentation
• Difficulty listening
• Temporary hyper focus for high enjoyable or work-related tasks
• Getting details lost
• Procrastination with difficulty in finishing tasks
• Difficulty in organising tasks
• Mind wandering
• Mental restlessness

The Dysfunction must have at least moderate impairment in more than 2 settings: family, social, occupational, and academic impact.

4. Why treat ADD?

ADD is now being diagnosed more frequently, it remains one of the areas of Psychiatry which is misunderstood & incorrectly managed in this time. People with ADD can function & reach great heights in life, however, untreated ADD can have alarming consequences and is associated with higher incidences of:

• Work problems & unemployment
• Financial problems
• Alcohol substance misuse
• Higher incidence of car accidents & other accidents
• Unstable relationships, higher divorce rates
• Poor physical & other mental health issues (Depression ext.)
• Poor self-image

5. How is ADD treated?

Stimulant medication is the corner stone for ADD treatment.
Other forms of treatment include:

• Exercise
• Skills training
• Counselling
• Behavioural Therapy
• Cognitive Behavioural Therapy (CBT)
• Mindfulness

The non-medication aspect of treatment is used to:

• Improve time management & organisational skills
• Learn how to reduce impulsive behaviour
• Develop better problem-solving skills
• Cope with past academic, work & social failures
• Improve self-esteem
• Learn ways to improve relationships with family, co-workers & friends
• Develop strategies for controlling anger

6. Medication

The term hyperactivity in ADHD can wrongly be interpreted as an over stimulated brain. An ADD brain is under stimulated. As a theoretical example, a non-ADD persons sitting & resting brain is functioning at approx 80%. (Theoretical estimate). The ADD person is 50%. Therefore, the ADD patient needs stimulant medication.

Until fairly recently Methylphenidate (Ritalin, Neucon, Contramyl etc.) was the only stimulant available in South Africa. Two new stimulant medications of the Amphetamine group functioning (Vyvance, Amfex) are also now available in South Africa.

Medication/treatment must be individualised for every patient. An open, frank & ongoing discussion on the manner in which the long-term chronic condition should be managed, is essential. Therefore, the treatment decision is a shared decision between a treating doctor & patient.

7. Not only Concentration & Cognitive Function

Emotional de-regulation is a lesser-known aspect of ADD but can have a debilitating impact on emotional functions.
These symptoms include:

• Mood liability
• Irritability
• Emotion Impulsivity
• Low tolerance for frustration
• Anger outbursts
• Pre-menstrual increase

8. Co-morbid conditions

Co-Morbid conditions are other Psychiatric illnesses which might present with the diagnosis of ADD.
Statistically about 89% of adults with ADHD has at least 1 co-morbidity.

• Bipolar Mood Disorder 23% co-morbidity (Normal population BMD 3%)
• Depression
• Anxiety
• Substance use disorders (Alcohol, codeine, cannabis etc)

Treatment of ADD in a patient with a substance use disorder is paramount as both disorders can worsen the other. This is a dual diagnosis & would lean more to referral to a Psychiatrist.

9. Chronic Condition

The medication/treatment does not cure ADD. As with another chronic illness regular follow ups & evaluation of medication is paramount. Informing a partner with an explanation of the diagnosis, treatment & couple/family therapy are aspects to explore.

10. Do I need to use the mediation everyday & how long must I take medication?

These questions must be individualised in every patient Certain patients will only take medication during stressful periods. Other will take stimulant holidays. Most of the patients will be on chronic daily medication.

There is also a non-stimulant form of treatment, but results are not as good as stimulants (Atomoxivine) in adult patients.

If you think you have some of the symptoms, visit your GP. They will assist you in the diagnosis, management & need for referral to a psychiatrist or psychologists as needed.