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Childhood and adulthood on the same trail: this is how ADHD takes hold on the brain

ADHD is a lifelong neurodevelopmental disorder in which the brain grows differently. This leads to a deficient action of the neurotransmitters involved in pleasure and reward. The name ADHD is somewhat unnecessary as people with the disorder do not have an attention deficit, plus a lack of ability to control what they pay attention to. The hyperactivity part is also not always evident, at least externally. ADHD is commonly associated with problems with “executive function”. These are higher thinking skills, such as planning, task management, cognitive inhibition, and working memory. ADHD was first described in medical texts dating back to the 18th century in the pediatrics section. In fact, it sounds strange to talk about ADHD for adults, given that we are used to hearing about the problem in the pediatric field.

But although it is usually diagnosed in childhood, most people continue to live with ADHD throughout their adult lives. ADHD is estimated to affect approximately 9% of children between the ages of 3 and 17 and 4% of adults in the United States alone. In a 2017 study, researchers found that adults who reported more ADHD symptoms had a higher risk of feeling lonely. Findings from a 2015 study and a 2017 study suggest that social isolation may lead to worse mental health outcomes in both children and adults. Social isolation can be especially harmful for people with ADHD, as ADHD usually occurs with other mental health conditions, including anxiety and depression. Navigating life from home can also lead to big changes in a person’s daily routine. For example, people with ADHD may have a hard time waking up and falling asleep at the same time when they don’t have to leave the house.

Recently, a growing number of people are reporting ADHD symptoms as an adult for the first time, partly due to high-profile cases or the impact of social media. In fact, around 2.8% of adults are thought to live with ADHD, with the vast majority of these undiagnosed. Despite this growing awareness, problems with healthcare resources, poor understanding among healthcare professionals, and the stigma surrounding the disorder mean that many adults have difficulty obtaining a diagnosis. The neurological basis of the disorder means that brains with ADHD often look for ways to stimulate chemicals that have a deficient action, which is why those suffering from the disorder may experience some or all of the main traits: inattention, hyperactivity and impulsivity. These core traits can manifest themselves in a number of ways, including not being able to complete longer tasks, restlessness and seeking out activities, including risky behaviors, that provide immediate reward.

The symptoms of ADHD are largely similar for both adults and children, although ADHD can present differently with age. For example, inattention is the most persistent symptom in adults and hyperactivity is less noticeable. ADHD can be extremely debilitating if left untreated. It has been associated with an increased likelihood of reduced quality of life, increased risk of substance use problems, unemployment or underemployment, accidental injury, suicide, and premature death, among other problems. Furthermore, untreated ADHD is believed to have significant costs to society, due to problems such as medical care and unemployment costs. In addition to the main features of ADHD, a number of commonly associated coexisting conditions are reported in adults with ADHD.

These coexisting conditions include a three times greater risk of mood disorders than non-ADHD adults, a doubled risk of having an anxiety disorder, and a greater risk of eating disorders and obesity. Additionally, about 70% of adults with ADHD also experience emotional dysregulation, making it difficult to control emotional responses. Almost all adults with ADHD are believed to suffer from rejection sensitive dysphoria (RSD), a condition in which real or even perceived rejection or criticism can cause extreme emotional sensitivity or pain. As public awareness of adult ADHD increases, it has become evident that getting diagnosed with ADHD as an adult can be particularly difficult. There have been reports in some areas of baseline times of up to 5 years or more. These long waiting times are due to the need for a diagnosis by a competent psychiatrist.

Even with a referral to a specialist, there are still challenges. The individual must show clear evidence of a significant number of ADHD traits, evidence of the presence of these traits from childhood, and evidence that the disorder has a moderate impact on two separate areas of a person’s life, such as causing problems with work, education or in maintaining relationships. The rise in people seeking referrals means that even private clinics have long waiting periods for diagnosis. While there is now increasing recognition of ADHD in adults, many people continue to live with it undiagnosed for a variety of reasons: lack of awareness that ADHD in adults is the real thing, mistreatment by healthcare professionals, or hesitation in diagnosis. Not to mention the fear of being labeled with something that carries a stigma in society.

Understanding the condition in adults, taking it more seriously as a disorder, raising awareness both in society at large and among health care professionals, and investing in services to improve timing to diagnosis are essential to addressing this growing problem. Improving access to diagnosis and reducing the stigma associated with ADHD would open the door to treatment, which can have a major impact on living with the disorder, such as improving self-esteem, productivity, and overall quality of life.

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

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Scientific references

Chen L et al. J Atten Disord. 2022 Mar; 26(5):723-734.

Lai MC et al. Curr Opin Psychiatry 2022; 35(2):90-100.

Fuller-Thomson E et al. J Affect Disord. 2022; 299:707.

Steele CM et al. J Atten Disord. 2022; 26(2):296-306.

Powell V et al. J Affect Disord 2021 Dec; 295:1153-60.

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Dott. Gianfrancesco Cormaci

Medico Chirurgo, Specialista; PhD. a CoFood s.r.l.
- Laurea in Medicina e Chirurgia nel 1998 (MD Degree in 1998) - Specialista in Biochimica Clinica nel 2002 (Clinical Biochemistry residency in 2002) - Dottorato in Neurobiologia nel 2006 (Neurobiology PhD in 2006) - Ha soggiornato negli Stati Uniti, Baltimora (MD) come ricercatore alle dipendenze del National Institute on Drug Abuse (NIDA/NIH) e poi alla Johns Hopkins University, dal 2004 al 2008. - Dal 2009 si occupa di Medicina personalizzata. - Guardia medica presso strutture private dal 2010 - Detentore di due brevetti sulla preparazione di prodotti gluten-free a partire da regolare farina di frumento enzimaticamente neutralizzata (owner of patents concerning the production of bakery gluten-free products, starting from regular wheat flour). - Responsabile del reparto Ricerca e Sviluppo per la società CoFood s.r.l. (Leader of the R&D for the partnership CoFood s.r.l.) - Autore di articoli su informazione medica e salute sul sito www.medicomunicare.it (Medical/health information on website) - Autore di corsi ECM FAD pubblicizzati sul sito www.salutesicilia.it
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