Attention disorder: Now an adult affliction

Fading fast at the Madras high court, Krishnan paced around in his black and white robe missing key arguments being made by them defendant counsel. It wasn't the first time for this lawyer in his early 30s as he eventually zoned out from parts of the judgement itself. “I just cannot focus,“ Krishnan said throwing up his hands in despair sitting opposite his doctor who scribbled ADHD in the prescription.Attention Deficit Hyperactive Disorder (ADHD) is one of the most prevalent psychiatric conditions diagnosed next to mental retardation across the globe. Though diagnosis of ADHD has been on the rise in India over the last decade, several people go into adulthood without ever acknowledging this condition. What is left untreat ed turns into a serious limitation for adults at work, in developing relationships and achieving life goals.
Krishnan was made to sort and strike numbers in what looked like a train-time schedule to sharpen focus.Having struggled from school to become a practicing lawyer, it was late for him but with a combination of therapy and the most prescribed drug, Ritalin he slowly addressed his difficulties.
Adults with ADHD can be addressed and cured but early intervention is key , say doctors adding that parents and educators should be trained to identify the condition in children which when untreated affects their work life and relationships. “In India, we only see the tip of the iceberg where the most severely affected children come to doctors,“ says Dr Ennapadam S Krishnamoorthy, founder of Neurokrish and Trimed. “In ADHD, hyperactivity is a more visible problem than attention deficit which often goes unnoticed. So despite being intelligent the child's performance is impaired and they end up suffering in school as they may not achieve their potential without the right inputs.“
Short attention spans, lack of focus, restlessness and acting without thinking through are clinical ways of identifying an individual with the condition of ADHD. In adults, doctors first do cogni tive testing to check if there is a lack of intelligence or dyslexia. About 20% to 30% of ADHD individuals are said to be dyslexic and mood swings can at times lead to depression. On the onset, most adults reportedly come to counsellors or doctors assuming they are depressed.
Dr Vasudha Prakash, founderdirector of Chennai based VExcel Centre for Research and Rehabilitation, recalls an IT employee who approached her saying he had all the symptoms that he heard her describe in a radio show but did not know he had this condition. At work, adults with ADHD find it troubling to complete tasks and projects and underperform. “The ills of under-diagnosis is much worse as people don't get help, they get judged and they start thinking poorly about themselves,“ says Dr Prakash.Those with ADHD do well in interviews as they are smart but it becomes difficult for them to achieve deadlines. While they do well in hands-on jobs which requires them to move around, many take up intellectual jobs and develop dependence on addiction such as smoking, he said.
Several factors contribute to ADHD sometimes being an invisible disorder.Teachers and parents often think the child is naughty , careless, and forgetful while some are in denial so the visit to the doctor comes late. “Parents also question medication but it can do wonders,“ says Dr Krishnamoorthy .
Chemical levels in the brain that impair a person's impulse control and attention skills are stabilised with the help of drugs. In several countries these several countries these drugs such as Ritalin and Adderall are misused to either calm children down or adults take them as stimulants. This situation doesn't arise in India as these are scheduled drugs, which makes them harder to get, and safer alternatives such as Addwize, carbamaz e pine, oxcarbazepine and atomoxetine are there.
For years in the US, both diagnosis and treatment of ADHD has swelled, with a nexus between doctors and pharmaceuticals often being alleged. Unlike in western states, the condition is met with a nuanced approach here, say experts. Mental health practitioners are said to make a clear distinction between a clinical disorder and someone with mild symptoms.“ADHD is being diagnosed with more confidence now,“ says Veena Doss, head, department of psychology, Women's Christian College. “Earlier any overactive child would be put under this category . Now doctors and psychologists are asking parents questions and analysing if the hyperactivity is situational or consistent. Some children maybe restless but calm while watching TV or doing something they like. We tend not to put them under medication.“
*Names of all individuals with ADHD have been changed to protect identity