Should You Be Assessed For ADHD? Psychiatrist, Dr Stephen Humphries - Harley Therapy

[Music] my name is dr. Stephen Humphries I'm a consultant psychiatrist I specialize in adult ADHD what a thought I do today is a short video on how you might decide that you want assessment Friday HD in adulthood it's quite a big decision it's not always cheap to get an assessment privately and I've assessed many people over many years and they quite often would like to know beforehand whether or not they're barking up the wrong tree so in order to help you decide I thought I'd run through some of the typical features that presenting adulthood as opposed to childhood and it is rather different what I won't be doing is I won't be going into a doctors called etiology or pathology in other words that we won't be dealing with the causes of ADHD or the structural brain changes or biochemical changes that occur because that's for another video perhaps the first thing to say very clearly this is a common condition there's very very robust research which suggests that about 4% of the population have ADHD in adulthood and that are less than 1% diagnosed so it is massively under diagnosed part of the reason for that is historical if you go to parts of America maybe 6 to 12 percent of people are diagnosed with a condition and that's probably too many in this country it's less than 1% British psychiatry in adulthood always looked at ADHD as part of a hyperkinetic disorder this is not the same condition this is a very severe condition associated usually with brain damage spotting someone with hyperkinesis is relatively straightforward ADHD is a much milder more subtle condition and much more common it also wasn't helped by some very influential research which was carried out in the 1990s which appeared to show that children at the age of 18 magically stopped getting ADHD this was very convenient in some ways and there's still some of that around that adults cannot have ADHD the truth of the matter is that that research was debunked the reason being that they used the wrong scales they used childhood scales for adults and if use adult scale standards if we find that 60 to 70 percent of people retain symptoms but the profile of symptoms differs in adults there's much less hyperactivity there's much less impulsivity although that still does exist and the inattentiveness which is the third of the features remains so an adult is far more likely to present with inattentive features than gross hyperactivity that's relatively uncommon in adults their looks the other question that sometimes raised when we talk about adults with ADHD is surely everybody would respond to treatment with stimulants which are the mainstay of treatments in ADHD you know give people and fret amines or Ritalin they're going to feel more animated better focused this isn't actually true there's been some significant research done recently which shows the people without ADHD who take stimulants to enhance their cognitive performance actually decline in their performance so only people with ADHD that respond properly to treatment what might you notice if you have ADHD and it hasn't been diagnosed and you're an adult you might think you might be feeling that you were always somewhat different perhaps from your siblings maybe you in your family you stood out as rather different in approach to things you often children with ADHD often find it very difficult to sleep they can't settle they have problems with school parents are always being dragged in to complain about naughty children that chatterbox says they're always in detention they're often very active and into sports but in a way that's the easy way to that's the easy form and a lot of people don't present like that particularly if there is not as much hyperactivity children and adults often present with inattentiveness they're described as a daydreamer and if you're lucky enough to be intelligent and this is not the same as concentration concentration is a part of performance related to intelligence but if you're an intelligent child you can coast you can coast through primary school easily you don't need to do anything just it's natural often children in primary school in the early stages of secondary school with ADHD don't do any preparation they don't study they don't they don't do any homework we don't do any coursework they turn it for exams and they're bright and they do that they do well it tends to start to bite however at secondary school I see so many people who got through primary school okay went to secondary school and they needed to hand in coursework they needed to do homework they just didn't do it what they often rely upon is the effect of stress with it with an impending deadline to generate focus what happens is that your adrenal glands respond to the to the fear of an impending exam they start to produce cortisol and adrenaline which drives you into an all-night state of hyper focus so so many people I see day to day got through exams on basically an all-nighter they were unable to work consistently towards a goal and this this is okay at a certain level but it starts to get more and more difficult as you get older because basically what is happening is you're driving yourself into a stressed state to provoke focus and you can't do a levels very easily on that sort of stress you certainly can't do exams or dissertations at university on a night study and what often happens is that people Pikachu CSE's which to an intelligent person are relatively easy to accomplish without much study and they start to flounder at a levels and then they fall apart at university another issue with universities is of course it's a much less structured environment you're told what to do much less and monitored much less and it's quite common for people with ADHD to get through a levels and then to pancake at at university level or if they get a bit further and they end up with doing a master's the dissertation has seven or eight deferrals and it takes years to complete something which should take one year one other misunderstanding about ADHD is that concentration is constant and it isn't people's concentration varies and parents and teachers sometimes say to me Oh work colleagues well if he likes something or she likes something they can concentrate on it well that's not surprising that just happens often people with ADHD have Islands or what's called a hyper focus they can concentrate on computer games for days on end but they can't do ten minutes homework so it's it isn't just about concentrating it's about the nature of the task things like computer games certain pastimes evoke a lot of dopamine release which provokes hyper focus let's be clear the hyperactivity in adulthood is often not present or is or it remains as a bit of fidgeting or restless legs impulsivity is often less in adulthood and children we learn social adaptation social restraints we learn that if we keep on butting into conversations we don't have any friends so we stopped doing it we override and some of those features it's the inattentiveness which often persists into adulthood and our next one to turn to how does that present itself the sort of people that I see in adulthood with ADHD their life is usually a bit of a mess everything's incomplete whether that be the washing the ironing that the the dishes study work meals things get started people get distracted partway through and leave them unfinished the same applies often to careers people with ADHD often have mote have had multiple jobs they enter they enter a job or a qualification with enthusiasm and then run out of steam so they've often had several attempts at university move job every few months or every year or so as they lose interest and they lose the dopamine drive procrastination is a mainstay of ADHD I've never seen anybody with ADHD who didn't procrastinate they put things off till the very last moment particularly things which they don't want to do but also anything that is fairly routine so tax returns don't get sent in bills don't get paid and court summons has come for unpaid traffic fines things like that most people with ADHD in adulthood are intensely distractible both to external stimuli but often also to internal thought they cannot stick with a train of thought without becoming diverted to something else which leads to what's called difficulties with sequential processing so they do not do ABCD they do a D F n Z B and go back again and leave everything incomplete in the meantime another common feature of ADHD in adulthood is a zoning out as it's called you're talking to a person and you can tell they're not really listening they're thinking about something else and often they can come back into focus but there's a there's a drift and the eyes disappear as they start to think about what they're going to do later on that day perhaps or something totally inconsequential people with ADHD in adulthood often but will not always have difficulties with sustaining relationships difficulties with maintaining consistency in relationships and so they often move from one relationship to another the early stage is when there's a lot of excitement and drive it engages them and then they move on adults with ADHD very very commonly have associated what's called comorbid mood disorder or emotional dysregulation which is usually a sense of anxiety frustration and low-grade depression often misdiagnosed as depression but it's a consequence of the the chronic disorganization people may self-medicate they may go into phases of substance misuse particularly stimulant drugs which of course produce an improvement in focus and concentration and often not the euphoria that somebody without ADHD experiences and the other thing to say is that a common treatment for mood disorders are SSRI antidepressants SSRI antidepressants tend to make ADHD slightly worse a serotonin which is the the chemical increased by those antidepressants has an antagonistic effect towards dopamine there are antidepressant treatments which work much better in people with ADHD but the standard sertraline prozac citalopram often reduce anxiety but they often do not improve the the concentration so that's probably as much as I want to say for today in the setting of a short video which is aimed at people with ADHD who don't sustain their concentration much longer than 10 minutes so I'm not going to go on for hours it is a common condition just to recap a common condition often misdiagnosed under diagnosed eminently treatable the modern treatments are much better there are treatments which lasts all day which are non addictive to not induce tolerance and which do not have serious side effects those treatments do not need to be taken every day there and this this is a an eye-opening moment for a lot of patients they realize that they're not behold them they don't have to take the treatment every they may have days off and may have weeks off there's some very good long-term research recently which shows that nearly everybody on treatment for ADHD has breaks whether it be long or short it's not a life sentence it's a bit like these a pair of glasses you you you wear in order to focus when I go swimming I don't wear my glasses I don't need them so it's the same with ADHD treatments people may use them times of study some may use them all the time but often you can have breaks and there is no need for continued treatment and they work straight away once the appropriate dose is achieved so there's a lot that can be done out there and hopefully this video will give you some idea of the sort of things to look for if you're considering that maybe you have a problem and it needs assessment thank you

Channel: Harley Therapy - Psychotherapy & Counselling

Views: 1,300,887

Keywords: Stephen Humphries, ADHD, hyperkinetic disorder, symptoms of ADHD, ADHD research, health counselling, counselling, treatments, medical treatments, medical counselling, psychotherapy, adulthood, behavioural therapy, therapy, dysfunctional relationships, Dr Stephen Humphries is a consultant psychiatrist, Dr Stephen Humphries, psychiatrist, harley therapy - psychotherapy & counselling, harley therapy, adult adhd, adhd assessment, do i have adhd, adhd psychiatrist, adhd london psychiatry

Id: lSjHYiTEA4M

Length: 13min 36sec (816 seconds)

Published: Fri Sep 20 2019

Reddit Comments

[u/NovSnowman]

A 13 min long video ? I'm not watching that

[u/callmefed]

I trailed off after 30 seconds. Very successful video at diagnosing ADHD in adults.

[u/radiant_waffle]

I can actually comment on this video as someone who was diagnosed with ADHD as an adult. I was assessed for it in my last year of university studying computer science. Growing up I was definitely hyperactive but only somewhat more than most and I did well in school so there wasn't cause for concern. During junior high when that hyperactive behavior would be more prominent I was actually also suffering with undiagnosed hypothyroidism which significantly slowed my metabolism and energy levels. So any and all behavioral/education challenges were blamed on that for the following years. In university my hypothyroidism was being properly treated and my energy levels were at a "normal" amount but I seriously struggled with classes, dropping out of some and failing others.

I don't mean to sound proud but it was the psychologists words not mine. Apparently the reason I was not diagnosed until after most of university was because I was able to compensate for distraction by being smart in other areas. So the words of this video where he describes an ADHD person not studying at all and then doing alright on the test by picking it up as you go, is something I have done far too often. I can also personally relate to the idea of being able to focus on somethings for hours while not even 5 minutes on studies. One thing that convinced me to get assessed was when I struggled to focus on things I wanted to do that weren't constant dopamine feed like prepping a D&D session, or practice an instrument.

I now work a programming job and I started taking medication and it has seriously improved my focus. It's not that I don't get distracted, but that I don't lose focus within 30 seconds of starting something.

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[u/h8bearr]

Misspelled psychiatrist on this dude's name marquis thing

[u/6footdeeponice]

I disagree with him about giving neurotypical people amphetamines. The studies I've read say that everyone DOES benefit from stimulants, it's just that neurotypical people should only take a very small dose.

A normal person on 5mg of amphetamine is going to be more motivated. But yes, give the average person 50mg and they'll be acting like a coke head.

But here's the thing, how do we know the people with ADHD aren't just tolerant of stimulants? Surely the people with ADHD have been treated in the past, so they'll have a tolerance and be able to handle larger doses than a person without adhd who probably hasn't ever taken amphetamines.

I've been diagnosed with ADHD late in life, and I found the amount of stimulants to be too high, and I think it would have been better for me if the doctor started at 5mg or 10mg instead of jumping right to 40mg.

As I get older, Even caffeine is starting to have a stronger effect in me, and I think adults might metabolize stimulants differently, more slowly, or something like that.

It all feels very unfair to me that because of the stigma on stimulants, I can't test out taking the amount of stimulants I want, because doctors are so strict and sometimes demand you take drug tests to confirm you aren't taking too much or too little of the drug. Because in my case I'd probably be splitting up my pills to take much less.

Sorry about the essay, I'm just pretty mad about all this, I've resigned myself to self medicating with caffeine and sometimes nicotine gum when I really need to focus. I've noticed a lot of my friends that can't seem to quit nicotine act like they might have ADHD and they're self-medicating.

[u/Laughing__Man]

Just curious because these videos always make me feel like I have adult ADHD. How does a person getting medication feel different? Does it allow them to concentrate on other things equally as other "islands of concentration" that some people with ADHD have? Is the goal to stop them from daydreaming or fidgeting their leg as often?

Whats wrong if you ultimately don't treat ADHD? just stay an unproductive adult?

[u/jonofthesouth]

Interesting. Apologies for my ignorance, but what exactly is the difference between diagnosable ADHD disinterest/distraction/procrastination that he describes and the everyday disinterest/distraction/procrastination that I would imagine most of us experience. Putting off the tax return is something I also experience because, well, it’s very boring. I’m also very likely to stop reading/turn off something I’m not interested in. I am not trying self diagnose, I’m just trying to understand when that might be considered an illness? It seems quite normal behaviour for myself and many I know.

My nephew will sit for a long time playing his Switch or watching Transformers on Netflix. However, he struggles to sit still when doing his maths homework. Is this an illness or simply that he’s not interested in the maths homework?

[u/[deleted]]

succinctly

13 minute long video