New research highlights the need for earlier diagnosis of ADHD

High levels of suicide attempts, self-harm and suicidal ideation in adults with attention deficit hyperactivity disorder (ADHD) have been highlighted by new research from Ireland.

According to a study by Professor Jessica Bramham, Professor of Neuropsychology at UCD’s School of Psychology, one in five adults with ADHD said they had attempted suicide, a further 61% had had suicidal thoughts, while 50% s were mutilated.

“I was surprised with the results,” she says. Having worked with adults with ADHD for 20 years, first in the UK and then Ireland, “I knew it was there, but, without asking, I wasn’t sure what the rate would be.”

Some 90% of people who took part in the survey had been diagnosed with ADHD only in adulthood.

ADHD is the most common childhood neurodevelopmental disorder, affecting about 5-7% of children and persisting into adulthood in about 80% of cases. The main symptoms include inattention, impulsivity, and hyperactivity, along with additional emotional dysregulation.

Bramham doesn’t want parents of children who have been diagnosed with ADHD to think an increased risk of suicide is inevitable because “it certainly isn’t.” Most of these adults have not been diagnosed in childhood and are experiencing more difficulties.

Professor Jessica Bramham, professor of neuropsychology at UCD’s School of Psychology, says a likely factor is mental health, ‘not fitting in, feeling different, the susceptibility to rejection that people have’

It’s not having the emotional brakes to slow down and react rather than react to situations

“If your child has been diagnosed, it can’t be better than that,” she says, and she hopes the results will encourage parents who might be undecided whether or not to have a child evaluated for ADHD, to move on. before, so that they can be treated if diagnosed. She fears the crisis at South Kerry CAMHS, where a review found 240 young people had received substandard care, could deter people.

“It was an anomaly, I hope. Many of them are very well cared for, do very well and avoid a lot of difficulties in adulthood.

As to why ADHD would be an independent risk factor for suicide and self-harm, she says her “clinical hunch” is that it’s linked to emotional impulsivity. “It’s not having the emotional brakes to slow down and react rather than react to situations.”

Another likely factor is mental health, “not fitting in, feeling different, susceptibility to rejection from people”. She is also very concerned that although ADHD is more widely recognized in higher education and accommodations are provided for affected students, there is still a lack of professional help.

“The problem is that the services, in terms of psychiatry, are just not there to support them.” If you find you are struggling in the first semester of your degree, it may not be until you fail your first set of exams that you decide to do something about it. “You try to get on a waiting list and it can take 18 months before you’re seen and your degree is over.”

People with ADHD can get by in elementary and high school undiagnosed because the school system and parents are supportive. At the third level “where it’s a lot more about being self-motivated and self-disciplined and having organizational skills, it’s really difficult for people.”

The indication that some children are “growing up” with ADHD is due to several factors, she believes. “It depends on how you define ADHD in adults. Boys who are more hyperactive and impulsive in childhood, it seems to burn out. But what could happen is that it becomes internalized – that their inner world becomes very restless and this is not on the symptom checklist.

However, she also thinks that brain changes as young people grow up reduce the incidence. The prevalence rate among the adult population is estimated at 3.4%.

It also depends on people’s circumstances. “ADHD is a big problem in educational institutions where you’re expected to sit still, quiet and cooperative, whereas if people find the right job and the right partner, they can really relate. flourish and the symptoms become a strength rather than a problem.

“Unfortunately a lot of people will pick up other things along the way – so mental health comes into play, along with anxiety and depression.”

About 50-70% of adults with ADHD also have a mental health problem.

Dr Margo Wrigley, clinical lead for the HSE's National Clinical Program Model of Care for Adults with ADHD, explains that the approach is to view the condition 'as an impaired ability rather than a disability'.  Photography: Brenda Fitzsimons

Dr Margo Wrigley. Photography: Brenda Fitzsimons

At the launch of the HSE’s National Adult ADHD Care Clinical Program model last year, clinical lead Dr Margo Wrigley said the approach looked at the condition “as an impaired ability rather than a disability. Effectively managing its core symptoms and negative impacts allows people to unlock the positives of ADHD and lead fulfilling lives. »

The charity ADHD Ireland is launching a self-help program on understanding and managing ADHD in adults on April 28. Bramham, who was involved in the development of the online program which takes place over five sessions, with support from the breakout room, says it is meant to help with the emotional aspects. “It’s a toolbox, for people to try things out; it’s not going to cure everything. But she thinks it will be helpful for people on waiting lists for services.

ADHD Ireland chief executive Ken Kilbride says he hopes UCD’s research will help raise awareness. Although they were aware of similar international findings, “to see these figures come out in Ireland was shocking”.

He fears that there are still a large number of children who do not receive the support they need for their ADHD. “Like many conditions, the sooner it is caught, the sooner it is treated, the better the outcome of life.”

Bramham acknowledges that the research sample size of 136 people is small and that the fact that participants self-selected to complete a questionnaire meant it was likely that more people with experience of the subjects would respond. On the other hand, 78% of the respondents have a third level education, she points out, so this is a very functional group, who know they have ADHD and are linked to the association charity.

“That was what worried me – where are the other people who don’t know they have it, who don’t get help, who haven’t gone through the education system?

“And there are all these people who committed suicide, of which we will never know if they had it.”

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