New research highlights need for earlier diagnosis of ADHD

High levels of attempted suicide, self-harm and suicide ideation among adults with attention deficit hyperactivity disorder (ADHD) have been highlighted by new Irish research.

One in five adults with ADHD said they had attempted suicide, a further 61 per cent had experienced suicide ideation, while 50 per cent had self-harmed, according to a study led by Prof Jessica Bramham, professor of neuropsychology at UCD's School of Psychology.

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

Some 90 per cent of those who took part in the survey had been diagnosed with ADHD only as adults.

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ADHD is the most common neurodevelopmental condition in childhood, affecting an estimated 5-7 per cent of children and continues into adulthood in about 80 per cent of cases. Core 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 heightened risk of suicide is an inevitability because “it’s certainly not”. Most of these adults didn’t get a diagnosis in childhood and they’re struggling more.

It is not having the emotional brakes to slow down and respond rather than react to situations

"If your child has been diagnosed, it can only be better than this," she says, and she hopes the findings would encourage parents who might be undecided whether or not to have a child assessed for ADHD, to go ahead, so they can be treated if diagnosed. She worries that the crisis in South Kerry CAMHS, where a review concluded that 240 young people had received sub-standard care, might deter people.

“That was an anomaly, I hope. A lot of them are very well looked after, do very well and avoid a lot of difficulties as an adult.”

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

Another likely factor is mental health, “not fitting in, feeling different, the rejection sensitivity people have”. She is also very concerned that while ADHD is more widely recognised in third-level education and accommodations are being provided for affected students, there is still a lack of professional help.

“The problem is the services, in terms of psychiatry, just aren’t around to support them.” If you find you are struggling in the first semester of your degree, it may only be after 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 be 18 months down the line before you get seen and your degree is over.”

People with ADHD may get by in primary and secondary school without being diagnosed because the school system and parents are supporting them. In third level “where it’s a lot more about being self-motivated and self-disciplined and having organisational skills, it’s really hard for people”.

The indication that some children “grow out” of ADHD is down to several factors, she believes. “It depends how you define adult ADHD. Boys who are more hyperactive and impulsive in boyhood, that does seem to burn out. But what might be happening is that it becomes internalised – that their inner world becomes very restless and that isn’t in the symptom checklist.”

However, she also believes that brain changes as youngsters mature reduce the incidence. The prevalence rate among the adult population is an estimated 3.4 per cent.

It also depends on people’s circumstances. “ADHD is a big problem in education settings where you’re expected to sit still and be quiet and co-operate, whereas if people find the right job and the right partner, they can really thrive and symptoms become a strength rather than a problem.

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

Some 50-70 per cent of adults with ADHD also have a mental health condition.

At last year's launch of the HSE's national clinical programme model of care for adults with ADHD, the clinical lead, Dr Margo Wrigley, said the approach was seeing the condition "as an altered ability rather than a disability. Effective management of its core symptoms and negative impacts enables people to unlock the positive aspects of ADHD and lead fulfilling lives."

The charity ADHD Ireland is launching a self-help programme on Understanding and Managing Adult ADHD on April 28th. Bramham, who was involved in developing the online programme that runs over five sessions, with break-out room support, says it is intended to help with the emotional aspects. "It's a tool kit, for people to try out things; it's not going to cure everything." But she believes it will be helpful for people on waiting lists for services.

The chief executive of ADHD Ireland, Ken Kilbride, says he hopes the UCD research will help to raise awareness. Although they knew of similar international findings, "to see those figures coming out in Ireland was shocking".

He is concerned there is still a high number of children who aren’t getting the supports they require for their ADHD. “Like a lot of conditions, the sooner it is picked up, the earlier it is treated, the better the life outcomes.”

Bramham acknowledges the research sample size of 136 is small, and the fact that participants self-selected to answer a questionnaire means it was likely more people with experience of the topics would respond. On the other hand, 78 per cent of the respondents have third-level education, she points out, so they are a very high functioning group, who know they have ADHD and are linked in with the charity.

“That was the worrying bit for me – where are the other people who don’t know they have it, who are not getting support, who have not made it through the education system?

“And there are all those people who have completed suicide, who we’ll never know if they had it.”

Read: Barrister with ADHD stresses importance of diagnosis