Patients with attention-deficit/hyperactivity disorder are left without help

Attention-deficit/hyperactivity disorder, or ADHD, remains one of the most misunderstood and overlooked conditions in Europe, reports Euronews.

Characterized by inattention, hyperactivity, and impulsivity, the neurodivergent condition became not only a challenge for the children it affects most commonly, but also for the adults who continue to struggle with its symptoms into later life.

The underdiagnosis and undertreatment of this condition has created significant barriers, preventing effective support for those affected.

Dr. Tony Lloyd, CEO of the ADHD Foundation, attributes one of the primary reasons for this issue to historical stigma and misconceptions.

"Because of the historical stigma and ignorance around ADHD as being a behavioural disorder and commonly associated with children who are perceived as badly behaved in school, there is a great deal of shame and stigma around the condition and a great deal of misunderstanding," Lloyd told Euronews Health.

The recent years, however, have seen a significant shift, with a surge in ADHD recognition and diagnoses, particularly intensified by the COVID-19 pandemic.

"When the pandemic came, people were locked down, were not able to go out, exercise, interact with other people, have close personal support from colleagues at work. A lot of the support structures that enabled them to manage ADHD successfully were taken away," he explained.

While the pandemic has increased recognition and support for ADHD, it remains underdiagnosed in Europe, according to experts.

For instance, in the UK, the rate of ADHD diagnoses is significantly low.

"In the UK, only 13 percent of children with ADHD are medicated, and only 11 percent of adults. So, it's significantly underdiagnosed and significantly undertreated," Lloyd said.

This aligns with a consensus statement published by members of the British medical community, which states, “despite evidence-based national guidelines for ADHD in the United Kingdom, the condition is under-identified, under-diagnosed, and under-treated.”

The statement also notes that people seeking help in the country face many challenges, including prejudice, long wait times, and inconsistent availability of services.

Despite ADHD being one of the most discussed neurological conditions today, it remains highly susceptible to misconceptions that can lead to misdiagnosis.

According to Lloyd, neurodiverse individuals were long seen as less intelligent or morally weak, which contributed to the formation of a stigma around ADHD.

Dr. Jan Buitelaar, professor of medical sciences at Radboud University in the Netherlands, further supports that ADHD tends to be perceived negatively, which impacts how individuals with the condition are perceived and treated socially.

"Overall, ADHD has a rather negative public image. If you look at the media, the social media, people with ADHD are portrayed as being lazy, noisy, not very nice people," he said.

"I have met people who have had eight diagnoses of depression and then they meet a doctor who can say no, it's not depression, it's ADHD. The key of our work is the awareness," said Nina Hovén, president of ADHD Europe.

ADHD diagnosis usually involves behavioural assessments and interviews with inputs from various sources, including parents, teachers, and self-reports from older adolescents and adults.

Additionally, for a diagnosis to be established, symptoms must have been present for at least six months and must start before the age of 12, Buitelaar explained.

While symptoms of ADHD typically emerge during childhood and are not conditions that suddenly develop in adulthood, many adults that were undiagnosed in childhood tend to seek diagnosis later in life.

“We have to remember that children’s ADHD doesn’t look like when you are an adult. Children can be hyperactive, they cannot concentrate, but when you go to adults, it changes,” Hovén said.

Still, an early diagnosis in childhood is generally preferred.

"If you identify early in children and you support children and their parents early on, then their life chance trajectories are profoundly better," Lloyd said.

ADHD being mischaracterized as a behavioural disorder often results in diagnostic criteria that tend to overlook girls and women.

This is because ADHD presents differently in females, who exhibit less visible hyperactivity and their symptoms tend to be less disruptive.

“We have the girls who we don't often see what's happening with them because they are nice, they are quiet, but we don't know that they are in their own mind,” Hovén said. “They sit still in the classroom, but they are not there."

According to Lloyd, this has led to a historical gender disparity in diagnosis, with women frequently being misdiagnosed with some other mental disorders.

"Women who had ADHD were more likely to be misdiagnosed as having anxiety, depression, eating disorders, and even bipolar disorder," Lloyd noted.

According to Buitelaar, treatment for ADHD needs to involve multiple components including psychoeducation, medication, and behavioural interventions.

"Managing ADHD successfully is not just about taking medication, which lasts for eight hours. It's about understanding how ADHD affects you and what lifestyle choices you need to make, and what your cognitive strengths are," Lloyd said.

Hovén further explains that people with ADHD need the support of their surroundings to better manage their ADHD.

“I think it's very important to look at the whole family, if you get support for the children in the kindergarten, it doesn't help if you have chaos at home,” Hovén said.

In the case of adults with ADHD, Lloyd explains that society needs to start opening up to their diverse cognitive capabilities and change how the condition is perceived in the workplace.

"We need to recognize that the diversity of human neurocognitive capability is far greater than we think. Just because 20 per cent of people think differently doesn't mean they are less intelligent or employable," he concluded.

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