Myths and stigma about ADHD contribute to poorer mental health for those affected


David Coghill, The University of Melbourne; Alison Poulton, University of Sydney; Louise Brown, Curtin University, and Mark Bellgrove, Monash UniversityAround one in 30 Australians (or 3.4% of the population) have attention-deficit hyperactivity disorder (ADHD). Yet it remains a poorly understood and highly stigmatised disorder.

Our new paper, which reviews the research on community attitudes about ADHD, found misconceptions are common and affect the way people with ADHD are treated and see themselves.

Stigma is an underestimated risk factor for other negative outcomes in ADHD, including the development of additional mental health disorders such as anxiety, depression, alcohol and substance abuse, and eating disorders.

Stigma is also likely to contribute to the increased risk of suicide, with people with ADHD three times more likely than the rest of the population to take their own life.

Early recognition and treatment of ADHD significantly improves the physical, mental and social outcomes of people with the condition who, like everyone else, deserve to live full and rewarding lives.

No, ADHD isn’t caused by too much TV

Our review of the research found many people erroneously attribute ADHD symptoms – particularly in children – to exposure to TV or the internet, lack of parental affection, or being from a broken home.

Read more:
Research Check: are phone-obsessed teens at greater risk of ADHD?

Rather, ADHD is a complex disorder that results from inherited, genetically determined differences in the way the brain develops.

People with ADHD have persistent patterns of hyperactive, impulsive and inattentive behaviour that are out of step with the rest of their development. This can affect their ability to function and participate in activities at home, at school or work, and in the broader community.

Boy looks at computer screen with hand in hair, thinking.
ADHD can affect your ability to concentrate.

There are clear criteria for diagnosing ADHD, and a diagnosis should only be made by a specialist clinician following a comprehensive medical, developmental and mental health review.

No, ADHD isn’t routinely overdiagnosed

Our review of the research found three-quarters of Australian study participants believe the disorder is overdiagnosed.

Based on the international research, an estimated 850,000 Australians are living with ADHD.

Yet current rates of diagnosis are much lower than this, particularly in adults where fewer than one in ten have received a diagnosis.

There is also widespread scepticism in the community about the use of medicines to treat ADHD.

Medication is only one part of the management of ADHD which should always include educational, psychological and social support.

Clinical evidence does, however, support the use of prescription medications as a key part of the treatment for ADHD. And there is evidence to show these medications are seen as helpful by those who take them.

Read more:
My child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?

Although rates of medication treatment have increased over the years, less than one-third of Australian children with ADHD and fewer than one in ten adults with the condition are currently receiving medication. This is much lower than expected, based on international guidelines.

How this stigma feels

People with ADHD can struggle with day-to-day things other people find easy, with little understanding and acknowledgement from others.

Typical examples include butting in to others’ conversations and activities, leaving tasks half done, being forgetful, losing things, and not being able to follow instructions.

The response to these behaviours from family, teachers and friends is often negative, critical and relentless. They’re constantly reminded of just how much they struggle with the day-to-day things most people find easy.

Teenage boy in a hoodie stands against a wall, looking down
People with ADHD know they’re being judged.

Our review found young people are particularly affected by this judgement and stigma. They’re aware they’re viewed by others in a negative light because of their ADHD and they commonly feel different, devalued, embarrassed, unconfident, inadequate, or incompetent.

Some respond to this constant criticism by acting out with disruptive and delinquent behaviours, which of course usually just escalates the situation.

Stigma can be a barrier to treatment

The perception and experience of stigma can influence whether a parent decides to have their child assessed for ADHD, and can leave parents underestimating the risks associated with untreated ADHD.

The confusion about what parents should believe can also affect their ability to make informed decisions about the diagnosis and treatment of their child. This is concerning because parents play a vital role in ensuring health professionals properly recognise and support their child’s health needs.

When diagnosis is delayed until adulthood, people with ADHD are four times more likely to die early than the rest of the population. This not only reflects the increased risk of suicide, but also an increase in serious accidents which arise due to impulsive behaviours.

Read more:
ADHD in adults: what it’s like living with the condition – and why many still struggle to get diagnosed

When we treat people with ADHD, many of these problems dramatically improve. It’s not uncommon for someone who has recently started on treatment to say, “wow, I didn’t know life was meant to be like this”.

Treatment also improves the physical, mental and social well-being for children and adults with the disorder.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or visit Headspace.The Conversation

David Coghill, Financial Markets Foundation Chair of Developmental Mental Health, The University of Melbourne; Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney; Louise Brown, PhD candidate, Curtin University, and Mark Bellgrove, Professor in Cognitive Neuroscience, Director of Research, Turner Institute for Brain and Mental Health; President Australian ADHD Professionals Association (AADPA, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

My child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?


Alison Poulton, University of SydneyIf your child has been diagnosed with attention deficit hyperactivity disorder (ADHD), you might be wondering: what now? And how do I know if medication is warranted?

The answer will depend on circumstances and will change over time. It’s quite OK to leave medication as a last resort — but it can be a very useful last resort.

Here are some questions I typically work through with a parent and child negotiating this issue.

Read more:
ADHD affects girls too, and it can present differently to the way it does in boys. Here’s what to look out for

Five key questions for parents and children with ADHD

1. Is this child underachieving academically in relation to their ability?

Was the child bright as a preschooler but struggled at school for reasons unclear (not, for example, due to vision or hearing problems)? Did they cope OK early in school but didn’t achieve at the level expected when schoolwork got harder?

2. Is this child’s behaviour creating unreasonable levels of stress or disruption at school?

For a child with ADHD to complete a task, it must be sufficiently interesting, short or easy. If a child can’t concentrate in class, they get bored. They might talk in class, create distractions or disrupt class. Obviously, careful judgement is needed to differentiate typical child behaviour from problematic behaviour.

3. Is this child’s behaviour creating unreasonable levels of stress or disruption at home?

At home, is the child able to draw, construct with LEGO, do puzzles or play blocks for longish periods of time? Or do they find the sustained effort needed unachievable? Do they then annoy a sibling to make life more interesting, or constantly ask adults to play with them?

If a child is working on homework for half an hour, how much time is spent concentrating? Are they focused for only ten minutes and the remainder is spent guiding them back on track?

Is the parent tearing their hair out with countless reminders and finding every time they check, the child is distracted again?

Doctors, parents, teachers and the child must work together and regularly ask whether the current approach is actually providing benefit.

4. Is there a significant effect on peer relationships?

Children with ADHD don’t always have the patience to wait their turn or concentrate on what peers say. They may come across as bossy; they find it easier to focus on what’s happening in their own mind but more challenging to listen and process what others say. Their peers may eventually find someone else to play with.

5. Is there an impact on self esteem?

Is this a smart child who doesn’t think they’re smart because they struggle to concentrate long enough to get work done? Do they speak negatively about themselves? It’s important to take self esteem seriously.

There are also diagnostic criteria that need to be checked.

Support strategies at home and in class

What other supports could help? Is the child sitting at the front of class? Is the teacher giving written instructions? Do they sit next to a good role model?

Has the parent done parenting classes? Have they tried home strategies rewarding good behaviour, or giving appropriate consequences for problematic behaviour?

Having a chart for the morning routine can be helpful. Many such strategies work nicely on children without ADHD. But children with ADHD often find the effort needed to earn a sticker isn’t worth it and may try to negotiate ever greater rewards.

If you’ve got to the end of that road and the child is still having problems, you might consider medication.

The first thing to know is these stimulants wear off reasonably quickly — after about four hours.

Read more:
ADHD: claims we’re diagnosing immature behaviour make it worse for those affected

What does medication do?

With ADHD, it’s like your brain is running on a half-charged battery. Your concentration keeps flicking off or winding down. Medication makes it more like your brain is running with a fully charged battery.

The active ingredient in medication is usually a stimulant such as dexamphetamine or methylphenidate. You might know it by the brand name Ritalin.

These stimulants wear off quickly — after about four hours. That may help the child get through the school morning; they may need another dose at lunch and perhaps a third dose if they have after-school activities. There are also capsules that release medication more slowly.

The medication is always wearing off and you are back to square one. On the one hand, that’s a nuisance. On the other, it means you can try medication, then stop and you’ll still have the same child you had at the beginning.

You start low and increase gradually until you find a dose that lasts about four hours. The teacher can help with feedback. The dosage may need to be adjusted as the child grows. These decisions are all made with the support of the clinician.

Generally, you get improvement up to a point where no further benefit is seen. If the dosage is too high, a child may seem aggressive, depressed or “zombie-like”. Nobody wants a dosage that is not leading to a better outcome.

If you decide to use medication, the dosage may need to be adjusted as the child grows.

What about side effects?

The most significant side effect is appetite suppression, so we monitor weight and height closely. Generally, weight stabilises in the long run.

Rebound hyperactivity as the medication wears off and difficulty sleeping can occur. Sometimes this can be managed by changing the dosage or by not medicating too late in the day.

The decision to give medication is made on a daily basis. If you aren’t happy, you can omit it and see how things go.

This medication improves anyone’s concentration, not just children with ADHD, so it’s also sometimes a drug of abuse (among university students, for example). When used for treating ADHD, the risk of addiction is minimal.

But if you have concentration problems, you have more scope for improvement. A child who is concentrating most of the time cannot experience much improvement.

Reviewing progress

I always ask the child: does the medication work? How do you know? I might find out from a teenager that their concentration has improved from 20% to 80% or 90% of classtime. A younger child who prefers to feel in control of their behaviour may actually remind the parent when the next dose is due.

Often I hear from parents the child is now keen to get homework done, has more friends and feels happier and more confident.

All parents want their child to feel they’re functioning and fulfilling their potential. Most will achieve this without medication. That’s plan A. Plan B is that they are fulfilling their potential and living a great life, helped by medication.

Doesn’t every child, every person, with ADHD deserve a plan B?

Read more:
ADHD prescriptions are going up, but that doesn’t mean we’re over-medicating

The Conversation

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Article: Students Suffer from Lack of Sleep

The link below is to an article that makes for an interesting follow-up from an earlier article on ADHD ( – this one looks at students suffering from a lack of sleep around the world.

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ADHD: Wrong Diagnosis?

Finally, some questions are being raised about ADHD, which I think is long overdue. The link below is to an article that suggests something different.

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