Thursday, February 9, 2023

What happens when children with ADHD become adults?

ADHD (Attention Deficit Hyperactivity Disorder) is perhaps the most controversial mental health problem, at times riddled with rage and moral indictments from its extreme poles. There are those who, relying on the non-existence – to date – of a biological marker, advocate treating it as an invention, a simple product of commercial interests. There are also people who label any misbehavior in the classroom, poor school performance, or disruptive behavior as ADHD. In this area, in order to be of some help to patients and their families, it is recommended to be cautious, analyze what is equivalent to scientific evidence and avoid ideological and “right to truth” discourses.

What we do know is that there are some children who just won’t stop, who seem to be driven by an internal motor that makes them run, jump, sit in a chair, talk a lot and sometimes at the wrong time (restless). and hyperactive groups). Others – and sometimes the same ones – are too impulsive, find it difficult to stop what’s going on in their head, get bored with any task and constantly interrupt the conversation (parents get frustrated) . Finally, others show inattention: they get distracted by the slightest stimulus, they have forgetfulness, they forget, they leave things halfway, it seems that when spoken to So they don’t listen and their mind is “elsewhere”. Of course, almost all young children are like that, so a diagnosis of ADHD shouldn’t be made before age 6 or 7. But when the child gets older and these symptoms are so obvious and persistent, when they are expressed at school but also at home and in other settings, that it seriously affects their performance and well-being, it is necessary to Further study may be required. The purpose of assessment is not to label anyone (no one is diagnosed with the disease that he or she has) or to reduce the wealth of overflowing childhoods to a few simple agreed requirements; A diagnosis is just the beginning of a help plan. And a support that must be comprehensive and multidisciplinary, in which families, teachers, school counselors, psychologists, pediatricians, and psychiatrists participate. According to the World Health Organization, ADHD affects about 5% of children and since its etiology is multifactorial, genetic factors come to the fore: having a parent with ADHD increases the risk of suffering it by 8 times. As always, this appears to be the result of a complex gene-environment interaction: having a low birth weight increases the risk 3 , social adversity increases it 4 , and maternal alcohol and tobacco use during pregnancy 3 it happens. Explanatory models about the complex underlying brain dysfunction are still insufficient, which should encourage us not to feign ignorance as supposed evidence that the mind has nothing to do with the brain, but to promote quality biopsychosocial research. Is.

But what is relevant about ADHD is its consequences over the lifespan of patients. At its worst, when it goes unnoticed and is not adequately treated, it can lead to school failure (40% drop out from ESO), relationship difficulties with other children (fighting, bullying), Leads to high frequency of accidents and serious problems. self respect. ADHD, in addition to being a disorder, serves as a developmental risk factor for other mental health problems (depression, anxiety, conduct disorders, substance addiction). But what happens when kids with ADHD get older?

Longitudinal studies have consistently shown that ADHD symptoms decrease over time, but persist in 40–50% of adults. Hyperactivity usually improves, sometimes turning into restlessness, and what prevails is usually difficulty concentrating, organizing, and managing time to find needed breaks. These adults tolerate frustration poorly, are impulsive, and in more than half of cases turn to substances such as alcohol, cannabis, or cocaine. It is difficult to diagnose in adult life, as it is confused with personality disorder and substance dependence. Untreated ADHD is associated with higher rates of fines and traffic accidents, more family conflict, and unemployment. Patients largely have legal problems and there are studies in prison populations that estimate a prevalence of the disorder at 30%.

Everything indicates that we should know that the symptoms grouped in childhood as ADHD persist in a large percentage of patients; that its presentation changes in adult life, mimicking a borderline or antisocial personality disorder, often accompanied by substance abuse and a range of personal, social, and legal problems. It is probably a good idea, when adults with the above problems are faced, to ask them what difficulties they would have had on a day-to-day basis, as they were as children, if only they had had a little attention. Or they weren’t sitting still, or if a counselor told them about possible ADHD. This is not usually done. The lives of these people are faltering and society interprets their behavior as a moral disorder. I remember an interview with the brilliant psychiatrist Luis Rojas Marcos in which he revealed that he had been diagnosed with ADHD: “I thought I was a bad child,” he said. Knowing mental health problems can help to understand, adapt and seek support for abnormal behaviours, and can have a positive impact on people’s life programmes. Certainly it would not explain the vast majority of human actions, sometimes so frustrating and unpredictable. But it might shed some light for us. Let’s be optimistic, this year the specialty of child and adolescent psychiatry was finally created in Spain, the perception of mental health as a health and social problem has increased in the population, a certain political consensus (miracle!) in the address seriously the issue of suicide And with determination. I want

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