I am not naughty, I have...

ADHD is caused by a delay in maturation involving parts of the brain responsible for attention control and behaviour inhibition.
ADHD is caused by a delay in maturation involving parts of the brain responsible for attention control and behaviour inhibition.PHOTO: ISTOCK

Symptoms of attention deficit hyperactivity disorder often persist into adulthood

Increased awareness of attention deficit hyperactivity disorder, or ADHD, has led to more new cases being identified in recent years, but misconceptions about it persist .

Reach (Response, Early Intervention and Assessment in Community Mental Health), Institute of Mental Health (IMH) and National University Hospital (NUH) have continued to report new cases each year.

ADHD is a neurobiological condition that affects one's academic learning and social behavioural development in varying degrees of severity. About 5 to 8 per cent of children and young people, and 2 to 3 per cent of adults have it, said Associate Professor John Wong, the head and senior consultant of NUH's department of psychological medicine.

ADHD can also occur with other problems such as anxiety and learning difficulties such as dyslexia, which tend to affect structured learning and its outcome. This then catches the parents and teachers' attention, said Prof Wong.

ADHD is the top mental health condition seen at IMH's Child Guidance Clinic. From 2012 to last year, the clinic saw an average of 645 new cases with ADHD a year.

Even after diagnosis, parents and teachers often need plenty of convincing before realising the symptoms are not wilful or deliberate.

It is the top mental health condition picked up in schoolchildren aged six to 19, under Reach, a mental healthcare service that works closely with schools, voluntary welfare organisations and doctors to help students with emotional, social and behavioural issues. It is a collaborative effort between the IMH's Child Guidance Clinic, KK Women's and Children's Hospital, NUH and the Ministry of Education. It helped identify 242 cases last year, up from five cases in 2007 when it started.

In the west zone, the number of new ADHD cases reached 43 last year, up from 26 to 32 cases a year in the previous three years, said Prof Wong, who is also programme director, Reach (West), at NUH.

He estimates that the Neuroscience Clinic and Paediatric Psychiatry Clinic at NUH sees about 40 new ADHD cases each a year. There would also be new cases seen in the private sector.

Dr Lim Boon Leng, a psychiatrist at Gleneagles Hospital, said he has seen a rise in ADHD cases, especially in adults. He saw about 100 adult and children's cases last year, compared with about 10 in 2012.

Adjunct Associate Professor Ong Say How, chief and senior consultant at IMH's department of child and adolescent psychiatry, described an ADHD child as one who is often disorganised, forgetful and lacking the ability to focus or obey instructions. He behaves impulsively and is constantly restless.

Some people think the ADHD child will outgrow it. But the symptoms often persist into adulthood.

Dr Lim said: "It is common for ADHD symptoms to be misconstrued as "naughty" behaviour. Even after diagnosis, parents and teachers often need plenty of convincing before realising the symptoms are not wilful or deliberate."

There are three types of ADHD - those who are predominantly inattentive, those who are predominantly hyperactive-impulsive and those with a combination of the two.

Dr Lim said those who are predominantly in the attention deficit domain do not display hyperactive behaviour and are often well behaved in school.

Adults may not realise that they are having problems concentrating in class and are not fulfilling their potential academically.

Dr Ong said ADHD is highly treatable. Those with mild ADHD may just require behavioural therapy and environmental adjustments.

Adjustments could include having a timetable to remind them to do things. In school, these children can sit in front of the class and not near the window where they may look out.

Dr Ong said if the child is so hyperactive that he cannot learn in school, medication may be needed.

Prof Wong said: "When left untreated, a child tends to under- achieve in his academic learning, leading to poor self-esteem from negative attention and scolding from parents and teachers."

The lack of control in impulsivity may evolve into risk-taking and anti-social behaviour, frequent aggressive outbursts and violent behaviour, and lack of friends and social support, he said.

A child or teenager with ADHD may also miss out on opportunities at critical streaming milestones in the education system, he added.

Dr Ong said ADHD is caused by a delay in maturation involving parts of the brain responsible for attention control and behaviour inhibition. These are in the pre-frontal cortex, which is the last brain area to develop fully. "This is why some ADHD symptoms may decline slightly with age. But the biological deficits largely remain."

Hyperactivity, for instance, tends to improve with age but the ADHD person may still have problems focusing on tasks. Those with ADHD like to multi-task, he said.

The good news is, many people with ADHD learn to cope well. Some even go on to achieve greatness. American swimmer Michael Phelps, who has won 22 Olympic medals, including 18 golds, is one such person.

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A version of this article appeared in the print edition of The Straits Times on July 12, 2016, with the headline 'I am not naughty, I have...'. Print Edition | Subscribe