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ADHD Treatment Melbourne, ADHD Center, ADHD Assessment

 
ADHD Treatment in Melbourne

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ADHD is a well recognised neurodevelopmental disorder that involves problems with regulation of the capacity to attend, regulation of emotions, and regulation of alertness.

While the greatest focus has been on childhood ADHD, we now know that about two-thirds of children with ADHD go on to suffer problematic symptoms well into adulthood. Symptoms may naturally diminish at any age.

While ADHD in children is typically seen of as a problem involving hyperactive young boys, it affects both sexes, and in adults the symptoms can present very differently.

Adults with ADHD frequently present with symptoms of persistent difficulties in organisation, in starting or completing tasks, and in being on time for or remembering appointments. They are frequently restless and even driven and often may be workaholics. They are often poor listeners and have great difficulty especially in group settings such as meetings. These symptoms are often disruptive in workplace settings, in intimate relationships, and in friendships and broader social settings.

If undiagnosed and undertreated, ADHD is associated in adults with a broad range of significant consequences or co-morbidities. It is strongly associated with sleep disorders, anxiety disorders (including post traumatic stress disorder) and depression, and less strongly associated with bipolar disorder. It is strongly associated with addictive behaviours of all kinds. It is associated with poorer than expected career performance and financial outcomes, with higher than average rates of marital problems and it presents a considerable challenge to the provision of effective parenting. It is also associated with a higher risk of traffic offences and criminal convictions. Adults with ADHD are usually aware of a sense of having failed to meet their potential, and often have serious self esteem issues related to this sense.

Despite these serious consequences, individuals with ADHD often have considerable personal resources, including a natural capacity for lateral thinking (which can be translated to very high creativity). It is thought that a number of highly creative individuals such as Thomas Edison demonstrated ADHD traits in their childhood, and that in fact their creativity and lateral thinking stemmed from the same attention patterns that caused difficulties in other areas.

Treatment for ADHD is usually imagined to focus on stimulant medication, but in adults more comprehensive treatment is needed. Often medication may not be suitable due to co-occurring medical problems. Secondary problems need to be managed so they do not worsen attention. Poor organisational habits need to be improved. Management of problems with sleep, stress, anxiety and diet will greatly improve attention. The most promising treatments now evolving are various forms of mindfulness programs and neurofeedback. Some patients may need more comprehensive psychotherapy to deal with self esteem and other secondary issues.

It is now clear that mindfulness training can produce substantial improvements in regulation of both attention and emotional control in ADHD individuals as well as in other disorders. Evidence that these behavioural changes are accompanied by positive changes in brain areas associated with these abilities is now becoming much firmer.

VCPS aims to provide comprehensive management of ADHD within a team environment.

Medicare rebates apply when you visit our psychologists, psychiatrists and GPs. Phone (03) 9419 7172 or make an appointment via our web site.

The following practitioners at VCPS provide assessment and treatment for those with ADHD:

Dr Dennis Shum - Consultant Psychiatrist

Ms Maria Galatsis – Consultant Psychologist

If you a’re struggling with ADHD, or think you might be, click here or phone (03) 9419 7172 to make an appointment today with one of our experienced practitioners. We’ll help you focus on a better future.

The information below has been proivded by Dr Andrew Kinsella, one of our practitioners with a special interest in mental health and the integration of mental and physical health. Dr Kinsella has a particular interest ADHD and its co-morbidities, especially in adults. He provide integrative care for his patients, looking at all areas of physical health that may impinge upon achieving stable attention, and emotional self regulation, and managing the broader psychological and social consequences of dealing with longstanding attention problems. He assists his patients become aware of the positive characteristics that are associated with ADHD, but usually overlooked.

ADHD is a common and potentially highly impairing developmental condition that involves impairment in regulation of attention, impulse control and, in some cases, physical hyperactivity.

ADHD is most associated with hyperactive small boys, but it has many different presentations, depending on the child's character and his personal circumstances. It is now known that 2/3 of children who are diagnosable with ADHD will still fulfil full diagnostic criteria even as mature adults. It seems that only about 5% of ADHD children completely outgrow the condition (Reference: Prof Alisdair Vance, Royal Children's Hospital).

ADHD is highly prevalent: a recent study completed at ANU looked at data from the PATH Through Life project (a longitudinal study of ageing and mental health that has been running 20 years) found that 6.2% of the cohort of middle aged residents of Canberra and Queanbeyan were likely to meet diagnostic criteria for ADHD: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031500

ADHD is well researched. In 2002, at the time of the International Consensus Statement on ADHD, there were over 10,000 papers published on ADHD, making it the most thoroughly researched mental health condition. In 2008 the psychiatrist John Ratey wrote in his book “Spark: The Revolutionary New Science of Exercise and the Brain” that ADHD was then the single most researched condition in Medicine.

There has been some controversy about ADHD, mostly driven by very ill informed commentary.

ADHD, like all “mental health conditions” is a behaviourally defined syndrome. In other words the assumptions behind the official formulation of the ADHD diagnostic concept are the same as those behind the diagnostic formulations of major depression, generalised anxiety disorder or social anxiety, for example.

As a syndrome, though, ADHD will naturally consist of a number of different subgroups with significant differences in specific causation and neurological dysfunction. Therefore it is likely to be impossible to devise a biological test that will diagnose it reliably every time.

Critics of ADHD have claimed that it is an invented diagnosis, or a creation of the pharmaceutical industry. These claims do not stand up to educated scrutiny.

In his aphorisms Hippocrates described individuals who experienced “"quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression"

Two excellent accounts exist from the 18th Century.:

1775 Melchior Adam Wiekard- a German Physician published the textbook Der Philosophische Arzt Weikard's text contained a description of ADHD-like behaviours, Weikard described many of the symptoms now associated with the inattentive dimension of ADHD in the DSM

In 1798 The Scottish Physician Alexander Crichton ( 1763-1856) was
was the second person to describe a condition similar to the inattentive subtype of (ADHD), in his book “An Inquiry into the Nature and Origin of Mental Derangement”

(This book can be read on Google Books).

Further descriptions exist throughout the 20th Century- the condition has been known under a number of labels as medical practitioners have struggled to adequately describe and delineate the problem.However it is clear that there are very old descriptions of ADHD, and many of the predate both the existence of a pharmaceutical industry and the relatively recent discovery that “stimulant” medication is beneficial in helping manage the condition. A fuller (though still incomplete) history of ADHD can be found here: http://www.addforums.com/forums/showthread.php?t=161686.

Much of the difficulty in understanding ADHD comes from a confusion between wilful misbehaviour and and unwilled dysregulation of behaviour. The problem is further compounded by the fact that many ADHD symptoms are situational and may vary from day to day. In addition, many ADHD individuals have developed a compensatory pattern of locking their attention very firmly on to the current object of interest in an attempt to avoid the distraction that plagues them. This “hyperfocus” is often seen in young children who have found that they can concentrate on video games, and become quite unreachable when engaged in their game.

However, all ADHD individuals recurrently experience impairment due to an unpredictable ability to focus even on activities that they enjoy. Dr John Ratey argues that the condition would be better called “Attention Variability Disorder”. Certainly that name would settle much of the confusion associated with the disorder.

Many conditions such as depression are often misdiagnosed because of the confusion between the common usage of the term “depression” and the precise clinical usage of terms such as major depression, unipolar depression, dysthymia etc.

The situation with ADHD is somewhat different. The diagnostic criteria are precise and multiple. Simple occurrence of individual symptoms is not enough to make the diagnosis. There have to be multiple symptoms, they must occur in multiple different settings, they must have had their onset in childhood (or in children have been present for at least 6 months), they must be causing impairment in more than one setting, and they must not occur solely in the context of another psychiatric disorder.

The listed symptoms in the formal description of ADHD do not constitute a complete description of ADHD. More recently it has become clear that a large subset of ADHD individuals have difficulty in regulating alertness (difficulty getting to sleep, difficulty staying asleep, difficulty waking up and difficulty with drowsy periods during the day. More severe cases become difficult to distinguish from narcoplepsy, and additionally the derangement of sleep leads to sleep deprivation, often contributing to worsening ADHD symptoms). The majority of ADHD individuals will have difficulties with clumsiness, sometimes with poor handwriting and fine motor control and often with subtle issues with balance. Frequently this clumsiness will manifest as clumsy speech (dysarthria). Equally the majority of ADHD patients will have some degree of problems with specific learning disabilities such as mild dyslexia, poor eye tracking impairing reading, central auditory processing disorder or issues with sensory integration. The latter may present as intolerance of new tastes, intolerance of smells, intolerance of uncomfortable clothing or bedding, or intolerance of noisy environments like shopping centres.Given that the neurology of attention is tightly linked to the neurology of movement, the co-occurrence of these problems is hardly surprising. Spark (Ratey, J. and Hagerman, E. 2008).

In addition the research around ADHD has clearly linked undertreated ADHD to the following outcomes and complications (usually called co-morbidities, but thorough history taking will reveal them as compliacations). ADHD is strongly associated with increased risk of anxiety and mood disorders, increased risk of developing oppositional defiant behaviour, with poorer educational and career outcomes, with significantly lower lifetime income than comparable peers, with higher rates of marital conflict and divorce, with higher rates of social isolation, with increased risk of addictive behaviours and all their complications, with higher risk of traffic accidents, and with increased risk of obesity and its compliactions such as hypertension, diabetes and heart disease. In severe, undertreated cases there is evidence to support the assertion that it may evolve into more entrenched personality disorders.

While stimulant medication is usually recommended for all but the mild cases of ADHD, it is well recognised that “medication only” treatment is incomplete, and has a much lower rate of success than more comprehensive treatment, which should at least involve counselling and behaviour therapy aimed at establishing stable routines that will serve the individual even when their attention is dysfunctional.

In addition, there is clear evidence that the stress states associated with ADHD will worsen attention, and comprehensive management should also address relaxation and the sleep issues.

There is increasing evidence now that meditation is an effective form of attention training and that given sufficient practice it will result in neuroplastic growth in the brain, effectively “wiring in” more functional attention and emotional self regulation.

It is also clear that individuals affected by the balance and coordination issues will have their attention compromised by these problems, and that where they are identified these should be addressed.

Some ADHD individuals will have underlying issues with food intolerances or genetically based deficiencies in metabolism that can also add to their problems.

Stimulant medication (such as Ritalin or Dexamphetamine) is useful for most ADHD patients, and in about 80% of cases a medication can be found that will offer significant benefits without unacceptable side effects. Many ADHD individuals have significant problems with organisation and follow through of more comprehensive treatment strategies and are effectively unable to make any progress without the assistance of medication. Most adults treated with ADHD find their need for medication will decrease over time as more comprehensive treatment stabilises their function.

A significant proportion of ADHD individuals will have issues with self esteem and with prior trauma. Many of these will benefit from psychotherapy. It is to be noted though, that untreated ADHD is often a major barrier to progress in psychotherapy.

In short, despite the controversy, ADHD is a real condition. It is common, and potentially highly destructive if not attended to. It can be treated effectively, but proper treatment requires thorough work up and comprehensive management, and a commitment to working over the longer term.