Do you feel like more adults around you are being diagnosed with attention deficit hyperactivity disorder (ADHD)? This could be explained by the fairly recent diagnosis of cognitive disorder in adults, which dates back to the 1990s. “We realized the positive impacts that giving adults access to treatment can have. We realized that these are exactly the same medications as for children and, therefore, in a context like that, we saw an emergence on a statistical level in the number of adults treated for ADHD,” notes the psychiatrist. Annick Vincent, who has been supporting patients with cognitive disorders for over 25 years.
Inattention at work, impulsivity, difficulties managing children, the symptoms of ADHD in adulthood are numerous. Cognitive disorder affects 4.4% of the population according to the most recent study carried out in the United States, which dates back to 2006. While ADHD is frequently studied in children, it tends to go under the radar when it comes to adults. .
Comedian and host Philippe Laprise was diagnosed with ADHD around the age of 35, when his daughter was seeking treatment for the same disorder. “I never suspected that I would one day have a diagnosis,” he says straight away. Since the hereditary transmissibility or genetic influence of ADHD is approximately 75%, some parents sometimes discover by the time their child is diagnosed that they also have undiagnosed ADHD. “The diagnostic process is what we call “clinical”. We would really like to have a biological marker, a bit like for diabetes, so that I can take a blood test to say “you have ADHD”, but the biological index does not exist in ADHD,” says Annick. Vincent.
Patients are therefore evaluated according to 18 diagnostic criteria. “In Quebec, there is no universal way to evaluate people. There are some who will give you psychometric tests, there are some who will give you clinical interviews based on questionnaires,” indicates psychologist Martin Pearson, specialist in the assessment and treatment of ADHD in adults.
When I was younger, I felt like an alien. […] I always felt like I was a circle and everyone else was a square.
Although he had several symptoms related to his ADHD, Philippe Laprise was surprised by his diagnosis. “When you receive the diagnosis, there are several stages. Obviously, the first thing you say is “frankly, it has no relation”. Then, at some point, you begin to understand what you have,” he expresses. By analyzing himself, he noticed his frequent forgetfulness, the fog in his head, his excess anger towards his children and his work colleagues, but above all, he understood that these symptoms had been present since his childhood. “When I was younger, I felt like an alien. […] I always felt like I was a circle and everyone else was a square. »
Neurobiological explanations
The difference in the brain of a person with ADHD lies in two neurotransmitters: dopamine and norepinephrine. “Dopamine allows us to center ourselves. […] It’s like a laser, it also allows you to motivate yourself to the task when dopamine is well stimulated. Noradrenaline is a bit of a filter that allows you to put aside what is less relevant,” explains the DD Vincent.
Both are necessary for the regulation of attention and executive functions that allow us to control our thoughts, actions and emotions. “We therefore introduced prescriptions for psychostimulants to try to regulate these two types of neurotransmitters,” adds Martin Pearson.
There are other ways than medication to try to deal with this disorder, including cognitive-behavioral therapy. “It helps people manage, for example, their emotions. It provides tips and strategies for better managing your time, your priorities, and better modulating your attention. Mindfulness meditation techniques have also demonstrated their effects at the clinical level. Obviously, everything related to a healthy lifestyle will not cure ADHD, but will clearly help a person to have their dopamine and noradrenaline levels,” says the psychologist.
Under or overdiagnosis?
Figures from the Régie de l’assurance santé du Québec obtained by The duty in 2015 noted that the number of prescriptions for psychostimulants for ADHD was 25 times higher than in 1995. However, the Federation of General Practitioners explains that according to the study carried out on the adult population in 2006, only 10% “received treatment specific for this problem”, including medication or psychotherapy.
According to psychiatrist Annick Vincent, this duality could be explained by the fact that only children were diagnosed before. “When I did my medical school in the 1980s, I was taught that ADHD was a childhood problem that disappeared in adolescence. At that time, there were no adults receiving treatment for ADHD. Our understanding focused on hyperactivity, impulsivity, a phenomenon that attenuates with neuronal maturation. » A few years later, specialists understood that untreated ADHD could have chronic repercussions such as difficult emotional management, financial difficulties and underproductivity at work.
The way of diagnosing ADHD therefore evolved and specialists began to prescribe psychostimulants for adults. Annick Vincent admits, however, that specialists are more interventionist than before. “I often get asked the question “Are we in a context of overdiagnosis here in Quebec?”, because precisely, we have more prescriptions than elsewhere in Canada or even elsewhere on the planet. And I would tell you maybe yes, maybe no, because we also have a context of underdiagnosis. »
However, she believes that all treatments, pharmacological or not, should be made available. “We are fortunate to have access to more pharmacological treatments which are reimbursed by our insurance program, and that is important to note. We are also fortunate to be in a health care environment where we do not have to pay to go see the doctor. […] What is lacking in Quebec is access to non-pharmacological approaches. So, from that side, I think that in an ideal world, we would have a service trajectory that would be simplified,” she concludes.