It could be ADHD!
Recently, I attended to a 17-year-old boy in my family practice. His parents brought him because they had reached their wits' end in raising their only child. The main problem was underperformance at school. Throughout his school life, his teachers insisted he had the ability, but his achievements were borderline or just average. His parents said that he did not listen to instructions and was often forgetful.
His father complained that he was lazy and was shirking tasks that require sustained effort. He graduated from high school with three CXC subjects with mediocre grades. The parents pointed out that he was very sociable and would often go off for hours without their knowledge. Things came to a head when they discovered he was smoking ganja (marijuana) with friends.
Here is another case. A middle-aged man visited the practice because he felt extremely stressed. He worked as an electronic repair technician. He was considered an excellent worker and was recently promoted to a supervisory level. Suddenly, life became challenging. He experienced difficulty managing the paperwork as well as former colleagues. He admitted that he no longer enjoyed his work.
These two cases describe men who are underachieving at home, school or work. I found nothing physically wrong with them but further questioning revealed that they had symptoms of attention deficit hyperactive disorder (ADHD). This is a genetic condition which often affects several family members. There are three types of ADHD: predominantly hyperactive; predominantly inattentive; and combined. The symptoms of ADHD are usually present before age seven but it is known that four to five per cent of adults are never diagnosed.
The main characteristics of inattentive ADHD are careless mistakes, difficulty sustaining attention, seeming not to listen when spoken to, failure to complete tasks or instructions, difficulty organising work to be done, often losing things, easily distracted by extraneous stimuli, and often forgetful in daily activities. Someone who demonstrates any six of these traits over six months or more should be checked for ADHD.
Predominantly hyperactive or impulsive ADHD is manifested as fidgeting with hands or feet, shaking one's leg or squirming in seat, running about or climbing excessively, feelings of restlessness, blurting out answers to questions before the questions are completed, talking excessively, often butting into conversations, general impatience or difficulty waiting in lines or awaiting one's turn, and seeming to be always on the go (energiser bunny). Any six of these symptoms which occur most or all the time over a long period (more than six months) should call for an evaluation by a psychologist or psychiatrist.
There are no blood tests or X-rays for ADHD. Diagnosis is made by careful interview of the person and his family or friends. Treatment for children and adults with ADHD requires medication. Many adult males self-medicate with nicotine (cigarettes), marijuana and alcohol. This may lead to substance abuse and addictions.
Much of the information presented here came from a book by Sharon Burey,
The Many Faces of ADHD
, available in local bookstores. I suspect that ADHD goes undiagnosed, especially among men who are underachieving.
Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians. Email: firstname.lastname@example.org.