Optimal Management of ADHD - Episode 2
Rakesh Jain, MD, MPH, comments on factors pre-disposing children and adults to ADHD and the impact of disease on patients’ and caregivers’ quality of life (QoL).
Rakesh Jain, MD, MPH: Many factors predispose children and adults to ADHD [attention-deficit/hyperactivity disorder]. No doubt, the No. 1 factor appears to be genetics. In fact, ADHD is probably the single most genetic neuropsychiatric disorder my colleagues and I take care of. Depending on the study reporting on the disease’s prevalence, the risk is anywhere between 70% and 78%. That’s a great deal of inheritance, and it affects men and women.
But there are other factors. For example, a deprivation environment in childhood can be a risk factor. Maternal cigarette smoking is a risk factor. Nutrition can be a risk factor.
In terms of adult ADHD, this is not an event that all of a sudden magically appears in adulthood. The onset of ADHD symptoms occur before age 12, and the majority of adults we see are ones who’ve had ADHD all their lives but are just being diagnosed.
In terms of ADHD and quality of life, it is very clear that the disorder is not just a collection of symptoms. It profoundly impacts quality of life in a variety of ways.
Let’s look at someone who is 9 years old. In fact, the last patient I saw, a 9-year-old boy, is affected. But how? His quality of life is impacted at school academically. He’s 9, but he’s already had loss of self-esteem, self-confidence. He wants to drop out of school permanently. He’s 9 years old. That’s a major impact on quality of life. His friends shun him because of his hyperactivity and impulsivity. You can imagine at any age social connectivity is important, but ADHD that has not been treated well took that away from him.
On top of that, he has an older sister whose patience with him has worn thin. His parents—he, by the way, has wonderful parents—are very tired. This is a clear demonstration of how ADHD, even though it’s a symptomatic disorder, can affect quality of life. I’ve seen the same thing with adult ADHD. Work suffers. Marriages suffer. Parent-child relationships can suffer. Self-esteem suffers. Wellness suffers. Social interaction suffers. As far as the eye can see, in most of my patients with ADHD, no matter what their age might be, quality of life takes a rather large hit.
Transcript Edited for Clarity