Are there treatment options for ADHD in adults? What are some therapies that are working well for adults? South First finds out.
Speaking at an event at Kothamangalam, the 41-year-old actor revealed his condition, sparking a broader conversation about adult ADHD.
It came like an unexpected twist in a movie, which initially stunned the audience into silence.
South Indian actor Fahadh Faasil’s revelation that he was recently diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) came like a twist in the tale, even as his latest, Aavesham, kept enthralling movie aficionados in theatres and on the OTT platform.
Speaking at an event at Kothamangalam in Kerala’s Ernakulam district, the 41-year-old versatile actor revealed his condition, sparking a broader conversation about adult ADHD and the challenges surrounding the diagnosis.
South First spoke to experts working with adults with ADHD and people who have been diagnosed with the condition during their adult years. They agreed that the condition was typically associated with children.
While the World Federation of ADHD International Consensus Statement found the disorder in 5.9 percent of youngsters and 2.5 percent of adults, experts underscored the high chances of mis- and under-diagnosis of the condition in adults.
Faasil was diagnosed with the condition at the age of 41.
The actor was speaking to students after dedicating the Peace Valley Children’s village at Kothamangalam.
“When I reached here, Mr Sabith gave me a tour of the facilities. There is a disorder called ADHD. I asked him if it was possible to cure ADHD. He told me it is easily curable if diagnosed during childhood,” Faasil said.
“I asked him if it can be cured if diagnosed at 41,” the actor then announced that he was clinically diagnosed with ADHD.
He further added that “even if it is not that big, I too have some traits of the disorder”.
This revelation has brought to attention the challenges of diagnosis, treatment options and persistence of this condition in adulthood.
According to the American Psychiatric Association, ADHD is a neurodiverse condition that affects people’s behaviour and social interaction.
The Association said ADHD is one of the most common mental disorders affecting children. Symptoms of ADHD include lack of attention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the spur of the moment).
Studies showed that ADHD is considered a chronic and debilitating disorder, known to impact the individual’s many aspects of life, including academic and professional achievements, interpersonal relationships, and daily functioning.
Experts explained that ADHD can lead to poor self-esteem and social function in children when not appropriately treated.
Dr Jamuna Rajeswaran, Prof and Head, the Department of Clinical Psychology at NIMHANS, told South First that ADHD is commonly believed to primarily affect children and is easier to diagnose.
However, many adults with ADHD symptoms, who shared their childhood experiences, revealed that they had undiagnosed ADHD symptoms during their younger days.
While the basic symptoms, hyperactivity, impulsiveness and inattention could also be seen in adults, Dr Alok Kulakarni, senior consultant and interventional psychiatrist at Manas Institute of Mental Health in Hubballi, said there is a set of criteria in psychiatric classificatory systems that outline ADHD signs and symptoms.
“Broadly, ADHD symptoms include inattention, impulsivity and hyperactivity. However, these symptoms can be seen with other psychiatric disorders as well. Hence a comprehensive clinical assessment by a psychiatrist using structured rating scales for diagnosis is of paramount importance,” he told South First.
Dr Kulkarni said that it is very rare for adult ADHD to arise afresh without symptoms in childhood.
ADHD symptoms can appear as early as between the ages of three and six years, and can continue through adolescence and adulthood.
“For an adolescent or adult to receive a diagnosis of ADHD, the symptoms should be present before the age of 12,” he said.
Experts said that adults with ADHD experience an ongoing pattern of inattention, hyperactivity and impulsivity, with consequent disruption in the sphere of social, interpersonal and occupational life.
Dr Kulkarni said the individual will have trouble staying on a task as a result of poor focus and disorganisation. A hyperactive individual constantly moves even in situations where it is deemed inappropriate.
Alternatively, Dr Kulkarni said the individual could fidget, tap or talk excessively.
An impulsive individual may act without thinking or may have difficulty in exercising self-control. “This may manifest as a need for immediate reward or as a difficulty in delayed gratification. An impulsive person interrupts others, or makes major decisions without considering long-term consequences,” he said.
Dr Kulkarni added that people with ADHD may often miss or overlook details. They make seemingly careless mistakes at work, have difficulty in sustaining attention, find it hard to follow through instructions, start tasks but lose focus and get side-tracked.
Dr Jamuna explained that many times families or they themselves identify some of these symptoms and such others when they notice that these people are usually above average or average when it comes to work or intellectual abilities.
They may be good at a few tasks, get appreciated by their bosses or do well at work but it could be short-lived as they may suddenly decide to quit jobs or be asked to leave by their bosses.
These people may be unable to finish tasks or get distracted when spoken to, start to avoid tasks that need sustained mental effort, constantly keep losing things, or in general, are forgetful about daily chores or keeping appointments.
Dr Kulkarni said that those with hyperactivity-impulsivity may fidget and squirm while being seated, abruptly leave their seats in situations where they are expected to be seated or are unable to engage in hobbies that need attention or have to sit quietly.
They tend to talk extensively, answer questions very fast, finish other people’s sentences and have difficulty waiting for their turn or even interrupt others in conversation, games or activities.
Adults with ADHD may experience poor self-worth, sensitivity towards criticism, and increased self-criticism possibly stemming from higher levels of criticism throughout life.
Experts suggested that while the symptoms may indicate ADHD in adulthood, they said that it is rare that the diagnosis happens as adults, unless the symptoms are missed in childhood and it persists in adulthood as well.
However, Dr Jamuna explained that there are patients aged 42-45 who have been diagnosed with ADHD.
She said it would be best if people could identify the symptoms of ADHD themselves or if family members can be able to spot the symptoms. However, they must visit a psychiatrist to clinically diagnose these symptoms. Multiple standard tests can diagnose ADHD clinically.
Discussing the intervention techniques Dr Kulkarni said there are training for caregivers where educational interventions disseminating information on ADHD is typically delivered in groups.
The carers, especially parents of young children, should be educated about the strategies to target and monitor problematic behaviours, encouraged to liaise with teachers, use positive reinforcement, and plan ahead to anticipate problems.
Another method is cognitive behavioural therapy where adults with ADHD are encouraged to identify dysfunctional patterns of thinking and behaving.
“They are equipped with skills to improve self-esteem, and to deal better with emotional and social difficulties. This modality targets specific domains such as attention, working memory, and inhibitory control, and aims to improve the functionality of these domains,” Dr Kulkarni added.
Meanwhile, experts vouched for strong evidence that supports the efficacy of drugs for ADHD in reducing the core symptoms for one year.
“The most common type of medication used is called a ‘stimulant’. Stimulants increase the brain chemicals, dopamine and norepinephrine, which are thought to be dysfunctional in ADHD, and thereby allow better thinking and focus. Can be used only when prescribed by a doctor,” he explained.
Discussing intervention techniques, Dr Jamuna spoke about good results in children as well as adults. She vouched for neurofeedback therapy.
Neurofeedback, also known as brainwave training, is a state-of-the-art technology. The brain has five types of waves: Beta, gamma, delta, sensory motor rhythm, and alpha.
“For ADHD patients, symptoms like attention issues are often related to the frontal area of the brain. We provide training at central three (C3) and central four (C4) regions, focusing on beta waves, which are associated with attention, impulsivity, and decision-making,” Dr Jamuna said.
India is a pioneer in equipment-based brainwave training. “I went to the US and got trained in 2006, then introduced it at NIMHANS. Today, we have worked with children as well as adults with ADHD, and have been seeing excellent results,” she said.
She explained that one can transform brainwave activity with intense practice. “We work with this equipment to increase the ratio of faster brain waves, leading to stronger focus and improved impulse control.”
“Brainwave alterations can be measured and by the end of the therapy, we do get to know how they have endured. Also, brainwave improvements can lead to improvement in behaviours. Most evidently seen are sustained focus, diminished impulsivity and reduced distractibility in the real world,” she said.
“Several of our children have gone on to become PhD graduates, etc., after this therapy in childhood. Even in adults, we have seen tremendous improvements. They are able to focus, retain jobs, reduce impulsive behaviour, etc,” Dr Jamuna added.
Dr Jamuna spoke about the practical aspects of neurofeedback training. “It involves equipment that needs to be FDA-approved, and practitioners must be trained.”
The practitioners monitor a patient’s brain waves using scalp sensors. These sensors pick up the brain’s activity and relay it so that the therapist and patient can see exactly when and how brain waves reach an optimal level. They then try and repeat and practice the behaviours that lead to this ideal brain state till it becomes second nature.
“Each session lasts about an hour, but for ADHD patients, we start with two minutes and gradually increase to 20 minutes. Children, in particular, may find it challenging initially, as they tend to pull out the electrodes. We use the 10-20 international system to place electrodes on the scalp, which requires precise placement,” Dr Jamuna said.
She added that results varied with different conditions. For instance, migraine relief can be seen within five sessions, while ADHD requires about 40 sessions over alternate days. We’ve followed up with 23 children who underwent this training at ages 7-8, and they are now doing well, some pursuing professional careers,” the doctor said.
(Edited by Majnu Babu).
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