Guidelines to improve care for adults with ADHD

Posted on 11 August 2017

In a first for South Africa, new guidelines written by Cape Town based psychiatrist Dr Renata Schoeman, with help from Mediclinic Sandton psychiatrist Dr Rykie Liebenberg, outline better care for adults with Attention Deficit Hyperactivity Disorder.

Although an estimated one million South Africans between the ages of 20 and 50 are affected by adult Attention Deficit Hyperactivity Disorder (ADHD), Mediclinic Sandton psychiatrist Dr Rykie Liebenberg says the condition has only recently been recognised as a neurodevelopmental disorder that generally lasts throughout the patient’s lifetime.

The misunderstood condition

‘ADHD is underdiagnosed and undertreated in adults,’ she says. ‘There is still the belief that adults do not suffer from this disorder and that it can be “outgrown”.’ Yet at a sensitive time in their lives, many sufferers leave school and, just when they need to perform optimally, they may no longer receive payment for their treatment as part of their chronic medication. ‘Most young adults who suffer from ADHD are unlikely to be able to afford ongoing treatment from their own pockets,’ Dr Liebenberg explains. And with the belief that ADHD is a childhood condition, they will invariably go off their medication when they need to start carving out a successful future.

In addition, women with ADHD are often not diagnosed as children, especially if they belong to the inattentive subtype. Comorbidity in adults with ADHD is also very high, which further complicates diagnosis, treatment and prognosis – and GPs are often unable to make an accurate diagnosis in a standard 15-minute consultation. ‘But if the condition is left untreated, it can lead to a life of “perpetual failure” and underperformance in personal and professional areas,’ Dr Liebenberg cautions.

Recognising Adult ADHD

In light of this, Dr Liebenberg co-founded the Special Interest Group for Adult ADHD with fellow psychiatrist, Dr Renata Schoeman. The group falls under the protection of the Society of Psychiatrists of South Africa and aims to promote awareness of adult ADHD, guidance, correct diagnosis and training.

‘One of our main objectives was to write guidelines as there is a need for standardising treatment and disseminating knowledge to healthcare professionals based on evidence and international studies,’ Dr Liebenberg explains. These guidelines include assessment procedures, drug treatment options and the treatment plan for long-term health. They have been peer-reviewed by fellow psychiatrists and ratified and approved by the SASOP adult ADHD SIG, as well as the boards of the South African Society for Psychiatrists and the Psychiatry Management Group (PsychMG). ‘Guidelines also give recognition to the condition and the hope is that funders will acknowledge the diagnosis of adult patients who suffer from ADHD and pay for their treatment too,’ Dr Liebenberg says.

Plans for the future

The Special Interest Group for Adult ADHD has 24 members and has already conducted successful workshops for GPs and other health professionals. ‘We understand the cost implications of a psychiatrist making a diagnosis, but once the diagnosis has been made, patients could follow up with their GP,’ Dr Liebenberg says

For adults, medication is the most effective – and most cost-effective – treatment for ADHD, as therapy can be a long and expensive process. ‘Of course, we also recognise that therapy and lifestyle interventions are very important in the management of this disorder but we need to recognise the shortage of resources in the South African context,’ Dr Liebenberg says. ‘We simply do not have enough trained professionals – and our ongoing plan is to train more psychiatrists, conduct more workshops in different regions and approach funders with plans to help patients with the costs of treatment.’

Adult ADHD is a common disorder and can be successfully treated, Dr Liebenberg concludes. ‘Our hope is that the guidelines will serve to enlighten and strengthen the hand of medical professionals and assist patients in getting the help they need.’

Download the SASOP adult ADHD SIG guidelines here: https://www.sajp.org.za/index.php/sajp/article/view/1060

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