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Background Info

ADHD is a neurodevelopmental disorder resulting in difficulties in three key areas of functioning: impulsivity, inattention and hyperactively/restlessness. It is a genetic condition where, in many cases, the outcome can be positively or negatively affected by the person’s environment. Commonly considered to be a childhood condition, in 15% of cases the full diagnosis can still be applied at age 251. Debilitating symptoms persist into adulthood in 65% of cases1 and are often associated with depression or anxiety, mental health issues, addictions, obesity, criminal behaviour and/or high risk pursuits with increased incidence of accidents and driving convictions. Prevalence rates are reported by NHS Scotland as 3-9% of school-age children and young people and 2% of adults1. In Scotland approximately 0.6% of school-aged children and young people are diagnosed with the condition and an indeterminately low percentage of adult patients, indicating that the condition is grossly under diagnosed. It does not develop in adulthood, though many adults can be undiagnosed in childhood, seeking support and treatment in adulthood after symptoms make their lives impossible to manage.

Although adult ADHD is a well documented condition, it remains little understood and resourced in Scotland2, which lags behind the rest of the UK, evidenced by the lack of integrated clinical pathways and specialist clinics, which are in place in England 3.  The NHS in Scotland is failing to provide appropriate specialist resources and facilities for the many undiagnosed adults in the population, and for young people with the condition who reach adulthood and are then left unsupported; often falling prey to addictions, long term joblessness, depression, lack of education, homelessness, and problems with the law.

Adults with ADHD face substantial difficulties in accessing assessment by those with the appropriate level of skill and expertise. There is clear evidence that undiagnosed and untreated adult ADHD in the population imposes huge costs on society.4, 5 The impairments suffered are not trivial, they include increased risks of accidents, substance misuse, mood disorders and antisocial behaviour, poor academic and occupational histories, poor inter-personal relationships and increased risk of relationship difficulties and breakdown. 6, 7 In 2009 the Chief Medical Officer for Scotland said that “adult ADHD services in Scotland are at best an unfamiliar diagnosis and at worse its existence is denied.” 8

It is widely accepted that there are considerably higher levels of addiction, marital breakup and homelessness among adults with untreated ADHD, yet the treatment, by medication and other means, can be effective in helping with the condition. The social and economic costs of failing to provide a proper clinical pathway for adults with ADHD are immense. We ask the Parliament and Government to address this issue urgently. The lack of ADHD services for adults in Scotland is a matter of discrimination and inequality which we believe contravenes the Equality Act 2010 (Statutory Duties) (Scotland) Regulations 2011.

Even though adult ADHD is not at present formally addressed by NHS Scotland, we believe they must acknowledge there is recognition given to adult ADHD by the NHS in England and Wales and therefore adult ADHD will have to be included in the consultation on a mental health for Scotland (2011-15) 9 and provided with a specific integrated clinical pathway which must encompass the range of severity in ADHD and ensure that the appropriate help is indentified and implemented.

References:

1. NHS Inform. Attention deficit hyperactivity disorder (ADHD). www.nhsinform.co.uk, accessed 12/08/2011.
2. NHS Scottish Intercollegiate Guidelines Network  (SIGN) Guideline 112. (2009) Management of attention deficit and hyperkinetic disorder in children and young people.
3. NHS National Institute for Health and Clinical Excellence (2008) Diagnosis and management of ADHD in children, young people and adults (England only).
4. McCarthy et al (2009) ADHD treatment discontinuation in adolescents and young adults. Journal of Psychiatry       195(3):273-277.
5. Young S et. al (2009) ADHD and critical incidence in a Scottish prison population. Personality and Individual Difference 46(3):265-269.
6. Coghill , D. (2004) Understudied and under-recognised. Adv. In Psychiatric Treatment (10) 338-340.
7.  Editorial (2011) Adults with ADHD: ignored and under-treated. Drug and Therapeutics Bulletin (49) 7: July 2011.
8. NHS Scotland (2009) Annual Report of the Chief Medical Office. December 2009 p27.
9. Scottish Government (2011). Consultation on a mental health strategy for Scotland 2011-15.