MHM Magazine

functioning often leading individuals to feel overwhelmed, misunderstood and incompetent. In children, the academic impact of ADHD can be long lasting. The core symptoms of ADHD, such as inattention, leads to children missing out on core fundamental skills, particularly in the earlier grades of school, falling further and further behind their peers. They often take longer to finish their work, may fail to complete tasks, and may be labelled as “stupid” or “lazy”. In some instances, the impairments caused by ADHDmay lead to the developing of a specific learning disorder, which causes further difficulties. In addition to the academic impacts, children with ADHD are often socially ostracised due to their behaviour or difficulty in following social norms. Peers find it challenging to engage with children whose impulsivity prevents them fromwaiting their turn, making inappropriate comments, engaging in games which don’t necessarily interest them, or lashing out physically. They may be experienced by peers or adults as cheeky, naughty or as bullies. Symptoms in adulthood often present differently to the stereotypical picture of an ADHD child who dashes around the classroom disrupting others. Adults report feeling as though their lives are in a constant state of chaos and they’re unable to meet normal adult responsibilities. In a work environment, they may struggle to meet deadlines, be disorganised, forget important tasks, or procrastinate, leading to decreased performance. Outside of work, individuals may find relationships difficult to manage, experience household chores as impossible to begin and follow-through, and in some instances turn to reckless use of addictive substances or engage in risky behaviour to manage their emotional and physical discomfort. Adults report feeling as though their best efforts are never good enough, and that their life seems to be a series of failures. Considering the experiences described above, one can see that while the core symptoms of ADHD create dysfunction, the impact of these symptoms can create secondary challenges. Children and adults with the condition are often faced with negative feedback from teachers, employers, colleagues, and family members, leading to decreased self- esteem and self-confidence, as well as increased anxiety, depression, and feelings of hopelessness. Losing out on early core educational skills may continue to affect children throughout their schooling and tertiary careers and into adulthood; continual employment difficulties are often reflected on an individual’s curriculum vitae and impede further job opportunities; social difficulties may lead to withdrawal and isolation, difficulties connecting with others and poor quality of relationships – all of which lead individuals to be at risk for developing co-morbid psychiatric conditions, engaging in risking behaviour and employing unhealthy coping mechanisms. Ultimately, the goal of treatment is to address both the core symptoms of ADHD, as well as the multitude of possible adverse outcomes associated with the condition. As health professionals, it’s judicious to engage in a conversation with our patients (or the parents of our patients) about the risks and benefits of treatment, both in the short and long-term. Concerns regarding immediate and long-term side effects of psychopharmacological treatment should be taken seriously, and up-to- date evidence-based research must be used as a basis for the information provided to patients and parents. If patients experience side-effects due to medication, these should be managed by considering an alternative dosage or type of medication, or in some cases considering that ADHD is perhaps either the incorrect diagnosis, or part of a more complex diagnosis. In the same way that the potential physical side-effects should be discussed, so too should the potential implication of non-treatment receive adequate attention. Psychoeducation regarding the long-term outcome of both treating and not treating ADHD should be presented to facilitate informed decision making to act in the best interest of the patient.