Pandemic triggers rise in ADHD referrals

Papercut silhouette of human head with colorful constructor pieces

The Australian mental health sector is seeing a recent surge in referrals for ‘ADHD diagnosis’ since the pandemic began, experts say.

Dr Sujit Sharma, Consultant Psychiatrist at Monash Health, said over the last several months, there has been a significant increase in number of the referrals for assessment of ADHD (attention deficit hyperactivity disorder) and this has been one of the main topics of discussion during peer group meetings.

“Almost every other referral is about whether a patient has ADHD because they’re struggling to focus, it has absolutely peaked during COVID-19 and there are more referrals during this time for ADHD than usual,” he said.

Dr Sharma said the bulk majority of the surge in referrals were for adults, as the pandemic has given them more time to reflect about their difficulties but also due to increasing awareness of this diagnosis.

“The lockdown is perhaps the main trigger for why people have started questioning whether they have this disorder,” he said.

“It can also be when a person’s mental effort increases, like starting a university course or a new job, and they can’t cope or focus so they turn to investigate whether or not they have ADHD”

While some referrals are indicative of ADHD and should have been diagnosed much earlier in life, Dr Sharma said many people seeking a diagnosis do not actually have ADHD despite their experiencing difficulties maintaining attention.

“It’s important to note that not every attention problem is ADHD, and some people need to think about co-morbid conditions like anxiety disorders as they underestimate how much anxiety can affect focus,” he said.

“Many people are also experiencing more fatigue and concentration issues due to lockdowns during the pandemic and are mistaking this for the development of ADHD.”

He said social media and discussions with family & friends may also be contributing to the surge.

“Some people say that my friend has been diagnosed with ADHD, and they think I have it too, as they relate and make associations,” Dr Sharma said.

“Social media may also be creating a sense of confusion leading to misinterpretation and over representation of this diagnosis”.

ADHD is a neurodevelopmental disorder which is usually diagnosed in childhood however can also last into adulthood.

There are three types of this disorder: inattentive (where most issues are with attention span), hyperactive (where there are difficulties in controlling impulses and often described as “running around like a motor”), and combined, which is a combination of the two above.

For management of the disorder, Dr Sharma said stimulant medication should only be one part of the puzzle.

“Medication alone is not the answer, and you need a holistic approach to treat ADHD,” he said.

“There are strategies to improve attention span and overall executive function but if stimulant medication is essential as a tool to manage ADHD, it needs to be done judiciously”, he said.

“The golden rule for stimulants is to start low and go slow. Increasing the dose without direction or mixing with illicit substances can be life threatening,” he said.

There are also several non-stimulant medications which are emerging treatment options for ADHD.

ADHD can significantly affect quality of life and interpersonal interactions. However, the good news is there are several strategies to help improve these difficulties.

“The brain is plastic and can adapt to new information hence attention training can help significantly,” Dr Sharma said.

Some tips to help ADHD symptoms include:

  • Memorisation, such as poems or jokes
  • Counting exercises (for example, counting back from 100)
  • Mindfulness
  • Relaxation exercises
  • Going through the alphabet and naming a different country for each letter
  • Deep breathing and visualisation of focusing on a particular task
  • Planning your day and having a structured routine
  • Decluttering your desk or room and creating more space
  • Reminder systems such as sticky notes, to do lists and calendars
  • Prioritisation and completion of priority tasks as opposed to procrastinating
  • Going slow and steady rather than doing everything at the last minute
  • Identifying problem areas and practice structured problem solving
  • Budgeting your expenses
  • Time management and rest breaks
  • Reducing distractions
  • Improving personal organisation

Dr Sharma said if someone is wondering whether they have ADHD, they should first talk to their GP, who should do an initial assessment in the primary care setting. Onward referral to a clinical psychologist or a psychiatrist can then be made for further assessment if there are any strong pointers towards this diagnosis.