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The Times (London), 12/4/04

RUDE, SCATTY OR ILL?

Millions of us could be suffering from a new behavioural disorder. Or is it just human nature?

by John Naish

Rolanda Reid is convinced that she has a clinical condition that can make her appear rude, scatty and forgetful. It causes her social and employment problems. She believes that many thousands of Britons have the disorder but have never heard of it. The condition is called adult attention deficit hyperactivity disorder (AADHD) -- a grown-up version of the childhood hyperactivity that has led to hundreds of thousands of British youngsters being put on Ritalin and similar brain-altering drugs.

The adult disorder is set to hit our shores as a new social scourge. British and American companies are marketing new drugs for it, and in a landmark legal case in October it was successfully used in a British court appeal to quash a murder conviction. Some researchers believe that the condition underlies much criminal behaviour, but sceptics question whether the disorder is a true disease -- or merely a set of character traits that society increasingly finds difficult to accept.

Reid, a 40-year-old insurance manager, is convinced it is a disease. “From my schooldays in South Africa I always felt there was something wrong with me. I had to work twice as hard. And I would think nothing of taking on my teacher if I felt their teaching was wrong,” she says. “I have language problems -- I can’t string a sentence together if I am tired. The problems magnify in the workplace: in afternoon meetings, I drift off. The workplace is full of people with the disorder who don’t recognise it.”

She discovered the condition through her son’s problems. “I couldn’t cope with him when he was 3 or 4 because he was so unruly. I couldn’t get British doctors to help, so I went back to South Africa to get a diagnosis, where he was confirmed as having attention deficit hyperactivity disorder. I went to my son’s psychiatrist at the Priory Clinic in Bromley, Kent, and they diagnosed me as having the adult version of the condition. It was a surprise, though I did think I might have some of my son’s traits. I take Ritalin when I have to study and it helps. I don’t have a prescription. I take some of my son’s.

“The disorder is genetic, so every child with it has at least one parent with the adult version,” says Reid, who runs a group for adult sufferers in Surrey. “There are six of us, though most do not have a diagnosis. Our children have been diagnosed, and we recognise it in ourselves.”

Andrea Bilbow, the director of the charity, Attention Deficit Disorder Information and Support Service, says that growing numbers of adults have the condition. “We get about five calls a day,” she says. She has clinical support. Brian Toone, a consultant neuropsychiatrist at the Maudsley Hospital, in London, runs one of Britain’s two UK clinics. “We get around four referrals a week. About half a per cent of adults have it,” he says. “It’s like the childhood disorder, though you don’t see overactivity, more a lack of personal organisation and poor punctuality. Treatment is primarily drugs.”

How come we suddenly have this new condition? Dr Toone thinks it’s always been there but has been recognised only recently. “A change in society has thrown this into relief. If you dig up roads for a living, it does not make much difference if your concentration is poor, but if you’re an executive, it does. I get a lot of scepticism from GPs who disagree with the diagnosis, but conditions can suddenly get recognised; coronary heart disease was only identified at the turn of the last century.”

Suzy Young, a clinical neuropsychiatrist at Bethlehem Hospital in London, says that the diagnosis could revolutionise many prisoners’ treatment. She was researching adults with the disorder some years ago and they often disappeared. They were in jail: “They have poor control of their impulses, are novelty-seekers and tend to commit opportunistic crimes without checking for witnesses, so they get caught.”

She claims that her study of special units for prisoners with personality disorder shows that nearly a third have AADHD symptoms. “One was labelled ‘an untreatable psychopath’, but once treated with Ritalin, moved into a lower-security unit,” she says. “We are now giving Aberdeen prisoners full neuropsychological assessments of their attention spans and impulsivity. It could help us to rehabilitate thousands.”

Aren’t we just dealing with criminal traits and calling them symptoms? “Maybe,” Young says. “But if a lot of people committing crimes have short attention, then if we can treat it and help them to overcome their impulsive behaviour, that’s a good thing.”

Two months ago, the Court of Appeal quashed the murder conviction of Billy Joe Friend, a South Londoner, who as an adolescent eight years ago was involved in a killing. The court said that he had been suffering from attention deficit hyperactivity disorder and had not been fit to give evidence at his trial. It says he now has the adult disorder and is not fit to stand a retrial. Young calls it “a landmark case ”.

But sceptics fear that our readiness to recognise such conditions enables us to quick-fix difficult behaviour with drugs without addressing the underlying problems. Dave Woodhouse is the director of the Cactus Clinic, at Teesside University, which pioneers alternative treatments for children with the condition who have been put on Ritalin, an amphetamine-like stimulant that is believed to help to focus hyperactive children’s attention. He does not believe that the adult disorder exists because he thinks that the childhood disorder is a misdiagnosis. He fears that Ritalin is causing an emotional dependency that children take into adulthood: “Kids tell me that they ‘can’t function’ without their medication. The job of our clinic is to get them off their dependency both on drugs and a diagnosis.”

The clinic has treated more than 40 children since it began two years ago. Woodhouse believes that many cases are in fact nutritional deficiencies and food intolerances. “We have also seen some children with mild epilepsy who frequently blank out for five seconds. It looks like they are not paying attention, and they can be hard to control. American research indicates this may explain 80 out of 500 cases,” he claims.

Nevertheless, pharmaceutical companies are seeing sales soar in America for drugs to treat the adult disorder. There’s gold in them there pills. The market leader is Eli Lilly, with its drug Strattera, though earlier this year the UK drug giant, Shire Pharmaceuticals won permission to launch a rival, Adderall XR. Matthew Emmens, Shire’s chief executive, says: “The adult market is three times the size of the £1.14 billion-a-year children’s market. The market is ripe and is moving in the right direction.”

It certainly will, if it follows the British career path of Ritalin. In 1993 there were about 3,000 Ritalin prescriptions for children. By last year this had shot up to 250,000.

The adult disorder has had a slow start. It was first mooted in America in the 1970s but an official diagnostic tool was published only last year, by New York University in conjunction with the World Health Organisation (see panel). Its development was funded by Eli Lilly. A survey funded by Eli Lilly claims that the condition affects nearly eight million Americans. Eight million. All of a sudden. Whether you believe that the adult disorder is a real condition, or a way of labelling people’s antisocial behaviour as a disease that can be controlled by drugs, one thing is sure: the level of interest and investment from pharmaceutical giants means childhood ADHD is fast growing up into adulthood. It’s going to be huge.

WARNING SIGNS

Here are some of the questions from an adapted version of the World Health Organisation’s Adult ADHD self-report scale. If you answer yes to most of them, you may have the disorder. Or it could just be that you’re only human.

-- Do you have trouble finishing a project once the challenging parts have been done?

-- Do you have difficulty getting things in order when you have to do a task that requires organisation?

-- Do you have a problem remembering appointments or obligations?

-- When you have a task that requires concentration, do you avoid or delay it?

-- Are you fidgety when you have to sit still for long?

-- Do you often feel overly active and compelled to do things, as if you were driven by a motor?

Copyright 2004 Times Newspapers Ltd.

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