Psychiatric Problems in Irish Children and Adults – From Childhood to Adulthood

A longitudinal follow up study

From Child to Adult 
A Longitudinal Study of Irish Children and their Families
Co-Author: Cleary A., Fitzgerald M., & Nixon E.
Publisher:  University College Dublin
Criterion Press Ltd.
ISBN: 1 9022 7785 6
Child to Adult Michael Fitzgerald
Free book to download on psychological problems in Irish Children and Adults. 
A follow up study of children, studied in childhood to adulthood, 21 years, showed symptom levels were high and approximately one fifth of the respondents had probable psychiatric conditions and 55% had used non prescription drugs. Behavioural deviance at age 11 was highly predictive of poor educational outcome at age 21.
A majority of mothers previously diagnosed as suffering from psychological problems when their child was 10 had now recovered. Economic disadvantage exasperated the negative outcomes.
40% of children followed up, regarded religion as important in their lives.
This book is free to download from my website.

 

Autism – Serious Diagnostic Problems – Irish Medical Times Article – 4th Nov 2016

autism-article-in-irish-medical-times-nov-2016There has been a massive broadening and evolution of the concept of autism over the past three-quarters of a century. Hans Asperger (1938, 1944) and Leo Kanner (1943) initially described autism. The prevalence of autism depends on whether you use old, narrow, out-of-date concepts of autism or new concepts of the condition. The original prevalence studies of autism in Ireland conducted by McCarthy, Fitzgerald and Smith showed a prevalence of four per 10,000 in the Eastern Health Board. Current rates as shown by the Centres for Disease Control in 2016 put the prevalence of autism at one in 68. Autism is characterised by problems in social relationships and communication, repetitive activities, narrow interests, sensory issues with an onset early in childhood but can be diagnosed at any point on the life cycle. Autism is under-diagnosed in Ireland and often comorbidities (which often co-occur), like attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, sensory issues, dyspraxia, or emotional behaviour problems are focused on and the autism spectrum disorder is missed, with serious and detrimental consequences for the child. Early diagnosis is critical for a good outcome, and there is universal agreement on the critical importance of this early diagnosis and interventions.
Guidelines
One of the problems is that the UK’s National Institute for Health and Clinical Excellence (NICE) guidelines on the diagnosis of autism, which are accepted throughout the world, are not followed. These state that there is no specific instrument recommended for a diagnosis of autism and that it is a clinical diagnosis by an experienced clinician in the diagnosis of autism. Unfortunately, in Ireland, instruments like the Autism Diagnostic Interview-R (ADI-R) are often misused as specific clinical diagnosis for autism and parents will state, “often with tears in their eyes”, that the child is, “ADI-R negative”, or does not have autism on this instrument, when it is crystal clear to the parents, teachers etc that the child has autism. This means that the child is deprived of services for children with autism, the school is deprived of extra resources, and the child becomes extremely anxious, depressed and behaviourally disordered. Prof Dorothy Bishop, Professor of Developmental Neuropsychology at the University of Cambridge, United Kingdom, told Adam Feinstein, which is reported in his book, Autism in History, that: “The main problem with the ADI-R is not just the financial cost (though that is certainly prohibitive), but also the cost in time; time for training, time for administration, and time for scoring and consensus coding,” and Bishop told Adam Feinstein that: “If it could be shown that there were real benefits in accuracy of diagnosis from adopting this lengthy procedure, then I’d be happy to say: ‘Okay.’ “But the originators of the instrument have never demonstrated that you actually need such a long process – it is really more an article of faith with them.” Faith has no place in clinical diagnosis and seems to be more a religious concept to my point of view. Bishop also told Feinstein that: “Part of the problem is that criteria for autism keep changing.”
Phenotype 
This is true, and the concept has broadened throughout the years. Today the broader autism phenotype is accepted by most professionals throughout the world, with the exception of those who use an old-fashioned, narrow-based concept of autism, or instruments focusing on narrowbased ideas of autism. I’d like to mention The International Meeting for Autism Research (IMFAR), in London in May 2008, where many of the most experienced researchers and clinicians on autism in the world attended. As reported by Feinstein in Autism in History, many of these critics “lambasted the tool (ADI-R), for missing many cases of autism”, and that this instrument was an expensive and “ineffective instrument”.
Expert clinical opinion 
Prof Bishop concluded after the use of these expensive instruments that there was often no choice but, “to seek expert clinical opinion”, which of course very often happens in Ireland but takes years to achieve, and then over all that period, the children are deprived of diagnosis and services for autism. Of course, the NICE guidelines primarily recommend expert clinical opinion anyhow. This is now a public health problem. In addition, a speech and language therapy assessment and occupational therapy assessment and possibly a cognitive psychological assessment are also necessary.
Prof Michael Fitzgerald, Department of Psychiatry, Trinity College Dublin.

 

Overlap: Autism and Schizophrenia – Considerable confusion surrounds the overlapping of autism and schizophrenia

Advances in Mental Health and Intellectual Disabilities

Author:   Michael Fitzgerald (Professor of Child Psychiatry, based at Department of Psychiatry, Trinity College, Dublin, UK)
Citation:  Michael Fitzgerald , (2014) “Overlap between autism and schizophrenia: history and current status”,Advances in Mental Health and Intellectual Disabilities, Vol. 8 Iss: 1, pp.15 – 23
ABSTRACT
Purpose

– Considerable confusion surrounds the overlapping of autism and schizophrenia. This has significant implications for clinicians given that correct diagnosis is critical for treatment.

Design/methodology/approach

-This paper sets out to clarify the position by reviewing the history and current status of the relationship between autism and schizophrenia. A general review was conducted using a chronological approach that focused on phenomenology, aetiology, genetic mechanisms and treatment.

Findings

– Persons with autism are far more rigid, have difficulties set shifting and get far more upset and aggressive when their routines have changed. They have far more severe theory of mind and empathy deficits than those with schizophrenia.

Research limitations/implications

– Future diagnostic refinement by means of molecular genetic studies will alter the diagnostic categories. Further studies of the conditions of autism and schizophrenia are therefore necessary.

Practical implications

– Both conditions need treatment both clinically and practically.

Originality/value

– This paper elucidates the relationship between autism and schizophrenia from a historical and current perspective. It emerges that this confusion is likely to be resolved by molecular genetic studies that will alter the diagnostic categories.

        

 

Mass Killers – Can we identify a mass killer e.g. pilot, school shooter etc. in advance?

These are extremely rare events and it is almost impossible to predict with any degree of accuracy rare events. Nevertheless, we must try but at the same time realise that many of the individual features of the profile I describe about potential mass killers are not rare in the general population. It’s the more overall picture that is relevant.

We must look at:-

  1. 1.      Medical history pattern deviating from average medical history pattern of pilots, students, military personnel etc

 

  1. 2.      Childhood history of being bullied, being a loner, being very routine bound person with special interests in death, perversions, dead animals, serial killers, mass killing, police work, military activities, horror movies, killing of animals, e.g. cats etc showing callous and unemotional trails, moodiness and showing gross lack of empathy, problems reading other people’s minds emotionally, being excessively controlling and dominating, problems with reciprocal social relationships, having sensory problems, noise, taste, touch, being significantly clumsily, being very unpopular in school but having special talents with numbers, mathematics, technology, engineering, construction and logic.

Other features would include poor eye contact, problems reading non-verbal behaviour, problems sharing emotional thoughts, problems turn taking and being very poor at group games. Many or most readers will dismiss this profile as nonsensical. The only answered to them is to ask them to produce a better alternative approach to the problem. Clearly we have to be extremely careful in labelling people inappropriately. If one is totally anti-labelling or identifying potential mass killers then one has to accept the activity of mass killers.

If one hears of a person who is in an average job and who has never performed above the average or indeed less than the average level and they state they will one day be famous and that “everyone will know my name” and they have the profile outlined above then airline management or schools managers or army commanders should ask some questions and explore the background and motive of this person a little more. If in addition to the above profile already described, a person is depressed, has recently experienced stress at his job, has had personal relationship breakup or conflict with his employers or problems with his work performance, is in a position of major responsibility e.g. airline pilot, then they should be examined further, if they make unusual and bizarre statements which could be taken as a joke if one wasn’t listening carefully.

Another scenario is a pupil (almost always male) with the profile described, who shows strange comments on his social media sites, has been bullied (or is being bullied in school), is depressed, ostracised, can’t relate to girls, is a loner, has had an academic crisis or access to guns at home or elsewhere and makes violent threats, these should be investigated by the health and safety officer in school (who should be responsible for gun attacks in school) in conjunction with the management of the school where a thorough investigation should take place. People like the readership keep Adam Lanza, Harold Shipman and Timothy McVey in mind.

 

References:

Autism Spectrum Disorders - Recent Advances - New Book Cover ‘Autism and School Shooting’

by Michael Fitzgerald

has been published in April 2015 in the book ‘Autism Spectrum Disorders – Recent Advances’

by InTech Publishing in a book edited by Michael Fitzgerald.

Click here to download for free

 

young violent dangerous to know

 

Young Violent and Dangerous to Know’, a book by Michael Fitzgerald

was published by Novinka, New York in 2013 and focuses on mass killers and serial killers.

Click here for more details

 

Psychopathy -Risk Factors, Behavioural Symptoms and Treatment Options

 

A new book called “Psychopathy”

published in 2014 by Nova Science, New York, edited by Michael Fitzgerald,

has a chapter on ‘Criminal Autistic Psychopathy’ by Michael Fitzgerald, a not uncommon diagnosis in mass killers.

Click here for more details

The Mind of the Artist – Attention Deficit Hyperactivity Disorder, Autism, Asperger Syndrome & Depression

The Mind of the Artist
This is a provocative and novel investigation of the psyches of sixty artists, predominantly from the world of film, theatre and television/radio – writers, actors, producers and directors ranging from Shakespeare and Voltaire to major late-twentieth-century figures such as Spike Milligan, Sam Peckinpah and Frank Sinatra, by way of F. Scott Fitzgerald, Orson Welles and Judy Garland. Irish artists featured include Oliver St. John Gogarty, Jimmy O’Dea and Richard Harris.
The chapters, which range from quite brief vignettes to more in-depth studies, examine the background of each individual before considering their personality, social relationships and work. Professor Fitzgerald brings his expertise to bear in elucidating the psychological factors, strengths and frailties that shaped the lives and careers of these prominent creators, many of whom are regarded as geniuses.
The lives of extraordinary artists are of interest in themselves; when their stories are told from the perspective of expert psychological insight, the results are fascinating and revealing


Click here to read more or purchase this book from Nova Publishers

Did W.B. Yeats have Aspergers Syndrome?

A number of historical figures, including Eamon de Valera, WB Yeats and American artist, Andy Warhol, had Aspergers Syndrome according to Professor Michael Fitzgerald. They all showed signs of Asperger’s syndrome, a type of autism in which the person affected generally has a very high IQ, but extremely poor social and communication skills. This is explained in the following books: ‘In Autism and Creativity: Is There a Link between Autism in Men and Exceptional Ability?’ published by Brunner-Routledge and Unstoppable Brilliance, published by Liberties Press. “WB Yeats for example did very poorly at school. He failed to get into Trinity College and was described by his teachers as ‘pedestrian and demoralised’. His parents were told he would never amount to anything”, This is typical of people with Asperger’s syndrome. They do not fit in as they do not relate to others. They are often seen as odd or eccentric and may be bullied at school as a result. Many people in Ireland are thought to have Asperger’s syndrome, with males significantly more likely to develop the condition than females. unstoppable brilliance

Adult Attention Deficit Hyperactivity Disorder: The European Perspective

ADHDThe prevalence of Adult Attention Deficit Hyperactivity Disorder is between 1 and 5%.  Both DSM-IV and ICD-10 criteria recognise that symptoms of Attention Deficit Hyperactivity Disorder and Hyperkinetic disorder persist beyond childhood into adulthood. However neither classification gives fixed thresholds for the number of symptoms required to make a diagnosis in adults.  DSM-IV criteria suggests that adults with only some of the symptoms of Attention Deficit Hyperactivity Disorder should be given a diagnosis of Attention Deficit Hyperactivity Disorder in partial remission; however, this diagnosis seems to underplay the significant impairments seen in adults no longer meeting the full DSM-IV criteria.  There is no doubt that symptoms of adult Attention Deficit Hyperactivity Disorder should be judged with reference to developmentally appropriate norms. The expression of Attention Deficit Hyperactivity Disorder in adults is different from that in children and the diagnostic descriptions of symptoms are not easily applicable to adults.  For example physical activity in children is replaced by constant mental activity, feelings of restlessness and difficulty engaging in quiet sedentary activities in adults. Compared to the diagnosis in children, a diagnosis of Attention Deficit Hyperactivity Disorder in adults is also heavily dependent on self-reporting symptoms. For that reason an independent informant particularly one who had knowledge of the adult in childhood is particularly important. In addition school reports can be most helpful.  Girls particularly with Attention Deficit Disorder without the hyperactivity tend to be under diagnosed and under treated.  In Adult Psychiatry Attention Deficit Hyperactivity Disorder is probably one of the commonest missed diagnosis, the second most commonly missed diagnosis being Asperger’s syndrome.  What is treated is the comorbid anxiety, depression, or drug abuse and the underlying Attention Deficit Hyperactivity Disorder is left untreated with serious consequences.

 

The key element in diagnosis is the lifetime and persistent history of symptoms with impairment in either school, work, home, or interpersonal relationships.  This was emphasised at a recent meeting of the European Network for Attention Deficit Hyperactivity Disorder in Frankfurt.

 

Treatment should focus on psychoeducation for persons with Attention Deficit Hyperactivity Disorder, as well as pharmacotherapy, and in addition the treatment of comorbid disorders.  Stimulants like Methylphenidate are used in the treatment of adults. Long acting Methylphenidate for example Concerta is being used off label for adult Attention Deficit Hyperactivity Disorder.  Atomoxetine (Strattera) which is licensed for adults in the United States and is available in Ireland on a named patient basis is being used for the treatment of Attention Deficit Hyperactivity Disorder.  It is the first non-stimulant medication for Attention Deficit Hyperactivity Disorder.  I have found that the tricyclic antidepressants are unfortunately rather ineffective. The core symptoms of Attention Deficit Hyperactivity Disorder require pharmacological treatment.  The other behavioural associated problems or disorders can benefit from psychotherapy, cognitive, supportive, etc..

 

It is possible that Adult Attention Deficit Hyperactivity Disorder may belong to a more severe and more genetically effected condition. Morbidity and mortality are both increased in adults with Attention Deficit Hyperactivity Disorder. It appears that Attention Deficit Hyperactivity Disorder can result in more accidents including traffic accidents and alcohol and drug abuse.  There is evidence that where Attention Deficit Hyperactivity Disorder has been adequately treated the rate of substance abuse was less.  It is important to reiterate that in adulthood the features of Attention Deficit Hyperactivity Disorder that are most common are inattention, impulsivity, poor organisation, and restlessness. Attention Deficit Hyperactivity Disorder can be associated with creativity for example Kurt Cobain who had diagnosed Attention Deficit Hyperactivity Disorder in childhood, Oscar Wilde, Lord Byron, Ernest Shakleton, and Richard Brinsley Sheridan.

 

Adult Attention Deficit Hyperactivity Disorder is of critical importance in services treating drug problems, personality disorders, and forensic services.  The rate of Attention Deficit Hyperactivity Disorder in Mountjoy Prison is much higher than in a non-prison population.  A recent edition of the Journal (2003) Drugs:  Education Prevention and Policy emphasised the association of adult Attention Deficit Hyperactivity Disorder, Antisocial Personality Disorder and substance misuse.  Despite this clinicians have a reluctance to take Attention Deficit Hyperactivity Disorder into account at the diagnostic and therapeutic level.  The reluctance to accept the diagnosis is even more puzzling because of its very high heritability which is higher than many conditions psychiatrists treat.  There should be regional centres for the treatment of adult Attention Deficit Hyperactivity Disorder but this is not possible with the catchment area arrangement. Therefore one Consultant Psychiatrist in each catchment area should take a special interest in adult Attention Deficit Hyperactivity Disorder.

Kurt Cobain was wrong about the treatment of Attention Deficit Hyperactivity Disorder.

Kurt Cobain was wrong – the treatment of Attention Deficit Hyperactivity Disorder with Methylphenidate does not predispose to substance misuse indeed precisely the opposite is true.  Adults with Attention Deficit Hyperactivity Disorder have difficulties tending to tasks and activities and inhibiting their impulses. They have a poor ability to sustain attention over long periods, and are unable to concentrate on short, focussed work. They act without thinking, often resulting in reckless and impetuous behaviour.  Indeed, impulsiveness may be an important defining characteristic of Attention Deficit Hyperactivity Disorder in adulthood.  Although they do not necessarily present with the overactive behaviour frequently seen in children they feel restless.  As a result an individual may act without reflection or consideration for the consequences of action.  They may be disorganised, forgetful, and have planning deficits and poor time management skills.  Impetuous novelty-seeking behaviour may result in criminal acts, substance misuse and dependence according to Susan Young a psychologist who focuses on adult Attention Deficit Hyperactivity Disorder.  About 4.4% of adults in the community have adult Attention Deficit Hyperactivity Disorder.  Unfortunately there is an error in DSM-IV diagnosis for Attention Deficit Hyperactivity Disorder. Particularly with adults the age seven cut off is unsatisfactory and it is likely in future that onset in primary school or before the age of 12 will be accepted rather than onset before the age of seven.  In making the diagnosis multiple informants are very helpful or information from parents of a person with adult Attention Deficit Hyperactivity Disorder or school records to improve diagnosis.  It is more common in males than females.  Clearly there is a great deal of comorbidity particularly in the area with Antisocial Personality Disorder, substance misuse, and depression.  They have often poor occupational histories and considerable breakdown in the long term in interpersonal relationships, marriages etc. They often feel socially isolated and misunderstood.  This is unfortunate since there is relatively good treatment available.  Nevertheless they can be successful particularly in the artistic areas.  John Osbourne, Clark Gable, Jesse James, George Carman, and Kenneth Tynan had adult Attention Deficit Hyperactivity Disorder.

 

Kurt Cobain had Attention Deficit Hyperactivity Disorder, and was prescribed Methylphenidate when he was at school. Unfortunately he only took it for three months.  The impression was given later that this was a factor in his developing substance abuse. Indeed precisely the opposite is the truth.  Persons who are treated for Attention Deficit Hyperactivity Disorder on a continuous basis with Methylphenidate are less likely to abuse substances as they get older. The abuse of drugs like cannabis or cocaine is often a feature of self-medication for Attention Deficit Hyperactivity Disorder.  The increased use of cigarettes by persons with Attention Deficit Hyperactivity Disorder may also be done for the same reason.  There is no doubt that persons with Attention Deficit Hyperactivity Disorder have an earlier onset of cigarette smoking and a greater use of it. There is no evidence for long term risks for substance use disorders in persons prescribed Methylphenidate. Indeed there is a reduced likelihood of substance misuse if Attention Deficit Hyperactivity Disorder is properly treated with stimulants.  This doesn’t mean that there aren’t some risks from stimulants i.e. through diversion. A new medication for Attention Deficit Hyperactivity Disorder Atomoxetine has been shown to have no greater abuse liability than Desipramine an antidepressant or placebo. Unfortunately Attention Deficit Hyperactivity Disorder is a serious condition which requires early intervention and the misinformation about it is preventing some children from getting the treatment that they need.

 

Children with Attention Deficit Hyperactivity Disorder are at risk of increasing complications as they get older.  They start in childhood with Attention Deficit Hyperactivity Disorder alone and then can develop disruptive behaviour disorders, oppositional disorders, challenging behaviour, and later from about 14 years onwards they experience often school exclusion, substance abuse, mood disorder, conduct disorder, and finally antisocial personality disorder and often get involved with the law at the same time.  Of course this trajectory only occurs in those with severe Attention Deficit Hyperactivity Disorder and severe complications.  Comorbid Oppositional Defiant Disorder occurs in over 40%, Conduct Disorder in 20 to 56%, delinquent and antisocial activities in 18 to 30%. Many continue their problems into adulthood and they are more likely to enter the workforce at unskilled or semi skilled level. They are twice as likely to be dismissed from their employment, tend to have many more jobs than the average, and to show much lower work performance than the average.

 

In examining motor vehicle driving risks persons with Adult Attention Deficit Hyperactivity Disorder are 60% more likely to have a crash with injuries as compared to 17% of the general population. As well as having much more accidents they tend to have worse accidents.  They have four times higher risk of having sexually transmitted diseases because of their earlier onset of sexual activity and their increased number of sexual partners.  In addition they are less likely to employ contraception and spend less time with each partner than the average population.  Girls with Attention Deficit Hyperactivity Disorder are over 9 times more likely to have a teen pregnancy than those without Attention Deficit Hyperactivity Disorder.  The judicial costs of having Attention Deficit Hyperactivity Disorder are vastly increased as compared to people without Attention Deficit Hyperactivity Disorder. In America it has been estimated that the total criminal costs for persons with Attention Deficit Hyperactivity Disorder and Conduct Disorder combined are 37,830 dollars.

 

Unfortunately Adult Attention Deficit Hyperactivity Disorder is largely missed as a diagnosis.  It appears to me that the  next most missed diagnosis in adults is Asperger’s syndrome which nowadays tends to misdiagnosed as Mild Bipolar disorder.  It tended in the past (and this still occurs in the present) to be misdiagnosed as Personality disorder or Schizophrenia.  This meant they didn’t get the treatment they needed and got inappropriate treatment.  A typical example is the novelist who was nominated for a Nobel Prize Janet Frame who was diagnosed with Schizophrenia outside Europe.  She was put on a list for lobotomy in 1952.  She was told by the Maudsley Hospital later that she did not have Schizophrenia.  She died in 2004.  In actual fact she had Asperger’s syndrome.  There may be thousands in a similar situation throughout the world with misdiagnosis of psychiatric disorder.  Hopefully the Irish College of Psychiatrists, Irish Psychiatric Association and those responsible for C.M.E. will take up this issue.

 

Going back to Kurt Cobain he would have a much greater chance of having survived if he persisted taking his Methylphenidate on a regular basis and had intensive multimodal treatment for his Attention Deficit Hyperactivity Disorder and associated problems.  He showed the majority of comorbidities that one can get with Attention Deficit Hyperactivity Disorder.  It was not surprising that he completed suicide.

 

Road Traffic Accidents and Adolescent / Adult Attention Deficit Hyperactivity Disorder.

Automobile crashes are one of the leading causes of deaths in adolescents.  Accidents are three to four times more frequent in persons with Attention Deficit Hyperactivity Disorder.  The Attention Deficit Hyperactivity Disorder driver is three to four times more likely to be at fault.  The Attention Deficit Hyperactivity Disorder driver is six to eight times more likely to loose their license.  The treatment of Attention Deficit Hyperactivity Disorder with stimulants improves the performance of the driver.  There is a serious lack of attention being given to the impact of Attention Deficit Hyperactivity Disorder on driver’s performance in relation to accidents in Ireland.  Unfortunately adult Attention Deficit Hyperactivity Disorder is not uncommonly missed as a psychiatric diagnosis.

 

Adults with Attention Deficit Hyperactivity Disorder have difficulties tending to tasks and activities and inhibiting their impulses. They have a poor ability to sustain attention over long periods, and are unable to concentrate on short, focussed work. They act without thinking, often resulting in reckless and impetuous behaviour.  Indeed, impulsiveness may be an important defining characteristic of Attention Deficit Hyperactivity Disorder in adulthood.  Although they do not necessarily present with the overactive behaviour frequently seen in children they feel restless.  As a result an individual may act without reflection or consideration for the consequences of action.  They may be disorganised, forgetful, and have planning deficits and poor time management skills.  Impetuous novelty-seeking behaviour may result in criminal acts, substance misuse and dependence according to Susan Young a psychologist who focuses on adult Attention Deficit Hyperactivity Disorder.  About 4.4% of adults in the community have adult Attention Deficit Hyperactivity Disorder.  Unfortunately there is an error in DSM-IV diagnosis for Attention Deficit Hyperactivity Disorder. Particularly with adults the age seven cut off is unsatisfactory and it is likely in future that onset in primary school or before the age of 12 will be accepted rather than onset before the age of seven.  In making the diagnosis multiple informants are very helpful or information from parents of a person with adult Attention Deficit Hyperactivity Disorder or school records to improve diagnosis.  It is more common in males than females.  Clearly there is a great deal of comorbidity particularly in the area of Antisocial Personality Disorder, substance misuse, and depression.  They have often poor occupational histories and considerable breakdown in the long term in interpersonal relationships, marriages etc. They often feel socially isolated and misunderstood.  This is unfortunate since there is relatively good treatment available.  Nevertheless they can be successful particularly in the artistic areas.  John Osbourne, Clark Gable, Jesse James, George Carman, and Kenneth Tynan had adult Attention Deficit Hyperactivity Disorder.  Doctors can also have adult Attention Deficit Hyperactivity Disorder and the following questions are often worth considering:

 

(1)       Do you have difficulty concentrating or focussing your attention on one thing?

 

(2)       Do you often start multiple projects at the same time, but rarely finish them?

 

(3)       Do you have trouble with organisation?

 

(4)       Do you procrastinate on projects that take a lot of attention to detail?

 

(5)       Do you have problems remembering appointments or obligations?

 

(6)       Do you have trouble staying seated during meetings or other activities?

 

(7)       Are you restless or fidgety?

 

(8)       Do you often loose or misplace things?

 

In terms of driving behaviour Methylphenidate (Ritalin / Ritalin LA) significantly reduces inattentive driving errors.  It would appear that for those driving in the early evening including during the day Concerta XL (Methylphenidate) which lasts for 12 hours would be more relevant.  This is also a form of slow release Methylphenidate and is off label in Ireland for adults.  Of course accidents do occur in the evening and so good attention is particularly required at this time.  There is also a new medication the first non-stimulant medication available in Ireland for Attention Deficit Hyperactivity Disorder on a named patient basis called Atomoxetine (Strattera) which is active over the 24 hours. This has slow onset and has to be taken seven days a week. This would seem to have a place when you are particularly focussing on wanting to have a person on continuous treatment as it does not wear off.  It would particularly appear to be important for late evening / night, the time of maximum danger for accidents.  Adolescents with Attention Deficit Hyperactivity Disorder also benefit from cognitive / behavioural therapy which focuses on the inhibition of impulses, time management, organisational skills, problem solving skills, anger management, decision-making skills, social skills training, and improved social perception.  Persons with Attention Deficit Hyperactivity Disorder need to be educated about it.  Once the diagnosis is given to them it can suddenly make sense of their lives and sometimes of the chaos of their lives.  It is difficult to get a chaotic life into order if one doesn’t understand what the problem is.  Genetic factors play a major role in Attention Deficit Hyperactivity Disorder.  The problem of adult Attention Deficit Hyperactivity Disorder and accidents is a matter that should be taken up by professional psychiatric bodies and by consultants in Accident and Emergency Departments who are often on the receiving end of problems with Attention Deficit Hyperactivity Disorder.  Organisations involved in road safety should also examine this issue.

Book Review: Straight talk about Attention Deficit Hyperactivity Disorder

by William K. Wilkinson. Published by the Collins Press: Cork, 2003

This book is essential reading for parents, children, and adolescents with Attention Deficit Hyperactivity Disorder and for General Practitioners, Paediatricians, Child Psychiatrists, and Doctors working in Community Services.  It is comprehensive, and very practical and answers most of the questions that parents and professionals ask about Attention Deficit Hyperactivity Disorder. In addition it has a useful Appendix of Organisational Contacts for parents and also a useful reading list for parents and professionals.  It discusses in detail the diagnosis of Attention Deficit Hyperactivity Disorder as well as the causes of Attention Deficit Hyperactivity Disorder.  It gives proper weight to biological and genetic factors. It also tackles the issue of ‘blaming’ the parents for the disorder.

In my experience the tragedy of Child Psychiatry / Child Psychology in the 1970s in Ireland, 1980s and indeed early 1990s was the tendency to see children’s problems with Attention Deficit Hyperactivity Disorder as being due to inadequate parenting.  This had a devastating and negative effect on parents.  The therapists of a family or psychodynamic orientation particularly took the view that the child’s problems were caused by the family dynamics.  Indeed this false view of Attention Deficit Hyperactivity Disorder still occurs. Wilkinson provides an accurate and balanced view of this complex topic.  Wilkinson gives a superb and detailed understanding of the Clinical and Educational Psychologist Assessment of persons with Attention Deficit Hyperactivity Disorder.  He answers in detail the kind of questions parents asked about what Psychologists do.

One minor quibble is that there is no index and in the next edition of this most valuable book I hope that he will add in a Chapter on Adult Attention Deficit Hyperactivity Disorder