Mental health: Lack of funds and understanding are the two biggest obstacles to diagnosing ADHD, says expert

approximately 1 in 20, and follows about 65% of them into adulthood, affecting about 1 million adults in South Africa. Picture:Unsplash/Marcel Strauß

approximately 1 in 20, and follows about 65% of them into adulthood, affecting about 1 million adults in South Africa. Picture:Unsplash/Marcel Strauß

Published Sep 19, 2023


Attention-deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children, affecting approximately 1 in 20, and follows about 65% of them into adulthood, affecting about 1 million adults in South Africa.

ADHD is characterised by a persistent pattern of inattention, hyperactivity and impulsivity that impair development and functioning, and are often coupled with behavioural, academic, social and emotional problems that can lead to difficulties in interpersonal relationships and school and work performance.

According to the Centres for Disease Control and Prevention, there are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

Predominantly inattentive presentation:

It is hard for the individual to organise or finish a task, pay attention to details, or follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

Predominantly hyperactive-impulsive presentation:

The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly.

The individual feels restless and has trouble with impulsivity. Someone impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

Combined presentation:

Symptoms of the above two types are equally present in the person.

More often than not ADHD is a condition that is usually misdiagnosed and plagued by myths and misunderstandings, particularly regarding treatment.

The condition hampers sufferers’ educational performance, self-esteem, relationships, and work productivity, and leads to increased risk of other psychiatric disorders, reduced social functioning, delinquency, and substance abuse.

The lack of knowledge about ADHD and other mental health issues, as well as the strain on healthcare systems and the stigma associated with mental health, according to Congress convener and Head of Healthcare Leadership at Stellenbosch Business School, prevents the early identification and treatment of ADHD and comorbid disorders.

According to estimates, 17% of children and adolescents in countries with low to middle incomes experience mental health difficulties, and 50% of all mental health illnesses start before the age of 14. However, only 1% of all psychiatric services dedicate themselves to the mental health of children and adolescents.

“The lack of knowledge and funding for treatment are two of the main access barriers to diagnosis and treatment,” points out Prof Renata Schoeman. Moreover, in countries such as South Africa, only 5% of the health budget is allocated to mental health.

The 4th South African Multidisciplinary ADHD Congress, a virtual gathering of international and local professionals, took place from August 30 to September 2.

Organised by the Stellenbosch Business School in collaboration with the Goldilocks and the Bear Foundation, this congress brought together a diverse range of experts, including psychiatrists, paediatricians, general practitioners, psychologists, and occupational therapists.

The aim was to present cutting-edge research and provide valuable insights into the optimal management of ADHD.

With the prevalence of ADHD and the significant impact that undiagnosed and untreated ADHD can have on various aspects of individuals' lives, Congress highlighed the importance of advocacy and access to treatment.

The scholastic, occupational, emotional, financial, and social well-being of those with ADHD are at stake, making it crucial to address the condition effectively.

The congress highlighted Africa's mental health challenges, including a low number of psychiatrists per population, a lack of mental health policies, and insufficient awareness.

Africa has an alarmingly low average number of psychiatrists per population, with only 0.05 per 100 000 people, compared to 9 per 100 000 in Europe. The congress addressed these issues through improved mental health support across the continent

According to one of the key organisers, Professor Schoeman, the congress featured40 sessions that specifically focused on ADHD.

The congress sparked renewed interest in ADHD research, provided opportunities for upskilling, and fostered collaboration among healthcare professionals.

Ultimately, it improved outcomes for individuals with ADHD in the unique Southern African context.

ADHD can continue to have a severe impact, with many adults with ADHD going untreated for most of their lives while being at increased risk of other psychiatric conditions, substance abuse and work-related problems caused by their poor time management and organisational skills.

“Although some children appear to ‘outgrow’ ADHD, the condition does continue into adolescence in most cases and it is more a case of some becoming more skilled in managing the symptoms and, as adults, compensating for their ADHD-related impairment through lifestyle and career choices,” said Prof Schoeman.

Additionally, the importance to consult a health professional such as a paediatrician, psychiatrist, or psychologist for a formal diagnosis of ADHD, and to determine whether there are other causes for the symptoms (such as sleep deprivation, depression, anxiety, excessive screen time, or medical conditions), and to obtain appropriate treatment.

“The negative impact of ADHD on a person’s overall quality of life can be substantially improved with the correct diagnosis and effective, multi-modal treatment, including medication, behavioural therapy and social and educational support,” championed the mental health advocate.