with their peers . So , there is a subgroup of patients which I come across , especially in this population , where underlying ADHD is a common condition .
And there is also another category of individuals , whose lives , especially when they are coming out of a structured environment like school , have been regimented to some degree and who , when they go to university or join the workforce , face looser work structures calling for greater self-reliance . That ’ s when we see some of these individuals struggling . And depending on their nature and certain rules and regulations for prescriptions , we pick them up and treat them .
Adrian : So a lot of them would have comorbid conditions such as addictions , and when they transition from the school environment into a workplace where maybe there ’ s not so much structure , then that ' s when some of these symptoms will become more apparent for them . And that ' s when they ' ll probably come and see someone like yourself ?
Sanjeev : That ' s correct .
Adrian : So , if we think about attention deficit hyperactivity disorder , now , does everybody with ADHD have hyperactivity or can you have just the attentional / inattention condition and not have the hyperactivity ?
Sanjeev : It ' s a very good point . And as I mentioned earlier , for a diagnosis of ADHD , hyperactivity is not required , although ADHD may be involved . DSM-5 distinguishes between disorders of hyperactivity and inattentiveness and designates as mixed-type the disorder in which both conditions are present .
So , to answer your question , hyperactivity may not be there in everyone . And , particularly in the case of adults , what happens is that even people who have been diagnosed with ADHD when they were young may have a mixture of hyperactivity and inattentiveness , but the hyperactive component tends to mellow as they grow into their late teens to early 20s . But the inattentive component can stay . So three out of four people will continue to have an inattention problem when diagnosed . That significantly affects their academic and professional pursuits . And this is where these people become quite dysfunctional . And I have seen remarkable changes once , certainly the medications , but also the integrative approaches , are used in these individuals .
“... particularly in the case of adults , what happens is that even people who have been diagnosed with ADHD when they were young may have a mixture of hyperactivity and inattentiveness , but the hyperactive component tends to mellow as they grow into their late teens to early 20s . But the inattentive component can stay . So three out of four people will continue to have an inattention problem when diagnosed . ”
Adrian : I ' ve got the DSM-5 criteria here . Some of the symptoms of inattentiveness are that they often fail to give close attention to details or make careless mistakes , or they often have difficulties sustaining attention to task or play activities . They may not seem to listen when spoken to directly , they can have problems following through with instructions or fail to finish schoolwork , or chores , or tasks . They may have difficulty organising tasks and activities , and they often avoid or are reluctant to engage in tasks that require sustained mental effort , or they often lose things . So , based on the DSM-5 criteria , six of those symptoms need to be persistent for at least six months . And they need to have been prevalent in childhood , don ' t they ?
Sanjeev : Yes , sometimes we do standardised questionnaires but we do a small checklist of questionnaires . And there is a detailed one , it is called a Diagnostic Interview for Adults with ADHD ( DIVA ), in which there are some questions related to their childhood . It also takes into account an individual ’ s cultural environment . Often , parents who are migrants or themselves have their own challenges may not even recognise that their children have problems . But when they look back and ask questions like those in DIVA they can see that they may have had these symptoms all their lives but without having had them brought to their attention . So this is where these individuals miss out a lot . If such symptoms had been picked up earlier , then chances are they could have done much better . At least some of them .
Adrian : And what was the questionnaire you mentioned that you use ?
Sanjeev : It is called DIVA . It is basically a diagnostic tool based on the DSM-5 questionnaire . Individual symptoms have been broken down into a checklist of questions . Patients indicate whether they had symptoms in the mild , moderate or severe categories . And
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