then , based on that , you calculate your approach to the individual . In some cases , particularly with children , they complete some kind of a standardised diagnostic checklist . One such is the Conners Speech Rating Scale , which has a version for caregivers and parents , and another for teachers .
So , patients can be formally assessed as well , but , especially with adults , I primarily rely on the free-flow interview , in which we can listen to their struggle . And once we have gone through the individual categories which are related to their academics , their time management , their organisations , their finances , their impulsive behaviours , or lifestyle challenges , or sleep disturbances , you will come to know that yes , most of the areas within the symptoms are covered . And hopefully , then we can proceed with the treatment options .
Adrian : Now , is the diagnosis important ? Is that something that you think is important when it comes to ADHD , is actually coming up with the formal diagnosis ?
Sanjeev : Yes , that ' s where we have to be assured that we are making a diagnosis at an appropriate age . And especially there are some subgroups of people who come , who were seen by their doctors , or by paediatricians , or psychologists , but their treatment was never initiated . And that ’ s OK . As long as there ' s a diagnosis there and I ' ve got documentary evidence , certainly then they can be eligible for PBS rebate . Otherwise , they may have to pay like a private script for medications . So , that ' s an advantage of early diagnosis .
Adrian : When do you think , " Okay , this is ADHD . This is not just your normal inattention , forgetfulness , a bit of hyperactivity ." When do you think , " Yes . definitely , diagnosis is warranted here ."
Sanjeev : I can give you example . I saw a lady who was told by her general practitioner that , " Well , I don ' t think you have ADHD because you have been sitting for one hour ." And that is what she had done . Okay . But that ' s the biggest myth . So , let them flow – the free-flowing interview method I ’ ve referred to - then what these people will do , if they ' re hyperactive , first , they will be very fidgety . They will be constantly tapping their legs , moving their hands , moving their bodies . And they sometimes want to stand up . Some of them find it very difficult to sit at one place and in fact do stand up .
So these are some people we come across . And they will preferably want jobs which require movement , such as a tradesman or a warehouse worker . They would hate an office job , one that requires a lot of attention to details , especially administrative tasks like invoicing and data entry - they just cannot do it .
“ I saw a lady who was told by her general practitioner that , " Well , I don ' t think you have ADHD because you have been sitting for one hour ." And that is what she had done . Okay . But that ' s the biggest myth ”
Now , there are other subgroups of people for whom if you allow them to speak at length , you will see that they are just like a wanderer . They will just deviate from the topic . And sometimes they will ask “ What was the question ?” because they themselves know that they have deviated . So , we call it going off on a tangent . But it is not a tangent if it is a primary psychiatric illness , then you have to rule out that it is not a part of hypomania , or a mania , or a psychosis .
So , we must be very wary of other comorbid psychiatric disorders , because of the rules restricting prescriptions of certain medications . An individual in Australia with a primary psychiatric illness , like a bipolar affective disorder and schizophrenia , is not eligible , at least in the beginning , for stimulants , and that can cause difficulties . This applies also to people who have been using , people with a substance abuse disorder . There are very strict regulations and each state has it ’ s own .
And that subgroup of individuals who are at high risk , we have to be even more cautious , because not only the side effect of medications can be a risk , but also if they misuse their medication they can have relapse of psychosis . And this is something I often see in a small percentage of people in my practice when they have misused their medication . But once they have misused , if there ' s a stimulant-induced , primary psychiatric illness like bipolar disorder or schizophrenia , then there is mandatory reporting of that incident to the health department .
Adrian : Okay . So there are regulations in place and it sounds like that ’ s for good reasons . Now , obviously , the mainstream treatment for ADHD is your stimulant medication .
Sanjeev : Yes .
Adrian : I ' m interested in hearing about your therapeutic approach , but before that , what causes ADHD ?
Sanjeev : Good question . Well , certainly there ' s a genetic component . I have seen that if either of the parents has ADHD then the chances are that familial prevalence will increase . But in general 1 in 20 individuals are diagnosed with ADHD in Australia . And of those 1 in 10 are treated , which means there ' s a substantial gap in between .
Adrian : And you mentioned there ' s a genetic component to it . Some neurotransmitters are implicated with it too , aren ’ t they , like dopamine and noradrenaline . Is that one of the theories behind it ?
Sanjeev : Yes . That ' s where the medications work . What happens is that
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