ADHD testing in adults in India: What you need to know

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is often associated with children, but it can persist into adulthood, impacting various aspects of an individual's life. In India, awareness about ADHD in adults has been gradually increasing, leading to a growing demand for accurate diagnosis and effective management. This article aims to provide a comprehensive overview of ADHD testing in adults in India, shedding light on the signs, the diagnostic process, and available treatment options.

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Understanding ADHD in adults

ADHD is a neurodevelopmental condition characterised by persistent patterns of hyperactivity, impulsivity, and/or inattention. In adults, the symptoms may manifest differently than in children, making it challenging to recognize. Common signs include:

• Disorganisation, problems with keeping track of tasks, or prioritising them
• Lack of focus and being easily distracted, finding it difficult to pay attention in a conversation, overlooking small details, and finding it hard to complete tasks
• Time management difficulties leading to procrastinating, forgetting about events, or having trouble focusing on planning.
• Forgetfulness tends to occur more frequently and can have larger impacts on relationships and career.
• Impulsivity in adults presents differently as it does in children. Here, it can be seen as interrupting others during conversations, being inappropriate in social settings, rushing through tasks, and acting without considering consequences. Impulsive shopping, sexual activity, and substance use can also be noted.
• Lack of motivation, hyperfocus, and fatigue might also be present.
• Adults with ADHD can also present with restlessness and anxiety, experience emotional concerns and frequent mood shifts, negative self-image, and substance misuse.

These symptoms can have vast impacts on individuals’ personal lives, relationships, and careers. 

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Diagnostic criteria for ADHD in adults

Diagnosing ADHD in adults involves a thorough assessment, considering both the symptoms and their impact on daily functioning. Testing and diagnosis of ADHD in adults is done by an RCI-registered clinical psychologist/clinical psychologist (Associate) or psychiatrist, with experience of working with individuals with ADHD. The process of testing involves several steps, and seeks to gather as much information as possible from varied sources, such as parents and teachers.

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The process starts with clinical evaluation, to understand the symptoms and manifestations of ADHD in the individual. Here, one will be asked to provide information on their childhood development, completion of developmental milestones, and behaviour throughout childhood. They will be asked to provide how the symptoms manifest in their lives currently, and which areas these symptoms are seen in. 

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Furthermore, diagnosis of ADHD will be based on the specific criteria outlined in diagnostic manuals such as the DSM and ICD. The criteria for diagnosis include:

• A persistent pattern (of at least 6 months) of inattention symptoms and/or combination of hyperactivity and impulsivity symptoms that is outside the limits of what is expected for the age and intellectual development. 
• Symptoms of inattention that are persistent and sufficiently severe to have a direct negative impact on academic, occupational, or social functioning. The symptoms are within the following clusters:

• Difficulty sustaining attention in tasks that don’t provide high stimulation, provide rewards, or require mental effort
• Lacking attention to detail, making careless mistakes, and not completing tasks
• Easily distracted by extraneous stimuli or thoughts not related to the tasks at hand, appearing as if one is not listening when spoken to, daydreaming, or having the mind elsewhere
• Losing things, forgetful in daily activities, difficulty remembering to complete tasks or activities, difficulty planning, managing, and organising tasks and activities

• Several symptoms of hyperactivity/impulsivity that are persistent, and sufficiently severe to have a direct negative impact on academic, occupational, or social functioning. These are seen in structured situations requiring behavioural self-control. The symptoms are in the following clusters.

• Excessive motor activity, physical restlessness, a sense of discomfort with being quiet or sitting still
• Difficulty engaging in activities quietly, talking too much
• Blurting comments at work, difficulty waiting turn in conversation, games, or activities, interrupts or intrudes other conversations or games
• Tendency to act in response to stimuli without consideration of risks and consequences (eg. engaging in behaviours with potential for physical injury, impulsive decisions, reckless driving)

• Evidence of significant inattention and/or hyperactivity-impulsivity symptoms prior to age 12, even though individuals may first come to clinical attention as adults, when demands exceed the individual’s capacity to compensate for limitations.
• Manifestations of inattention and/or hyperactivity-impulsivity must be evident across multiple situations or settings (eg. home, school, work, with friends or relatives), but are likely to vary according to the structure and demands of the settings.
• The symptoms are not better accounted for by another mental disorder (eg. an anxiety or fear-related disorder, a neurocognitive disorder such as delirium).
• Symptoms are not due to the effects of a substance (eg. cocaine) or medication (eg. bronchodilators, thyroid replacement medication) on the central nervous system, and are not due to a disease of the nervous system.

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Based on the ICD-11 or DSM-5-TR, the individual might receive a diagnosis of ADHD, predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, or combined presentation.

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The ADHD testing process in India

• Clinical evaluation: The first step in ADHD testing for adults in India involves a clinical evaluation conducted by a qualified mental health professional. This may include psychiatrists, psychologists, or clinical social workers. During the evaluation, the clinician will gather information about the individual's medical history, symptoms, and their impact on various life domains.

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• Self-reporting and observations: Adults seeking an ADHD diagnosis may be required to provide self-reports of their symptoms, such as the Adult ADHD Self-report Scale (ASRS-v1.1). Additionally, feedback from close friends, family members, or colleagues who have observed the individual's behaviour can offer valuable insights. The combination of self-reports and external observations helps in establishing a more comprehensive understanding of the individual's experiences.

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• Psychological testing: Psychometric assessments and standardised tests may be employed to evaluate cognitive functioning, attention, and other relevant aspects. These tests help in ruling out other possible causes of the symptoms and provide additional objective data to support the diagnosis. This would be done by a RCI-registered clinical psychologist/clinical psychologist (associate).

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• Rule out other conditions: Many other conditions can present with symptoms similar to ADHD, such as anxiety disorders, depression, or certain medical conditions. It is crucial to rule out these possibilities through thorough assessment to ensure an accurate diagnosis.

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• Duration and severity: The clinician will assess the duration and severity of symptoms to determine if they meet the criteria outlined in the ICD-11 or DSM-5-TR. This involves considering when the symptoms started, their persistence, and the degree to which they impact the individual's life.

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Challenges in ADHD testing in India

Despite the increasing awareness of ADHD in adults, several challenges persist in the testing process in India:

• Limited awareness: Many individuals in India may not be familiar with ADHD or may associate it only with children. This lack of awareness can lead to delayed diagnosis and treatment for adults experiencing symptoms.

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• Stigma: Mental health stigma remains a significant challenge in India, discouraging individuals from seeking help. The fear of judgement and societal misconceptions about mental health conditions can prevent people from discussing their symptoms and seeking timely diagnosis and intervention.

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• Access to mental health professionals: Access to qualified mental health professionals, especially in remote or underserved areas, is a significant concern. This limited accessibility can result in delays in diagnosis and treatment initiation.

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• Cultural factors: Cultural factors can also influence how ADHD symptoms are perceived and reported. In some cases, cultural norms may lead to underreporting or misinterpretation of symptoms, affecting the accuracy of the diagnosis.

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Treatment options for ADHD in adults

Once diagnosed, individuals with ADHD in India have access to various treatment options aimed at managing symptoms and improving overall functioning.

• Medication: Stimulant medications, such as methylphenidate and amphetamines, are commonly prescribed to help manage ADHD symptoms. Non-stimulant medications, like atomoxetine, can be considered, based on the individual’s presentation. However, medication should be prescribed and monitored by a qualified healthcare professional.

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• Psychoeducation and counselling: Psychoeducation plays a crucial role in helping individuals and their families understand ADHD better. Counselling, including cognitive-behavioural therapy (CBT), can provide practical strategies for managing symptoms and improving coping skills.

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• Lifestyle modifications: Symptom management can also include lifestyle modifications. This includes maintaining a structured routine, incorporating regular exercise, ensuring adequate sleep, and implementing organisational strategies.

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• Support groups: Joining ADHD support groups can offer individuals a sense of community and understanding. Sharing experiences with others facing similar challenges can provide valuable insights and emotional support.

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Conclusion

ADHD testing in adults in India is a complex process that requires a comprehensive and multidimensional approach. Increased awareness, improved access to mental health professionals, and destigmatisation of mental health issues are essential for facilitating timely diagnosis and intervention. Individuals experiencing symptoms of ADHD should seek professional help, recognizing that effective management strategies and support are available. Through a combination of accurate diagnosis, personalised treatment plans, and ongoing support, individuals with ADHD in India can lead fulfilling and productive lives. One can reach out to the team of psychiatrists and clinical psychologists at Rocket Health to explore testing options for ADHD and receive a comprehensive treatment plan. 

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References

“Adult attention-deficit/hyperactivity disorder (ADHD).” (2023, January 25). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adult-adhd/diagnosis-treatment/drc-20350883. 

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Brook, J. S. et al. (2015). Compulsive buying: Earlier illicit drug use, impulse buying, depression, and adult ADHD symptoms. Psychiatry Research, 228(3), 312-317. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532632/. 

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Goldman, R. (2023, January 2). “Symptoms of adult ADHD.” Healthline. https://www.healthline.com/health/adhd/adult-adhd. 

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Kessler, R. C. et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf. 

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World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/browse11/l-m/en.