The Psychological Wellness Centre

Singapore Psychiatrist treating ADHD, Anxiety and Depression
Emotional Wellness is Just a Step away

Attention Deficit Disorder (ADHD/ADD) in Singapore

The most common childhood disorder treated by Singapore psychiatrists is Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD) as it was formerly known. It is a childhood disorder with a prevalence of about 5%. It is perhaps the most common psychiatric disorder in children that present to Psychiatrists in Singapore. Symptoms are not only very debilitating but what is probably of more concern, is that the child is often labeled as naughty, impulsive and disruptive; even though they have little control over their behaviour. This often has an emotional toll on the child and they may develop emotional problems as a consequence. As a result, there can be far-reaching issues in terms of long-term self-esteem, confidence and also the development of more anti-social behavior in the future. There was a belief in the past that children with ADHD will “outgrow” the condition and become better with age. We now have evidence that points to the fact that while behavioural symptoms of hyperactivity and impulsivity would improve with age, symptoms of inattention often persist into adulthood. This is associated with inner restlessness, poor organisational skills and risk taking behaviours in these individuals. This is a significant area  which has been previously neglected and under-recognised in Singapore. Recognition of adult ADD/ADHD is an important area as it also holds significance in causing under-performance in otherwise capable individuals; often with its own sequelae of anxiety and mood disorders forming. Sufferers of Adult ADHD are also more likely to have co-existent problems such as substance abuse, hence the importance of treatment in adults whose symptoms fail to fully resolve with time, or in those who have earlier been misdiagnosed or undiagnosed. Some of the common symptoms we see in ADHD include the following. Symptoms can be divided into symptoms of restlessness and hyperactivity, impulsivity and also of inattention.

Symptoms of restlessness, hyperactivity and impulsivity

* fidgeting and difficulty remaining seated

* excessive running or climbing

* difficulty playing quietly

* always seeming to be "on the go"

* talking excessively

* blurting out answers before hearing the full question

* difficulty waiting for a turn or in line

* interrupting when others are talking

Symptoms of inattention 

* inability to sustain or pay attention to details

* tendency to make careless errors in schoolwork

* apparent listening problems

* difficulty following instructions

* problems with organization

* avoidance or dislike of tasks that require mental effort

* tendency to lose things like toys, notebooks, or homework

* distractibility

* forgetfulness in daily activities

Differences Between Adult and Childhood ADHD

While Adults with ADHD still have the same underlying problems as children with ADHD, they often manifest differently. Having learnt more about social norms and its consequences, signs of ADHD like fidgeting, hyperactivity and interrupting others are less commonly seen in adult sufferers.
Adult symptoms may also be more subtle, they’re easily distracted, disorganised and while many would have learnt coping mechanisms such as making lists and priorities, they still often have issues completing and following through on tasks. Also being forgetful they neglect their responsibilities and are often late for appointments.
Their inner restlessness also often remains and while they may not appear fidgety, this may be re-channelled into activities like risk taking behaviours such alcohol and drug abuse as well as reckless driving. These behaviours can often co-exists with issues such as personality problems, anxiety or depression but may be incorrectly solely attributed to these conditions alone, rather than partly from ADHD. This explains why adult patients frequently go undiagnosed even after seeing a doctor or therapist. This is especially since ADHD often leads to disappointments, underperformance and the stress and emotional toll that brings.
Adult ADHD is often diagnostically more challenging but is not hard to make out, if we bear in mind its possibility. In our clinic, we find that co-existing psychiatric conditions is actually rather common, hence we actively look out for such issues. Neglecting one of the conditions leads to less ideal outcomes and It is only by treating all the different aspects effectively that we can bring the patient to a true state of remission and fulfil their true potential.

What happens when you see a psychiatrist for ADHD in Singapore?

ADHD can of course exist even without the presence of restlessness of hyperactivity. This is the inattentive subtype of the disease. This is as disabling but may be harder to pick out, given that externalising behaviour, such as restlessness and aggressiveness is more likely to be picked up, as it is more disruptive. Girls and adults are more likely to have the inattentive subtype of ADHD but it is just as important for this subtype to be treated adequately, given its similar serious consequences. It’s of course common for children to exhibit these symptoms at times, especially when they are anxious or excited. When these symptoms predominant a child’s life and affects his functioning in the family, as well as socially and academically, ADHD is a definite possibility to be considered. 

Although it can be challenging to raise children with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. They may have significant difficulty controlling their behaviour without medication or behavioural therapy.

A psychiatrist is a medical doctor who specializes in emotional and behavioral disorders.The psychiatrist would take a very detailed history from the parents or the patient if an adult. If previous reports from teachers are available, it would be helpful to bring these along to get a more complete picture of the situation. The child would also be observed and examined thoroughly while in the clinic. The point of the initial consultation would be to confirm the diagnosis and also to look for other conditions such as dyslexia and emotional conditions that often co-exist with ADHD. It would be important to address these issues if they are in present to optimise results. Sometimes, psychological testing may also be required to confirm the diagnosis or its extent.

Having confirmed the diagnosis, a good psychiatrist would use a combined approach to treatment to give the patient the best optimised results. A behavioural approach would always be necessary and often parent training with regards to how best to support the child with the disability would be taught as well. A good psychiatrist dealing with children would also liaise with the school to help them understand the child’s situation and help them make necessary provisions to optimise the child’s learning environment.

A supplement such as Vayarin may be useful in some cases. Medications such as Ritalin or Concerta would also be needed in other cases. Your psychiatrist would discuss the pros and cons of medication with you if necessary, but the final decision as to whether to start or continue medications would still remain with you. ADHD is a common condition but one that carries serious long-term consequences if left unchecked. Besides academic problems, it’s perhaps the serious emotional and social issues of poor impulse control that lead to low self-esteem and loss of confidence that are more troubling. On the other hand, ADHD can be easy to treat once identified and this can set your child or yourself (if you are an adult sufferer) up for  a much more successful and happy future.