From fringe condition to mainstream recognition, we look at the many faces of attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD).
Procrastination, risk-taking, impulsivity, difficulty completing tasks and problems maintaining focus are among the features of ADD in adults. In children, these symptoms often – though not always – come with noticeable hyperactivity and fidgeting, which are typically associated with attention deficit hyperactivity disorder.
“In the past 30 to 40 years, what was once considered a fringe condition affecting only children and adolescents has become widely recognised in mainstream medicine as a condition that can affect both children and adults,” says psychiatrist Dr Ulli Meys, who practises at Netcare Akeso Kenilworth.
“Children were often thought to ‘grow out’ of’ ADHD, but we now know that many continue to experience symptoms into adulthood. Adults with this predominantly genetic brain condition may not display obvious hyperactivity. They can appear calm or relaxed, but they often struggle with concentration, planning, task completion, procrastination and varying levels of impulsivity.”
ADHD in children
Children with ADHD may display excessive energy combined with risk-taking behaviours. They are often overly talkative, constantly on the move, “like the Duracell Bunny”, climbing to dangerous heights, jumping off roofs or engaging in other risky activities. In the classroom, they may leave their seats, be disruptive, fail to listen or be easily distracted. Their impulsivity can increase the risk of broken bones or other accidents beyond typical childhood play.
Impulsivity may also present as difficulty waiting their turn, blurting out answers or lashing out easily. By contrast, children with ADD without hyperactivity are often quiet daydreamers, inattentive and unable to complete their work, which can have significant academic consequences.
Teachers may observe that such children are easily distracted, struggle to follow instructions and underperform academically despite potential ability. This can affect self-esteem and future prospects if not addressed.
Read our article on determining ADHD.
executive functioning and working memory
“Individuals with ADD or ADHD often struggle with executive functioning, controlled by the brain’s prefrontal cortex,” Dr Meys explains. “This includes planning, organising, problem-solving, time management and regulating emotions and behaviour. Working memory is also impaired, making it difficult to hold and manipulate information, for example, remembering a list of names and putting them into alphabetical order. Flexible thinking is often compromised as well.”
impact on adults
Difficulty with impulse control can have serious consequences for adults. “There may be a constant need for instant gratification,” says Dr Meys. “Instead of budgeting for a purchase at the end of the month, the urge to buy immediately can lead to long-term financial problems. Impulsivity can also manifest in gambling, promiscuity or reckless driving.”
Motivation is another challenge. The condition should not be mistaken for laziness: many adults with ADHD may begin projects with intense focus and enthusiasm but lose momentum before completion, creating frustration for themselves and those around them. Procrastination further compounds these issues – bills go unpaid and tasks are delayed until the last minute, adding stress to relationships and work.
“In the distant past, impulsivity and risk-taking may have been advantageous for survival,” Dr Meys notes. “However, in today’s information-driven, high-demand society, these same traits often make daily functioning more difficult. Someone who managed mild ADHD symptoms twenty years ago may now struggle significantly due to the pace of modern life, necessitating professional support.”
the consequences of untreated ADHD
If not properly diagnosed and treated, ADHD can have lifelong repercussions. At school, children may be mislabelled as disruptive or lazy, leading to feelings of rejection, low self-worth and heightened sensitivity. For parents and teachers, untreated ADHD in children can be exhausting, increasing the risk of anxiety, depression and other mental health conditions later in life.
“Individuals with untreated ADHD are at higher risk of anxiety, depression and substance use disorders,” Dr Meys cautions.
Many individuals with undiagnosed ADHD attempt to self-medicate with drugs or alcohol. Combined with their natural impulsivity, this raises vulnerability to addiction. Other risk-taking behaviours are also more common.
treatment and support
“Medication remains the cornerstone of attention deficit hyperactivity disorder management,” says Dr Meys. “It is highly effective in improving concentration and impulse control. However, psychotherapy and behavioural strategies are also valuable in creating structure, establishing routines and improving planning skills. This could be as simple as setting reminders for deadlines or scheduling a fixed date each month to pay bills.”
Psychotherapeutic interventions can be useful for those who cannot tolerate medication. Structured routines, lifestyle adjustments and coping strategies play an essential role in improving quality of life.
Find fun activities for children with ADHD.
the way forward
“It is vital that we train more teachers, counsellors and healthcare workers to recognise ADHD,” Dr Meys concludes. “With the right skills and early medical intervention, the condition can be managed effectively within primary healthcare. By improving awareness of the many faces of attention deficit disorder and attention deficit hyperactivity disorder, we can help people lead safer, more stable lives while reducing the strain on health systems by preventing the avoidable complications of untreated ADHD.”
