Limited access to care for patients living with ADHD


More than one million South Africans between the ages of 20 and 50 are affected by adult attention-deficit hyperactivity disorder (ADHD), says a new study by Dr Renata Schoeman, psychiatrist and University of Stellenbosch Business School (USB) top MBA student for 2015.

For her MBA thesis, she looked at establishing the current situation in South Africa focusing specifically on the psychiatric management and funding for treatment of adult ADHD in the private sector.

Dr Schoeman says: “Recognition of adult ADHD as a chronic disorder in need of treatment, is crucial. Yet, adults with ADHD, even those within the private health care system, have limited access to care. This is because medical schemes that cover childhood ADHD often do not provide benefits or treatment for adults. Patients struggle to afford private treatment, over and above the cost of their monthly medical contributions and for the most part, the disorder is left untreated.

“It is a costly, chronic disorder, with significant impact on the quality of life of patients and their families. The costs (direct, indirect, and intangible) are substantial,” says Dr Schoeman.

Her study identified the lack of knowledge and financial support for ADHD as the main barriers to accessing treatment and diagnosis of the disorder and she has proposed a new funding model for private health care as a possible solution.

“Adults with ADHD continue to be faced by scepticism from those around them, fuelled by persistent and sceptically uninformed media-driven perceptions that ADHD is not a real disorder with real consequences and costs,” says Dr Schoeman.

If left untreated or misdiagnosed, the consequences of adult ADHD can be detrimental to the long-term health of those affected.

“Many adults with ADHD go untreated for the majority of their lives. This can lead to significant increases in the risk for other psychiatric conditions such as anxiety and mood disorder as well as substance abuse. In the work environment their poor time management, goal setting, stress management and organisational skills can have a considerable impact on their employers.”

ADHD is characterised by severe and impaired levels of inattention, hyperactivity and impulsivity. As a developmental disorder, symptoms are already evident in childhood. Although some children appear to “outgrow” their ADHD, it is more a case of some becoming more skilled in managing the symptoms and, as adults, compensating for their ADHD-related impairment through lifestyle and career choices.

According to Dr Schoeman, adults suffering from ADHD are often viewed by their peers and family members as good starters but bad finishers, poor listeners, bad organisers, inconsistent performers, distractible, absent-minded and impatient.

“Individuals with ADHD are often highly intelligent, very creative with lateral and analytical thinking – yet they often lead a life of underachievement and perpetual failure, manifested as poor academic and work performance, interpersonal conflict, marital disorder and experience of financial difficulties,” she says.

“These negative experiences can lead to the development of destructive, negative thoughts and beliefs that further decrease motivation and performance and increase avoidance behaviour and emotional problems.”

Stimulant medications are considered first-line treatment but many adults prefer not to take medication due to the stigma attached to the diagnosis and treatment.

However, medication is not the only option. Cognitive behavioural therapy targets the destructive thought patterns and beliefs and associated emotions that contribute to the negative behaviour.

Many students and professional adults misuse the medication to improve concentration without having been diagnosed with ADHD. “This is irresponsible and potentially risky,” warns Dr Schoeman.

Her study included an analysis of one of the largest medical scheme administrators in terms of medical, pharmaceutical and claims data for the treatment of ADHD over a two-year period. It also included a survey with psychiatrists in private practice who manage adult ADHD.

Qualitative analysis from in-depth interviews with key opinion leaders on their experiences in working with adult ADHD patients, were also used.

Her funding model proposal – developed in confidence for the private health administrator involved in her research – will greatly assist in understanding the long-term needs, improvement of access to diagnosis and treatment of adults with ADHD.