Mental health experts and people with attention deficit hyperactivity disorder, or ADHD, have called for greater public awareness of the higher levels of attempted and completed suicide among adults with ADHD and autism compared to the general population.
At a recent webinar (see sjogresearchfoundation.ie), Prof Jessica Bramham, professor of clinical neuropsychology at University College Dublin said the risk of suicide in adults with ADHD is four times higher than in the general population. “The rates of attempted suicide and self harm are two and a half times higher in people with ADHD than in general population,” she explained.
Five to seven per cent of children are diagnosed with ADHD in Ireland, while three to four per cent of adults are estimated to have ADHD. Fifty to 70 per cent of these have a mental health condition and up to 20 per cent of adults using mental health services in Ireland were found to have undiagnosed ADHD.
The term neurodivergent is now often used to describe people with different brain function, such as those with ADHD, autism or dyslexia, while the term neurotypical is used to describe people outside of these groups.
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Some studies have found that more than one in 10 third level students with ADHD have attempted to take their own lives, while four in 10 contemplated dying by suicide.
Prof Bramham said researchers have looked at several factors to explain why people with ADHD have this increased risk of suicide. These include the impulsivity associated with ADHD as well as depression, anxiety and emotional regulation difficulties. Abuse of alcohol or drugs also increases risk of suicide in some cases.
“We need to make sure that there are enough mental health services for adults with ADHD and those working in these services need to be more vigilant to the suicide risk of this group. There are high rates of undiagnosed ADHD in the Irish mental health services and people needed to be trained to screen for ADHD so people can be signposted to [appropriate] services,” Prof Bramham said. A new app to provide accurate information on self-help and services for adults with ADHD has just been launched by University College Dublin (UCD). (ADHD-in-adults)
Dr Aiveen Kirley, is a consultant psychiatrist at St John of God mental health services in South Dublin who runs one of the first three mental health services for adults with ADHD in Ireland (the others are in counties Sligo and Limerick). She acknowledged there is a “massive unmet need” for mental health services for adults with ADHD and autism.
“There is a need for greater awareness in the health systems, in schools, and in the general public about the mental health needs of people with ADHD and autism,” Dr Kirley said.
They can have a turbulent inner atmosphere, which they are unable to express
Dr Johanna Clancy, senior clinical psychologist in paediatric primary care services in Dublin, suggested one to one talk therapy could be beneficial for young adults with ADHD. “There is a high level of anxiety, low mood and relationship issues, which get worse during the teenage years with higher expectations of social functioning,” she said.
Dr Clancy noted there has been an 800 per cent increase in medication for ADHD between 1995 and 2015, yet many young adults stop taking medication when they reach the age of 21.
“The problem is that adolescents are not seen as equals in their treatment plans and treatment often falls short of understanding their thoughts and their emotional needs,” she said.
Following on from her research into one-to one psychoanalytical therapy with young adults with ADHD, Dr Clancy asked if this form of therapy could offer a unique connection with their emotional pain and personal stories.
“A lot of young people with ADHD feel misunderstood by family and in school. They feel poorly connected to others and alone. They move from feelings of distress to feeling of elation – moving in and out of control. They can have a turbulent inner atmosphere, which they are unable to express,” said Dr Clancy. She suggested ADHD should be understood in emotional terms and people helped to deal with their complex emotional needs and not just their behaviours.
Jessica K Doyle spoke about her experiences of spending 10 years in and out of hospital following suicide attempts. In a colourful presentation using drawings and images to describe her thoughts and feelings, she explained how she felt misunderstood by many of the therapists who worked with her.
“People didn’t want to know that I was autistic and understand that I flipped from being the real me to masking [myself] with ‘fake Jess’ who was quiet and agreeable,” said Doyle, who is an assistant psychologist at the Adult Autism Practice and a project officer at TCD Sense, a sensory processing project at Trinity College Dublin. “Health professionals need to be more aware of the sensory needs of people with ADHD and autism.”
There isn’t enough discussion in Ireland about neurodiversity and trauma in Ireland
Catriona Nicholls also shared a very powerful personal testimony of how being diagnosed with ADHD as an adult helped her understand her traumatic upbringing in a dysfunctional home where many family members also had undiagnosed ADHD.
“Trauma passes from one generation to the next unless people recognise the pattern. I was always hypersensitive. I thought differently. My diagnosis of ADHD helped me understand myself more, and my addiction to drugs and alcohol fell away once I started dealing with the trauma. I never attempted suicide but I self harmed and thinking about dying by suicide was almost a relief sometimes,” she explained.
Nicholls spoke about how she no longer needed drugs and alcohol once she learned to deal with the “shame and pain”.
“Dealing with the trauma completely turned things around for me. There isn’t enough discussion in Ireland about neurodiversity and trauma in Ireland. A lot of people who are turning up at the adults ADHD services have a lot more complex things going on for them,” Nicholls said, who has just completed his Masters in Equality Studies and is currently doing a postgraduate diploma on neurodiversity at UCD.
Nicholls also said people with ADHD need to be listened to more and asked what they need. “There are very few GPs who understand ADHD. There needs to be broader education about it in the health services,” she added. Currently, diagnosis of ADHD is not recorded in the data collected on people who have died by suicide in Ireland.
- Aware, 1800 80 48 48, supportmail@aware.ie.
- Pieta House, 1800 247 247, text HELP to 51444.
- Samaritans, 116 123, jo@samaritans.ie.
- ADHD Ireland, 01-874 8349, info@adhdireland.ie
- Irish Society for Autism, 01-874 4684, admin@autism.ie
