Living and Studying with ADHD in Hong Kong

Attention Deficit Hyperactivity Disorder (ADHD/專注力不足/過度活躍症) affects 6.4% of children and adolescents in Hong Kong, yet awareness and understanding remain low. This blog aims to shed light on living with ADHD in Hong Kong, covering symptoms, diagnosis, and treatment options to help individuals and families navigate their ADHD journey effectively.

Understanding ADHD

Attention Deficit Hyperactivity Disorder（專注力不足/過度活躍症）, or ADHD in short, is a neurodevelopmental condition marked by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning. It becomes a clinical concern when these symptoms last for more than six months and significantly affect a child's social and academic life, compared to peers of the same age.

What are the Common Symptoms of ADHD?

Inattentive symptoms:

• Fail to pay close attention to details or make careless mistakes in schoolwork
• Have trouble staying focused on tasks or play
• Appear not to listen, even when spoken to directly
• Have difficulty following through on instructions and fail to finish schoolwork or chores
• Have trouble organising tasks and activities
• Avoid or dislike tasks that require focused mental effort, such as homework
• Lose items needed for tasks or activities, for example, toys, school assignments, pencils
• Be easily distracted
• Forget to do daily activities, like brushing your teeth before bed.
  
  

Hyperactive/impulsive symptoms:

• Fidget with or tap his or her hands or feet, or squirm in the seat
• Have difficulty staying seated in the classroom or other situations
• Be on the go, in constant motion
• Run around or climb in situations when it's not appropriate
• Have trouble playing or doing an activity quietly
• Talk too much
• Blurt out answers, interrupting the questioner
• Have difficulty waiting for his or her turn
• Interrupt or intrude on others' conversations, games, or activities

If you’re worried that your child shows symptoms of ADHD, click here for a quick assessment!

How can ADHD Affect Daily Life at School and Home?

ADHD can impact daily life, particularly in school and home settings, leading to academic struggles and challenges in routine activities. Researchers propose various causes of ADHD ranging from anatomical, genetic, to social factors. Anatomical studies suggest that children with ADHD may have a 3% decrease in brain volume, particularly in the temporal and frontal lobes, areas responsible for attention and impulse control^[1]. Other factors include abnormalities in brain chemicals such as dopamine, genetic predispositions, social factors related to upbringing and environment, maternal drug use, premature birth, and exposure to certain chemicals.

Causes of ADHD: Brain Structure, Genetics, and Environment

While many children outgrow ADHD as their brains develop into adulthood, some continue to experience symptoms if they were not adequately controlled during childhood. Additionally, some individuals may not have noticed their ADHD symptoms when young or may not have received any treatment. In other cases, children with ADHD might have developed coping mechanisms that fail to meet the demands of adulthood, leading to persistent symptoms. ADHD symptoms in adults are largely similar to those in children, including difficulty focusing, prioritizing tasks, missing deadlines, and forgetting meetings and social plans.

ADHD in Hong Kong

A 2018 study found that ADHD affects 6.4% of children and adolescents and 2.5% of adults in Hong Kong^[2][3]. Despite these numbers, many remain undiagnosed or untreated. Students with ADHD in school face unique challenges. The competitive academic environment can exacerbate symptoms, making it difficult for students to keep up with peers. However, treatments options can alleviate such circumstances.

How to get a diagnosis for ADHD?

The diagnostic process typically involves a comprehensive clinical interview, behavioural assessments, and standardized questionnaires. Specialists may also use objective psychometric tests to confirm the diagnosis.

Can you diagnose yourself with ADHD?

While only professionals can diagnose ADHD, self-assessment tools can be a useful starting point. OT&P offers the Adult ADHD Self-Report Scale (ASRS) and the SWAN Rating Scale for ADHD (Children). These tools can help individuals recognize symptoms and decide if they should seek professional evaluation.

Delayed Diagnosis

Early diagnosis is crucial as delayed intervention can impact a child’s academic, social, and emotional development. Children may struggle academically, have low self-esteem, and develop secondary issues like anxiety or depression. Early identification and intervention are key to managing ADHD effectively.

ADHD Treatment Methods: Medication vs Therapy

Medication is often the first line of treatment for ADHD^[4]. There are two main types—Stimulants and non-stimulants. Both types can have side effects, so it is important to work closely with a healthcare provider to find the most suitable treatment.

• Stimulants (such as Methylphenidate, otherwise known as Ritalin or Concerta, and lisdexamfetamine, otherwise known as Vyvanse): These are the most prescribed and can help increase attention and focus while decreasing hyperactivity and impulsivity. Common side effects of stimulants include loss of appetite, insomnia, gastrointestinal upset, dizziness, mood lability, tics, and in rare cases, increased irritability. Stimulants also have the potential for misuse and abuse. These side effects are usually mild and transient, and can improve with a change in dosage or dosing schedule.
• Non-stimulants, which include atomoxetine (otherwise known as Strattera): These may be prescribed if stimulants are ineffective or cause significant side effects. Reported side effects of atomoxetine include nausea, vomiting, dizziness, deranged liver function, and in very rare cases, an increase in suicidal thoughts.
  
  

Various therapies can complement medication:

• Behavioral Interventions: Focuses on modifying behavior patterns. These include the use of rewards, and decrease problematic behaviour, such as time outs. Behavioural interventions are preferred for preschool children. Research shows that combination therapy of behavioural interventions and medications are more efficacious than behavioural therapy alone.^[5]
• Cognitive-Behavioral Therapy (CBT): Helps individuals manage symptoms by changing negative thoughts and behaviors. Cognitive behavioural therapy is useful in some adults, especially those focusing on training on executive functioning, though the evidence is not strong.^[6]
• Psychotherapy: Psychotherapy would be useful if a child suffers from depression and anxiety at the same time.

OT&P offers these therapies as part of a comprehensive treatment plan.

Living with ADHD in Hong Kong presents unique challenges, especially as a student with ADHD in school. But understanding the symptoms, seeking timely diagnosis, and exploring appropriate treatment options can make a significant difference. If you or your child show signs of ADHD, consider scheduling a consultation with OT&P to discuss your concerns and explore the best path forward.

References

[1] Castellanos, F. X., Lee, P. P., Sharp, W., Jeffries, N. O., Greenstein, D. K., Clasen, L. S., ... & Rapoport, J. L. (2002). Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Jama, 288(14), 1740-1748.  

[2] HKU finds ADHD drug use increase in Hong Kong and 13 different countries. Research findings. (2018). Retrieved September 22, 2020, from https://www.med.hku.hk/news/press/ADHD_drug_use_increase_in_Hong_Kong_and_13_different_countries 

[3] HKU finds ADHD drug use increase in Hong Kong and 13 different countries. (2018). Retrieved September 22, 2020, from https://www.med.hku.hk/news/press/ADHD_drug_use_increase_in_Hong_Kong_and_13_different_countries 

[4] Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4). 

[5] Van der Oord, S., Prins, P. J., Oosterlaan, J., & Emmelkamp, P. M. (2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clinical psychology review, 28(5), 783-800. 

[6] Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018). Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 3(3), CD010840. https://doi.org/10.1002/14651858.CD010840.pub2