Attention-deficit/hyperactivity disorder (ADHD) in South Africa: diagnosis and treatment from childhood to adulthood
- Authors: Munasur-Naidoo, Ashmitha Premchand
- Date: 2020
- Subjects: Attention-deficit hyperactivity disorder
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46398 , vital:39603
- Description: Background: Historically Attention-Deficit/hyperactivity disorder (ADHD) was, considered to be a condition that affected mainly children. Over a period of time, there has been a greater understanding to recognize that this condition is also present in the adult population. Globally, treatment for adults has been established as is evident from the various guidelines available. In South Africa, however,healthcare is split into the public and private sectors, which results in differences in the extent of diagnosis and treatment for adults with ADHD.Aim: The primary aim of the study was to evaluate ADHD in South Africa from childhood to adulthood and to determine to what extent adults are being diagnosed and treated.Method: This study comprised of two facets, namely, a drug utilization review and a questionnaire survey. The first part comprised of a retrospective drug utilization study evaluating the consumption and cost of medication used in the treatment of ADHD. The questionnaire was undertaken using a survey methodology amongst selected healthcare professionals in South Africa involved in the diagnosis and treatment of adult ADHD. The data generated from this study together with available guidelines was assessed and a proposed framework for the treatment and diagnosis of adult ADHD was developed for use in the South African public healthcare sector. Results: Based on the registered medication available to treat ADHD, the consumption of methylphenidate and atomoxetine in the private healthcare sector using the Intercontinental Marketing Service database from 2013 to 2016was established. Despite the controversy regarding stimulant medication, methylphenidate was shown to be the medication of choice in South Africa. The consumption of methylphenidate (95.85%) was higher when compared to atomoxetine (4.15%) in 2013 and very slight changes were observed in 2016 were the consumption was 96.40% and 3.60%, respectively. Similarly, over a four-year period, the spend on ADHD medication increased in 2013 to 2016 by 62.63%. Furthermore, the market share for ADHD is dominated by extended-release methylphenidate tablets (59.53%). The questionnaire survey amongst selected healthcare professionals in South Africa involved in the diagnosis and treatment of adult ADHDhighlighted the tools used for diagnosis, pharmacological and non-pharmacological treatment options, which treatment has been found to be most successful, difference in treatment between genders, incorporation of supplementation into the management of patients, difficulties experienced by patients and which co-morbid conditions were also prevalent with ADHD. Based on the data collated in this study and an evaluation of the available guidelines, a framework for treatment of adult patients in the public healthcare sector has been proposed for South Africa at a provincial and national level. Conclusion: In South Africa treatment for ADHD is increasing in the private healthcare sector. The cost and consumption of methylphenidate and atomoxetine has risen over a short period. The treatment of adults in the private sector has also garnered interest, however, the public sector has not yet published guidelines enabling access to diagnosis and treatment for these adult patients. Given the chronic, costly, and debilitating nature of this condition more needs to be done to assist those affected by it. Further studies in this area of neuropsychiatry in South Africa is required to enable access to diagnosis and treatment in the public healthcare sector.
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- Date Issued: 2020
Pre-natal maternal stress and its potential correlation to attention deficit hyperactivity disorder (ADHD): An exploration into the potential correlation between the prevalence of chronic stress among a sample of Eastern Cape (South African) women during pregnancy and the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in their children by the time they are of school-going age
- Authors: Mukheibir, Adrienne Jayne
- Date: 2019
- Subjects: Attention-deficit hyperactivity disorder , Learning, Psychology of Adaptability (Psychology) Developmental psychology
- Language: English
- Type: Thesis , Doctoral , DEd
- Identifier: http://hdl.handle.net/10948/42353 , vital:36648
- Description: This study is an exploration into the potential correlation between the prevalence of chronic stress during pregnancy among a sample of Eastern Cape (South African) mothers and a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in their school-going children. The theoretical framework on which this study is based is Barker’s Developmental Origins of Health and Disease (DOHaD) model. This model proposes that in utero development is influenced by the intrauterine milieu provided by the mother, where even a slight deviation to this environment during critical periods of development can lead to alterations in structure, physiology and metabolism in the child via fetal programming, which, depending on the cause, timing, duration and intensity of the stress, can cause pervasive, long-lasting consequences to disease and health later in life. This particular study examines existing literature regarding the phenomenon of how prenatal maternal stress (PNMS), as the adverse in utero influence, exerts a long-lasting negative effect on fetal development in the form of ADHD in childhood, and compares these findings to the circumstances surrounding a sample of 60 mothers whose school-going children have been diagnosed with ADHD. A mixed methods approach was used in this study, incorporating firstly a quantitative strand of Eastern Cape mothers where the prevalence and range of chronic stress during gestation was explored. From this sample, a qualitative sample was selected to provide more in-depth information regarding their stressful pregnancies. The flipside of the DOHaD model is that because of fetal developmental plasticity, positive in utero influences can undo the harmful effects caused by over-exposure to stress hormones, thereby enhancing fetal development. Unfortunately, this study highlighted how few mothers were aware of the positive influence a relaxation intervention programme could have on reducing stress which could alter the trajectory of their child’s development. The significant role that a genetic predisposition towards ADHD plays is not being debated. However, this study has provided much needed insight about PNMS as a negative influence on gestational development that could lead to the onset of, or exacerbation of ADHD traits.
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- Date Issued: 2019
A sociological analysis of Rhodes University Students previously diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) and prescribed psychostimulant medications
- Authors: Brasher, Chelsea Marilyn
- Date: 2017
- Subjects: Stereotypes (Social psychology) , Mental illness -- Public opinion , Attention-deficit hyperactivity disorder , Attention-deficit hyperactivity disorder -- Treatment , Symbolic interactionism
- Language: English
- Type: Thesis , Masters , MSocSc
- Identifier: http://hdl.handle.net/10962/7610 , vital:21278
- Description: Using the theoretical framework of symbolic interactionism, bringing into account the labelling theory, the stigmas attached upon mental health issues and the medicalization approach, this study sought to document and analyze the viewpoints that previously diagnosed Rhodes University students hold towards the ADHD label and the subsequent usage of psychostimulant medications. Seven respondents were involved in an in-depth interviewing process. Out of the seven respondents chosen, five of the respondents were diagnosed in their primary school years, whereas the other two respondents were diagnosed in their late teenage years or early adult years. These respondents were included to enlighten and support the narrative of the five respondents diagnosed in their youth. The findings varied, with some of the respondents feeling negatively affected by having the ADHD label attached to them, and others, positively affected by it. The findings were also diverse in terms of how the respondents experienced stimulant usage, with some believing that the benefits of usage outweigh the costs, and others, the opposite. At a general level, it was discovered that the respondents were not affected by the ADHD label in terms of their interactions with others in primary school. It was only as they got older did some become fearful of the stigma attached to the ADHD label, and that of medication.
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- Date Issued: 2017
The experience of psychologists and psychiatrists providing services to adults living with attention deficit hyperactivity disorder
- Authors: Gowar, Rozanne Petal
- Date: 2017
- Subjects: Psychoanalysts , Attention-deficit hyperactivity disorder , Attention-deficit disorder in adults
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/15879 , vital:28281
- Description: There is widespread international interest in Attention Deficit Hyperactivity Disorder (ADHD). ADHD was considered to be a childhood onset neurodevelopmental disorder with few presenting symptoms in adulthood. Current research disputes this belief and there are a significant number of adults that meet the diagnostic criteria for ADHD in adulthood. This study explored the experience of selected Psychiatrists and Psychologists providing mental health services to adults living with ADHD. The awareness and presenting patterns of ADHD among adults as well as the intervention strategies used by these practitioners was explored. Furthermore, an exploration of the differential diagnoses associated with ADHD was undertaken, as well as whether the disorder was considered to be the primary or a co-morbid diagnosis in the treatment process. An explorative, descriptive- research design, utilizing a semi-structured interview format and a short survey of participants to provide descriptive statistics was used. Non-probability purposive snowballing sampling was used to gain access to psychiatrists and psychologists in both public or hospital service and independent private practice who met the inclusion criteria and who were willing to participate in the study. Interviews were conducted in English by the researcher. The major findings of the present study were categorized in three over-arching themes namely (1) views regarding the diagnosis of adults with ADHD, (2) experiences regarding the effects of impairment related to ADHD in adults, and (3) treatment and current care options for Adult ADHD. Sub-Themes were used to further explore the results. This study provides for a more in-depth understanding of Adult ADHD.
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- Date Issued: 2017
Improving reading ability and academic performance through working memory training
- Authors: Mukheibir, Adrienne Jayne
- Date: 2015
- Subjects: Reading -- Ability testing , Short-term memory , Attention-deficit hyperactivity disorder
- Language: English
- Type: Thesis , Masters , MEd
- Identifier: http://hdl.handle.net/10948/4840 , vital:20716
- Description: This dissertation is based on the results of a study that used a working memory (WM) adaptive computer programme known as Jungle Memory to determine whether training WM would have a positive impact on learners with reading difficulties, which would ultimately lead to an improvement in their overall academic performance. A pragmatic paradigm has been used, involving a mixed methodology that allowed for a postpositivistic as well as a constructive approach. The first section of the investigation involved the quantitative component, where specific variables (performance levels of the sample of learners) were determined. Thereafter, empirical measures were used to determine if these specific variables increased once the WM intervention programme had been completed. Concurrently, in the qualitative component, the sample group (namely the teachers working with these learners) provided qualitative information to verify if any changes in the participants were observed after the intervention. The participants included 30 boys who attend an ex Model C School in the Eastern Cape where I teach, all of whom had been identified as experiencing various reading difficulties and were receiving remedial assistance. The boys were placed into three groups according to specific criteria: Group A had all been diagnosed as having ADHD and were being treated pharmaceutically for the disorder; Group B all had significant ADHD symptoms but were not receiving any pharmaceutical assistance to alleviate these symptoms; and Group C displayed no significant ADHD symptoms. Five boys from each subgroup formed the Experimental group and the other five formed the Control group in each stratum. The participants' class-based teachers involved in the qualitative component of the study provided information-rich data regarding any notable progress made by each participant. Each participant took part in a battery of pre-assessment tests to determine their general level of academic performance. These assessments included the following well-known standardised tests in South Africa: the Young Group Reading Test, the Essi Reading Test, the Essi Spelling Test and the Vassi Mathematics Proficiency Test. The participants from all three Experimental Groups then took part in the eight week intervention programme, Jungle Memory, while the Control groups continued with their regular remedial programme. At the end of the eight weeks, all the participants were re-assessed using the same standardised tests.The findings from this study revealed that the participants from all three strata of the Experimental group showed significant improvements in the quantitative postassessment results and twelve of the fifteen also showed significant improvements in the comments made by the teachers in the qualitative component. The majority of the participants from the Control groups however, made very little progress in both components, and these small improvements were probably due to other variables such as maturity, incidental WM improvements through observing their peers, or familiarity with the tests.
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- Date Issued: 2015