Adult attention-deficit disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Background

Although the exact prevalence of ADHD is unknown, studies thus far reveal that the condition, marked by inattentiveness, difficulty getting work done, procrastination, and/or organization problems, according to epidemiological data, involves approximately 4% to 6% of the U.S. population. it usually persists throughout a person's lifetime; approximately one-half to two-thirds of children with ADHD will continue to have significant problems with ADHD symptoms and behaviors as adults, which impacts their lives on the job, within the family, and in social relationships. [1]

The conditions present in adulthood follow the same diagnostic criteria as ADHD in children. The neurological basis of ADHD is a lifelong condition. The prevalence in adults as a clinical disorder is difficult to gauge because individuals differ in their level of affliction. Those who seek treatment as children, and others, over time, may develop coping skills which make the disorder less noticeable; indeed, if the underlying conditions do not cause functional problems in their lives, they may no longer meet the diagnostic criteria at all. However, those whose symptoms continue to significantly negatively affect their functioning in adulthood can be labeled as having the adult version of ADHD. Although the disorder may not have been diagnosed in an individual during childhood, for adults to be diagnosed, the criteria require that they must have had symptoms in childhood.

AADD (aka ADHD in adults) is recognized as a disability under U.S. federal legislation including the Rehabilitation Act of 1973 and the Americans With Disabilities Act (ADA). Appropriate and reasonable accommodations are sometimes made in the workplace for adults with ADHD, which help the individual to work more efficiently and productively. [2]

History

In the 1970s researchers began to realize that the condition now known as ADHD did not always disappear in adolescence, as was once thought. At about the same time, some of the symptoms were also noted in many parents of the children under treatment. The condition was formally recognized as afflicting adults in 1978. Current research indicates that up to 60% of children with ADHD carry their symptoms into adulthood. [3]

Prevalence

In the context of the World Health Organization World Mental Health Survey Initiative, researchers screened more than 11 thousand people aged 18-44 years in ten countries in the Americas, Europe and the Middle East. On this basis they estimated adult ADHD prevalence to average 3.4% with a range of 1.2% to 7.3%, with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). They said that adult ADHD often co-occurs with other disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for the co-occurring disorders.[4]

Controversy

As with childhood ADD or ADHD, the diagnosis for adult ADD or ADHD is controversial and has been questioned by some professionals.

Some critics point out that patients with ADD or ADHD may exhibit certain positive behaviors, such as the ability to hyperfocus on an interesting task. Others believe ADD or ADHD is a divergent or normal variant of human behaviour.[citation needed]

Still other critics are suspicious of the health industry's role in authorizing the psychiatric definitions of ADHD and promoting the use of pharmaceutical drugs for its treatment.[citation needed]

Symptoms

Adults are less likely than children to realize that they might have ADD/ADHD. Children tend to be looked at in school. ADD and ADHD are somewhat difficult to diagnose as symptoms can be present in adults, as well as children, in at least 16 different ways.

In the book Driven To Distraction[5], Edward M. Hallowell described an experience of the "hyperactive" aspect of the ADHD disorder from a patient's perspective:

...It's like being super-charged all the time. You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sorts of impolite words that miss the point completely. Because you're trying really hard. It's just that you have all these invisible vectors pulling you this way and that, which makes it really hard to stay on task.

Many people express that they "feel" this way in their lives. That does not mean that the person has ADD or ADHD. It is important to be tested if you choose to seek treatment. It is also important to note that ADD and ADHD are not the same thing. ADD stands for "Attention Deficit Disorder". ADHD stands for "Attention Deficit Hyperactivity Disorder". ADD can be likened a bit more to inattention, without the hyperactivity. The people typically diagnosed with it are not "hyper" at all. They typically tend to "miss" important information, have papers everywhere and the inability to "keep things tidy", but many of them are very calm, less "hyper" than their ADHD cousins.[citation needed]

The "combined subtype" of ADHD is characterized by symptoms of inattention, impulsivity, and "hyperactivity". Both with childhood onset, although the condition may not have been diagnosed then. Hyperactivity symptoms tend to be less noticeable in adults. Some do not exhibit hyperactivity/inattentiveness and rarely adults exhibit only hyperactivity/impulsivity symptoms.

ADHD in adults can cause moderate to extreme difficulties in functioning at work, home, or school[6]. The disorder is usually characterized by inattentiveness, impulsive behavior, and restlessness. In adults the problem can be manifested in an inability to structure their lives and plan simple daily tasks. ADD/ADHD can also lead to loss of relationships, job hopping, or difficulty with people or work. The difficulty is not due to the ADD person's direct behaviour, but usually more due to "the simple things that the ADD person will miss", especially when an adult of their age or experience should catch onto or know.

Generally, symptoms may manifest themselves differently in adults than in children.[7] Adults with hyperactive-impulsive symptoms feel extremely driven, sometimes restless. To calm themselves down, they tend to stay constantly "on the go" and attempt to do but usually fail to complete "multiple tasks at once". They are often perceived as not thinking before they act or speak. Generally, the biggest problem is developing self-regulation, which is not necessarily expected of young children. The mechanism for self-regulation is medically not present in someone with ADD or ADHD. This is what is treated medically in the ADD/ADHD person. This lack of self-understanding and what looks like "lack of control" affects an adult's ability not just to do tasks, but to determine when and how they need to be done, as well as how other people perceive them. [8]

Symptoms of ADHD can vary widely between individuals and throughout the lifetime of an individual. The most prominent characteristic in ADHD often is difficulty with executive functioning, which is the brain activity that oversees the ability to monitor a person's own behaviour by planning and organizing. Other symptoms include inattention, impulsivity, and restlessness as well as frequently accompanying behavioral problems and learning disabilities. Growing up with all these deficits often leads to emotional problems.

Studies have indicated that adults with ADHD are more likely to "self medicate" with alcohol or drugs including caffeine, cocaine or marijuana. They also tend to have a slightly higher rate of substance abuse problems than adults who do not have ADHD.[citation needed] They are also more likely to suffer from depression and anxiety, be fired from jobs, and get divorced, more often than non-ADHD adults[citation needed].

The Hallowell Center identifies the following indicators to consider when ADHD is suspected and recommends that individuals with at least twelve of the following behaviours since childhood—provided these symptoms are not associated with any other medical or psychiatric conditions—consider professional diagnosis[9]:

  1. A sense of underachievement, of not meeting one's goals (regardless of how much one has actually accomplished).
  2. Difficulty getting organized.
  3. Chronic procrastination or trouble getting started.
  4. Many projects going simultaneously; trouble with follow through.
  5. A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
  6. A frequent search for high stimulation.
  7. An intolerance of boredom.
  8. Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
  9. Trouble in going through established channels and following "proper" procedure.
  10. Impatient; low tolerance of frustration.
  11. Impulsive, either verbally or in action, as an impulsive spending of money.
  12. Changing plans, enacting new schemes or career plans and the like; hot-tempered
  13. Physical or cognitive restlessness.
  14. A tendency toward addictive behaviour.
  15. Chronic problems with self-esteem.
  16. Inaccurate self-observation.
  17. Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.

Diagnosis

The diagnostic criteria for ADHD in adults are identical to those for children. It is important to note that adult diagnosis requires establishing whether the symptoms were also present in childhood, even if not previously recognized. [2] Diagnosis must also exclude other medical or psychiatric causes of symptoms. The diagnostic criteria[10] require multiple symptoms observed in multiple settings (school, home, work, etc.) within the preceding 6 months.

Assessment of adult patients seeking a possible diagnosis can be better than in children due to the adult's greater ability to provide their own history, input, and insight. The therapeutic process may also see more benefit in behavioral solutions because they can be designed more collaboratively with mature individuals. BUPA says: “Aggressive or disobedient behavior can get worse if ADHD is left untreated, so early diagnosis and management is important”[citation needed]

Treatment

Generally, treatments which have proved effective for children were observed to work equally well or better in adults with similar diagnosis.[citation needed]

(Adult ADD or AADD) is a term commonly used to describe the neurological disorder attention-deficit hyperactivity disorder (ADHD) when it occurs in adults. It is important to note that ADD and ADHD are the same thing under clinical terminology; the ADHD label was an update to the overall syndrome in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition); ADD (Attention-Deficit Disorder) with or without hyperactivity is the older term from the DSM-IIIR. [11] Approximately one-third of people with ADHD do not have the hyperactive or overactive behavior component. This leads to some preference for using the ADD and AADD terminology when describing individuals those lacking the hyperactivity component, particuarily by those persons when self-describing their condition to others.  

See also

References

  1. http://www.add.org/articles/factsheet.html
  2. http://www.add.org/articles/factsheet.html
  3. http://www.adhd.com/adults/adults_whatis_add.jsp
  4. Fayyad J., De Graaf R., Kessler R., Alonso J., Angermeyer M., Demyttenaere K., De Girolamo G., Haro J.M., Karam E.G., Lara C., Lepine J.-P., Ormel J., Posada-Villa J., Zaslavsky A.M., Jin R., "Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder" British Journal of Psychiatry 190, May 2007, pp402-409
  5. Hallowell, Edward M, and Ratey, John J. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood
  6. http://www.fda.gov/fdac/features/2004/604_adhd.html
  7. http://findarticles.com/p/articles/mi_pric/is_200112/ai_1545187408
  8. http://www.fda.gov/fdac/features/2004/604_adhd.html
  9. http://www.drhallowell.com/resources/articles/diagnostic_adults.html
  10. http://www.behavenet.com/capsules/disorders/adhd.htm
  11. http://www.adhd.com/adults/adults_whatis_add.jsp

Further reading

  • Amen, Dr. Daniel G., Healing ADD: The Breakthrough Program That Allows You to See and Heal the Six Types of ADD
  • Doyle, Dr. Brian B, Understanding and Treating Adults with Attention Deficit Hyperactivity Disorder
  • Hallowell, Edward M, and Ratey, John J., Answers to Distraction
  • Hartmann, Thom, Attention Deficit Disorder: A New Perspective
  • Hersey, Jane, Why Can't My Child Behave?
  • Lawlis, Frank, The ADD Answer
  • Matlen, Terry. (2005) "Survival Tips for Women with AD/HD". ISBN 1886941599
  • Solden, Sari, Women with Attention Deficit Disorder
  • Mate, Dr. Gabor, "Scattered Minds"
  • Brown, Dr Thomas E. "Attention Deficit Disorder: The Unfocused Mind in Children and Adults", Yale University Press, Sep 2005.

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