Five Dimensions of Adult ADHD in Everyday Behavior
From procrastination to driving offenses, ADHD can affect people's daily lives.
Posted Dec 27, 2011
Individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) have, to an extreme degree, behavior patterns in which they are inattentive and hyperactive and/or impulsive. Until relatively recently, ADHD was thought to be a disorder that occurred only in childhood and then gradually faded away. Researchers and clinicians now recognize that people with ADHD continue to experience symptoms throughout adolescence and into adulthood.
Even if an individual never was diagnosed with the disorder as a child, it's possible that the symptoms may not have been properly identified at an earlier age. Teachers and even counselors may have attributed the child's inattention to other factors. Perhaps as many as 4 percent of American adults meet the diagnostic criteria for this disorder, with nearly equal numbers of men and women having this condition (Kessler et al., 2006).
As people get older, their ADHD symptoms can take a different form than they may have in childhood. Whereas children may show greater evidence of restlessness and impulsivity, adult ADHD involves difficulties in maintaining attentional focus (Kessler et al., 2010). Adult ADHD symptoms fit a picture consistent with deficits in so-called "executive functioning," a term that psychologists use to describe how well an individual can plan, organize, and inhibit irrelevant thoughts. People with adult ADHD have more trouble organizing tasks, make careless mistakes, lose things, and are unable to prioritize their daily activities.
ADHD expert Russell Barkley proposed a theory in 1997 that continues to receive support today. According to Barkley, the core impairment of ADHD is the individual's inability to inhibit responses due to abnormalities in the prefrontal cortex and its connections to other parts of the brain. The individual's impairment of response inhibition manifests itself in four areas of functioning: (1) working memory, (2) internalization of self-directed speech, (3) the self-regulation of affect, motivation, and level of arousal, and (4) reconstitution, the ability to break down observed behaviors into component parts that can recombine into new behaviors directed toward a goal.
In addition, according to Barkley, children with ADHD fail to develop a future orientation and sense of the self across time. As they mature into adulthood, individuals with ADHD are at higher risk, due to these deficiencies in executive functioning, of engaging in deviant or antisocial behavior. In one study, adults with executive functioning deficits were more likely to commit antisocial acts and to be involved in traffic offenses committed while driving (Barkley & Murphy, 2011).
Barkley and Murphy's research not only showed the risks of having adult ADHD, but also introduced a new measure of executive functioning associated with ADHD that asks people to rate their own behaviors. Called the Deficits in Executive Functioning Scales (DEFS), it can also be used by clinicians to compare a person's self-ratings with the ratings that a relative, spouse, or close friend can make along those same dimensions. Impressively, Barkley and Murphy found a greater relationship between these self-ratings of ADHD-type executive functioning and behavior than between ADHD-related behaviors and scores from neuropsychological tests.
The potential danger of having people assess their own psychological functioning is that they over-diagnose themselves. This test's advantage, however, is that it can be used to help people gain insight into the behaviors that may get them into serious trouble in their work, relationships, and even legal status. Don't jump to conclusions that because you show these behaviors, you have adult ADHD. An important feature of the executive functioning scale is that people can show more or less of these tendencies. This is not an all-or-nothing, categorical diagnostic scale.
With this in mind, here are the five executive functioning scales and a sample item from each:
1. Self-management to time:
Ability to manage your time, plan, prepare for deadlines, and work toward a goal.
Sample item: Waste or mismanage my time
2. Self-organization and problem-solving:
Having difficulty organizing thoughts, expressing yourself, thinking quickly when you encounter an unexpected event, coming up with solutions to problems that you run into when you're trying to reach a goal, and understanding how to sequence activities.
Sample item: Often at a loss for words when I want to explain things to others
Making impulsive comments, being unable to inhibit your reactions to things going on around you, making quick decisions without considering their consequences, and acting without thinking about the implications.
Sample item: Making impulsive comments to others
Feeling lazy or unmotivated, needing others to prod you to complete your tasks on time, not putting sufficient effort into a task to complete it successfully.
Sample item: Likely to take short cuts in my work and not do all that I am supposed to do.
5. Self-activation and concentration:
Being easily distractible and frustrated, having trouble staying alert when the situation is boring, being prone to daydreaming, being readily excited when something exciting is happening.
Sample item: Can't seem to sustain my attention on reading, paperwork, lectures, or work.
For clinicians working with adults who have or are suspected to have ADHD, the DEFS has the advantage of being less expensive to adminster and more closely related to actual behaviors that people with adult ADHD may show that get them into trouble. Most surprisingly, however, was that the DEFS scores were related to driving violations, including number of crashes, driving under the influence, speeding violations, and license suspensions. The clinician-performed neuropsychological tests did not have this predictive power.
A diagnosis of ADHD can only be made by a mental health professional. However, if these scales seem to describe you or someone you love, you may want to investigate further with a psychologist or counselor.
Behavioral approaches to treating adult ADHD can have great success, particularly when they're oriented toward helping individuals identify and then focus on specific targets of change. Even simple strategies can make day-to-day tasks and responsibilities more manageable. To-do lists, notepads, and appointment books (or their electronic versions) can be extremely helpful, especially when individuals are rewarded for sticking to these self-management behaviors. Because adult ADHD can also wreak havoc in an individual's close relationships, marital or family counseling can also be a vital therapeutic tool.
Even if you don't have adult ADHD, knowing that you have some of the executive functioning problems identified in the DEFS can help you manage your routines more successfully. If you do have ADHD-like symptoms, it's helpful to know that there are ways to overcome them without medication. You don't have to be stuck with ADHD, or its symptoms, for life.
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Copyright 2011 Susan Krauss Whitbourne, Ph.D.
Barkley, R. A. (1997). ADHD and the nature of self-control. New York, NY US: GuilfordPress.
Barkley, R. A., & Murphy, K. R. (2011). The nature of executive function (EF) deficits in daily life activities in adults with ADHD and their relationship to performance on EF tests. Journal of Psychopathology and Behavioral Assessment, 33(2), 137-158. doi: 10.1007/s10862-011-9217-x
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., . . . Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey replication. The American Journal of Psychiatry, 163(4), 716-723. doi: 10.1176/appi.ajp.163.4.716
Kessler, R. C., Green, J. G., Adler, L. A., Barkley, R. A., Chatterji, S., Faraone, S. V., . . . Van Brunt, D. L. (2010). Structure and diagnosis of adult attention-deficit/hyperactivity disorder: Analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Archives of General Psychiatry, 67(11), 1168-1178. doi: 10.1001/archgenpsychiatry.2010.146