Attention-Deficit/Hyperactivity Disorder, Adult

Definition

Attention-Deficit/Hyperactivity Disorder is a neurobehavioral disorder characterized by a combination of inattentiveness, distractibility, hyperactivity, and impulsive behavior. Symptoms include difficulties with attention to tasks, being forgetful in daily activities, difficulties in organizing, and following through. Hyperactivity symptoms can include being fidgety, restless, talking or interrupting others excessively and being impulsive. 

ADHD is generally identified early in life and manifests through behavioral problems in school, or difficulty understanding, completing tasks or being easily distracted by others. It is estimated that unto 5 percent of school-age children are diagnosed with ADHD; with boys receiving the diagnosis more often than girls. Females are more likely to present with inattentive features. Untreated ADHD has been shown to have long-term adverse affects on academic performance, vocational success, relationships with others, and social-emotional development.

Recent prevalence studies suggest that 4.4 percent of American adults may suffer from ADHD.

Symptoms

To be diagnosed with ADHD, a person must present with problems related to inattention and/or hyperactivity-impulsivity for a period of at least six months that significantly negatively impacts their performance or functioning. These behaviors must also exist in two or more settings such as home, work, with friends and family.

Symptoms of inattention include:

  • Making careless mistakes, overlooking details
  • Difficulty remaining focused on tasks, conversations
  • Being easily distractible
  • Difficulty following through on instructions, or duties in the workplace
  • Difficulty organizing tasks and activities
  • Avoidance, or refusal of activities that require sustained attention (reports, forms, reviewing papers)
  • Losing things frequently
  • Being forgetful of daily activities (appointments, chores)

Symptoms of Hyperactivity and Impulsivity include:

  • frequent fighting, squirming, tapping
  • often leaving seat when remaining seated is expected
  • feeling overly restless
  • difficulty being still for an extended period of time
  • difficulty engaging in leisure activities 
  • talking excessively
  • impulsively blurting out
  • difficulty waiting for a turn
  • intruding or interrupting others

A diagnosis of Combined Presentation is made when a person presents with both hyperactivity-impulsivity and inattention symptoms for at least 6 months.

A diagnosis of Predominantly inattentive type is made when a person presents with criteria for inattention symptoms but not for hyperactivity-impulsivity symptoms for at least 6 months.

A diagnosis of Predominantly hyperactive-impulsive type is made when a person presents with criteria for hyperactivity-impulsivity symptoms but not for inattention symptoms for at least 6 months.

In adults with ADHD, symptoms of inattention are generally more prominent. Men and women with ADHD may have struggles related to focusing on tasks or prioritizing activities, which may in turn lead to difficulty with completing work, missed deadlines and forgotten social engagements.

Causes

Most people question the source of their attentional problems or difficulties with impulsivity or restlessness. ADHD is not known to arise purely from social factors or child-rearing methods and most substantiated causes appear to fall in the realm of neurobiology and genetics. Environmental factors may further influence the severity of the disorder, and especially the degree of impairment and suffering experienced. 

Research on the casual factors related to ADHD tend to study younger children with ADHD. In terms of genetics, 25 percent of the close relatives in the families of ADHD children also have ADHD. This indicates that genes are an important factor in the development of ADHD. Research by the NIMH Child Psychiatry Branch, which compared kids diagnosed with and without ADHD found that ADHD children generally have a 3-4 percent reduction in brain volumes in important regions of the brain including the frontal lobes, temporal gray matter, caudate nucleus, and cerebellum. These brain structures play a vital role in allowing us to solve problems, plan ahead, understand the behavior of others, and restrain our impulses. 

Environmental agents identified in the cause of ADHD include a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. High levels of lead found only in older buildings, and exposure to lead through water sources, are also implicated in the risk to ADHD.

Social theorists and clinicians have sometimes referred to ADHD as the epidemic of modern times, implying the role of a fast paced, consumerist model and lifestyle that allows us to be immersed in "a world of instant messaging and rapid-fire video games and TV shows." The implications of a lifestyle that affords us the luxury of not having to wait and have our needs met by the click of a button or text, may extend beyond our genetic history or biology and further interact with a biological predisposition.

Treatments

ADHD is successfully treated with both therapy and medications. Therapy provides skills to help the person more easily direct themselves to tasks and assignments as well as become more knowledgeable about their behavior to regulate it better. Medications concurrently help the person gain more focus and feel less restless, and can further improve the results of skills applied and learned in therapy on social skills.

Medications most commonly prescribed in the treatment of ADHD include a class of drugs called Stimulants that have both short-acting and long-acting properties. Short-acting medications may need to be taken more often, and long-acting drugs can usually be taken once daily. Those commonly prescribed include Amphetamine/ Dextroamphetamine (Addreall), Dexmethylphenidate (Focalin), Lisdexamfetamine (Vyvanse), Methylphenidate (Concerta, Ritalin).

Antidepressants are considered a second choice for treatment of adults with ADHD. Similar to stimulants, antidepressants also target norepinephrine and dopamine neurotransmitters. These include the older class of drugs called tricyclics but also newer antidepressants such as Venlafaxine (Effexor), and Bupropion (Wellbutrin). These medications also additionally help with nicotine cravings and smoking cessation.

Generally, hyperactivity symptoms are less prevalent in adulthood, but symptoms of inattention and impulsivity often persist. Therapy for adults with ADHD generally incorporates skills to help with everyday executive functions that are needed to effectively manage time, organize, and plan in the short term and the long term. Therapy can also help by targeting emotional self-regulation, impulse control, and stress management. By improving emotional and interpersonal self-regulation, adults can more confidently navigate work, familial and social relationships. 

Many adults with ADHD have received negative social feedback from parents, teachers, employers, and peers through the course of their academic or employment history that can negatively impact their confidence, self-esteem of beliefs about their capabilities. Cognitive behavioral therapy (CBT) can help identify negative biases in thinking and beliefs that reduce motivation and increase avoidance behaviors as well as work on increasing a range of adaptive behaviors. Mindfulness mediation training can also help improve sustained attention on tasks and ability to work through problems, reducing impulsive emotional reactivity.

Treatment may also be targeted towards other mood and anxiety disorders that commonly co-exist in adults with ADHD.

References

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  • Consensus Development Panel (CDP) (1982). Defined Diets and Childhood Hyperactivity. National Institutes of Health Consensus Development Conference Summary, Volume 4(3).
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  • Harvard Mental Health Letter (2002). Attention Deficit Disorder in Adults. Vol. 19:5, 3-6.
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Last reviewed 05/30/2017