Attention-Deficit/Hyperactivity Disorder, Adult

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

ADHD is generally identified early in life and manifests through behavioral problems at school or difficulty understanding material, completing tasks, or being easily distracted by others. It is estimated that up to 5 percent of school-age children are diagnosed with ADHD, and boys are more often diagnosed than girls, according to the DSM-5. Girls and women are more likely to present with inattentive features. Symptoms of ADHD can be treated effectively with a combination of medication and therapy. When left untreated, however, ADHD can have long-term adverse effects on academic performance, vocational success, relationships, and social-emotional development.

Studies suggest that 2.5 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 impact their performance or functioning, according to the DSM-5. These behaviors must also exist in two or more contexts such as at home, at work, or in social settings.

Symptoms of inattention include:

  • Making careless mistakes, overlooking details
  • Difficulty remaining focused on tasks or 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
  • Preemptively blurting out answers to questions
  • 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 six 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 six 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 six months.

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

Causes

Health professionals are still unsure what causes ADHD. Most people question the source of their attentional problems or difficulties with impulsivity or restlessness. ADHD does not arise purely from social factors or child-rearing methods, and the most substantiated causes appear to fall in the realm of neurobiology and genetics. Environmental factors may further influence the severity of the disorder. 

Research on the casual elements of ADHD tends to focus on younger children. In terms of genetics, 25 percent of close relatives of a child with ADHD also have the condition—indicating that genetics play an important role in the development of ADHD. Research by Child Psychiatry Branch of the National Institute of Mental Health found that compared to children without ADHD, children with the condition generally have a 3-4 percent reduction in volume 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 solving problems, planning ahead, restraining impulses, and understanding the behavior of others.

Environmental agents may contribute to ADHD. A correlation has emerged between the use of cigarettes and alcohol during pregnancy and the risk of ADHD. High levels of lead found in older buildings and exposure to lead through water sources are also implicated in the risk of developing ADHD.

Social theorists and clinicians sometimes refer to ADHD as the epidemic of modern times, implicating the role of a fast paced, consumerist lifestyle that immerses people in "a world of instant messaging and rapid-fire video games and TV shows." The effects of a lifestyle in which one's needs can instantly be met with the click of a button may extend beyond genetics or biology to interact with one's biological predisposition in a different way.

Treatment

ADHD can be treated successfully with therapy and medication. Therapy provides skills to help the person direct themselves to tasks and become more knowledgeable about their behavior to regulate it effectively. Medications concurrently help boost focus, quell restlessness, and improve the progress made from social skills learned in therapy.

Medications most commonly prescribed to treat 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 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 improve everyday functions such as time management, organization, goal execution. Therapy also helps target emotion regulation, impulse control, and stress management. By improving emotional and interpersonal self-regulation, adults can more confidently navigate work as well as 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 damage their confidence, self-esteem, of beliefs about their capabilities. Cognitive behavioral therapy (CBT) can help identify negative biases in thinking that reduce motivation and perpetuate avoidance behaviors and help cultivate a range of adaptive behaviors. Mindfulness mediation training can also improve sustained attention to tasks and the ability to work through problems.

Treatment may also be targeted towards other mood and anxiety disorders that commonly co-occur 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 02/26/2019