Adult ADHD Diagnosis and Treatment
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Attention deficit hyperactivity disorder is a behavioral disorder that is characterized by distractibility, impulsivity, and/or hyperactivity. This condition can have a significantly negative impact on an adult's ability to make and keep relationships and perform well at work and/or in the community in general.
Although there is no single cause for ADHD, there are a number of biological and social factors that seem to increase the risk of a person developing the disorder. ADHD affects from 2%-6% of adults. While this disorder is thought to afflict more boys than girls in childhood, it seems to occur in men and women equally. About 60% of children with ADHD continue to have some symptoms of the disorder as an adult, and about 50% continue to suffer from symptoms that are numerous and severe enough to continue to qualify for the diagnosis of ADHD.
Adults with ADHD may show little to no evidence of suffering from hyperactivity. Symptoms of inattention include making careless mistakes, trouble paying attention during work or leisure activities, not seeming to be listening when spoken to directly, and being forgetful or easily distracted. Examples of hyperactivity/impulsivity include frequent fidgetiness, trouble staying seated, feeling restless, trouble engaging in leisure activities quietly, engaging in multiple activities at once, as well as talking or interrupting excessively.
To meet the diagnostic criteria for ADHD, an adult needs to exhibit five or more of the listed symptoms. The symptoms should start before 12 years of age, be present in more than one setting (for example, home and work), be severe enough to cause problems for the individual, and not be able to be better explained by another condition if the diagnosis of ADHD is to be assigned. There are thought to be three kinds of ADHD: predominately inattentive type, predominately hyperactive/impulsive type, and the combined (inattentive, hyperactive and impulsive) type.
Many health-care professionals may help make the diagnosis of ADHD in adults. One of these professionals will likely conduct or refer for an extensive medical interview and physical examination, as well as conduct lab tests as part of the assessment in order to rule out medical conditions or medication side effects that can mimic ADHD. As ADHD is sometimes associated with a number of other mental-health problems, the evaluator will likely screen for signs of depression, manic depression, anxiety and other mental-health conditions. The sufferer may be asked a series of questions from a standardized questionnaire or self-test to help establish the diagnosis in adults. Examples of such checklists include Conners' Adult ADHD Rating Scale, or CAARS, as well as the Adult Self Report Scale.
Psychological treatments for ADHD in adults include education about the illness, participation in an ADHD support group, and skills training in a variety of issues, like job, organizational, parenting, financial and time-management skills. Some adults with the disorder may benefit from cognitive behavior therapy, which is a form of psychotherapy that focuses on helping the ADHD sufferer alter negative thinking patterns that may impede their functioning.
Similar to the treatment of ADHD in children, adults often benefit from being prescribed a stimulant or non-stimulant medication. Perhaps the oldest prescribed stimulant for the treatment of ADHD is methylphenidate (Ritalin). However, given the longer days that teens and adults have compared to young children, stimulants that last much longer are usually prescribed in adults. Some adults may need to take a non-stimulant medication for treatment of ADHD, particularly those whose symptoms early in the morning or late in the evening are not effectively treated by stimulants, those who have side effects when taking stimulants, or those who have a significant history of drug abuse. People who suffer from ADHD are at higher risk for developing mood problems during adulthood; therefore they may benefit from medications that have been found to be helpful for people who have both ADHD and depression or anxiety. Lifestyle improvements like regular exercise and getting adequate sleep each night may help reduce some ADHD symptoms in adults.
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