Adult ADHD (Attention Deficit Hyperactivity Disorder)

Studies show that people with ADHD are more likely to speed, have accidents, and lose their drivers' licenses.

Attention deficit hyperactivity disorder, often called ADHD or ADD (attention deficit disorder), is a behavioral condition that is characterized by symptoms of distractibility, impulsivity, and/or hyperactivity. This disorder often results in the sufferer having relationship problems, as well as difficulty performing well at work or in their community.

Although it is estimated that 2%-6% of adults have ADHD, this illness begins during childhood. While the condition is assessed more often in boys than in girls, it appears to occur in men and women at equal rates. Nearly two-thirds of children with ADHD retain some symptoms of the illness as adults, and about half have just as many symptoms of sufficient severity to still qualify for the diagnosis of ADHD. Other key statistics include that more than 90% of adults with the condition describe having trouble focusing, and more than 50% have both distractibility and hyperactivity/impulsivity, while more than one-third have just distractibility.

Children with ADHD are more likely to grow into teens and adults with the condition.

While there is no one specific cause for ADHD, there are a number of biologically and socially based risk factors that can increase the likelihood of a person developing the illness. Children with ADHD are more likely to grow into teens and adults with the condition. Brain-imaging studies indicate that traits of the brains of people who have ADHD include a tendency to be smaller, to have less connection between certain areas of the brain, and have less regulation of the neurochemical dopamine compared to people who do not have the disorder.

In addition to being risk factors for other neuropsychological issues, factors prior to birth that can increase the likelihood of developing ADHD include

• maternal stress,
• smoking during pregnancy,
• prematurity and low birth weight, as well as
• an early life stressor in the individual with ADHD.

Males and having a family history of this disorder increase the chances that a person will be diagnosed with ADHD. Low family income and low educational achievement for a person's father are social risk factors for developing ADHD.

Adults with ADHD may have trouble prioritizing, starting, and finishing tasks.

What is thought to be partly the result of maturity, adults with ADHD may show little to no signs of hyperactivity or the hyperactivity may look more like restlessness and a tendency to become bored easily. For those who do, symptoms and signs of hyperactivity, impulsivity, and inattention may resemble those that are exhibited by children and teens. However, how those symptoms are exhibited tends to vary with age. Symptoms of ADHD include the following:

Inattention

• Often makes careless mistakes or pays inadequate attention to detail
• Trouble focusing during work or leisure activities
• Does not appear to be listening when spoken to directly
• Is often unable to complete directions, work tasks, or chores
• Frequently disorganized when trying to complete a task or activity
• Has a tendency to avoid, dislike, or resist (procrastinate) engaging in activities that require sustained attention
• Often loses things that are necessary to complete tasks or activities
• Easily distracted by extraneous or unrelated stimuli
• Frequent forgetfulness

While the excessive focus, often described as hyperfocus, is not included as a formal symptom of ADHD, it is often described by people who suffer from this condition or their family members. This symptom is thought by many to be a manifestation of the ineffective focus that is associated with this condition.

Hyperactivity/impulsivity

• Frequently fidgety or moves hands or feet
• Frequently has trouble remaining seated
• Has a tendency to feel restless
• Has difficulty participating in leisure activities quietly
• Performs multiple activities at once
• Excessive talking
• Often interrupts others talking
• Trouble waiting for his or her turn
• Frequently intrudes on other people
• Often does something without thinking about it first (behavioral impulsiveness)

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), in order to be diagnosed with ADHD, an older teen or adult need only demonstrate five of each group of symptoms. Diagnostic criteria further state that symptoms should occur in more than one setting (like home and work), be significant enough to cause difficulties for the person, and not be able to be better explained by another illness. There are three types of ADHD: predominately inattentive presentation, predominately hyperactive/impulsive presentation, and the combined (inattentive, hyperactive, and impulsive) presentation.

Many health care professionals, like psychiatrists, psychologists, social workers, mental health physician's assistants and nurse practitioners, may help diagnose ADHD. A professional will likely perform or refer for a thorough medical interview and physical exam as part of the evaluation. Since ADHD can be associated with other mental health conditions, like depression, bipolar disorder, obsessive compulsive disorder, and other anxiety disorders, as well as with autism-spectrum disorders, the evaluator will likely screen for signs of those and other forms of mental illness. The signs and symptoms of adult ADHD may also be caused by many medical conditions or can be a side effect of a number of medications. Therefore, blood tests are frequently done as part of the initial assessment. Occasionally, an imaging study like an X-ray or CAT scan may be necessary. As part of the evaluation, the individual may be asked questions from a standardized questionnaire or self-test to assist in determining the diagnosis. Some ADHD symptom checklists for children have been adapted to screen for the condition in adults. Examples of such diagnostic tools include the Conners' Adult ADHD Rating Scale (CAARS) and the Adult Self Report Scale.

Treatments for ADHD in adults that do not involve medication include education about the illness, participation in an ADHD support group, and instructional training for a number of issues, including career counseling, organizational skills building, parent counseling, financial training, and development of time-management skills. Many people with this condition may benefit from cognitive behavior therapy, a form of psychotherapy that seeks to help the individual alter patterns of thinking that may interfere with their functioning.

Adults often benefit from being treated with a stimulant medication. Commonly, the first prescribed stimulant for the treatment of this condition in children is a derivative of methylphenidate (Ritalin) or dextroamphetamine (Dexedrine). Given the longer days and increased responsibilities that adolescents and adults have compared to young children, longer-acting stimulants are usually prescribed. Examples of those medications include long-acting methylphenidate, like Daytrana patches, Concerta, Quillivant XR, and dexmethylphenidate (Focalin-XR). 

Adults whose symptoms early in the morning or late in the evening are an issue, or whom have a history or propensity to a drug use disorder, stimulants may not be the optimal medication treatment and, therefore, they may respond better to a nonstimulant medication for treatment of ADHD. Side effects like low appetite, trouble sleeping, tremors, emotional inhibition, irritability or depression, less frequently tics, and rarely hallucinations may make taking a stimulant medication unwise. Using a stimulant to treat ADHD in people who have no history of drug abuse tends to decrease the likelihood of their ever developing a substance abuse problem. However, people with a recent history of alcohol or other drug abuse may want to avoid the small but possible addiction potential of stimulant medication. The long-term impact of addiction to a stimulant may be serious, potentially resulting in having a stroke or heart attack.

Individuals who either had less-than-optimal effects or had significant side effects to taking stimulants may respond better to a nonstimulant medication like guanfacine (Tenex or Intuniv), clonidine (Catapres or Kapvay), or atomoxetine (Strattera), or to taking the prescription supplement phosphatidylserine-omega-3 (Vayarin), which has a specialized delivery system compared to over-the-counter preparations of the omega-3 supplement.

People with ADHD are more likely to develop mood problems as adults. They therefore may benefit from medications like bupropion (Wellbutrin) or venlafaxine (Effexor) that treat both ADHD and depression or anxiety.

Are there any home remedies for adult ADHD?

Further research is needed to determine the potential effectiveness of natural remedies for treating adult ADHD. Examples of such remedies include dietary restrictions and vitamin supplements. The limited research available on the effectiveness of these remedies does not usually include studies on adults.

Lifestyle changes that have been found to be useful in reducing some symptoms of ADHD in children and may be considered for adults include regular exercise and improving sleep every night.

The prognosis for ADHD adults seems to be influenced by the severity of symptoms, scores on intelligence tests, whether the person with the condition has other mental health problems, as well as if there are family issues, such as parental mental health problems, family problems, socioeconomic challenges, and if the individual with ADHD receives treatment. Studies show that stimulant treatment of this condition often improves the prognosis for adults, decreasing the risk for developing other psychiatric problems, failing in school and in the world of work.

What are complications of adult ADHD?

Adults living with ADHD are more likely to have low self-esteem, depression, anxiety, and are not as adaptive with their social abilities compared to adults without the illness. The presence of other mental health disorders (co-morbidity) is more likely in adults who are hyperactive and/or impulsive as opposed to being distractible as part of ADHD. Adults with this condition are also more at risk for underachievement in school or at work, being in more car accidents, using tobacco products or other drugs, having problems managing their anger, and are more likely to develop antisocial behaviors, particularly if not treated. Given the cost effectiveness of treating ADHD and the potentially dire consequences of this illness going undiagnosed and untreated, the importance of identifying ADHD is clear.

Relationships/family life

ADHD adults tend to have more marital problems, as well as troubles getting along with peers and authority figures. They may, therefore, become isolated socially.

Education and career

Adults with ADHD are at risk for completing fewer years of education compared to their non-ADHD counterparts. They are often more interested in careers for which forgetfulness is less of an obstacle for good performance, as well as those that provide immediate gratification and other forms of excitement, like sales. They are often at risk for procrastinating on tasks, frequently changing jobs, and losing more jobs.

Research indicates that breastfeeding up to 6 months of age may help prevent the development of ADHD. Since environmental and social problems like drug use in the mother, medical, and emotional challenges increase the likelihood of developing this condition, prevention or treatment of those issues can help prevent ADHD. In addition, early treatment of children with ADHD can decrease the impact the illness has on the individual's life into adulthood.

CHADD (Children and Adults With Attention Deficit Hyperactivity Disorder)
http://www.chadd-mc.org

Daily Strength
http://www.dailystrength.org

American Counseling Association
http://www.counseling.org

American Psychiatric Association
http://www.psych.org

American Psychological Association
http://helping.apa.org

National Association of Social Workers
http://www.naswdc.org

National Mental Health Association
http://www.nmha.org