ADHD: Not Just for Kids

If you're easily distracted, can't concentrate, and are chronically disorganized, you could have ADHD. Here's how to pinpoint symptoms and find the best treatment options

November 3, 2011

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Attention deficit hyperactivity disorder (ADHD) is a highly publicized childhood disorder that affects approximately 3 percent to 5 percent of all children. What is much less well known is the probability that, of children who have ADHD, many will still have it as adults. Several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.


Typically, adults with ADHD are unaware that they have this disorder -- they often just feel that it's impossible to get organized, to stick to a job, to keep an appointment, to concentrate. The everyday tasks of getting up, getting dressed and ready for the day's work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult.

Pinpointing the Problem
Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years -- distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Because they are so easily distracted, they may be involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood -- onset, persistent, and current symptoms. The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient's childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, is needed. A physical examination and psychological tests should also be given. Other conditions, such as specific learning disabilities, anxiety, or affective disorders, may exist as well.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of herself that may have led to low esteem. Now she can begin to understand why she has some of her problems and begin to face them. This may mean not only medical treatment for ADHD, but also therapy to help her recapture a sense of self-esteem and cope with the anger she feels about the failure to diagnose the disorder when she was younger.

ADHD Symptoms
The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. There are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD -- an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms).

Hyperactive adults may feel internally restless. They often report needing to stay busy and may try to do several things at once.

Impulsive adults may impulsively choose to do things that have an immediate but small payoff, rather than engage in activities that may take more effort and yet provide much greater but delayed rewards.



Is It Really ADHD?
Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Since most people sometimes blurt out things they didn't mean to say, or jump from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD?

Because everyone shows some of these behaviors at times, the diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. Above all, the behaviors must create a real handicap in at least two areas of a person's life such as at home, at work or in social settings. So someone who shows some symptoms but whose work performance or friendships are not impaired by these behaviors would not be diagnosed with ADHD.

To assess whether a person has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place? The person's pattern of behavior is compared against a set of criteria and characteristics of the disorder as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

What Causes ADHD?
Scientists are studying causes in an effort to identify better ways to treat, and perhaps someday, to prevent ADHD. They are finding more and more evidence that ADHD does not stem from the way in which they were raised, but from biological causes. Over the last few decades, scientists have come up with possible theories about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation. Possible causes include:

1. The physical environment. Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

2. Brain injury. One early theory was that attention disorders were caused by brain injury. Some people who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of people with ADHD have been found to have suffered a traumatic brain injury.

3. Genetics. Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population. Many studies of twins now show that a strong genetic influence exists in the disorder. Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD.


ADHD Treatment
1. Medications. If adults take a medication for ADHD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (StratteraÂ®), has been tested in controlled studies in both children and adults and has been found to be effective.

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (EffexorÂ®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (WellbutrinÂ®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may take other medications for physical problems such as diabetes or high blood pressure or for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

2. ADHD Coach. Although medication gives needed support, the individual must succeed on her own. To help in this struggle, both "psychoeducation" can be helpful. A professional coach can help the ADHD adult learn how to organize her life by using "props" -- a large calendar posted where it will be seen in the morning, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

3. Psychotherapy. Therapy can be a useful adjunct to medication and coaching. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into her life by treatment -- the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begin to have small successes in her new ability to bring organization out of the complexities of her life, she can begin to appreciate the characteristics of ADHD that are positive-boundless energy, warmth, and enthusiasm.


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Tags: Brain Health