Adult attention deficit hyperactivity disorder
- This article is intended to focus on the condition in adults. Please see also main article Attention-deficit hyperactivity disorder
Adult attention deficit disorder (AADD) refers to the psychiatric condition currently known as attention-deficit hyperactivity disorder (ADHD) (also known as attention deficit disorder (ADD)) when it occurs in adulthood. Although the exact prevalence in adults is unknown, epidemiologic studies thus far reveal that the condition, marked by inattentiveness, difficulty getting work done, procrastination, or organization problems, probably exists in about 2-4% of adults. The condition persists to adulthood in about half of children diagnosed with the disorder.[citation needed]
Although most diagnoses of ADHD are made for children, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions of ADHD do not confine the disorder solely to childhood and in fact many adults are also diagnosed. Although the disorder may not have been diagnosed in an individual during childhood, it is also currently thought that all adults with the disorder had it in childhood. There are three subsets of ADHD in the DSM, and one is a form which does not include hyperactivity.
Because symptoms tend to diminish with age, a lesser number of adults are thought to have ADD than children. Current studies indicate that approximately 50% of children diagnosed retain the condition as adults. However, there have been only a few studies, and results varied widely from as low as 9% to as high as 66%. An ADD/ADHD diagnosis is also dependent upon an impairment of functionality. Thus, an individual (adult or child) meeting ADD/ADHD criteria may change through various combinations of maturity, medication, education, and learned behavior to no longer be so diagnosed.
Professionals have noted that adults with ADD/ADHD have often developed coping skills and other forms of adaptive behavior which make symptoms less noticeable to themselves and others. [citation needed] Sometimes also found to be a gift, often accompanied by hyperfocus, the condition is thought to have been a factor for historic figures and persons currently well-known in a wide range of fields. Apparently many of the factors which define the disorder have also been successfully used by individuals to turn a potential problem in their lives into an advantage.
Terminology
The conditions currently known as attention-deficit hyperactivity disorder (ADHD) were once called simply attention-deficit disorder (ADD), a term many adults still prefer since it does not seem to carry with it the stigmatized connotation of hyperactivity more apparent in children.
History
A watershed event in the history of this condition occurred in the 1970s as researchers began to realize that the condition now known as ADHD did not always disappear in adolescence, as was once thought. At about the same time, some of the symptoms were also noted in many parents of the children under treatment. The condition was formally recognized as afflicting adults in 1978.
Controversy
As with childhood ADHD, the diagnosis is controversial and has been questioned by some professionals, adults diagnosed with ADHD, and parents of diagnosed children. They point out the positive behaviors that some people with ADHD have such as hyperfocus. Others believe ADHD is a divergent or normal variant of human behavior and use the term neurodiversity to describe it.
Further, critics suspect ulterior motives of the medical industry, which both authorizes the psychiatric definitions of mental disorders and promotes the use of pharmaceutical drugs for their treatment.
Symptoms and hallmarks
Adults are more likely than children to realize that they might have ADD/ADHD. However, because the very nature of the condition makes a person likely to be poor at self-observation, it is important to seek a professional diagnosis. In Driven To Distraction, Edward M. Hallowell describes the disorder from the patient's perspective:
...It's like being super-charged all the time. You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sorts of impolite words that miss the point completely. Because you're trying really hard. It's just that you have all these invisible vectors pulling you this way and that, which makes it really hard to stay on task.
The behavior of people with ADHD goes beyond occasional fidgeting, disorganization, and procrastination. For them, performing tasks can be so hard that it interferes with their ability to function at work, at home, at school, and socially. [1]
- In children the disorder is characterized by inattentiveness to external direction, impulsive behavior and restlessness. However, children with the inattentive type are actually often sluggish and hypo-active.
- In adults the problem is often an inability to structure their lives and plan simple daily tasks. Thus, inattentiveness and restlessness often become secondary problems.
Symptoms or hallmarks of ADD/ADHD vary widely between individuals, just as no two human brains are exactly alike. They also vary throughout a lifetime as the individual matures, and are affected by life experiences and learned behavior. However, the ADHD diagnosis is defined by multiple factors.
Attention-deficit/hyperactivity disorder, combined type, is characterized by symptoms of inattention, impulsivity, and hyperactivity with childhood onset, although the condition may not have been diagnosed then. Hyperactivity symptoms tend to be less noticeable in adults. One type of ADHD diagnosis does not require hyperactivity at all; this was formerly known as simply ADD.
Adults' symptoms may manifest themselves differently from children's. Often the most prominent characteristic in ADHD adults is difficulty with executive fexecutive functioning, which is the brain activity that oversees the ability to monitor a person's own behavior by planning and organizing. Other symptoms observed in adults include inattention, impulsivity, and restlessness as well as frequently accompanying behavioral, learning, and emotional problems.
Adults with hyperactive-impulsive symptoms feel restless and constantly "on the go" as they try to do multiple tasks at once. They are often perceived as not thinking before they act or speak.
"In adults, it's a much more elaborate disorder than in children," says Russell Barkley, Ph.D., a psychiatry professor at the Medical University of South Carolina. "It's more than paying attention and controlling impulses. The problem is developing self-regulation." This self-control affects an adult's ability not just to do tasks, but to determine when they need to be done, says Barkley. "You don't expect 4- or 5-year-olds to have a sense of time and organization, but adults need goal-directed behavior—they need help in planning for the future and remembering things that have to get done." [2]
Studies have indicated that adults with ADHD are much more likely to have substance abuse problems than adults who do not have ADHD. They are also more likely to suffer from depression and anxiety, be fired from jobs, and get divorced than non-ADHD adults.
For adults the most common symptom is a sense of underachieving. According to Hallowell, "No matter how well you are doing, you always have a sense of missing a lot in work, school, jobs relationships. That is what most often finally brings adults in for diagnosis and treatment."
The Hallowell Center identifies the following indicators to consider when ADHD is suspected and recommends that individuals with at least twelve of the following behaviors since childhood—provided these symptoms are not associated with any other medical or psychiatric conditions—consider professional diagnosis:
- A sense of underachievement, of not meeting one's goals (regardless of how much one has actually accomplished).
- Difficulty getting organized.
- Chronic procrastination or trouble getting started.
- Many projects going simultaneously; trouble with follow through.
- A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
- A frequent search for high stimulation.
- An intolerance of boredom.
- Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
- Often creative, intuitive, highly intelligent.
- Trouble in going through established channels and following "proper" procedure.
- Impatient; low tolerance of frustration.
- Impulsive, either verbally or in action, as an impulsive spending of money.
- Changing plans, enacting new schemes or career plans and the like; hot-tempered.
- A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
- A sense of insecurity.
- Mood swings, mood instability, especially when disengaged from a person or a project.
- Physical or cognitive restlessness.
- A tendency toward addictive behavior.
- Chronic problems with self-esteem.
- Inaccurate self-observation.
- Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.
Diagnosis
The diagnostic criteria for ADHD in adults are identical to those for children. It is important to note that adult diagnosis requires establishing whether the symptoms were also present in childhood, even if not previously recognized. [4] Diagnosis must also exclude other medical or psychiatric causes of symptoms.
The diagnosistic criteria require multiple symptoms observed in multiple settings (school, home, work, etc.) within the preceding 6 months. The full criteria are listed at Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder.
Psychological testing for ADHD
Adult patients seeking a possible diagnosis may especially benefit from psychological assessment due to the greater ability to provide history and input. The relationship thus established may also help with behavioral solutions in addition to any medication which may be indicated.
Treatment
Generally, treatments which have proved effective for children were observed to work equally well or better in adults with similar diagnosis. [citation needed]
References
- ^ Hallowell, Edward M, and Ratey, John J. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood
See also
- Attention-deficit hyperactivity disorder for main article
- Controversy about ADHD
Further reading
- Amen, Dr. Daniel G., Healing ADD: The Breakthrough Program That Allows You to See and Heal the Six Types of ADD
- Hallowell, Edward M, and Ratey, John J., Answers to Distraction
- Hartmann, Thom, Attention Deficit Disorder: A New Perspective
- Hersey, Jane, Why Can't My Child Behave?
- Lawlis, Frank, The ADD Answer