A booklet by the National Institute of Mental Health
Attention Deficit Hyperactivity Disorder in
Adults
Attention deficit hyperactivity disorder 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.16
The first studies on adults who were never diagnosed as children as having ADHD,
but showed symptoms as adults, were done in the late 1970s by Drs. Paul Wender,
Frederick Reimherr, and David Wood. These symptomatic adults were
retrospectively diagnosed with ADHD after the researchers' interviews with their
parents. The researchers developed clinical criteria for the diagnosis of adult
ADHD (the Utah Criteria), which combined past history of ADHD with current
evidence of ADHD behaviors.17 Other diagnostic assessments are now available;
among them are the widely used Conners Rating Scale and the Brown Attention
Deficit Disorder Scale.
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. 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.
Diagnosing ADHD in an Adult.
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. Often they have been involved in frequent automobile
accidents.
To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and
current symptoms.18 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, will be needed. A physical examination
and psychological tests should also be given. Comorbidity with other conditions
may exist such as specific learning disabilities, anxiety, or affective
disorders.
A correct diagnosis of ADHD can bring a sense of relief. The individual has
brought into adulthood many negative perceptions of himself that may have led to
low esteem. Now he can begin to understand why he has some of his problems and
can begin to face them. This may mean, not only treatment for ADHD but also
psychotherapy that can help him cope with the anger he feels about the failure
to diagnose the disorder when he was younger.
Treatment of ADHD in an Adult.
Medications. As with children, 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 (Strattera®), has been
tested in controlled studies in both children and adults and has been found to
be effective.19
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 (Effexor®),
a newer antidepressant, is also used for its effect on norepinephrine. Bupropion
(Wellbutrin®), 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 need
less of the medication for his weight. A medication may have a longer
"half-life" in an adult. The adult may take other medications for physical
problems such as diabetes or high blood pressure. Often the adult is also taking
a medication for anxiety or depression. All of these variables must be taken
into account before a medication is prescribed.
Education and psychotherapy. Although medication gives needed support, the
individual must succeed on his own. To help in this struggle, both "psychoeducation"
and individual psychotherapy can be helpful. A professional coach can help the
ADHD adult learn how to organize his life by using "props"—a large calendar
posted where it will be seen in the morning, date books, 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.
Psychotherapy can be a useful adjunct to medication and education. 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 his life by treatment—the perceived
loss of impulsivity and love of risk-taking, the new sensation of thinking
before acting. As the patient begins to have small successes in his new ability
to bring organization out of the complexities of his or her life, he or she can
begin to appreciate the characteristics of ADHD that are positive—boundless
energy, warmth, and enthusiasm.
Next