Friday, April 4, 2014

What Are Common Symptoms of Adult ADHD

What are common symptoms of adult ADHD, and how do these differ from symptoms in kids? ADHD is a disorder more commonly discovered in childhood. To meet diagnostic criteria, according to the DSM- IV- TR (Diagnostic and Statistical Manual version IV- Text Revision), symptoms of the disorder must be present by age 7. Even though symptoms or even a mild form of the disorder may be present in childhood, it is not uncommon for it to be discovered or seek treatment for it only in adulthood. Presently, there is not a separate symptom criteria for the diagnosis of ADHD in adults. Criteria for ADHD in childhood is often used and adapted to better account for the difference in life and developmental stages of adults. Symptoms in both children and adults largely stem from the hypo-functioning of certain areas of the brain that control executive functioning. The presentation of these symptoms in adulthood is often seen in the workplace and in the family and social arena. The main symptom clusters for both children and adults are in attention, hyperactivity and impulsivity. However, the disorder can look very different from child to adult and even person to person. Symptom Criteria from the DSM-IV-TR:

a) Symptoms of inattention:

1) Fails to pay close attention to details- tends to rush and often makes careless mistakes

2) Difficulty sustaining attention-tends to have poor concentration, difficulty initiating and completing tasks, tendency to get off task easily

3) Does not appear to listen- can "zone out" during conversations with others and may not realize it, thus losing important bits of information

4) Struggles to follow through on instructions- poor listening skills and memory contribute to difficulty following directions

5) Difficulty with organization- often has poor time management and is often late, often has a messy, disorganized or cluttered area in home/work place/car.

6) Avoids or dislikes tasks that require mental effort- tends to procrastinate

7) Easily distracted

8) Forgetful in daily activities- often misses deadlines, commitments and other important events or dates. Often losing or misplacing things such as keys, phones, bills, work

b) Symptoms of Hyperactivity/ Impulsivity:

1) Fidgets with hands, feet/legs, objects- may appear to have nervous energy, restless or anxious

2) Difficulty remaining seated- tends to get bored easily

3) Runs/climbs excessively- The highly energetic, "climbing-up-the-walls" energy commonly seen in childhood settles down by the mid teenage years. In late teens and adults 'hyperactivity' is more subtle

4) Difficulty in engaging in activities quietly- tends to crave excitement

5) Acts as if driven by a motor- tends to have more risk-taking behavior, acts reckless

6) Talks excessively- tends to have racing thoughts, states mind doesn't shut off, hyperactivity of the mind

7) Blurts out answers before questions have been completed-difficulty inhibiting ones actions

8) Has difficulty waiting or taking turns- poor patience

9) Interrupts or intrudes upon others- poor self-control, makes inappropriate comments

A certain number of symptoms need to be present in 2 or more settings- work, home, school, etc. The symptoms must also cause a functional impairment in those setting.

Is adult ADHD on the rise, and if so, why?

Adult ADHD is becoming more widely recognized and more people are been diagnosed than before, however, this is likely a function of more acceptance and consensus that the disorder can occur in adulthood. As well as better screening techniques with improved detection and treatment options. Adult ADHD is still largely under-reported and under-diagnosed.

If an adult thinks he might have ADHD, who should he see for a diagnosis/treatment?

Where a child can see a pediatrician or a Child and Adolescent Psychiatrist for diagnosis and treatment, an adult should see a mental health professional / Psychiatrist. Psychiatrist are specially trained and likely have more experience in recognizing symptoms of ADHD, diagnosing ADHD, and are more familiar with available treatments for Adult ADHD. Additionally, an adult who suspects ADHD, may want to find a Psychiatrist who has training or experience in working with children and adolescents- as these subspecialist have the most training and experience with the disorder. Once diagnosed, the treatment is multifactorial and best conducted through a team approach with professionals such as Psychiatrists to prescribe medications and Psychologists or other trained counselors/therapists to provide cognitive-behavioral therapy and skills training to learn practical solutions to everyday problems.

What are the treatment options for adult ADHD? Do all adults diagnosed with ADHD need medication? Will they need to take medication for life?

Treatment options are often the same for adults as in children, and typically consist of a combination of therapy, lifestyle adjustments, and medications. Therapies include behavioral modifications and skills training to manage the core deficiencies of ADHD including- organization, planning, time management, memory and impulsivity. Important lifestyle issues that need to be addressed and modified are adequate sleep, healthy diet, and regular physical activity. Medications target these symptoms chemically and can be very effective. According to the DSM-IV, to meet the diagnostic criteria for ADHD, symptoms should cause "social, occupational or functional impairment", therefore medications may be indicated especially if the therapy and lifestyle changes don't effect much improvement. Adults on medications may be able to be more successful at work and with their family/social life, and be better able to use their ADHD management skills to create a better routine and structure for their life. Depending on the severity of symptoms and the success of incorporating the skills training into ones daily life, it is possible to come off medications. Medications are just one piece of the treatment puzzle. Since there is no "cure" for ADHD, some form of treatment will always be needed, however, it may be as simple as keeping organized and getting enough sleep.

Some adults might say that they've made it this far w/o needing treatment. Why start now? How might untreated ADHD affect a person's life?

It is possible not to need "treatment" consisting of medications; however, it is unlikely that no component of treatment will be needed. Some adults with ADHD may be managing their symptoms and not really know it. How many times have we heard, "if I don't get enough sleep, I can't think straight", or "if it doesn't go in my planner, it doesn't exist", or "I need my double shot espresso in the morning to get me focused" (caffeine is a weak stimulant)- not saying that everyone who says and does these things has ADHD, but some who are aware of their issues maybe managing symptoms in various fashions. Also certain environments may be more conducive to managing the disorder than others. I have encountered many young adult patients who were valedictorians of their small highly structured high school class, however, upon entering a big university with less structure and guidance, they start having more problems with organization, meeting deadlines and academic performance. It is not that they suddenly "caught" ADHD; the disorder was likely present to some degree since childhood, however a change in the environment caused symptoms to be problematic enough to cause functional impairment. I've heard similar situations occur in work settings as well. If functional impairment exists, it is best to discuss treatment options with mental health professionals and your physician. Studies have shown that people with untreated ADHD are more likely to experiment/ "self-medicate" with substances, more likely to be unemployed, more likely to divorce and have relational issues and more likely to be involved in motor vehicle accidents.

I've read that people with ADHD often have other mental health problems like depression or anxiety. Please tell me more about the connection.

People diagnosed with ADHD are more likely to have other mental health diagnosis as well, in some reports 6x as likely. Reasons for this are multi-factorial. They can be due to chemical pathways and "wiring" in the brain- ADHD often seen with learning disabilities in children, esp. for reading. Other disorders can occur because the untreated ADHD symptoms put them at risk for other disorders- i.e. a child with ADHD who is extremely hyperactive, may be more likely to be abused and subsequently develop anxiety from the trauma.

I often see problems like depression and anxiety to be the primary reason one may seek treatment- esp. in adults and older teens. It is the untreated ADHD symptoms that can lead to repeated failures, poor performance (at home, school, work), and strained relationships which, depending on how longstanding, can lead to frustration, irritability and a low self-worth. Over time this stress and thought patterns can lead to serious depression.

At times, it appears that untreated ADHD can mimic symptoms of depression and by treating the ADHD, one starts to do better, accomplish more, get praise and improve self-esteem the depression is also treated. If depressive symptoms or disorder is co-occurring, it may be necessary to treat both issues.

Is there a genetic link to ADHD? If your child has it, does that mean you might have it and not recognize it?

There is a strong genetic link to ADHD as well as other mental health disorders. Accd. to Dr. Biederman and research from Massachusetts General Hospital, if a child has ADHD there is a five-fold increase in the risk to other family members (1). Genetic links are also discovered by doing twin (identical vsfraternal) studies. Identical twins have the same DNA, fraternal twins have DNA like any other sibling would share. In one such study, Dr. Florence Levy and her colleagues studied 1,938 families with twins and siblings in Australia. They found that ADHD has an exceptionally high heritability as compared to other behavioral disorders. They reported an 82 percent concordance rate for ADHD in identical twins as compared to a 38 percent concordance rate for ADHD in non-identical twins. (2)

If you or no one around you is recognizing it as a problem causing functional impairment, then the disorder may not be present or meet sufficient criteria for ADHD.

(1) Biederman, J., Faraone, S. V., Keenan, K., Knee, E., et al. (1990). Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 526-533.

(2) Levy, F., Hay, D.A., McStephen, M., Wood, C., & Waldman, I. (1997). Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 737-744.

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