Adult_attention-deficit_disorder

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Adult attention-deficit disorder

''' This article is intended to focus on the condition in adults. See also main article, Attention-deficit hyperactivity disorder.

Adult attention-deficit disorder (Adult ADD, Adult ADHD, or AADD) is informal terminology commonly used to describe the neurological condition "attention-deficit hyperactivity disorder" (ADHD) when it occurs in adults. Prior to 1987, ADHD (with or without a hyperactivity component) was formally known as ADD under the DSM-III issued in 1980. It has been estimated that about eight million adults have ADHD in the United States.

Although the exact prevalence of ADHD is unknown, studies thus far reveal that the condition, marked by inattentiveness, difficulty getting work done, procrastination, and/or organization problems, according to epidemiological data, involves approximately 3% to 5% of the U.S. population. It usually persists throughout a person's lifetime; approximately one-half to two-thirds of children with ADHD will continue to have significant problems with ADHD symptoms and behaviors as adults, which impacts their lives on the job, within the family, and in social relationships.

Untreated adults with ADHD often have chaotic life-styles, may appear to be disorganized, and may rely on non-prescribed drugs and alcohol to get by. They often have such associated psychiatric comorbidities as depression, anxiety, bipolar disorder, substance abuse, or a learning disability. In 2004, noted researchers estimated the yearly income loss for adults with ADHD in the United States as $77 billion. This may be partially because it is also estimated that only 15% of adults in the U.S. with ADHD are aware that they have the disorder, although many adults struggle with it.

A diagnosis of ADHD may offer an adult insight into their behaviors and allow the patient to become more aware and seek help with coping and treatment strategies. Studies show that adult ADHD is treated successfully with a combination of medication and behavior therapy. Some clinical professionals believe Adult ADHD should be categorized as a separate condition, even though it may have arisen from a childhood ADHD diagnosis. However, under the DSM-IV, the diagnostic criteria for ADHD in adults follow the same as in children. Although the disorder may not have been diagnosed in an individual during childhood, for adults to be diagnosed, the criteria require that they must have had symptoms in childhood. The neurological basis of ADHD is a lifelong condition. Some adults prefer to designate the condition as ADD or AADD (as opposed to the ADHD) because often the symptoms associated with a hyperactivity component, when present at all, are generally less pronounced. In fact, the prevalence of ADHD in adults as a clinical disorder is difficult to determine because individuals differ in their level of affliction. Those who seek treatment as children, and others, over time, may develop coping skills which make the disorder less noticeable; indeed, if the underlying conditions do not cause functional problems in their lives, they may no longer meet the diagnostic criteria at all. However, those whose symptoms continue to significantly negatively affect their functioning in adulthood in multiple settings (i.e., academic, relationship, and occupational) can be labeled as having the adult version of ADHD.

ADHD in adults (as with children) is recognized as a disability under U.S. federal legislation including the Rehabilitation Act of 1973 and the Americans With Disabilities Act (ADA). Appropriate and reasonable accommodations are sometimes made in the workplace for adults with ADHD, which help the individual to work more efficiently and productively.

Terminology

Clinically speaking, ADD and ADHD constitute a single disorder. The ADHD label was an update to the overall syndrome in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition); ADD (Attention-Deficit Disorder) with or without hyperactivity is the older term from the DSM-IIIR. Approximately one-third of people with ADHD have the predominantly inattentive type (ADHD-I), meaning that they do not have the hyperactive or overactive behavior components of the other ADHD subtypes. This leads to some preference for using the ADHD-I, ADD, and AADD terminology when describing individuals lacking the hyperactivity component, and some clinical professionals believe Adult ADHD should be categorized as a separate condition, even though it may have arisen from a childhood ADHD diagnosis.

History

In the 1970s 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. Current research indicates that up to 60% of children with ADHD carry their symptoms into adulthood.

Prevalence

In the context of the World Health Organization World Mental Health Survey Initiative, researchers screened more than 11 thousand people aged 18-44 years in ten countries in the Americas, Europe and the Middle East. On this basis they estimated adult ADHD prevalence to average 3.5% with a range of 1.2% to 7.3%, with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). They said that adult ADHD often co-occurs with other disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for the co-occurring disorders.

Symptoms

ADHD is somewhat difficult to diagnose as symptoms can be present in adults, as well as children, in at least 16 different ways.

In the book Driven To Distraction, Edward M. Hallowell described an experience of the "hyperactive" aspect of the ADHD disorder from a 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. Brain feels "cluttered", or sometimes light in weight (slightly light-headed). Sometimes difficult to sleep.

Many people express that they feel this way in their lives, but that does not necessarily mean that the person has ADHD. It is important to be tested if you choose to seek treatment.

Attention-Deficit/Hyperactivity Disorder, combined type (ADHD-C) is characterized by symptoms of inattention, impulsivity, and hyperactivity with childhood onset, although the condition may not have been diagnosed in childhood. Hyperactivity symptoms tend to be less noticeable in adults than in children. Some adults with ADHD are predominantly inattentive (ADHD-I) and, rarely, some are predominantly hyperactive/impulsive (ADHD-HI).

ADHD in adults can cause moderate to extreme difficulties in functioning at work, home, or school. In adults the problem can manifest as an inability to structure their lives and plan simple daily tasks. ADHD can also lead to loss of relationships, job hopping, or difficulty with people or work. The difficulty is not due to the ADHD person's direct behaviour, but usually more due to the simple things that the ADHD person will miss, especially when an adult of their age or experience should catch onto or know.

Generally, symptoms may manifest themselves differently in adults than in children. Adults with hyperactive-impulsive symptoms feel extremely driven, sometimes restless. To calm themselves down, they tend to stay constantly on the go and attempt to do but usually fail to complete multiple tasks at once. They are often perceived as not thinking before they act or speak. Generally, the biggest problem is developing self-regulation. The mechanism for self-regulation is delayed or deficient in people with ADHD. This is what is treated medically in the ADHD person. This lack of self-understanding and what looks like a lack of control affects an adult's ability not just to do tasks, but to determine when and how they need to be done, as well as how other people perceive them.

Symptoms of ADHD can vary widely between individuals and throughout the lifetime of an individual. The most prominent characteristic in ADHD often is difficulty with the brain activity known as executive functioning, which oversees the ability to monitor a person's own behaviour by planning and organizing. Other symptoms include inattention, impulsivity, and restlessness as well as frequently accompanying behavioral problems and learning disabilities. Growing up with all these deficits often leads to emotional problems.

The Hallowell Center identifies the following indicators to consider when ADHD is suspected and recommends that individuals with at least twelve of the following behaviours 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 in 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 lability, 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 ADHD 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. Diagnosis must also exclude other medical or psychiatric causes of symptoms. The diagnostic criteria require multiple symptoms observed in multiple settings (school, home, work, etc.) within the preceding 6 months.

Assessment of adult patients seeking a possible diagnosis can be better than in children due to the adult's greater ability to provide their own history, input, and insight. However, it has bene noted that many individuals, particularly those with high intelligence, develop coping strategies that mask ADHD impairments.

Generally, medical and mental health professionals follow the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. Periodic updates to the DSM incorporate changes in knowledge and treatments. Under the DSM-IV (published in 1994, with corrections and minor changes in 2000), the diagnostic criteria for ADHD in adults follow the same as in children. Many professionals have speculated that in the next DSM (tentatively DSM-V), ADHD in adults may be differentiated from the syndrome as it occurs children. Only recognized as occuring in adults in 1977, it is currently not addressed separately. Obstacles that clinicians face when assessing adults who may have ADHD include developmentally inappropriate diagnostic criteria, age-related changes, comorbidities, and the possibility that high intelligence or situational factors can mask ADHD symptoms.

Treatment

Generally, treatments that have proved effective for children have been observed to work equally well or better in adults with a similar diagnosis. Studies show that adult ADHD is treated successfully with a combination of medication and behavior therapy.

The therapeutic process may also see more benefit in behavioral solutions with adults because these can be designed more collaboratively with mature individuals.