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Rebecca Resnik, PsyD  
Female
Bethesda, MD

Specialties: ADHD, dyslexia, developmental delays

Interests: Developmental Disabilities
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Adult ADHD: A Common Source of Treatable Problems

Jul 15, 2009 - 6 comments
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Adult ADHD: A Common Source of Treatable Problems

Attention Deficit Hyperactivity Disorder has generally been considered largely a disability of childhood, one that many people expect to leave behind as they grow to adulthood. Most of us think of ADHD as primarily a child’s problem that interferes with progress at school. We often picture hyperactive little boys with behavior problems. However, when an adult has trouble doing all the things he or she needs to get done at home, work, and in educational settings, doctors do not always consider that the culprit could be ADHD. Recent research suggests that as many as 3-5% of adults have ADHD. That could mean that up to 5 out of every hundred adults struggle with underachievement and frustration due to a very treatable disorder. This is a significant number of people, particularly when you consider that ADHD runs in families. This rate would mean that ADHD among the most common mental health disorders in adults. The research suggests that more adults have ADHD than have schizophrenia, bipolar disorder, and many other well known mental health problems (though depression remains more common).

As Dr. Larry Silver so eloquently described it, ADHD is not just a learning disability; it is a ‘life disability.’ The problems associated with ADHD do not just occur in the classroom or during childhood. In a recent online panel discussion lead by Dr. David Goodman*, researchers emphasized that the same symptoms we recognize in childhood ADHD also occur in adults. These same childhood symptoms take on different forms in adults with ADHD. For example, most adults with ADHD are not floridly hyperactive. Instead, an adult is more likely to report ‘inner restlessness’ or problems with impulsivity. Symptoms of ADHD impact important adult tasks such as remembering to pay the mortgage, paying attention while driving, or managing your children’s schedules. Studies have shown that people with ADHD have higher rates of underachievement, car accidents, career setbacks, and substance use. Adults with ADHD have significant problems functioning in their daily lives. These problems can ‘snowball’ as individuals take on increasing responsibility throughout adulthood, such as raising a family or being promoted at work.

Dr. Russell Barkley has written about the ‘core deficits’ of ADHD. The deficits most likely to be seen in adults include: problems with working memory, impulsivity, distractibility, trouble persisting through challenges, and trouble organization and planning. While these deficits may not sound serious on paper, they are a very big deal to those with the disability and their families. Because ADHD can be successfully treated, it is important to obtain an accurate diagnosis.

The adults I have seen who have ADHD report frustration with their lives. They often describe the sense that they are capable of doing more, but can not do what needs to be done to achieve their goals. Many adults with ADHD, particularly women, have other mental health problems related to their ADHD symptoms. As is the case with children who have ADHD, adults with ADHD are at higher risk for anxiety or depression. Because ADHD runs in families, coping with a child who has ADHD may be particularly difficult for a parent with the same disability. The relatively high rates of anxiety and depression are not surprising when you consider the unpleasant consequences of living with the symptoms of ADHD. Dr. Russell Barkley has reported on findings that adults with ADHD have higher rates of car accidents and driving violations than the general population. College students with ADHD are less likely to meet their educational goals, and more likely to underperform in the workforce. The impulsivity associated with ADHD can lead to unwise choices about sexual behavior, relationships, spending, or risk taking.

It is also common for individuals to be diagnosed later in life than we used to expect. Many people do not seek assessment or treatment until they are adults, when problems have become intolerable. Just because symptoms of ADHD could be kept at bay for years does not mean that the disorder is not present. Many bright individuals develop ways of compensating for their disabilities. I have tested adults and older adolescents who managed to hide their disability by never having to study, or charming their teachers or bosses into giving them leeway. Adults with ADHD typically find jobs that allow them to keep active, such as being a paramedic or artist. They may also seek out environments that are very supportive, or rely on loved ones to manage the organizational details of life (like filing the taxes on time). The key is that the symptoms of ADHD were always there, even if it took until adulthood for those symptoms to have a serious impact on a person’s success and happiness. If a person has a longstanding pattern of symptoms associated with ADHD, it is an excellent idea to seek assessment.

At this time, ADHD is diagnosed by assessing symptoms. Psychologists and neuropsychologists use tests to formally measure a person’s ability to pay attention, sustain focus, work efficiently, and be strategic. It is important for the diagnosing clinician, be it a psychologist, psychiatrist, or general practitioner, to gather data as part of the assessment. Symptoms of ADHD can also be caused by other mental health disorders, such as depression or anxiety, or even medical conditions. Many problems can superficially resemble ADHD. The doctor should be careful to consider other mental health disorders as well as ADHD, given the high frequency of ADHD occurring with other mental health problems such as anxiety. If you can not access a psychologist or psychiatrist, you may wish to complete a reliable, empirically-validated rating scale and bring it to your next doctor’s appointment to help your doctor determine your diagnosis. The Harvard School of Medicine has provided the World Health Organization’s Adult ADHD Self Report Scale online. It can be downloaded at:   http://www.hcp.med.harvard.edu/ncs/ftpdir/adhd/18%20Question%20ADHD-ASRS-v1-1.pdf

The good news about adult ADHD is that it is a disorder that typically responds well to treatment. A ‘multi-modal’ approach is often recommended, meaning that treatment includes both medication and psychotherapy combined. Stimulant medications or alternatives (e.g. Atomoxetine is a non-stimulant medication used to manage symptoms of ADHD) are considered among the safest of psychotropic medications. Side effects are common, yet a skilled prescriber can adjust the dose, choice of medication or how the medication is released to maximize patient comfort. In addition to medication, psychotherapy is invaluable in helping people overcome the problems that ADHD has caused in their lives. Psychotherapy can assist adults with ADHD in developing better habits, managing their mood, and improving important relationships. Obtaining an accurate diagnosis is an important first step towards improving quality of life for both the adult with ADHD and the people count on him or her.

To learn more:

Dr. Russell Barkley's ADHD report is an excellent resource for keeping up to date with the state of the art in ADHD, http://www.russellbarkley.org/clinical-newsletter.htm (also see www.russellbarkley.com)
ADHD in Adults: What the Science Says by Dr. Russell Barkley

Children and Adults with Attention Deficit Hyperactivity Disorder www.chadd.org

National Institute of Mental Health Information Page: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Dr. Larry Silver’s Advice to Parents on ADHD by Dr. Larry Silver

*June 2009, Medscape CME, Psychiatry and Mental Health, Dr. David Goodman, Dr. Anthony Rostan, Dr. Richard Weisler discuss: Adult ADHD and the DSMV, www.medscape.com    (This wonderful online training video lead me to the Harvard Medical School's posting of the ASRS, for which I am very grateful)





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by Melissa0116, Jul 15, 2009
Thank you so very much for writing on this subject.  I am an adult who had ADD which of course is Attention Deficit Disorder.  I think why most adults do not think that they have this is because most people associate this disorder with hyperactiveness.  In my case, I was a hyperactive child but not as an adult.  I just really have major issues with concentration and remembering things.  Most adults just think or are told that it is just the aging process that causes these symptoms but in reality if they do not get the help that they need for this disorder they will eventually lose self esteem and in some cases go into deep depression.  Self esteem is a big issue with ADD/ADHD since we are focused on being the best at something but not understanding how we can achieve it.  I take meds for this condition and it has definitely helped.  

I have always wanted to teach or do therapy for adults with this disorder since their really is not any groups or doctors that truely understand or deal with ADD in adults.  I really feel that if their was more support and meetings for adults with this disorder then alot of adults would be able to find others that have these issues and get the help that they need.  Thanks again for bringing out this subject so that more adults are aware of this.  

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by Melissa0116, Jul 16, 2009
I should have read more into this article as I had skipped over the part of the learning disability.  See, this being called a learning disability is just a way for teachers to be able to separate the children that learn on a different level than others that may not have ADD/ADHD.  I have a 11 year old child with ADHD and immediately they said that he has a learning disability in reading and math but is exceptional at both of these.  In order for them to pass their state testing children with ADHD must be labeled learning disabled so that the funding is still given to the school district.  So, it truely is a myth that ADD/ADHD is a learning disability.  I had no issues with any of my subjects at school or in daily everyday life if just the decision making that I have trouble with not intelligence.  

Just because you have this does not mean that you are necessarily going to have a specific disability in a particular area.  THe brain functions on a different level but I would agree with equineluvr with the fact that it does not have anything to do with raw intelligence.  That is why they have neurotherapy and brain therapy for children and adults with ADD/ADHD.  

equineluvr, thanks so much for talking about this specifically as I really did not read all of the article very thoroughly.  

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by rinkedo, Jul 19, 2009
My first husband turned out to be an ADHD schizophrenic, which I did not know about when I married him.  We have one daughter, who is ADHD.  At 37, Though she has a good work ethic, life is difficult for her.  She tends to get depressed.  She is not a good parent, but does the best she can. Like her nephews, she does not stop moving. So far two of her sons have severe ADHD, and I imagine other things as well.

Three of my grandsons inherited all their father's problems.  At 11, 8, and 6, without medication they don't sleep for days at a time.  The 11 year old has ADHD and bipolar disorder as well.  He practices unnecessary violence, and has broken bones in both his younger brothers.  He makes friends easily, but does poorly in school. He is a gifted artist.

The 8 year old does not have ADHD, but is already showing signs of an addictive personality. He makes friends easily, and does extremely well in school.  His first addiction is video games.

Like his 11 year old brother, the 6 year old does not stop moving.    He does well in school, but does not make friends easily, or at all.   He has normal attachments to family.  He exhibits many disturbing behaviors,  including slapping and knocking his head violently, and scratching  and biting himself until it bleeds.  My daughter is working to get him evaluated.  His bizarre behavior could put him in physical danger.

The 3 brothers' father is an epileptic  bipolar ADHD dyslexic jerk who cannot read.  He bled her bank accounts dry and left the boys to her to care for.

No such problems occur in either my husband's or my immediate and extended families.

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by stella5349, Jul 31, 2009
Does anyone look at these disorders and think there is a hormonal defect in their background instead of just labeling them as a mental disorder?????

I just don't agree with this logic...

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by stella5349, Jul 31, 2009
Schools are being granted extra cash for there DPI counts if children are labeled with this disorders... where is the thought process there...

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by Johnexo, Apr 22, 2011
It is very difficult to define the ADHD symptoms in adults, mainly because there was no proper research conducted on this disorder in adults. The symptoms can be categorized into two types - symptoms of impulsiveness and hyperactivity and inattentiveness symptoms. Other conditions which may be related to the symptoms of this chronic disorder are obsessive compulsive disorder, personality disorder and bipolar disorder.
http://www.thebrainhealth.com/symptoms-of-adhd-in-adults.html

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