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)