Attention Deficit  Hyperactivity Disorder in Adults

   Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychological disorders in childhood. It is characterised by inappropriate levels of inattention, hyperactivity and impulsivity. Until recently, the disorder was considered by many to resolve during adolescence and young adulthood with little or no continued impact in adult life. However, the majority of cases of ADHD may persist into adult life where it is associated with a range of clinical and psychosocial impairments.

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       In a study from the World Health Organisation Mental Health Survey (Lara, 2009) identified symptom severity, the presence of comorbid depression, social adversity and parental psychopathology as childhood predictors of adult ADHD. Nevertheless, all forms of ADHD are known to persist into adulthood including ADHD with predominantly inattentive symptoms and ADHD associated with milder levels of impairment and comorbidity.

What are ADHD Symptoms in adults?

         The expression of ADHD in adults is to some extent different from that in children and the diagnostic descriptions of some of the features need to be adapted to adult expressions of the disorder. Whereas the core symptoms of hyperactivity, impulsivity and inattention, are well characterised in children, these symptoms may have different and more subtle expressions in adult life. For instance, where children with ADHD may run and climb excessively, or have difficulty in playing or engaging quietly in leisure activities, adults with ADHD are more likely to experience inner restlessness, inability to relax, or over talkativeness. Hyperactivity may also be expressed as excessive fidgeting, the inability to sit still for long in situations when sitting is expected (at the table, in the movie, in church or at symposia), or being on the go all the time. Impulsivity may be expressed as impatience, acting without thinking, spending impulsively, starting new jobs and relationships on impulse, and sensation seeking behaviours. Inattention often presents as distractibility, disorganization, being late, being bored, need for variation, difficulty making decisions, lack of overview, and sensitivity to stress.

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        Typically, adults with ADHD will not settle after the age of 30 but continue to change and/or lose jobs and relationships, either through boredom or being fired. As a consequence relationships and jobs are often short lived. Relationships that last are often impaired due to the inability to listen with concentration to the spouse, not finishing or procrastinating tasks, often being on a ‘short fuse’ and interrupting conversations.

        ADHD patients are also more likely to be subjected to other accidents like dog-bites and burns, and display an unhealthy lifestyle: smoking, alcohol and drug abuse, riskier sexual lifestyle, a delayed rhythm due to chronic sleep problems, lack of structure and inappropriate healthcare.

      Many feel isolated and lonely due to social handicaps and shame about failures. They may have less success with personal growth, lower ability to present themselves in a socially appropriate fashion and lower mental and physical well-being, even in the presence of a high IQ.

What is the prevalence of the disorder?

    Despite growing interest in adult attention deficit hyperactivity disorder, little is known about its prevalence or correlates. According to a study carried out by Kessler et al. in 2006 the estimated prevalence of adult ADHD in the United States was 4.4%. More recent studies show that the prevalence of ADHD in adults is in the range of 2-5% (Lara, 2009).

How can we treat ADHD in adults?

       Due to the demands and responsibilities of adult life, adults face many problems that are different from those faced by children and they therefore need a different range of psychosocial and psychological treatments tailored to both their developmental level and ADHD. Psychological treatments in the form of psychoeducation, cognitive behaviour therapy, supportive coaching or assistance with organising daily activities are all thought to be effective. Further research is however needed as there is an insufficient evidence base to recommend their routine use in clinical practice.

      In order to understand better adult ADHD The European Network Adult ADHD was founded in 2003. This independent expert panel was set up to help improve the diagnosis and management of ADHD in adults throughout Europe. The key to ADHD treatment is a correct evaluation and diagnosis, as well as an individualized psychological intervention.

       In conclusion, efforts are needed in order to increase the detection and treatment of adult ADHD. It is important to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.

 

References:

Kessler R.C. et al. (2006) The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey replication.  The American journal of psychiatry April 2006 Vol 163 Number 4

The European Network Adult ADHD  http://www.adult-adhd.net.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-10-67

Lara C, et al: Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry. 2009, 65 (1): 46-54. 10.1016/j.biopsych.2008.10.005.

 

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