ADHD in Adults

Many from the older generation believed that ADHD will be outgrown during the adolescence and adult life. It is now generally accepted that ADD/ADHD is prevalent in adults (Wender et.al., 2001; Kessler et.al. 2005, Barkley).

The difficulty is that it is not often diagnosed or picked up in adults as it is often parents who seek help regarding ADD/ADHD children. Adults have also learned to adapt to their ADD/ADHD traits by employing techniques, tools and life skills overcoming the behaviour traits even without knowing about ADHD. "You don’t grow out of ADHD; you just get better at coping with it". And ADHD adults doesn't present itself in the same way as with children. For example, children don't drive, don't have a work or finances to manage like in adult life; and research has show that these areas are adversely affected by ADHD.

If this "self-diagnosis" is positive, it is of utmost importance that a professional diagnosis be made. There are many associated behaviours that need to be ruled out before a positive diagnosis can be made, which only a professional diagnosis can do. If you think that you or someone might have ADHD / ADD, please refer yourself or them to a qualified psychiatrist and preferably, someone knowledgeable in the field of ADHD.

Diagnosing ADD/ADHD in adults are difficult. Researchers are of the opinion that it can only be diagnosed through a battery of tests and identifying characteristic behaviour. A popular test for adults is the well-known CAADID "Conners’ Adult ADHD Diagnostic Interview for DSM-IV," authored by Jeff Epstein, (Ph.D.), Diane E. Johnson, (Ph.D.), and C. Keith Conners, (Ph.D.). Wender³ (2001) et.al. has also developed a sequence of tests to use to diagnose ADHD in adults.

However, the comprehensive research done by Barkley et.al (2007) has found that other criteria could be implemented in diagnosing adults correctly; maybe even more than the current official DSM criteria.

Barkley's research found these criteria to be helpful in diagnosing adults (note: the DSM-V diagnostic criteria is still the only official and recognised diagnostic criteria; these are merely suggestions to help the body of knowledge on adult ADHD).

The DSM-V base the symptoms for adults on those of children and requires that is must occur in more than one setting, e.g. work and social environments. DSM-V lists the following characteristics for diagnosing:

Inattentiveness:

• Appears spacey, daydreaming tuned out, not listening
• Seems to be forgetful and disorganised and tends to lose things
• Appears to have a short attention span, and is easily distracted
• Often fails to finish things

Impulsivity:

• Is easily frustrated and abandons tasks easily
• May interrupt and have difficulty waiting turn
• May seem excitable and volatile
• May not anticipate the consequences of their behaviour or actions

Hyperactivity:

• Appears to have high energy levels
• Cannot keep still, always seems to moving some part of their body
• May have difficulty staying seated, may have to get up and walk around

When diagnosing adults, it is important to note that ADHD does not "happen" in adulthood. If there were no ADHD signs in childhood, there is a good chance that the adult suffers from other disorders. This is why Wender³ et.al. proposes parental interview to determine the prevalence of ADHD characteristics in childhood. After a positive indication from an interview on childhood symptoms, DSM-V can then be used to confirm ADHD in childhood. Wender ³ et.al consequently added a few adult symptoms to further confirm ADHD. These symptoms are:

• Hyperactivity - restlessness
• Attention deficits - forgetfulness
• Affective lability
• Hot temper - outbursts
• Emotional over reactivity
• Disorganization - inability to complete tasks
• Impulsivity - talking before thinking, interrupting, risk taking.

The most frequent complaints on adult behaviour are⁴:

• Inability to concentrate
• Lack of organising one's diary, work pressures, social life. Inability to estimate time; use time inefficiently.
• Forgetfulness and poor memory - can be corrected with notes, check-lists and to-do lists.
• Poor self discipline
• Inability to establish routine
• Confusion, can't think clearly
• Inability to perform up to intellectual level
• Performance on job can be below level of competence
• Difficulty in finding and keeping jobs
• Depression and low self-esteem
• Social clumsiness - can't pick up social cues.

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References:

1. Adult ADHD Assessment and Diagnostic Difficulties and Limitations
2. American Academy of Child and Adolescent Psychiatry
3. Wender, PH; Wolf, LE; Wasserstein, J (2001). Adults with ADHD: An Overview. Annals of the New York Academy of Sciences. 931, 1-16.
4. Green, C & Chee, K. (1997). Understanding ADHD.
5. Barkley, R.A. (2010). Attention Deficit Hyperactivity Disorder in Adults: The latest assessment and treatment strategies. Boston, Jones & Bartlett Publishers.Barkley, R.A., (2007). ADHD: What the science says.
6. Picture credit