You’re easily distracted, can’t sit still, and you’re misplacing things. You’re sure it isn’t depression, bipolarity, or dementia. Fact is, you’re beginning to wonder if it’s ADHD. “But it can’t be, I’m an adult.” Actually, it’s possible…
…there’s growing evidence that ADHD symptoms can continue into adulthood. More than that, it seems ADHD symptoms may emerge for the first time in early adulthood.
Discussing aADHD is well worth our time because it can look a lot like a mood or anxiety disorder. And when it comes to addressing our misery index, considering all options is important – especially one we may not know exists.
Tons of information in the Psychiatric Times piece to summarize. Let’s see what we can get to.
What is adult ADHD?
As you may know, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes, and includes diagnostic criteria for, three types of attention-deficit/hyperactivity disorder (ADHD): combined presentation, predominately hyperactive/impulsive, and predominately inattentive.
ADHD has always been considered a child and adolescent disorder; however, there’s growing evidence that ADHD symptoms can continue into adulthood. More than that, it seems ADHD symptoms may emerge for the first time in early adulthood.
For us to get our best view of ADHD I think it’s wise to turn to the DSM-5. What’s interesting is, it doesn’t assign a diagnostic code to aADHD, but professionals often use DSM-5 ADHD criteria to diagnose it.
Okay, our first step is to examine that criteria…
Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
- Often has trouble holding attention on tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
- Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
- Is often easily distracted
- Is often forgetful in daily activities
Hyperactivity/Impulsivity
- Often fidgets with or taps hands or feet, or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
- Often unable to play or take part in leisure activities quietly
- Is often “on the go” acting as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has trouble waiting his/her turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
“Can’t slow down. I gotta’ be on the go.”
To meet criteria for aADHD, an individual needs to have five or more of the nine symptoms of inattention and/or hyperactivity/impulsivity. These symptoms need to have persisted for at least six months.
Also, several inattentive or hyperactivity/impulsivity symptoms should have been present prior to the age of 12. These symptoms should be present in two or more settings, including home, school, or work. But let’s not forget about ADHD presenting for the first time in adulthood. Finally, there should be clear impairment with/or reduced quality of social, academic, or occupational functioning.
Yet more important information…
- The prevalence of ADHD in childhood is 4-7%. It’s thought that symptoms may persist into adulthood in 15-65% of cases. The prevalence rate of aADHD is 2.5%.
- Individuals with aADHD tend to have poor self-esteem and reduced quality of interpersonal and professional relationships. For instance, they’re twice as likely to be divorced.
- Individuals with aADHD have greater rates of traffic violations, motor vehicle accidents, and ER and hospital admissions.
- Some 80% of aADHD cases present with at least one other psychiatric disorder during their lifetime. Significant co-occurrence exists with the mood and anxiety disorders, as well as the substance use disorders.
- aADHD tends to run in families.
How is adult ADHD treated?
Given the significant co-occurrence with other psychiatric disorders, those disorders, ideally, ought to be diagnosed and treated first. That way, the best treatment can be chosen for the core aADHD symptoms.
Okay, meds are the first line intervention for aADHD. Approved for use are stimulants, such as amphetamines – amphetamine and salts (Dyanavel, Adderall, Mydayis, Adzenys), dextroamphetamine (Dexedrine, ProCentra, Zenzedi), and lisdexamfetamine (Vyvanse) – and methylphenidate – methylphenidate (Ritalin, Concerta, etc.) and dexmethylphenidate (Focalin). Also approved is the non-stimulant atomoxetine (Strattera). Prescribed off-label are other meds, such as modafinil (Provigil), guanfacine (Intuniv), venlafaxine (Effexor), bupropion (Wellbutrin), and desipramine (Norpramin).
The amphetamines and methylphenidate have been found equally effective in the treatment of aADHD, with approximately 70% of individuals reporting immediate improvement in core symptoms within one hour after administration of the drug. But it’s important to mention that side effects and contraindications need to be considered. Also, stimulant meds are classified as Schedule II substances, as there’s abuse potential – especially among individuals with a substance use disorder.
And then there’s therapy. Published studies indicate cognitive behavioral therapy (CBT) is the most effective psychological treatment for aADHD. That includes the comorbid symptoms of anxiety and depression.
My experience says meds alone is a dicey proposition for any psych situation. Adding therapy is always a wise choice.
Time to move-on
Even though there’s so much more to review we’re going to have to move-on. But I’ll tell you what – you can dig-in to all the information you’d like by reading the original article on Psychiatric Times.
By the way, if you’re looking for a great screening tool, check-out the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist.
So adult attention-deficit/hyperactivity disorder (aADHD): lots of common ground with the mood and anxiety disorders. And that’s why we need to be aware of it.
Yes, it’s possible.
Are you looking to learn more about the mood and anxiety disorders? Peruse the hundreds of Chipur titles.
