Characteristics of Adult ADHD

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General Facts About Adult ADHD

As many as 67% of kids w/ ADHD continue to have sx that significantly interfere w/ academic, vocational or social fxn’g in their adult lives. Approximately 2-4% of adults are affected by ADHD. Gender ratio = 2:1 (male:female).

Core sx: inattention, impulsivity, hyperactivity usu appear by age 7. In adults, sx are often obscured by problems w/ relationships, organization, mood disorders, substance abuse, employment or other difficulties.

Research suggests that hyperactivity declines w/ age, attentional problems remain fairly constant, and executive function problems increase in adulthood. Many adults remain unidentified & untreated.

ADHD is first recognized in some adults b/c of problems w/ depression, anxiety, SA, impulse control, or after their child is diagnosed.

Characteristics of Adults w/ ADHD

  • Fail to give close attention to details or make careless mistakes at work
  • Fidget with hands or feet or squirm in seat
  • Have difficulty sustaining attention in tasks or fun activities
  • Leave seat in situations where seating is expected
  • Don’t listen when spoken to directly
  • Feel restless
  • Don’t follow through on instructions and fail to finish work
  • Have difficulty engaging in leisure activities quietly
  • Have difficulty organizing tasks and activities
  • Feel “on the go” or “driven by a motor”
  • Avoid, dislike, or are reluctant to engage in work that requires sustained mental effort
  • Talk excessively
  • Lose things necessary for tasks and activities
  • Blurt out answers before questions have been completed
  • Easily distracted
  • Have difficulty awaiting turn (impatient)
  • Forgetful in daily duties
  • Interrupt or intrude on others

Associated problems & consequences that coexist w/ Adult ADHD

  • Problems with self-control and regulating behavior
  • Poor working memory
  • Poor persistence of efforts toward tasks
  • Difficulties with regulation of emotions, motivation and arousal
  • Greater than normal variability in task or work performance
  • Chronic lateness and poor time perception
  • Easily bored
  • Low self-esteem
  • Anxiety
  • Depression
  • Mood swings
  • Employment difficulties
  • Relationship problems
  • Substance abuse
  • Risk-taking behaviors
  • Poor time management
  • Antisocial behavior & criminality
  • Poor social skills or deficits in self-awareness

Causes

Heredity is the largest contributor. Other factors that contribute to ADHD to varying degrees: difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain

Diagnosis in Adults

  1. Comprehensive clinical interview surveying past & present ADHD symptomatology, developmental & medical hx, school, work & psych hx (including meds & level of functioning).
  2. First ID core ADHD sx, & then ensure the hx of these sx is both chronic & pervasive
  3. Corroborate hx w/ additional informants (if possible a parent or significant other), & review any past objective records (report cards, transcripts, prior testing/evaluation reports)
  4. Survey behavior from multiple settings (school, work, home)
  5. Rule in or out other psych diagnoses
  6. May use psychological testing to determine any cognitive or learning weaknesses that may underlie functional impairment.

Treatment

Greatest improvement in sx results from tx w/ stimulant medication combined w/ counseling; some antidepressants may also be effective:

  • Psychopharmacology
Stimulants: response rate over 15 studies (systematic review) ranged from 25-78%
  1. Methylphenidate (Ritalin) – 7 wk RCT crossover study showed favorable response in 78% (18/23) of subjects while taking drug vs 4% (1/23) while taking placebo; some adults need scheduled dosing, while others do well w/ as-needed dosing.
  2. Modafinil (Provigil)
  3. Dextroamphetamine (Dexedrine)
  4. Mixed amphetamine salts
Antidepressants:
  1. Desipramine (Norpramin) – TCA, most data from controlled trials supports efficacy of this antidepressant over others
  2. Atomoxetine (Strattera) – SNRI, less effective than desipramine
  3. Buproprion (Wellbutrin) – SS, SN, SDRI, efficacy unclear, one 7 wk RCT showed 64% response rate vs 27% for placebo for sustained-release buproprion
  4. Venlafaxine (Effexor) – SS, SN, SDRI, initial published open data suggest response rate of 50-78%.
  • Other treatments
Counseling & education about ADHD
Vocational assessment & guidance to find the most suitable work environment
Time management & organizational assistance
Behavior skill-building (list-making, day planners, filing systems & other routines)
Coaching
Academic or workplace accommodations
Behavior management strategies

Presented by Ana Carla Smith, MD

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