Attention Deficit Hyperactivity Disorder in Adults: Review of an Article

Article excerpt

It has long been thought that adult attention deficit/hyperactivity disorder did not continue beyond adolescence, but it is now known that this condition persists into adulthood and, in fact, exists in 3-9 percent of children and 4 percent of adults worldwide.

Studies of patients with ADHD over their lifespan do show a decrease in hyperactivity in adults but with persistence of symptoms of attentional syndromes. Not unlike some children with ADHD, adults with ADHD tend to have "executive function" defects, which include organizational problems as well as difficulties with problem solving. Adults with ADHD tend to have difficulties with educational achievement and do best if their curriculum is structured. Academic problems continue to manifest themselves as underachievement in college. Frequently, there is a history of suspension of driver's licenses for DUI and other violations.

Although the diagnostic criteria may seem unduly cumbersome and numerous, it is important that they be adhered to because of the many different etiologies of this syndrome and actual misdiagnosis because of similarities to other diagnostic etiologies.

Diagnosis of ADHD requires a minimum of six symptoms listed in Section A1 (inattention) and Section A2 (hyperactivity and impulsivity) as well as all the symptoms listed in Sections B through E, according to DSM-IV.

Diagnostic Criteria for ADHD

Section A:

For inattention, those symptoms are:

a. Often fails to give close attention to details or makes careless mistakes in school or other work

b. Often has difficulty paying close attention in games or other tasks

c. Often does not listen carefully

d. Often fails to complete schoolwork or other tasks

e. Has difficulty organizing tasks

f. Often has difficulty with tasks that require sustained activity

g. Often loses things necessary for activities or tasks

h. Is easily distracted

i. Is often forgetful in daily activities

For hyperactivity, those symptoms are:

a. Often fidgets with hands or feet

b. Often leaves seat in situations where remaining seating is expected

c. Often runs about where remaining still would be expected (or in adults excessive feelings of restlessness)

d. Often has difficulty engaging in leisure activities quietly

e. Often constantly "on the go"

f. Talks excessively

For impulsivity, those symptoms are:

a. Often blurts out answers before questions have been completed

b Often has difficulty awaiting one's turn

c. Often interrupts

Section B. Some hyperactive or inattentive criteria must have been present before age seven.

Section C. Some impairment from the symptoms must be present in at least two settings (e.g. school, home, work).

Section D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

Section E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, or schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder or a personality disorder).

General Points Regarding Diagnosis

In determining the correct diagnosis, particularly in adults where ADHD may not be suspected, 15-20 percent of adults with substance abuse disorders, anxiety, depressive disorders, and bipolar disorders have ADHD. Conversely, in primary depression, anxiety, and dementia, cognitive defects which exist as part of the disorder might be misinterpreted as being secondary to ADHD. In the reviewer's experience, however (as well as the authors), the diagnosis of ADHD may be missed more often in the context of symptoms suggesting major depression, bipolar disorder, panic, and substance abuse. …