ADHD: Not Just a Childhood Disorder: A Discussion of Evaluation, Diagnosis, and Treatment: In This 10-Part Series, EP Explores Attention Deficit Hyperactivity Disorder (ADHD)

Article excerpt

Many of us know children who have difficulty paying attention, are hyperactive, and/or demonstrate impulsive behaviors. Although years separate these children from adults in workplace situations, often these difficulties and behaviors do not go away, but they may present differently. You may know of adults who have trouble focusing and finishing their work, are restless during long meetings, or are consistently interrupting others so they don't lose their next thought. It is possible that these individuals, whether children or adults, have a real neurologic behavioral disorder called Attention Deficit Hyperactivity Disorder (ADHD).

While many people tend to think of ADHD as a childhood problem, at least two-thirds of children with ADHD maintain symptoms such as inattention, hyperactivity, and impulsivity into adulthood. In fact, in the United States alone, ADHD affects at least 4.4 percent of adults aged 18-44 (based on results from the National Comorbidity Survey Replication, a nationally representative household survey, which used a lay-administered diagnostic interview to access a wide range of DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, 4th Edition] disorders). If ADHD is not managed correctly in adults, it can make it challenging to be a parent, spouse, household manager, coworker, or friend.

This is evidenced by conversations I have with adults who come into my practice who have ADHD that is either undiagnosed or in which the symptoms are not managed effectively. They tell me that they often miss key parts of conversations and have trouble organizing at home and at work. These same individuals consistently miss deadlines, including financial responsibilities (i.e., paying bills on time) and family commitments (i.e., forgetting to sign up their child for after-school activities). Their friends, families, and co-workers often perceive them as careless or forgetful, which can be hurtful.

You may have noticed these behaviors in coworkers, your spouse, other family members, or even yourself. To help provide some background information on ADHD in adults, the following is an overview of how ADHD presents in adults, the consequences of undiagnosed ADHD, and current treatment options, which I hope will be helpful in gaining a better understanding of this common and treatable medical condition.

Causes of ADHD

It is now clear that ADHD is a genetic and neurological condition. It is thought to be caused by problems in the regulation of two neurotransmitters, dopamine and norepinephrine, which are believed to play an important role in the ability to focus and pay attention to tasks. Genetic research strongly suggests that ADHD tends to run in families and that 55 percent of diagnosed adults have one or more children with ADHD.

Almost always, the child is diagnosed and successfully treated first, and as the family comes to learn more about ADHD, other family members, including adult parents, recognize the symptoms and impairments of ADHD that have held them back for years. Although primarily a genetic condition, ADHD has contributions from other factors, such as neurotransmitter function and environmental factors like maternal smoking during pregnancy or premature birth.

Symptoms of ADHD

Both children and adults with ADHD share the same core symptoms of inattention, hyperactivity, and impulsivity, but they may exhibit them in different ways. For instance, in their day-to-day lives, while children with ADHD may demonstrate signs of inattention by having a hard time playing quietly or sitting still, adults with ADHD often exhibit signs of inattention, such as the inability to focus, organize, or finish work. They may also rush through work, avoid tasks that are challenging or lengthy, and forget a number of things in their daily routine. Virtually all of my adult patients report that their lives are so much harder than the lives of the people around them. …