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17 September 2014
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Adult ADHD

How adults are affected by ADHD and what can be done about it.

Horizon: Living with ADHD: Programme summary

Does ADHD affect adults?
At one time ADHD was considered to be a childhood condition. However, we now know that ADHD symptoms frequently persist in the adult lives of people who had ADHD as a child. Symptoms of ADHD in adult life are often associated with difficulties in everyday life at home, at work and with friends and family. There are increased rates of relationship problems, divorce, accidents, addictive behaviour and under-achievement. There is also an increased risk of developing other mental health problems such as anxiety, depression, alcohol and drug addiction and behavioural problems.

Many people do not realise that ADHD affects adults as well as children; even some health professionals doubt the existence of adult ADHD. However studies that have followed children into adolescence and young adulthood find that around two thirds have continued difficulties coping with the disorder. Recent estimates suggest that as many as one in 100 adults would benefit from treatment for ADHD.

One of the problems in recognising the disorder in adults is that symptoms of ADHD are similar to experiences that we all have in our daily lives such as forgetfulness, boredom, irritability, lack of motivation, disorganisation and impulsivity. However in adult ADHD these common experiences start in early childhood and are far more persistent and severe than that experienced by other people. As a consequence, adult ADHD can cause considerable distress and may have a profound impact on an individual's level of function in their daily life.

("There are good points and there are bad points". Read how one adult has lived with ADHD.)

What are the main symptoms of ADHD in adults?
Adults with ADHD describe a number of feelings and emotions that they find difficult to control and regulate. They feel restless most of the time and have difficulty sitting still even in situations that are calming or relaxing to most people. They experience multiple short-lived thoughts that are poorly focused and "on the go all the time". Some people liken this to "a vortex" or "spaghetti junction".

Mood problems are very common, with a constantly unstable mood that fluctuates up and down from moment to moment throughout the day. One person described swinging between the "fog" of a distracted mind and the "fire" of irritable and angry moods. Individuals with ADHD are frequently impatient, cannot wait for anything and become easily frustrated or irritated. As a consequence, they often avoid situations where they may have to wait their turn such as supermarket queues.

Although people with ADHD are often very active they tend to flit between tasks, starting one activity but rapidly loosing interest and moving on to other tasks before the first is completed. One person described how his life was a "jumbled mess". He was unable to complete even small tasks around the house such as paying bills, clearing the table and tidying up. The problem appears to be one of sustaining motivation and interest.

Adults with ADHD get bored far more quickly than most other people, become easily distracted and forget what they were meant to be doing. At the same time they may have the ability to focus for hours at a time on a few things that they find particularly exciting. One person with ADHD became a successful acrobatic ski jumper, while others are good at sports, computer games or playing music for hours at a time. Despite the ability to focus on a few tasks other aspects of their lives can fall apart due to extreme lack of focus, short-lived interest and disorganisation.

How is the diagnosis of adult ADHD made?
The diagnosis of ADHD is made following a complete clinical assessment to ensure that ADHD symptoms causing significant impairment are present and cannot be better explained by other problems such as anxiety, depression or medical conditions.

The clinical assessment includes the use of ADHD questionnaires and a diagnostic interview that asks about current behaviour as well as past behaviour from childhood. Enquiring about childhood behaviour is particularly important since ADHD starts in early childhood. Since it is not always possible for individuals to provide accurate accounts of their current and past behaviours, information is also sought from close relatives such as a spouse or close friend for current behaviour and from a parent or older sibling for childhood behaviour.

Psychological testing such as intelligence testing (IQ) and performance on special computer tasks can be helpful. At this time no diagnostic tests such a blood tests or brain scans can be used to diagnose ADHD. The aim of these investigations is to obtain a clear description of ADHD symptoms, the problems that have arisen from them and the age of onset and time-course of the disorder.

Mistaken diagnosis
A major problem at this time is that many GPs and psychiatrists have not been trained to recognise adult ADHD and may not know how to make a diagnosis. For this reason the disorder is sometimes mistaken for other conditions.

People with ADHD usually describe the symptoms as being there all the time and say that this is, "the way I have always been". For this reason symptoms of ADHD are sometimes mistaken for personality problems and may be considered as something that cannot be treated with medication. Other problems such as alcohol and drug abuse occur more frequently in individuals with ADHD and this may mask the need to diagnosis and treat ADHD. Occurrence of poorly controlled moods alongside low self-esteem may lead to a primary diagnosis of depression. Persistent thoughts that never stop can be mistaken for anxious worrying. This can make it difficult for an untrained person doctor or psychologist to reach the correct diagnosis.

Treatment for adult ADHD
The medical treatments for adult ADHD are the same as those used in children. The most effective and widely used treatment is stimulants such as Methylphenidate (Ritalin, Eqasym, Concerta) and Dexamphetamine (Dexedrine). A non-stimulant drug called Atomoxetine (Stratera) is also used and is very effective in controlling ADHD symptoms. These drug treatments give a significant improvement for around two-thirds of adults with ADHD.

Psychological treatments, such as certain forms of psychotherapy and counselling, can also be helpful by providing better coping strategies. When ADHD is not too severe such talking therapies may be sufficient on their own. Knowing more about ADHD and learning new ways to control the symptoms can have a huge impact on an individuals quality life.

People are often puzzled as to why hyperactive people are treated with stimulants. This may seem paradoxical or counter intuitive. The mechanisms are still not fully understood, but research evidence suggests that ADHD symptoms are caused by under arousal of the certain regions of the brain. Stimulants activate these areas and result in the reduction of ADHD symptoms.

Stimulants reduce over-activity, impulsivity and poor attention. Typically people describe feeling more calm and focused. One sufferer said, "I no longer notice any particular restlessness or fidgeting, I sleep better, my moods are far more stable and I no longer feel anxious or depressed. I've managed to get through work items that require sustained effort and I've found myself quietly reading a book for an hour without having to get up, having my mind wander, or losing track of where I was on the page. One of the things that I found surprising was that I guess I was expecting to feel more 'alert' or 'awake', but I actually just feel clear-headed. I have the confidence to decide when I want to work on something and for how long. Believe me such confidence is a new thing. I'm acquiring a new perspective on how regular people perceive and manage time."

Dr Philip Asherson MRCPsych, PhD

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 Elsewhere on bbc.co.uk

Health: ADHD and Hyperactivity
Some medical conditions get bad publicity... ADHD is one of them.

Health: Ask the Doctor: Oppositional Defiant Disorder
"My son has had behavioural problems since he could breathe."

Horizon: The Genetic Investigation of ADHD
Dr Philip Asherson on why gathering DNA from those with ADHD will help scientists understand the condition.

Horizon: Living with ADHD
Mood swings, forgetfulness and endless energy... Charlotte Fisher on living with adult ADHD.

 Elsewhere on the web

ADDERS
ADHD support group.

ADDISS
The National Attention Deficit Disorder Information and Support Service.

Institute of Psychiatry ADHD Genetic Group
Identifying the genes involved in ADHD and related behavioural traits.

Royal College of Psychiatrists: ADHD information
Factsheet for parents, teachers and young people.

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