Attention deficit hyperactivity disorder (ADHD) is a disorder of childhood but remains active into adulthood in about 10-60% of patients. The symptomatology does not differ from childhood to adulthood but it may become less intense. However, comorbid conditions may vary in adult ADHD.
Only adults who had ADHD in childhood are eligible for a diagnosis of adult ADHD at present. Adult ADHD is a globally pervasive disorder which affects areas such as academic pursuits, relationships with other people and workplace behavior and success.
Many conditions may be found to coexist with ADHD, some of them being comorbidities while others reflecting various attempts by the individual to face or overcome the difficulties of the condition.
Clinical Features
Adult ADHD usually presents with many of the following signs or symptoms:
- Initiation of a task is difficult
- Doesn’t pay attention to all aspects of a task
- Doesn’t know how to set priorities while doing something
- Can’t organize one’s efforts to fulfil the original aim
- Gets tired very fast of any task which requires sustained thinking
- Very impulsive and impatient
- Cluttered lifestyle and living space with half-finished projects everywhere
- Comorbid psychiatric conditions such as depression or other mood disorders, antisocial personality disorder, or developmental retardation
- Substance abuse very common
Diagnosis and Treatment
Individuals with ADHD are usually recognized by their history of ADHD in childhood, but others may be diagnosed using the standardized Conner’s Adult ADHD Rating scale or self-reported behavior rating scales. Liver, thyroid and blood tests should be carried out to exclude other disorders and to obtain a baseline before starting drug therapy. Neuropsychological tests are also indicated in the case of mental retardation or learning disabilities as well as if the patient has no apparent history of childhood ADHD.
Many mood symptoms may be mistaken for coexisting morbidities, but are really faulty coping mechanisms.
Many types of treatment have been researched for ADHD in adults, including pharmacological and psychological. Drugs used in the treatment of ADHD in adults include stimulants and drugs which inhibit the reuptake of the deficient neurotransmitters such as dopamine and norepinephrine, to increase their levels. These reduce the mental and physical restlessness, quieten the behavior, and may improve the attention span.
The adverse effects of stimulants include the significant development of addiction and abuse potential, which may be dangerous in patients who already abuse alcohol or drugs. They also stimulate the cardiovascular system to raise the heart rate and blood pressure, which could precipitate cerebrovascular accidents, myocardial infarctions, or sudden death in vulnerable individuals.
Other non-stimulant drugs include atomoxetine which has low abuse potential as well; tricyclic antidepressants which can increase norepinephrine and serotonin levels; and buproprion. These are used for their solely norepinephrinergic effects, mostly off-label. The doses needed in adults are usually half of those used in children, but the duration of therapy may be significantly longer.
It is important to identify and treat other psychological symptoms or disorders at the same time as they may affect the way the patient responds to treatment, influence the patient’s compliance with therapy, and prevent the patient’s self-recognition of the actual condition. Simultaneous psychotherapy is highly useful in treating the underlying ADHD as well as coexisting disorders.
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