The best patient guide to adult ADHD

Attention deficit hyperactivity disorder is a highly publicized childhood disorder that affects approximately 3 percent to 5 percent of all children. What is much less well known is the probability that, of children who have ADHD, many will still have it as adults. Several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.¹⁶

The first studies on adults who were never diagnosed as children as having ADHD, but showed symptoms as adults, were done in the late 1970s by Drs. Paul Wender, Frederick Reimherr, and David Wood. These symptomatic adults were retrospectively diagnosed with ADHD after the researchers’ interviews with their parents. The researchers developed clinical criteria for the diagnosis of adult ADHD (the Utah Criteria), which combined past history of ADHD with current evidence of ADHD behaviors.¹⁷ Other diagnostic assessments are now available; among them are the widely used Conners Rating Scale and the Brown Attention Deficit Disorder Scale.

Typically, adults with ADHD are unaware that they have this disorder—they often just feel that it’s impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day’s work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult.

Diagnosing ADHD in an Adult

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms.¹⁸ The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient’s childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for ADHD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.

Treatment of ADHD in an Adult

Medications. As with children, if adults take a medication for ADHD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.¹⁹

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight. A medication may have a longer “half-life” in an adult. The adult may take other medications for physical problems such as diabetes or high blood pressure. Often the adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Education and psychotherapy. Although medication gives needed support, the individual must succeed on his own. To help in this struggle, both “psychoeducation” and individual psychotherapy can be helpful. A professional coach can help the ADHD adult learn how to organize his life by using “props”—a large calendar posted where it will be seen in the morning, date books, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

Psychotherapy can be a useful adjunct to medication and education. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of ADHD that are positive—boundless energy, warmth, and enthusiasm.

Thirteen Great Books on ADHD

1. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood by Edward M. Hallowell and John J. Ratey (Paperback - Mar 2, 1995)
2. Answers to Distraction by Edward M. Hallowell and John J. Ratey (Paperback - Mar 1, 1996)
3. Odd One Out: The Maverick's Guide to Adult ADD by Jennifer Koretsky (Paperback - Sep 24, 2007)
4. Survival Tips for Women with AD/HD: Beyond Piles, Palms, & Post-its by Terry Matlen (Paperback - Jan 1, 2005)
5. ADD-Friendly Ways to Organize Your Life by Judith Kolberg and Kathleen Nadeau (Paperback - Aug 2002)
6. Organizing Solutions for People With Attention Deficit Disorder: Tips and Tools to Help You Take Charge of Your Life and Get Organized by Susan C Pinsky (Paperback - Dec 1, 2006)
7. Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder by Blythe Grossberg (Paperback - Sep 6, 2005)
8. Women with Attention Deficit Disorder: Embrace Your Differences and Transform Your Life by Sari Solden, Edward T. Hallowell, and John J. Ratey (Paperback - Nov 29, 2005)
9. Scattered Minds: Hope and Help for Adults with ADHD by Lenard Adler and Mari Florence (Hardcover - May 4, 2006) - Bargain Price
10. 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals (10 Simple Solutions) by Stephanie Sarkis (Paperback - Jan 2, 2006)
11. You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults with Attention Deficit Disorder by Kate Kelly, Peggy Ramundo, and Edward M., M.D. Hallowell (Paperback - April 25, 2006)
12. Attention Deficit Disorder in Adults, 4th Edition: A Different Way of Thinking by Lynn Weiss (Paperback - Nov 25, 2005)
13. The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks, and Talents by Nancy A. Ratey (Hardcover - April 1, 2008)

Resource and Support Groups for ADHD

1. Attention Deficit Disorder Association
2. The Center
3. Adders.org 
4. Daily Strength  
5. ADHD news.com  
6. Additude  
7. About.com ADD ADHD
8. WebMD  
9. The Real Beauty of ADHD Support Groups
10. Wegohealth

Additional Resources:

• For related articles on ADHD and adults on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
• For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: ADHD: General” or type in the keyword “ADHD and Adults” into “Google Search” located in the sidebar.
• For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “ADHD and Adults” into “Amazon Search” on the Amazon banner located in the side bar.

Sources: National Institute of Mental Health, See also blogposts in: Psychiatric Disorders: ADHD: General

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com