ADHD in Adults
ADHD in adults is on the rise. Between 1992 and 1997, the number of adults taking Ritalin for ADHD tripled.1 A study conducted by the National Institute for Mental Health estimates that 4.4 percent of adults between the ages of 18 and 44 experience some symptoms of ADHD.2 Roughly 60 percent of children with ADHD will continue to experience symptoms into adulthood.
That said researchers have also found that ADHD evolves with age.3 Whereas children with ADHD are more likely to have symptoms of hyperactivity and impulsivity, ADHD adults are more likely to suffer from inattentiveness. Equally common symptoms in ADHD adults include procrastination, forgetfulness, losing things, lack of organization and problems with jobs and/or relationships.4
ADHD is a child-onset disorder. This means that although ADHD may be diagnosed in adulthood, symptoms must have existed prior to age 7. Thus, first-time diagnoses in adults generally include a reconstruction of the individual’s childhood history. Professionals often accomplish this by reviewing old report cards and other school reports in addition to any psychological evaluations. Testing should include a diagnostic interview, informational from independent sources such as family members, standardized behavior ratings and checklists established by the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-IV). Originally designed for children, the DSM-IV checklist is far from an ideal measurement of adult ADHD. For this reason, a team of experts along with the World Health Organization developed a six-question test known as the Adult Self-Report Scale (ASRS) to screen for the disorder. The questions are as follows to which respondents have a choice of N for never; R for rarely; S for sometimes; O for often and V for very often:
- How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
- How often do you have difficulty getting things in order when you have to do a task that requires organization?
- How often do you have problems remembering appointments or obligations?
- When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
- How often do you fidget or squirm with your hands and feet when you have to sit down for a long time?
- How often do you feel overly active and compelled to do things, as if you were driven by a motor?
People who answered “S,” “O” or “V” for the first three questions or “O” or “V” for the last three questions receive a point. A score of four points or higher indicates the needs for diagnostic testing.
Far more research has been conducted on ADHD in children than in adults. For example, many of the different treatment options have been tested on children only and, thus, their effects on adults remain unknown. This is particularly true in the use of stimulants. In 2008, the American Heart Association recommended that children with ADHD receive a cardiac screening prior to beginning drug therapy. Whereas the recommendation was primarily made in respond to a rash of sudden death syndrome incidents in children on Ritalin, it is doubly applicable to adults who are at a greater risk of heart disease due to age.
Major depression, dsythyma, conduct disorder, anxiety and substance are often associated with ADHD. Thus, a comprehensive exam should include a screening for associated conditions. Problems associated with the disorder include chronic underachievement; poor work performance leading; difficulties in managing day-to-day responsibilities; relationship issues; stress due to the inability to accomplish goals; and feelings of frustration, guilt and/or blame.5
- “Attention deficit hyperactivity disorder,” MD Consult. http:///www.mdconsult.com/das/patient/body/180217507-3/0/10041/9462/html.
- “About ADHD: Statistical Perspective,” National Resource Center on AD/ HD. Last updated April 2010. http://www.help4adhd.org/en/about/statistics
- J. Myanthi Amarasinghe and Susan Young, “Practitioner review: Non-pharmacological treatments for ADHD: a lifespan approach,”* Journal of Child Psychology and Psychiatry 51*, no. 2 (2010): 116–133.
- “Recognizing and managing ADHD in adults: Symptoms tend to evolve and attenuate with age, but may still require treatment,” Harvard Mental Health Letter 26, no. 5. (November 2009).
- “Diagnosis of AD/ HD in Adults,” Children and Adults with Attention-Deficit/Hyperactivity Disorder. 2003. http://www.help4adhd.org/en/treatment/guides/WWK9S