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ADHD – An adult affliction

We see children being diagnosed with attention deficit/hyperactivity disorder (ADHD) left, right and centre but we seldom hear of adults with the condition. So, it’s surprising to learn that up to 60% of ADHD kids take the condition with them into adulthood; meaning that about one in 20 adults have it. The manifestation and consequences of the disorder are somewhat different for grown-ups, but just as debilitating.

As with children, adult ADHD appears to be caused by a combination of genetic and environmental factors and is characterised by symptoms of inattention, hyperactivity and impulsivity. ADHD adults show great difficulty with cognitive processes (memory, planning, inhibition), self- regulation (performance, behaviour and emotional control) and motivation or arousal (response to incentives, delaying gratification). These symptoms and difficulties have far-reaching effects on various aspects of adult life.

IMPACT

ADHD can drastically interfere with adults’ university and work achievements, daily activities, relationships, psychological and physical well-being and quality of life.

Fewer adults with ADHD graduate from university and more are unemployed due to low productivity caused by learning problems, poor time management, procrastination and distractibility. Some ADHD adults’ impulsivity and penchant to exhibit antisocial behaviour mean that they’re likely to have run-ins with the law: getting arrested, having accidents or abusing drugs. Interestingly, those ADHD individuals with higher IQs seem to be worse off, with a lower self-reported quality of life, poorer functioning at home and work and more difficulty coping in day-to-day life. To make matters worse, the ADHD parent may be contributing more than genes to increase his or her child’s risk of suffering from the same disorder. An ADHD individual’s parenting style could predispose a child to the condition.

Adults with ADHD exhibit less obvious inattentive, hyperactive or impulsive behaviours than their childhood counterparts. Instead, they’re more at risk of having concurrent psychiatric disorders, with 65-89% of ADHD adults suffering from conditions like oppositional defiance, bipolar, personality and eating disorders, depression, anxiety, drug abuse and attempted suicide. Many adults may be treated for these disorders, never knowing that they have ADHD and never experiencing complete relief.

Adults with ADHD often underestimate the impact of their symptoms, choosing lifestyles to compensate for ADHD-related impairments. Adults with inattentive type ADHD – who procrastinate, have poor time management and difficulty juggling tasks – may fastidiously make notes in a diary or planner to keep themselves on track. While the predominantly hyperactive or impulsive type may choose an active outdoor job that doesn’t require focusing on one task for long. Though some adults with ADHD seem to be functioning well, it’s likely that they’re distressed by the symptoms they’re constantly straining to overcome.

DIAGNOSIS

ADHD diagnosis in adults is made using the same Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria used to diagnose children. This isn’t ideal due to how differently adult ADHD presents.

Whereas childhood ADHD is notoriously over-diagnosed, adult ADHD is largely underdiagnosed and undertreated, especially in women. The presence of concurrent psychiatric disorders means that ADHD can easily be missed, especially when the conditions share similar symptoms. Misdiagnosis and subsequent treatment may relieve some symptoms, but not the core ADHD ones (inattention, hyperactivity and impulsivity), leaving the sufferer feeling like a hopeless case. And the coping mechanisms that many ADHD adults develop mean that few seek treatment and symptoms are often masked.

Despite these hurdles, it’s essential that a correct diagnosis is made and treatment is commenced to prevent the vast psychological, social and economic havoc that adult ADHD can wreak. A psychiatrically trained medical doctor should be able to make the diagnosis, even with the diagnostic difficulties.

TREATMENT

The medicines used to treat childhood ADHD are also used in adults. They boost the brain messengers – dopamine, noradrenaline and serotonin – that are low in ADHD. Dopamine and noradrenaline are responsible for reward, learning and attention, and serotonin is involved in mood. The addictive, dopamine- and noradrenaline- boosting, stimulant medicines – methylphenidate (Ritalin®, Concerta®) and amphetamines – are the first line of treatment. They effectively control symptoms in most adults with ADHD and are safe for short-term use; however, long-term safety in adults is unknown. Potential heart problems from raised heart rate and blood pressure, as well as psychiatric and addiction side effects can occur.

For those who have a history of drug abuse, heart disease risk or don’t tolerate stimulant medicines, less effective non-stimulants are prescribed. These include atomoxetine (Strattera), which boosts noradrenaline, and antidepressants, which boost serotonin, and sometimes dopamine. Antidepressants come with their own side effects (uncovered previously in Health Intelligence), although are generally thought to be safe. Atomoxetine, though, may cause liver damage and suicidal thoughts.

For those who’d prefer to avoid the potential side effects of these medications, alternative treatment options are available. Some natural medicines have proven beneficial by addressing the underlying causes of ADHD, including brain-messenger imbalances and nutritional deficiencies. Dietary changes that may help include identification and elimination of food which cause allergies or intolerances. Avoid additives, colourants, preservatives, refined carbohydrates, sugar and processed food. Rather focus on a healthy Mediterranean or high-protein diet full of fresh, high-fibre fruit and vegetables and omega-3 fats. Cognitive behavioural therapy and yoga also show some benefit.

So if you suspect that you or a loved one has unknowingly been suffering from ADHD, a proper diagnosis by a qualified health care professional is essential to ensure appropriate treatment to provide the sorely needed relief the sufferer and those around him or her crave.

References include

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