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- What is ADHD?
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What is Attention Deficit Hyperactivity Disorder (ADHD)?
Adult ADHD is a neurological brain disorder that presents itself as a persistent pattern of inattention and hyperactivity/impulsivity that is more frequent and severe than is typically observed in individuals at the same level of mental development.
ADHD (which usually begins with ADHD in childhood) has only recently been investigated. While some teens outgrow ADHD as they get older, about 60 percent continue to have symptoms late into adulthood.
ADHD is not specifically classified as a learning disorder, but can cause severe learning difficulties in adults and teens.
The Difference Between ADD and ADHD
Attention Deficit Disorder (ADD) is the umbrella disorder, encompassing three sub-groups. These three groups are defined as follows:
- ADD Inattentive Type
- Teens and adults with this disorder are not overly active. They do not disrupt the classroom/office, so their symptoms might not be noticed. Their main difficulty is the inability to focus and concentrate. In teen girls, this sub-group of ADD is the most common.
- ADD Hyperactive/Impulsive Type
In this sub-group of ADD, rarely adults exhibit only hyperactivity/impulsivity symptoms. This is classified as ADHD, as it includes the element of hyperactivity.
- ADD Combined Type
Teens and adults with this type of ADD show hyperactive behavior (starting in childhood), impulsive behavior, and cannot focus or concentrate. Hyperactivity symptoms tend to be less noticeable in adults. This is classified as ADHD as it includes the element of hyperactivity, and is the most common form of ADHD.
How Does ADHD Manifest in Adults?
ADHD in adults manifests differently than ADHD in children, as hyperactivity tends to decrease with age (for some but not all).
Although the exact prevalence in adults is unknown, studies thus far reveal that the condition probably exists in about 2 to 4 percent of adults, and is marked by the inability to maintain concentration, difficulty getting work done, procrastination, and organization problems.
A person’s inability to focus, sit still, concentrate, or follow instructions can greatly impair academic development or negatively affect their professional career.
Developing self-regulation is the biggest problem adults face when they have ADHD. This is often not expected of young children but is expected of adults. This self control affects an adult's ability not just to perform tasks, but to determine when they need to be done.
Individuals with ADHD have difficulty with certain brain activity, particularly in the area that is responsible for monitoring the behaviors that control planning and organization. This can be extremely frustrating to the ADHD adult.
When combined with ADHD, other learning disabilities can cause extreme frustration for adults or teens struggling at college or in the workplace. A few symptoms, such as disorganization, weak executive functioning, and inefficient use of strategies can be seen in ADD, ADHD, and other learning disabilities.
Although learning disabilities are common in adolescents with ADHD, they do not affect intelligence. People with ADHD span the same IQ range as the general population.
Diagnosing ADHD in Adults
How is ADHD Diagnosed?
The diagnostic principles used for ADHD in adults and teens are identical to those for diagnosing ADHD in children. It is important to establish whether the adult ADHD symptoms were also present in childhood, even if they were not previously recognized.
Steps in Making the ADHD Diagnosis
As with ADHD in children, the diagnosis is controversial and has been questioned by some professionals, adults diagnosed with ADHD, and parents of diagnosed teens.
They point out the potentially positive behaviors that some adults with ADHD have, such as hyperfocus. Others believe ADHD is a different form of human behavior and use the term neurodiversity to describe it.
Further, critics suspect ulterior motives of the medical industry, which authorizes the definitions of mental disorders and promotes the use of pharmaceutical drugs for their treatment. These are just some of the aspects making diagnosis of ADHD highly controversial.
Symptoms should be observed in multiple settings such as university, home, work, etc.
Adults (including teens) seeking a possible diagnosis can provide their own history, input, and insight and make the process much easier than in the case of very small children. Adults and teens can vocalize exactly what they feel and put into words the chaos sometimes felt inside. Adults are more likely than teens to realize that they might have ADHD. However, it is still very important to seek a thorough evaluation and professional diagnosis.
The process of diagnosing ADHD must be comprehensive. It requires several steps and involves gathering a multitude of information from multiple sources.
Under no circumstances should ADHD be diagnosed in any individual whose primary diagnosis is an emotional disorder, such as anxiety or depression.
Your health care professional/psychologist should investigate the following areas:
- School history and school reports (looking for specific problems beginning as early as possible that may have been encountered during development)
- Sibling relationships
- Family history (for any occurrence of ADHD)
- Eating habits
- Sleep patterns
- Medical problems (physical problems, particularly allergies)
Your health professional/psychologist will want to know how you handle different situations and may want to observe certain activities and interactions. In addition to looking at behavior, they may do a physical examination.
A full medical history will be needed to put your behavior in context and screen for other conditions that may affect your behavior. Your health care professional/psychologist will also want to talk to you about your feelings and ‘typical’ actions during the course of a routine day.
You will more than likely be asked to provide crucial information about your life at home, behavior in college/work, and in other social settings. Your health care professional/psychologist will want to know what symptoms you have, how long the symptoms have occurred, and how the behavior affects you and your family.
Other signs or symptoms may be identified, warranting blood tests, brain imaging studies, or an EEG. Blood or other laboratory tests are currently recommended only if your psychologist/health care professional suspects lead toxicity or other medical problems.
Recognizing the Symptoms of ADHD
Described by an author with ADHD:
"...It's like being super-charged all the time. You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one. You then go for that one, but of course a third idea intercepts the second, and you just have to follow that one. Pretty soon people are calling you disorganized, impulsive, and all sorts of impolite words that miss the point completely. Because you're trying really hard. It's just that you have all these invisible vectors pulling you this way and that, which makes it really hard to stay on task."
It is important to keep in mind that if there is no "impairment" in your life, and you are fully functional. The ways in which the following characteristics of adult ADHD affect each individual differently. Inattention and memory characteristics include the following:
- May be forgetful in daily activities
- May consistently begin a task and not complete it
- May have a problem following conversations.
- May be difficult to motivate yourself to begin a project
- May have difficulty following a timed schedule
- May be in constant movement
- May get bored easily
- May become restless after a few minutes of inactivity
- May have a great desire for active, risky and fast paced activities
Adult ADHD symptoms are not distinct, clear physical signs that can be seen in an X-ray or show up on a lab test. They can only be identified by looking for certain characteristic behaviors (and these behaviors vary from person to person) and by examining the history.
There are several symptoms for ADHD that seem to get worse when demands at school, college, work or home increase. They are:
- Not listening to instructions
- Inability to get organized
- Fidgeting, especially with the hands and feet
- Talking too much
- Failure to finish projects, including work assignments
- Difficulty paying attention to and responding to details
What Causes ADHD in Adults?
One of the first questions you may have after being diagnosed with adult ADHD is "Why is this affecting me? What went wrong?" or "Did I do something to cause this?"
When correctly diagnosed, there is little evidence that ADD can arise purely from social factors or environment. Knowing this can remove a huge burden of guilt from family members or partners who might blame themselves for the individual’s behavior.
Researchers suspect that there are several factors that may contribute to the condition, including:
- Heredity and genetics. The fact that ADHD tends to run in families suggests that children may inherit a genetic tendency to develop an attention-deficit disorder from their parents.
- Chemical imbalance. People who have ADHD may not be able to produce enough chemicals in key areas of the brain that are responsible for organizing thought.
- Brain changes. Areas of the brain that control attention are less active in adults with ADHD than in people without the disorder.
Myths Surrounding the Causes of ADHD
Although the following factors may present symptoms similar to those of ADHD, research has shown that there is no evidence that ADHD is caused by the following:
- Too much TV
- Poor home life
- Poor schools or colleges
- Bad parenting
- Aspartame (or sugar substitutes)
- Lack of vitamins
- Fluorescent lights
- Video games
However, in some cases, the above factors could certainly cause symptoms similar to those seen with ADD in certain individuals. It is worth investigating their impact if a link is suspected.
Help for Adults with ADHD
ADD is often treated using conventional prescription medications. While there is a place for prescription medication in certain cases of ADD, careful consideration should be taken regarding possible side effects and cautions.
There are also alternative solutions for ADD and ADHD available. Making simple changes in diet, sleep, exercise, and routine can help. Even trying more involved approaches like incorporating relaxation therapies such as guided imagery, meditation techniques, or yoga can be beneficial.
More Information on ADHD in Adults
Who is Likely to Suffer from Adult ADHD?
Although the exact prevalence in adults is unknown, studies so far reveal that the condition, marked by inability to concentrate, having difficulty getting work done, procrastination, or organization problems, probably exists in about 2 to 4 percent of adults.
- School-Related Impairments Linked to adult ADHD
Adults with ADHD may have had:
- A history of poor educational performance, thus a strong likelihood of underachievement
- More frequent school disciplinary actions
- May have repeated a grade
- May have dropped out of school
- Work-Related Impairments Linked to Adult ADHD
Adults with ADHD are more likely to:
- Change employers frequently and perform at less than optimal levels
- Have had fewer occupational achievements, independent of psychiatric status
- Social-Related Impairments Linked to Adult ADHD
Adults with ADHD are more likely to:
- Have a lower socioeconomic status
- Have driving violations such as: speeding tickets, suspended license, car accidents, and/or a record of poor driving
- Use illegal substances more frequently
- Smoke cigarettes
- Self-report psychological maladjustment more often
- Relationship-Related Impairments Linked to Adult ADHD
Adults with ADHD are more likely to:
- Have more marital problems and multiple marriages
- Have higher incidence of separation and divorce
Remember that every individual is unique, and just because you may have been diagnosed with ADD does not mean you will automatically experience or exhibit these behaviors.
Symptoms Indicating Something Other than ADHD
Many symptoms and behaviors can present themselves as symptoms of ADHD. These include:
- Underachievement at college/work due to a learning disability (eg. dyslexia)
- Attention lapses caused by petit mal seizures, also known as absence seizures
- Concentration and learning difficulties due to a sleep disorder or breathing problems
- Disruptive or unresponsive behavior due to physical abuse
- Disruptive or unresponsive behavior due to a family member or partner's substance abuse or dependency on alcohol
- Attention-seeking behavior due to family or partner's lack of interest
- A sudden life change
- Substance abuse
- Medical disorders affecting brain function
- Incorrect level of schooling or incorrect placement at work
- Chronic fear due to a traumatic event
- Disruptive or unresponsive behavior due to anxiety or depression
Under no circumstances should ADD or ADHD be diagnosed in any individual whose primary diagnosis is an emotional disorder, such as anxiety or depression.
It's very important that individuals are thoroughly evaluated and an in-depth history is investigated before the conclusion of adult ADHD is reached.
Other causes of ADHD type symptoms are food intolerance, hypoglycemia (low blood sugar), allergies, perceptual difficulties, nutritional problems, candida, hyperthyroidism, Tourette's syndrome, brain dysfunction, family and emotional problems, poor discipline, anxiety, depression, and other conditions. Each of these problems would require different treatment and may even be exacerbated by prescription medication for ADHD.
If other areas are determined to be a possible root cause of the behavior, the diagnosis of ADHD must be put on hold until these areas are fully explored. These include:
- Mental retardation
- Chronic illness being treated with a medication that may interfere with learning
- Trouble seeing and/or hearing
- History of abuse
- Major anxiety or major depression
- Severe aggression
- Possible seizure disorder
- Alcohol or drug abuse
Managing ADHD in Adults and Teens
You need to be proactive and take initiative to find the best possible treatment plan. Be positive. Here are a few tips.
- Tips for you as an ADHD Adult:
- Set aside a few minutes each night to schedule the following day's events
- Organize needed everyday items so you know where things are
- Use diaries and notebook organizers
- Don’t be too hard on yourself or set unrealistic goals
- Activities to Pursue:
While there is no single activity that guarantees teens with ADD/ADHD instant success, certain types of activities tend to reap more positive results.
- Look for activities with a singular focus, such as sports that center attention
- Consider activities that involve movement, providing an appropriate and controlled physical outlet
- Learn to play a musical instrument
- Seek activities that offer individualized instruction
- Explore activities that result in tangible rewards
- Activities to Avoid:
- Involve a lot of down time
- Require too much divided attention
- Require fine motor skills
Special Advice for Managing Teens with ADHD
Tips for you as a parent to help your ADD teen:
- Maintain as much routine and consistency as possible
- Try to avoid major or frequent changes
- Ensure that family relationships are stable
- Be very consistent in your discipline and keep all rules the same
- Speak often to your teen's teachers
- Engage in activities that promote concentration and listening skills
- Use frequent eye contact when speaking to your teen or giving instructions
- Keep directions simple and set simple house rules
- Provide a structured outlet for hyperactivity
- Teach using as many of the senses as possible and make learning interactive
- Review your expectations for your teen
- Reward positive behavior immediately
- Anticipate situations
- Make sure your teen is supervised at all times
- Learn and understand the symptoms of ADD
- Schedule tasks and reminders
- Organize needed everyday items
- Use homework and notebook organizers
- Set a homework routine
- Focus on effort, not grades
- Make a special effort to highlight positives in your child
Try not to:
- Use physical punishment
- Put too many expectations on your teen
- Focus too much on the areas your teen is struggling with
Prescription Treatments for ADHD in Adults
No comprehensive discussion of attention deficit hyperactivity is possible without considering the benefits and disadvantages of prescription drugs - a subject fraught with controversy.
ADHD stimulant medications have sparked a great deal of controversy. Often seen as an easy 'quick fix' they are prescribed to treat symptoms but not the underlying cause of ADHD.
Often people feel that by researching alternatives to prescribed drugs, they are in some way neglecting their teen or loved one, and endangering their health. Ironically, side effects of these prescription drugs can seriously endanger a person's health.
In fact, investigating the possible side effects and long-term impact of prescription drugs is almost certainly viewed as an act of love. Educating yourself on each of the prescription drugs used to treat ADHD is a necessity if you want to provide the safest treatment for yourself or for those you love.
There are some difficulties in using stimulants to treat ADHD in adults. Stimulants are controlled substances, and it is not uncommon for adults (including teens) with ADHD to have or to have had problems with substance abuse.
Short-acting stimulants may wear off quickly, and since adult patients administer the medication themselves but usually have problems with forgetfulness, consistency can be problematic with multiple-day dosing.
Adults may experience significant difficulty in the evening when they do housework, pay bills, help children with homework, or drive. They may be tempted to use substances 'to relax', which can lead to addiction and drug-dependency. Teens may sell their medication to friends, or combine it with other substances.
ADHD represents a growing market for pharmaceutical companies. Although psycho-stimulants may be helpful for many families, no one should underestimate the influence of the economic issues involved.
It is also a worry to note that the long-term effects of prescription drugs for the treatment of ADHD have not been determined. For this reason, treatment of ADHD with prescription drugs or stimulant drugs should be regarded a last resort when all other avenues have been exhausted.
Research into the long-term effects of drugs prescribed for ADHD is still in its early stages. More research is needed.
Discuss with your doctor the risks and benefits of using these medications or treating your teen with these medications.
It is strongly advised that the following criteria are fully investigated with regards to any stimulant drugs: common uses, cautions, possible side effects, overdose, additional information, and major drug interactions.
The Food and Drug Administration (FDA) are still investigating certain side effects of certain prescription ADHD drugs, and it is advisable that individuals do their own research into these medications so that they are fully aware of the potential risks.
Physicians still have a difficult time predicting which prescription medications will produce beneficial results, so treatment is individualized and performed on a trial and error basis. This 'hit or miss' technique requires close observation and cooperation between all participants, and is understandably not the best solution.
If an initial regimen doesn't work, doctors often change the dosage, switch to a different drug, or even add another medication. Some doctors even recommend trying a second psycho-stimulant if a first one does not work. If the individual still doesn't respond, antidepressants or other second-line drugs may be prescribed.
Before long, a person may be taking a cocktail of drugs to treat the side effects of the initial medication, thus creating a domino effect.
Remember, medications don't cure adult ADHD, they only control the symptoms on the day they are taken. Although the medications may help the individual pay better attention and complete work, they can't increase knowledge or improve academic skills.
The medications can only help the individual to use those skills he or she already possesses, which may just as easily be obtained through behavioral therapy and other proactive techniques, such as 'out of the box' creative methods.
It is vital that you educate yourself on all aspects of ADHD before making a decision regarding prescription drugs.
Other Treatment Options for Adults with ADHD
For people with ADHD, no single treatment is the answer for everyone. A person may have undesirable side effects to a medication, making a particular treatment unacceptable. Each person's needs and personal history must be carefully considered. It is important to work with a health care professional/psychologist to determine the safest treatment.
If all other options and avenues have been investigated and prescription drugs are chosen for treatment, frequent follow-up visits should be scheduled to assess the response and to detect possible side effects. Teens on medications should have regular checkups.
Stimulants are not a cure-all, and adults should be informed of healthy choices with regards to food, exercise, and healthy hobbies. The best chance of minimizing side effects is to use a remedy that is free of adverse or unwanted secondary effects completely.
- Dietary Approaches. A number of diets have been suggested for people with ADHD. Various studies have reported behavioral improvement with diets that restrict possible allergens in the diet. Parents may want to discuss with their health care professional, homeopath, or naturopath concerning implementing an elimination diet of certain foods or adding supplements that would not be harmful and that might help. This is a very individualized approach and would differ from child to child. Always consult a nutritional expert before restricting your diet.
- Feedback Approaches. A technique that uses auditory (sound) feedback may prove to be an effective tool for increasing attention.
- Neurofeedback. This technique uses electronic devices to help control brain wave activity.
- Interactive Metronome and Musical Therapy. Feedback from sound is used to improve attention, motor control, and certain academic skills.
- Massage and Relaxation Techniques. Massage therapy can help ADHD adults feel more relaxed, fidget less, be less hyperactive, and focus on tasks. Other methods include reflexology, relaxation training, meditation, and music therapy.