Adult ADHD
As a child and adolescent psychiatrist with over 25 years of experience with inpatients and outpatients I have become increasingly impressed with the biases within my field. None is more impressive than the bias against the identification of attention deficit hyperactivity disorder (ADHD) in adults by general psychiatrists.
Adult ADHD is not a rare disorder. Over 4% of adults have the disorder and yet few are either aware they have the disorder or are able to receive adequate care. Why?
Too many physicians including psychiatrists are reluctant to diagnose ADHD in their patients. This is borne out by the prominent absence of any mention of adult ADHD in any American Psychiatric Association press publications. And, in fact a review of academic de, excluding child and adolescent psychiatrists, shows there are almost no academics in the US that have ADHD as their primary focus of research interest. Why? It has never crossed over from being a disorder of children and possibly adolescents. It is widely believed that you out grow the disorder by the time you are an adult, therefore any psychopathology you might have has to be another disorder.
In fact I have heard “general psychiatrists”, those who have had minimum training with children and adolescents but focus primarily on adults or patients over the age of 18, say that ADHD does not exist. That’s right, DOES NOT EXIST! Despite compelling scientific evidence there is still the sentiment that “Adult ADHD” does not exist and that what is being seen is either a form of a mood disorder or a thought disorder. This then leads a “general psychiatrist” to use medications such as mood stabilizers (Depakote, Trileptal, Tegretal or Lithium), Antidepressants (SSRI - Prozac, Zoloft, Lexapro, Paxil, Celexa or Wellbutrin) and/or an anti –thought disorder medication, such as one of many antipsychotics (Risperdol or Geodon).
Facts about ADHD
- Estimated 7 million children, 7 million adults with ADHD
- 3%-7% of school-aged children
- Male to female ratio is 4:1 in children and adolescents.
- 60% carry symptoms into adulthood.
- Females present more as the inattentive subtype, may lead to under-diagnosis and under-treatment.
- Prevalence is similar across cultures
Attention-Deficit/Hyperactivity Disorder
(ADHD) is a neurobiological condition that is characterized by developmentally inappropriate level of inattention, [concentration, distractibility,] hyperactivity, and impulsiveness that can occur in various combinations across school, home, and social settings.
Presentation of the following symptom must occur often*
Impulsivity
Evaluation
There is no single test to diagnose AD/HD. Consequently, a comprehensive evaluation is necessary to establish a diagnosis, rule out other causes and determine the presence or absence of co-existing conditions. Such an evaluation should include a clinical assessment of the individual's academic, social and emotional functioning and developmental level. Checklists for rating AD/HD symptoms and ruling out other disabilities are often used by clinicians.
Consequences of AD/HD at the college level include procrastination, poor organization and time management resulting in academic underachievement, poor self-esteem, and difficulty keeping current with assignments and reading. Problems also arise in personal relationships and mood stability. Distractibility and difficulty focusing can lead to problems with reading comprehension, note-taking, and completing assignments and tests in a timely fashion. Impediment to success at the college level include issues that are both academic and/or personal.
Academic issues may include:
• poor organization and time management skills
• reading problems resulting from difficulty
concentrating and focusing
• poor note-taking or writing skills
Personal issues may include:
• high frustration levels or poor self-esteem
• inappropriate social skills or too much time
socializing
• confusion about goals and the future
Educational Accomodations
By law, all colleges and universities receiving any federal funding must provide "reasonable accommodations" for students with AD/HD. There are important differences, however, in the supports available at various schools. Some schools have very minimal staffing to provide support services and only adhere to the "letter of the law," while other schools provide extensive support and encouragement to students with AD/HD.
Resources
http://www.help4adhd.org/en/treatment/guides/dsm
Http://chadd.org
http://www.help4adhd.org/documents/WWK13.pdf
Questions to ask your physician or psychiatrist to determine if they are “Adult ADHD friendly”
Is ADHD/ADD a mental illness? Yes. Much as depression, bipolar illness or anxiety disorders, ADHD/ADD is a mental illness that has diagnostic criteria, a biologic etiology and treatments, both medical and nonmedical.
If I have been diagnosed with another disorder such as depression or anxiety can I have ADHD/ADD as well? Yes. It is not uncommon for an adult to have been diagnosed before the ADHD is identified.
Is there a difference between ADHD and ADD? No. It is an issue of nomenclature. In some cases esp boys/men you will find hyperactivity. Therefore they are more often diagnosed with ADHD. Girls/women are far less likely to present with hyperactivity and therefore will more often be diagnosed with ADD. The diagnostic criteria remains the same in either case.
Isn't ADHD a children's disorder? No. Although it may be present in a child it can go undiagnosed till either adolescence or adulthood. Also, once it was thought that most children outgrew the disorder, recent evidence suggests that it is a life long disorder.
Is there a simple test to diagnosis ADHD/ADD? No. Although there is compelling scientific evidence to support ADHD/ADD as being neuropsychiatric disorder with a biologhical basis and genetic inheritance, there is not a test that verify if a person has the disorder. The diagnosis is made based on clinical information gathered and evaluated by a mental health professional.
Are there more medication choices than either Ritalin or Adderall? Yes. Straterra, Wellbutrin and Clonidine/ Quanficine are sometimes used.
Is there something more than medications that I can use to cope with my ADHD/ADD? Yes.