What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is characterised by a “persistent pattern of difficulties sustaining attention and/or impulsiveness and excessive or exaggerated motor activity”. These symptoms may seem normal in that we all have had excessive energy and hyperactivity in our childhood, but to meet the criteria for ADHD the person needs to have these behaviours in a persistent manner and they must hinder their school, workplace, and personal life. (Diagnostic and Statistical Manual of Mental Disorders, 2013)
Although the onset of ADHD starts in the early developmental stages of childhood, if not diagnosed, it can prevail into adulthood. There is a prevalence of approximately 2.5% in adults with ADHD in the general population. ADHD in adults is associated with not only the inattention and hyperactivity, but with other individual burdens and comorbidities such as anxiety, depression, substance abuse disorders and psychotic disorders. “The National Comorbidity Survey reported that adults with ADHD are three times more likely to develop Major Depressive disorder (MDD), six times more likely to develop dysthymia, and more than four times more likely to have any mood disorder.” (Katzman, 2017)
How do we identify ADHD in adulthood?
ADHD in adulthood is mainly due to the prolonged occurrence of certain inattentive and hyperactivity symptoms, which were undiagnosed in childhood. Interestingly though, it has been reported that 95% of cases are identified with inattentive symptoms and only 5% with hyperactivity. In addition, adults can struggle with emotional dysfunction, resulting in increased emotional reactivity, mood swings, and self-image. (Hirsch, 2018)
Following are some of the major symptoms to identify ADHD in adults: (Present for at least 6 months)
- Inattention:
- Losing necessary items for daily chores, e.g. paperwork, stationery, bags, files, books etc.
- Often easily distracted or doesn’t have consistent working hours
- Can have trouble concentrating on one activity for a long period of time
- Does not pay close attention to details and the specificity of the task
- Hyperactivity:
- Often has trouble waiting in a line, or for their turn
- Can talk excessively and rapidly
- Interrupts or intrudes when someone else is speaking
In addition, adults can suffer from emotional dysregulation, especially in matters of self-concept/ self-image, emotional expression, explicitly positive and negative effects, along with emotional labiality. (Hirsch, 2018)
How to deal with adult ADHD?
Treatment for adults with ADHD works similarly to treatment for children, but with slight variations. A combination of stimulant medications and proper psychotherapy, along with family support, can treat the symptoms of ADHD.
Drugs are classified as stimulants and non-stimulants. Stimulants such as Adderall, Concerta, and Daytrana. They reduce the hyperactivity and increase alertness, with certain side-effects. People with ADHD and comorbidities would have to take a lesser dose as it may trigger other symptoms. Non-stimulants such as Strattera (Atomoxetine), can have a slower effect compared to stimulants, but work well with fewer and less intense side-effects.
With regard to talking therapies, the two most commonly used are Cognitive Behavioural Therapy and Family Therapy.
Cognitive Behavioural Therapy (CBT) enables people with ADHD to gain more control over their daily activities and to be more focused on their tasks. It helps in the important functioning aspects of life, such as in the workplace, interpersonal relationships, and personal development.
Family Therapy or Counselling helps family members in understanding how to support them, and how to communicate with an adult with ADHD. They also learn how to identify their patterns and sustain the daily functioning of that person. Another form of therapy is to have a specialised coach to guide the patient and their family on how to deal with ADHD in adulthood.
Although these therapies are highly effective, an intervention plan consisting of mindfulness was found to be effective for adults with ADHD, in a recent study with the fMRI as the diagnostic tool. It identified that the neurocognitive functions were significantly increased in ADHD patients, compared with the group who were only taught Psychoeducation. (Bachmann, 2018)
Lastly, it is in everyone’s best interest not to stigmatise this disorder, especially in children with ADHD. This only escalates the symptoms and burdens the individual. It is important to educate oneself and support the person who is going through such disorders.
Orchestrate Health provides bespoke mental health services that people can access from the comfort of their own home or within their community, with rapid response times and even daily visits if needed. Orchestrate Health can provide help for those struggling with Adult ADHD, and remove the inconvenience of travelling to and from appointments.
References:
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
- Bachmann, K., Lam, A. P., Sörös, P., Kanat, M., Hoxhaj, E., Matthies, S., … & Philipsen, A. (2018). Effects of mindfulness and psychoeducation on working memory in adult ADHD: a randomised, controlled fMRI study. Behaviour research and therapy, 106, 47-56. https://doi.org/10.1016/j.brat.2018.05.002
- Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H. (2018). Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of affective disorders, 232, 41-47. https://doi.org/10.1016/j.jad.2018.02.007
- Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3
- https://chadd.org/for-adults/treatment/
