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COLUMBIA CENTER FOR PSYCHIATRY

DAVID J. FISCHER, M.D.
MEDICAL DIRECTOR

PHONE: 202-363-4333
PHONE: 202-686-0114
Washington DC Psychiatrist

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ATTENTION DEFICIT HYPERACTIVITY DISORDER - AD/HD
& ATTENTION DEFICIT DISORDER - ADD

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DEFINITION

Attention-deficit hyperactivity disorder (ADHD) in adults is a common and frequently under diagnosed condition. Attention Deficit Disorder (ADD or ADHD) is a medical condition involving under activity in the frontal cortex of the brain. This area of the brain is responsible for the regulation of attention, impulse control and motor activity. This area also plays a role in the regulation of emotions. ADHD is largely inherited and tends to run in families. It was once thought that ADHD was limited to children. ADHD, however, is not limited to children. It starts in early childhood. The symptoms frequently persist and manifest themselves differently and more subtly into adulthood. In many cases, ADHD is not diagnosed in childhood but is diagnosed adults.

Adult attention-deficit hyperactivity disorder and adult attention deficit disorder can be treated with psychpharmacology and medicine

Approximately one-half to two-thirds of children with ADHD will continue to have significant problems with ADHD symptoms and behaviors as adults. It is estimated that roughly 10% of children and 5% of adults have ADHD. More than 15 million Americans are affected by ADHD. It is estimated that 10 million US adults, aged 18 and older, have ADHD.

The symptoms and problems of ADHD begin in childhood and continue to persist, in varying degrees, for many individuals throughout adult life. In some cases ADHD is not diagnosed until later in life. Adult ADHD symptoms are similar, but not identical, to those seen in children and adolescents. The basic categories of symptoms in children are inattention, hyperactivity, and impulsivity. People often refer to the adult form of the disorder as ADD (Attention-Deficit Disorder), because symptoms of hyperactivity tend to diminish with age, often taking the form of restlessness or fidgetiness and difficulty engaging in quiet activities.

There is no cure for ADHD and generally individuals do not outgrow ADD. The good news is that one can learn to master strategies to effectively compensate for the symptoms of ADHD. It is now understood that ADHD is a lifespan, inherited disability. It is genetically passed from one generation to the next. Adult ADHD can cause significant problems that generally improve with treatment. ADHD is a disorder that is managed and treated over time, probably for many years, and often over the person's entire lifetime.

Adults with symptoms of ADHD can exhibit anxiety and mood disorders, depression, impulse control disorders as well as impairments in executive functioning. These higher levels of cognitive functioning can directly impact on one's ability to perform as an effective employee, parent, spouse, and as a productive member of society.

Executive function is a term for cognitive processes that regulate, control, and manage other cognitive processes. Executive function includes the ability to:

• manage attention
• plan and organize
• time management
• problem solve
• switch tasks
• remember details
• initiate and monitor behavior
• exert appropriate emotional control
• integrate past experience with present action

When executive function breaks down, behavior becomes poorly controlled. This can adversely affect a person's ability to:

• work efficiently and effectively or perform well in school
• function independently
• maintain appropriate social relationships
• poor employment history,
• unstable long-term relationships
• being accident prone
• struggle with substance abuse.
• low self-esteem.
• being accident prone

An adult with ADHD may also exhibit problems with memory and recall, the ability to complete routine tasks, distractibility, and difficulty with timeliness. Impairment in any of the areas of executive function is tightly interlaced with the symptoms of adult ADHD. Individuals with Adult ADHD frequently have additional issues such as a poor employment history, difficulty with academic work, unstable long-term relationships, a tendency to accident proneness, and a tendency to struggle with substance abuse.

Untreated ADHD has been shown to have long-term adverse affects on academic performance, vocational success, and social-emotional development. Children who have ADHD have difficulty sitting still and paying attention in class and do not do well at school even when they have normal or above-normal intelligence. They may engage in a broad array of disruptive behaviors and are often rejected by their peers. As they grow up, children with untreated ADHD are more prone to drug abuse, antisocial behavior, and injuries of all sorts. More than half the children diagnosed with ADHD continue to have symptoms during their adolescent years and into adulthood.

ADHD shows itself as a persistent pattern of inattention and/or hyperactivity and/or impulsivity that is more frequent and severe than is typically seen in ones' peers. ADHD does not affect intelligence. It does affect performance and behavior. Many adults with ADHD are very intelligent. In late adolescence and early adulthood individuals who have had little difficulty in school may begin to experience academic problems due to difficulty concentrating and staying focused with the increased academic demands. Others with ADHD manage to perform well in college and graduate school but find once they are finished with their formal education and enter the adult world of working and responsibility, they develop difficulty performing and functioning effectively. Typically, adults with ADHD are unaware that they have this disorder. Often, the most prominent characteristic in adults with ADHD is difficulty with executive functioning, which is the brain activity that oversees the ability to monitor behavior by planning and organizing. They often just feel that it's impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day's work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult. Also, deficits in interpersonal skills involving attending and responding appropriately to others frequently become more prominent as people with ADHD become older.

CAUSES OF ADHD

Considerable evidence suggests that ADHD has a strong genetic component and a biological underpinning involving dysfunction in the neurotransmitters, norepinephrine and dopamine. ADHD often runs in families. About 25% of close relatives in the families of children with ADHD also suffer from ADHD. The rate is about 5% in the general population.

No physical findings are diagnostic of ADHD, and there is little compelling evidence that ADHD stems from the home environment. There is no real evidence that head injury, undetectable damage to the brain, early infection, or complications at birth cause ADHD.

DIAGNOSIS OF ADHD

In general, adults with the condition will not have considered ADHD as an explanation for their problems, which may include poor organizational skills, bad time-keeping and lack of sustained attention. Many times, when a child is diagnosed with the disorder, a parent will recognize that they have many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given them trouble for years—distractibility, impulsivity, and restlessness. They may have a history of school failures, problems at work, or more automobile accidents than their peers. Their everyday lives can be full of challenges that are not experienced by adults without the disorder, so diagnosis can be both a great relief and a great benefit. Diagnosis is made by taking a careful psychiatric history from the patient, using as much collateral information as is available, such as job evaluations, old report cards, and, if possible, the input of partners and family.

Some indicators that can be suggestive of ADD:

Difficulty Getting Organized

For people with ADHD, the increased responsibilities of adulthood, bills, jobs, and children, to name a few, can make problems with organization more obvious, blatant and harmful than in childhood. They tend to be disorganized, and their environmental space is messy and cluttered. Adults struggling with ADHD, often identified disorganization as a major factor that affects their quality of life.

Marital Difficulties

Often, the partners of people with undiagnosed ADHD have poor listening skills and an inability to honor commitments. This may be taken as a sign that their partner does not care.

Extreme Distractibility

Attention deficit hyperactivity disorder is a problem with attention regulation. Adults with ADHD are easily distracted, forgetful and tend to daydream. This can make it difficult to succeed in today's fast-paced, hustle-bustle world. Many people find that distractibility can lead to a history of career underperformance, especially in noisy or busy offices. They frequently lose or misplace things like wallets or keys.

Poor Listening Skills

Problems with attention result in poor listening skills in many adults with ADHD, leading to a lot of missed appointments and misunderstandings.

Restlessness, Difficulty Relaxing

Adults with ADHD are more likely to feel restless and find they cannot relax. Individuals with ADHD are described as edgy or tense. They are impatient and easily bored. They demonstrate an intense need for excitement.

Difficulty Starting a Task

Individuals with Adult ADHD often postpone starting tasks that require a lot of attention. They have an inability to complete things. Procrastination often adds to existing problems, including marital disagreements, workplace issues, and problems with friends. They also tend to be very indecisive.

Chronic Lateness

People with adult ADHD tend to underestimate how much time it takes to finish a task, whether it's a major assignment at work or a simple home repair. They are frequently late or rushed.

Angry Outbursts

ADHD often leads to problems controlling emotions. Many individuals with adult ADHD are quick to explode over minor issues.

Prioritizing Issues

Individuals with ADHD have poor planning skills. They frequently mis-prioritize and fail to meet important obligations, like a deadline at work, while spending countless hours on something insignificant, such as getting a higher score on a video game.

Frequent Changes

They frequently change jobs, interests or activities.

TREATMENT

Over the years, many people develop coping strategies to minimize the impact of ADHD symptoms. But without treatment, a person may still be struggling with the symptoms of inattention, hyperactivity and impulsivity. Moreover, without proper treatment, ADHD continues to produce chronically impaired functioning and pain. While there is no cure for ADHD, there are treatments that can effectively manage the symptoms caused by ADHD by reducing or eradicating them.

There are three main modes of psychiatric treatment of ADHD. Pharmacotherapy (medication treatment) remains the primary treatment for most patients suffering from ADHD. This is because it is the best-established and most effective treatment for most patients with ADHD. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. Medication has proven to be extremely helpful in correcting biochemical imbalances, which lead to inattention and poor organization skills.

The second most important treatment is to provide the ADHD adult with support and guidance in structuring and organizing their environment. This is important in improving an individual with ADHD's functioning. Individuals with ADHD need to develop structure in their life.

Adults with ADHD can benefit from education and psychotherapy. Psychosocial interventions, such as learning time management skills and psychotherapy provide additional important benefits. Learning and developing knowledge about ADHD is likely to give a sense of empowerment. With increased knowledge, the individual can devise techniques to counter the effects of the disorder. This knowledge helps the individual to develop skills and strategies that enable them to achieve personal, interpersonal and professional goals.

Psychotherapy can provide an opportunity to explore emotions related to ADHD. It may boost self-esteem through improved self-awareness and compassion, and offer support during the changes brought about through medication and conscious efforts to alter behavior and limit any destructive consequences of ADHD.

The therapist can encourage a patient with ADHD to adjust to the feelings of loss when risk-taking and impulsivity are curbed and the new sensation of thinking before acting emerges. As a person begins to have some success in bringing order to the complexities of life, they can also appreciate the characteristics of ADHD that are positive—boundless energy, warmth and enthusiasm. Integrating an increased ability to focus and better self-esteem will lead to individual growth and development and more satisfaction in life.

After a diagnosis of ADHD, an adult can begin the process of psychotherapy to make sense of the problems they may have suffered all their lives. This process can help individuals let improve low self-esteem. It can also aid close relationships by giving others an explanation for unusual behaviors. To help face up to and overcome these issues, the individual may consider a course of psychotherapy.

Dr. Fischer has extensive experience treating Adult ADHD He can help you cope with your ADHD by working with you to develop a realistic individualized treatment plan that will include obtaining control over ADHD symptoms, increased self-awareness and insight, improved self-esteem, enhance interpersonal relationships and increased motivation.



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