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DEFINITION

Attention-deficit/hyperactivity disorder (AD/HD) is a neurobehavioral disorder characterized by a combination of inattentiveness, distractibility, hyperactivity, and impulsive behavior. Individuals with AD/HD have problems with distractibility, procrastination, disorganization and prioritization. The learning potential and overall intelligence of an adult with ADHD are the same as those of adults who do not have the disorder. AD/HD is a chronic condition beginning in early childhood and lasting a lifetime. It is estimated that up to 70% of children with AD/HD will continue to have significant ADHD-related symptoms persisting into adulthood that may have a significant impact on their education, employment, and interpersonal relationships.

AD/HD appears early in life but is frequently not diagnosed. It is estimated that 3-7% of school-age children are diagnosed with AD/HD; boys are diagnosed more often than girls. Untreated AD/HD has been shown to have long-term adverse affects on academic performance, vocational success, and social-emotional development. Children who have AD/HD 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 engage in a broad array of disruptive behaviors and are often rejected by their peers. As they grow up, children with untreated AD/HD are more prone to drug abuse, antisocial behavior, and injuries of all sorts. More than half the children diagnosed with AD/HD continue to have symptoms during their adolescent years and into adulthood.

SYMPTOMS

Diagnosing an adult with AD/HD is not easy. 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. Other adults will seek professional help for depression or anxiety and will discover that the root cause of some of their emotional problems is AD/HD. They may have a history of school failures, problems at work, or frequent automobile accidents.

A correct diagnosis of AD/HD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of themselves that may have led to low self-esteem. Medication for AD/HD combined with psychotherapy that can help a patient deal with the symptoms of the disorder and deal with the anger resulting from failure to diagnose the disorder in childhood.

CAUSES

Considerable evidence suggests that AD/HD has a strong genetic component and a biological underpinning involving dysfunction in the neurotransmitters, norepinephrine and dopamine. AD/HD often runs in families. About 25% of close relatives in the families of children with AD/HD also have it; whereas, the rate is about 5% in the general population.

No physical findings are diagnostic of ADHD, and there is little compelling evidence that AD/HD 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 AD/HD.

Typically, adults with AD/HD are unaware that they have this disorder—they often just feel that it's impossible to get organized, to stick to a job or 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 adults with AD/HD.

Adults with AD/HD are often perceived by others as disruptive, flakey and disorganized. As their coping mechanisms become overwhelmed, some individuals may turn to smoking, alcohol or other drugs. As a result, many adults suffer from associated conditions such as depression, anxiety, or substance abuse. Many with AD/HD also have associated learning disabilities, such as dyslexia, that contribute to their difficulties.

SYMPTOMS

• Procrastination
• Indecision, difficulty recalling and organizing details required for a task
• Poor time management, losing track of time
• Avoidance of tasks or jobs that require sustained attention
• Difficulty initiating tasks
• Difficulty completing and following through on tasks
• Difficulty shifting attention from one task to another
• Avoidance of low physical activity or sedentary work
• Choosing to work long hours or two jobs
• Seeking constant activity
• Being easily bored
• Impatience
• Intolerance of frustration
• Frequent irritation
• Impulsivity. Prone to snap decisions and irresponsible behaviors
• Quick to anger

DIAGNOSIS

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 members

TREATMENT

Pharmacotherapy (medication treatment) remains the best established and most effective treatment for most patients. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. Medication is extremely helpful in correcting biochemical imbalances, but patients need to develop structure in their life to improve their functioning as well. Psychosocial interventions, such as learning time management skills and psychotherapy provide additional important benefits. To help in this struggle, both AD/HD education and individual psychotherapy are very helpful.

The therapist can encourage a patient with AD/HD 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 AD/HD that are positive—boundless energy, warmth and enthusiasm. Integrating an increased ability to focus and better self esteem can lead to individual growth and development and more satisfaction in life.