Adults Have ADD/ADHD Too
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Rebecca Longmire, Psy.D.
Presented to CHADD of Addison County, VT
October, 1998
Presented and compiled by: Rebecca Longmire, Psy.D.
Until recently, researchers thought ADD disappeared in adolescence because of ongoing brain development, hormonal change or other factors, but new studies suggest that as many as 70% of all children diagnosed with ADD continue to exhibit symptoms in adulthood.
About 5% of all school-age children have ADD, or about 2.6 million. Conservative estimates suggest 2 million to 5 million adults continue to be affected.
Because many children with ADD are never diagnosed properly, many adults with the disorder are unaware they have it. And because science is only beginning to recognize ADD in adults, many have been inappropriately treated for depression, personality disorders, or other problems.
ADD can cause problems on the job such as poor performance, failure to follow directions, boredom and resulting personality clashes. Such problems on and off the job can lead to low self-esteem, substance abuse and real depression.
By contrast, adults who learn to adapt to their disability and harness energy and creativity that often accompany it can thrive professionally, often as successful entrepreneurs.
~Taken from: Staff. (1998). Attention Disorder Affects Adults at High Rate, New Data Suggests. Report on Literacy Programs, p.5.
General Adult ADD Symptom Checklist
• Past History
• Short Attention Span/Distractibility
• Restlessness
• Impulsivity
• Poor Organization
• Problems Getting Started and Following Through
• Negative Internal Feelings
• Relational Difficulties
• Short Fuse
• Frequent Search for High Stimulation
• Tendency to Get Stuck (thoughts or behaviors)
• Switches Things Around
• Writing/Fine Motor Coordination Difficulties
• The Harder I Try The Worse It Gets
• Sleep/Wake Difficulties
• Low Energy
• Sensitive To Noise Or Touch
~Taken from: Amen, D. (1995). General Adult ADD Symptom Checklist. In One ADD Place [On-line]. Available: http://www.greatconnect.com/oneaddplace
What is ADHD (ADD)?
The official definition of Attention Deficit Hyperactivity Disorder (ADHD) as it appears in the Diagnostic and statistical manual of the American Psychiatric Association is: ADHD is a disorder that can include a list of nine specific symptoms of inattention and nine symptoms of hyperactivity/impulsivity.
Individuals with ADHD may know what to do but do not consistently do what they know because of their inability to efficiently stop and think prior to responding, regardless of the setting or task.
Characteristics of ADHD have been demonstrated to arise in early childhood
for most individuals. This disorder is marked by chronic behaviors lasting
at least six months with an onset often before seven years of age.
At this time, four subtypes of ADHD have been defined. These include the
following:
ADHD – Inattentive type is defined by an individual experiencing at least six of the following characteristics:
• Fails to give close attention to details or makes careless mistakes
• Difficulty sustaining attention
• Does not appear to listen
• Struggles to follow through on instructions
• Difficulty with organization
• Avoids or dislikes requiring sustained mental effort
• Often loses things necessary for tasks
• Easily distracted
• Forgetful in daily activities
ADHD – hyperactive/impulsive type is defined by an individual experiencing six of the following characteristics:
• Fidgets with hands or feet or squirms in seat
• Difficulty remaining seated
• Runs about or climbs excessively (in adults may be limited to subjective feelings of restlessness)
• Difficulty engaging in activities quietly
• Acts as if driven by a motor
• Talks excessively
• Blurts out answers before questions have been completed
• Difficulty waiting in turn taking situations
• Interrupts or intrudes upon others
ADHD – combined type is defined by an individual meeting both sets of attention and hyperactive/impulsive criteria
ADHD – not otherwise specified is defined by an individual who demonstrates some characteristics but an insufficient number of symptoms to reach a full diagnosis. These symptoms, however, disrupt everyday life.
The majority of adults with ADHD have been described as experiencing symptoms very similar to the problems experienced by children. They are often restless, easily distracted, struggle to sustain attention, are impulsive and impatient. They have been described as experiencing problems with stress intolerance leading to greater expressed emotion. Within the workplace they may not achieve vocational positions or status commensurate with their siblings or intellectual ability.
Children and adults who have ADHD exhibit degrees of inattention or hyperactivity/impulsivity that are abnormal for their ages. This can result in serious social problems, or impairment, or family relationships, success at school or work or in other life endeavors.
Children and adults can exhibit other psychiatric disorders (medically know as comorbidity), along with their ADHD symptoms. Most commonly, these include oppositional defiant or conduct disorder, along with or separate from internalizing disorders, such as anxiety and depression.
~Taken from: CHADD http://www.chadd.org
Presenting Complaints of Adults Being Evaluated for ADHD
• Difficulty in finding and keeping jobs
• Performing below level of competence on job
• Inability to perform up to intellectual level in school
• Inability to concentrate
• Lack of Organization
• Inability to establish and maintain a routine
• Poor discipline
• Depression, low self-esteem
• Forgetfulness or poor memory
• Confusion, trouble thinking clearly
~Taken from: Barkley, R. (1990). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press.
How is ADHD diagnosed?
While there is no biological or psychological test that makes a definitive diagnosis of ADHD, a diagnosis can be made based on one’s clinical history of abnormality and impairment.
An evaluation of ADHD will often include assessment of intellectual, academic, social and emotional functioning. Medical examination is also important to rule out low occurring but possible causes of ADHD like symptoms (e.g., adverse reaction to medications, thyroid problems, etc.) The diagnostic process must also include gathering data from teachers as well as other adults who may interact on a routine basis with the individual being evaluated.
It is even more important in the ADHD adult diagnostic process to obtain a careful history of childhood, academic, behavioral and vocational problems. With the increased recognition that ADHD is a disorder presenting throughout the life span, questionnaires and related diagnostic tools for the assessment of adult ADHD have been standardized and are increasingly available.
ADHD diagnoses are based on a person having three different symptoms. The full syndrome is diagnosed when at lease nine symptoms from both sets of subtypes (above) are present. Partial syndromes, which are predominantly inattentive or hyperactivity/impulsivity subtypes, are diagnosed when six or more symptoms are present from just one set.
~Taken from: CHADD http://www.chadd.org
Mirsky has identified four separate attentional processes:
• The capacity to focus upon and execute tasks over a short time span
• The capacity to encode and mentally manipulate information
• The capacity to sustain attention over a longer time period
• The capacity to shift attentional focus flexibly
~Taken from: Barkley, R. (1990). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press.
Multi-modal Treatment (medication and psychosocial treatment)
Treating ADHD in children requires a coordinated effort between medical, mental health and educational professionals in conjunction with parents. This combined set of treatments offered by a variety of individuals is referred to as multi-modal intervention. A multi-modal treatment program should include: Parent training concerning the nature of ADHD as well as effective behavior management strategies. An appropriate educational program. Individual and family counseling, when needed, to minimize the escalation of family problems. Medication when required.
Psychostimulants are the most widely used medications for the management of ADHD symptoms. At least 70% to 80% of children and adults with ADHD respond positively to psychostimulant medications.
Behavior modification techniques have been used to treat the behavioral symptoms of ADHD for more than a quarter of a century. A summary of the literature on trials that have validated the efficacy of this approach shows that, in many cases, behavior modification alone has not been sufficient to address severe symptoms of ADHD.
~Taken from: CHADD http://www.chadd.org
Top Ten Tips for Workplace Success with ADD
• Minimize paperwork to maximize success
• De-stress to avoid distress
• Plan to be early to arrive on time
• Simplify your filing system
• Do it now or write it down
• Negotiate for tasks that call on your strengths
• Schedule interruption-free time blocks
• Focus on ADD solutions, not ADD problems
• Get everything in writing, don’t depend on your memory
• Focus on task completion – no loose strings!
~Taken from: Nadeau, K.G. (1998). Top
Ten Tips for Workplace Success with ADHD. In ADD in the Workplace [On-line].
Available: http://www.add.org