Adult attention deficit disorder (AADD) is the common terminology for the psychiatric condition currently known as attention-deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD), when it occurs in adulthood.
Although most diagnoses of ADHD are made for children, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions of ADHD do not confine the disorder solely to childhood and in fact many adults are also diagnosed. Although the disorder may not have been diagnosed in an individual during childhood, it is also currently thought that all adults with the disorder had it in childhood. There are three subsets of ADHD in the DSM, and one is a form which does not include hyperactivity.
Because symptoms tend to diminish with age, a lesser number of adults are thought to have AADD than children. Current studies indicate that approximately 30% of children diagnosed retain the condition as adults. However, there have been only a few studies, and results varied widely from as low as 9% to as high as 66%. An ADD/ADHD diagnosis is also dependent upon an impairment of functionality. Thus, an individual (adult or child) meeting ADD/ADHD criteria may change through various combinations of maturity, medication, education, and learned behavior to no longer be so diagnosed.
Scientific research strongly indicates that the neurological condition is hereditary. Some adults may discover they have ADHD only after their children are diagnosed with the disorder. It is unknown how many persons have undiagnosed Adult Attention Deficit Disorder.
In some instances, the understanding of ADD attributes may provide a vital educational and emotional key for an individual, especially an adult who may have lived with undiagnosed symptoms for many years. One Wikipedia writer who found his AADD diagnosis to be something of a revelation stated "I got my diagnosis at age 44 and shortly later read "Driven To Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood Through Adulthood by Edward M. Hallowell M.D and John J. Ratey, M.D. "I would compare reading this book at age 44 to having a car and finding the owners manual in the glove box after you turn the first 100,000 miles!!!" [1]
Professionals have noted that adults with ADD/ADHD have often developed coping skills and other forms of adaptive behavior which make symptoms less noticeable to themselves and others. Sometimes also found to be a gift, often accompanied by hyperfocus, the condition is thought to have been a factor for historic figures and persons currently well-known in a wide range of fields. Apparently many of the factors which define the disorder have also been successfully used by individuals to turn a potential problem in their lives into an advantage.
See also main article Attention-deficit hyperactivity disorder
Terminology
There is not yet a naming consensus. Below are listed several terms that have been used, past and present. One challenge in taxonomy is that some patterns of behavior are labeled by experts symptoms or sub-types of ADHD, while other experts label those same patterns as their own disorders, independent of ADHD. For the purposes of this article, the "Terminology" section will be used only to name ADHD and its near equivalents, while the names for its manifestations and subtypes will be listed in 'Symptoms', below.
- Attention-deficit hyperactivity disorder (ADHD): In 1987, ADD was in effect renamed to ADHD in the DSM-III-R. In it, ADHD was broken down into three subtypes (see 'symptoms' for more details):
- predominantly inattentive ADHD
- predominantly hyperactive-impulsive ADHD
- combined type ADHD
- Attention deficit disorder (ADD): This term was first introduced in DSM-III, the 1980 edition. Is considered by some to be obsolete, and by others to be a synonym for the predominantly inattentive type of ADHD.
Possibly due to the lesser evidence of hyperactivity symptoms in adult, or the stigma attached to hyperactivity, or some combination, may adults prefer the ADD terminology, or AADD to differentiate adult-related issues.
History
The conditions currently termed under the ADHD designation have only become recognized in the past 100 years, and were first recognized in young children. In 1937, one doctor in Rhode Island gave a stimulant to hyperactive children, and observed that they became calmer, the exact opposite of a responded in non-hyperactive children. By the 1950, research clearly indicated that the hyperactive behavior was not by choice, shifting the study to neurological sources. Professionals learned how to tell ADD apart from conduct disorder or oppositional defiant disorder. It was a matter of volition. ADD is involuntary and spontaneous; other two are premeditated.
In the 70’s, researchers realized that ADHD didn’t disappear in puberty, and the condition was formally recognized as afflicting adults in 1978. When the invisible attentional component was recognized shortly thereafter, the disorder was renamed attention deficit disorder. Then, the hyperactivity component, so visible especially in boys, was added.
In the 90’s, the new tools of MRI, PET and spec scans demonstrated that the brains of ADHD persons are different. Alan Scentian published pet scan studies in which two groups of people with the use of radioactive glucose used by the brain for energy (scan shows brain activity in color) demonstrated that the frontal lobes of ADHD people are smaller, conclusively proving that there are biological differences.
Cause
ADHD was once looked upon as a discipline and behavioral problem resulting from bad parenting. Some suggested it was caused by high sugar intake, food additives, excessive TV viewing, and family problems. But none of these explanations is supported by scientific evidence.
Exact cause or causes of ADD are not conclusively known. However, scientific evidence strongly suggests that in many cases the disorder is genetically transmitted and is caused by an imbalance or deficiency in certain chemicals that regulate the efficiency with which the brain controls behavior.
A 1990 study at the National Institute of Mental Health correlated ADD with a series of metabolic abnormalities in the brain, providing further evidence that ADD is a neurological disorder. While heredity is often indicated, problems in prenatal development, birth complications, or later neurological damage can contribute to ADD.
The presumed causes under investigation include:
- brain differences (brain scan technology has revealed differences in the size, symmetry, metabolism, and chemistry of the brain in those who have ADHD; however, it should be noted that there is yet no clear determination of the source of these differences).
- genetics (children who have one parent with ADHD have a higher incidence of ADHD; current research is examining which genes are involved in ADHD). This investigative path also suggests environmental factors, handed down from generation to generation, that may trigger the symptoms associated with ADD.
- brain development in utero and during the first year of life (possibly related to drug use during pregnancy or environmental toxins).
There is increasing evidence that variants in the gene for the dopamine transmitter are related to the development of ADHD (Roman et al., 2004, Am J Pharmacogenomics 4:83-92). This makes sense, as according to other recent studies, people with ADHD usually have an abnormally high number of dopamine neurotransmitters which discard the dopamine before the brain can fully make use of it. The stimulant medications used to treat the disorder are all capable of blocking dopamine neurotransmitters. Therefore, it is theorized that stimulant medication allows the brain to use its natural supply of dopamine more efficiently by blocking the dopamine transporters. Currently this theory is the most widely accepted in the scientific and medical community.
New studies consider the possibility that norepinephrine also plays a role. (see Krause, Dresel, Krause in Psycho 26/2000 p.199ff).
Controversy
While ADD/ADHD is a known psychiatric condition, there are various theories about the cause and some controversy over the number of persons diagnosed and the cost of medications.
Hunter-versus-farmer theory
A broad theory, not necessarily in conflict with the current medical research findings, is the hunter vs. farmer theory, which holds that in some ways, some ADD attributes in some humans may be a form of environment adaption, or specialty. Under the theory, as civilized society evolved, the attributes of a hunter gave way to those of a farmer for most people as the survival skills needed changed. The hunter vs. farmer theory was first presented by Thom Hartmann, whose website describes him as "an internationally-known speaker on culture and communications, an author, and an innovator in the fields of psychiatry, ecology, and economics." [2]
ADD/ADHD a hoax?
There are some claims that ADD/ADHD is simply a hoax. Many of these charges are that there has been a conspiracy between medical and counseling professionals and the pharmaceutical companies, or that the former has been misled by the latter, which have profited greatly from the sale of medication such as Ritalin and Adderall, and have advertised their products extensively. Further, since medications became available there has been an increased number of persons diagnosed, though this might be explained by increased awareness.
It has also been suggested that it is actually a result of poor diet and other factors rather than something inherent in sufferers. The study of changes in diets of children provide anecdotal and scientific evidence for this.
However, the results achieved in clinical tests with such medication and anecdotal evidence of parents, teachers, and both child and adult sufferers suggest there is both a condition, and a treatment for at least some.
A further problem is that ADD and ADHD are syndromes, associations of symptoms. There is no well established cause for the condition. This means that it may actually be a blanket term covering a multitude of conditions with a variety of causes.
Confusion may also arise from the fact ADD/ADHD symptom vary with each individual, and some mimic those of other causes. A known fact is that, as the body (and brain) matures and grows, the symptoms and adaptability of the individual also change. Many children diagnosed with ADD/AHDH seem to outgrow it as they mature. Clearly, other individuals experience the symptoms their entire lives.
Symptoms and hallmarks
Adults are more likely than children to realize that they might have ADD/ADHD. Because the very nature of the condition makes a person likely to be poor at self-observation, it is important to seek a professional diagnosis.
What's It Like Having ADHD?
- "... It's like being super-charged all the time. You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sorts of impolite words that miss the point completely. Because you're trying really hard. It's just that you have all these invisible vectors pulling you this way and that, which makes it really hard to stay on task."
Edward M. Hallowell, M.D., excerpt from Driven To Distraction
Of course, everyone has trouble sitting still sometimes, or managing time, or completing a task. But the behavior of people with ADHD goes beyond occasional fidgeting, disorganization, and procrastination. For them, performing tasks can be so hard that it interferes with their ability to function at work, at home, at school, and socially. [3]
- In children the disorder is characterized by inattentiveness to external direction, impulsive behavior and restlessness. However, children with the inattentive type are actually often sluggish and hypo-active.
- In adults the problem is often an inability to structure their lives and plan simple daily tasks. Thus, inattentiveness and restlessness often become secondary problems.
Symptom (or hallmarks) of ADD/ADHD vary widely between individuals, just as no two human brains are exactly alike. They also vary throughout a lifetime as the individual matures, and are affected by life experiences and learned behavior. However, the ADD/ADHD diagnosis is defined by multiple factors, which in total, define the disorder in an individual.
ADD with hyperactivity (ADHD) is characterized by symptoms of inattention, impulsivity and/or hyperactivity which have an onset during childhood, although the condition may have been undiagnosed Some hyperactivity symptoms are less noticeable in adults. One subset of the current ADHD criteria does not require hyperactivity at all. This was formerly known as simply ADD.
An adult with ADHD (or ADD) has a different complex of symptoms than a child does. Often the most prominent characteristic in ADHD adults is difficulty with executive functioning, which is the brain activity that oversees the ability to monitor one's own behavior, to plan, and to organize. Other symptoms observed in adults include inattention, impulsivity, over-activity, behavioral, learning, and emotional problems.
Hyperactive and impulsive with ADD adults feel restless, are constantly "on the go," and try to do multiple tasks at once. They are often perceived as not thinking before they act or speak.
"In adults, it's a much more elaborate disorder than in children," says Russell Barkley, Ph.D., a psychiatry professor at the Medical University of South Carolina. "It's more than paying attention and controlling impulses. The problem is developing self-regulation." This self-control affects an adult's ability not just to do tasks, but to determine when they need to be done, says Barkley. "You don't expect 4- or 5-year-olds to have a sense of time and organization, but adults need goal-directed behavior--they need help in planning for the future and remembering things that have to get done." [4]
Studies have indicated that adults with ADD are much more likely to have substance abuse problems than adults who do not have ADD. They are also more likely to suffer from depression and anxiety, be fired from jobs, and get divorced than non-ADHD adults.
Self test for adults
For adults, the most common symptom is a sense of underachieving. No matter how well you are doing, you always have a sense of missing a lot in work, school, jobs relationships. That is what most often finally brings adults in for diagnosis and treatment.
The Hallowell Center provides the following possible indicators to consider in an individual when ADD is suspected. If you have exhibited at least twelve of the following behaviors since childhood and if these symptoms are not associated with any other medical or psychiatric condition, consider an evaluation by a team of ADD/ADHD professionals. [5]
1. A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).
2. Difficulty getting organized.
3. Chronic procrastination or trouble getting started.
4. Many projects going simultaneously; trouble with follow through.
5. A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
6. A frequent search for high stimulation.
7. An intolerance of boredom.
8. Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
9. Often creative, intuitive, highly intelligent
10. Trouble in going through established channels and following “proper” procedure.
11. Impatient; low tolerance of frustration.
12. Impulsive, either verbally or in action, as an impulsive spending of money.
13. Changing plans, enacting new schemes or career plans and the like; hot-tempered.
14. A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
15. A sense of insecurity.
16. Mood swings, mood instability, especially when disengaged from a person or a project.
17. Physical or cognitive restlessness.
18. A tendency toward addictive behavior.
19. Chronic problems with self-esteem.
20. Inaccurate self-observation.
21. Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.
Diagnosis
A multi-factored evaluation of an individual is important in the diagnosis of ADD. Diagnostic assessment of adults should be made by a clinician or a team of clinicians with expertise in the area of attentional dysfunction and related conditions. A professional diagnosis is the only way to distinguish true ADHD or ADD from other conditions that may cause symptoms that mimic ADHD. Most of the technical criteria is set out for professionals if designed for use with childhood onset, but can be easily adapted to the different world of an adult.
The diagnosis criteria requires multiple symptoms observed in multiple settings (school,home, work, etc.) within the preceding 6 months. The full criteria is listed at this link: Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder
It important to note that the symptoms must clearly impair the individual's functioning. For children, one would generally expect that the symptoms would have a negative impact on academic performance, ability to meet appropriate behavioral expectations (following rules), and their ability to get along with others. Even if the checklist number of symptoms were met, and in multiple settings, if the symptoms were mild and did not create difficulties in any of these areas, then ADHD would not be diagnosed.
The diagnosis of ADHD is not a simple matter. It requires that careful attention is given to a number of specific symptoms; that information about a child's functioning is collected from different sources (at least parents and a teacher); that there is a clear indication of impaired functioning in important life areas; and that other possible explanations for the child's symptoms are ruled out. [6]
Psychological testing for ADHD
Psychological testing for ADHD symptoms generally consists of obtaining multiple types of assessments. These usually include a clinical interview reviewing the DSM-IV criteria for ADHD diagnosis. The interview also needs to rule out as much as possible other types of syndromes which can cause attention problems, such as depression, anxiety, allergies and psychosis. Rating scales can be administered which provide measurement of the person's own view of their symptoms, as well as the views of parents, teachers, and significant others. Finally, computerized tests of attention can be helpful in providing a further independent assessment. These different assessments may not be consistent, but do provide a view of the person's difficulties. Subjectivity of the analysis can be compounded by the fact that physicians generally need not order psychological testing in order to make the diagnosis of ADHD, but many doctors use this kind of assessment to avoid over-diagnosis and treatment. The process of obtaining referrals for such assessments is being promoted vigorously by the President's New Freedom Commission on Mental Health.
Adult patients seeking a possible diagnosis may especially benefit from psychological assessment due to the greater ability to provide history and input. The relationship thus established may also help with behavioral solutions in addition to any medication which may be indicated.
Other forms of testing
Neurometrics , PET scans, or SPECT scans have been used for a more objective diagnosis. However, these may only be supplemental to the interview and behavioral criteria.
Treatment
The diagnosis itself is a form of remedial therapy for some adults. In the words of one woman, diagnosed at age 38 after both her sons has been diagnsosed with ADHD, she felt a weight being lifted off her shoulders, saying "I'm not using ADHD as an excuse; it's an explanation. Now I understand why."
There are many options available to treat people diagnosed with ADHD.
These options include a variety of medications, behavior-changing therapies, and educational interventions.
The usual course of treatment may include medications such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine) or pemoline (Cylert), which are stimulants that decrease impulsivity and hyperactivity and increase attention.
Because pharmaceutical companies are doing a lot of advertising, there may be soem public misconceptions regarding treatments and medication. Approximately 20-25% of people with ADD do not respond to medication. Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. For children, treatment should include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child. These can be adapted to the individual adult's circumstances and settings.
Generally, treatments which have proved effective for children were observed to work equally well or better in adults with similar diagnosis.
See main article Attention-deficit hyperactivity disorder for a listing of treatments.
Hope
While ADHD (aka AADD) is categorized as a disorder, many professionals believe that it can also be regarded in some individuals as a gift. With or without hyperfocus, a common manifestation, ADD/ADHD in combination with successful coping skills may be utilized to achieve remarkable accomplishments. The list of historic figures and persons currently well-known in a wide range of fields who have displayed ADD/ADHD symptoms is impressive and has been used by some medical and counseling professionals as a source of inspiration.
Organizations
There are large organizations and Internet groups for ADD/ADHD. Two of the larger Yahoo groups of this nature have hundreds of members, and one of these is focused on adults. (see external links section).
This is a list of organizations and contact information:
Attention Deficit Disorder Association (ADDA)
P.O. Box 543
Pottstown, PA 19464
mail@add.org
http://www.add.org
Tel: 484-945-2101
Fax: 610-970-7520
CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder
8181 Professional Place
Suite 150
Landover, MD 20785
http://www.chadd.org
Tel: 301-306-7070 800-233-4050
Fax: 301-306-7090
Learning Disabilities Association of America
4156 Library Road
Suite 1
Pittsburgh, PA 15234-1349
info@ldaamerica.org
http://www.ldaamerica.org
Tel: 412-341-1515 412-341-8077
Fax: 412-344-0224
National Center for Learning Disabilities
381 Park Avenue South
Suite 1401
New York, NY 10016
http://www.ld.org
Tel: 212-545-7510 888-575-7373
Fax: 212-545-9665
National Institute of Child Health and Human Development (NICHD)
National Institutes of Health, DHHS
31 Center Drive, Rm. 2A32 MSC 2425
Bethesda, MD 20892-2425
http://www.nichd.nih.gov
Tel: 301-496-5133
Fax: 301-496-7101
National Institute of Mental Health (NIMH)
National Institutes of Health, DHHS
6001 Executive Blvd. Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
nimhinfo@nih.gov
http://www.nimh.nih.gov
Tel: 301-443-4513/301-443-8431 (TTY) 866-615-NIMH (-6464)
Fax: 301-443-4279
See also
Sources
Books
- Amen, Dr. Daniel G., Healing ADD: The Breakthrough Program That Allows You to See and Heal the Six Types of ADD
- Hallowell, Edward M, and Ratey, John J. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood
- Hallowell, Edward M, and Ratey, John J., Answers to Distraction
- Hartmann, Thom, Attention Deficit Disorder: A New Perspective
- Lawlis, Frank, The ADD Answer
Websites
External links
