Adult Attention Deficit Hyperactivity Disorder

Adult attention deficit hyperactivity disorder (also referred to as adult ADHD, adult ADD or simply ADHD in adults) is the neurobiological condition of attention-deficit hyperactivity disorder (ADHD) in adults.

About one-third to two-thirds of children with symptoms from early childhood continue to demonstrate notable ADHD symptoms throughout life.

Three subtypes of ADHD are identified in the DSM-IV (inattentive, hyperactive/impulsive, and combined). In later life, the hyperactive/impulsive subtype manifests more frequently.

Adults with ADHD typically have difficulty following directions, remembering information, concentrating, organizing tasks, or completing work within time limits or meeting appointments.

Low self-esteem is common. These difficulties cause life problems within several different arenas, such as emotional, social, vocational, marital, legal, financial or academic areas.

Adult attention deficit disorder (AADD) is marked by inattentiveness, difficulty getting work done, procrastination, and organization problems.

Diagnosis of the condition includes assessment by clinicians, with examination of personal history, observational evidence from family members and report cards going back to school years etc., and neuropsychological tests as well as evaluation to rule out other possibilities or diagnose co-morbid (coincident) conditions.

The condition is highly heritable, and while its exact causes are not fully known, genetic and environmental factors are understood to play a part. ADHD is a childhood-onset condition, usually requiring symptoms to have been present before age seven for a diagnosis.

Children under treatment will migrate to adult health services if necessary as they transit into adulthood, while diagnosis of adults involves full examination of their history.

Successful treatment of ADHD is usually based on a combination of medication, cognitive behavioral therapy, and coaching or skills training.

Within school and work, reasonable accommodations may be put in place to help the individual work more efficiently and productively.

Efficacy of medications on symptoms was discovered during the 1930s and research continued throughout the twentieth century.

ADHD in adults began to be studied from the early 1970s and research has increased as worldwide interest in the condition has grown.

Signs and symptoms

Individuals with ADHD have deficiencies with self-regulation and self-motivation, that cause problems with distractibility, procrastination, organization, and prioritization.

The learning potential and overall intelligence of an adult with ADHD, however, are no different from the potential and intelligence of adults who do not have the disorder. ADHD is a chronic condition, beginning in early childhood and persisting throughout a person's lifetime.

It is estimated that up to 60% of children with ADHD will continue to have significant ADHD-related symptoms persisting into adulthood, resulting in a significant impact on education, employment, and interpersonal relationships.

Whereas teachers and caregivers responsible for children are often attuned to the symptoms of ADHD, employers and others who interact with adults are far less likely to regard such behaviors as a symptom. In part, this is because symptoms do change with maturity; adults who have ADHD are less likely to exhibit obvious hyperactive behaviors.

Adults with ADHD are often perceived by others as chaotic and disorganized, with a tendency to need high stimulation to be less distracted and function effectively. Additionally, many adults suffer from associated or "co-morbid" psychiatric conditions such as depression or anxiety.

Many with ADHD also have associated learning disabilities, such as dyslexia, which contributes to their difficulties.


Symptoms of ADHD can vary widely between individuals and throughout the lifetime of an individual.

As the neurobiology of ADHD is becoming increasingly understood, it is becoming evident that difficulties exhibited by individuals with ADHD are due to problems with the parts of the brain responsible for executive functions (see below: Pathophysiology).

These result in problems with sustaining attention, planning, organizing, prioritizing, and impulsive thinking/decision making.
The difficulties generated by these symptoms can range from moderate to extreme.

Inability to effectively structure their lives, plan daily tasks, or think of consequences results in various difficulties: poor performance in school and work leading to underachievement in these areas, in young adults poor driving record with traffic violations, as well as histories of alcoholism or substance abuse.

As problems accumulate, a negativistic self-view becomes established and a vicious circle of failure is set up. Up to 80% of adults may have some form of psychiatric comorbidity.

The difficulty is often due to the ADHD person's observed behaviour (e.g. the impulsive types, who may insult their boss for instance, resulting in dismissal), despite genuinely trying to avoid these and knowing that it can get them in trouble.

Often, the ADHD person will miss things that an adult of similar age and experience should catch onto or know.

These lapses can lead others to label the individuals with ADHD as "lazy" or "stupid" or "inconsiderate".

Ultimately, this constellation of symptoms can be summarized as a deficiency in self-regulation and self-motivation, especially for the impulsive/hyperactive types.

Assessment of adult patients seeking a possible diagnosis can be better than in children due to the adult's greater ability to provide their own history, input, and insight.

However, it has been noted that many individuals, particularly those with high intelligence, develop coping strategies that mask ADHD impairments and therefore they do not seek diagnosis and treatment.

Treatment
Treatment for adult ADHD may combine medication and behavioral, cognitive, or vocational interventions.

Treatment often begins with medication selected to address the symptoms of ADHD, along with any comorbid conditions that may be present.

Medication alone, while effective in correcting the physiological symptoms of ADHD, will not address the paucity of skills which many adults will have failed to acquire because of their ADHD (e.g., one might regain ability to focus with medication, but skills such as organizing, prioritizing and effectively communicating have taken others time to cultivate).

Inattentive-type (ADHD-I)	Hyperactive/Impulsive-type (ADHD-H)
In children: Forgetful during daily activities Easily distracted by extraneous stimuli Losing important items (e.g. pencils, homework, toys, etc.) Not listening and not responding to name being called out Unable to focus on tasks at hand, cannot sustain attention in activities Avoids or dislikes tasks requiring sustained mental effort Makes careless mistakes by failing to pay attention to details Difficulty organizing tasks and activities Always asking for attention Fails to follow-through on complex instructions and tasks (e.g. homework, chores, etc.)	In children: Squirms and fidgets (with hands and/or feet) Cannot sit still Cannot play quietly or engage in leisurely activities Talks excessively Runs and climbs excessively Always on the go, as if "driven by a motor" Cannot wait for their turn Blurts out answers Intrudes on others and interrupts conversations
In adults, these evolve into: Avoiding tasks or jobs that require concentration Procrastination Difficulty initiating tasks Difficulty organizing details required for a task Difficulty recalling details required for a task Difficulty multitasking Poor time management, losing track of time Indecision and doubt Hesitation of execution Difficulty persevering or completing and following through on tasks Delayed stop and transition of concentration from one task to another	In adults: Chooses highly active, stimulating jobs Avoids situations with low physical activity or sedentary work May choose to work long hours or two jobs Seeks constant activity Easily bored Impatient Intolerant and frustrated, easily irritated Impulsive, snap decisions and irresponsible behaviors Loses temper easily, angers quickly