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understanding and addressing adult adhd
- Attention-Deficit/Hyperactivity Disorder (ADHD) is generally diagnosed during childhood; however, a growing number of individuals are seeking initial testing and treatment for ADHD in adulthood. We often see adults requesting services once their children have been diagnosed with ADHD, problems at work arise, or a medical provider refers them for services. For some individuals the thought of being diagnosed with ADHD as an adult can be scary, while for others, it may feel validating and reassuring for them. Many adults may diminish or minimize their symptoms due to receiving false information on ADHD or because of the stigma associated with the diagnosis. My hope is that the information provided in this newsletter will help individuals gain more information on adult ADHD and whether or not testing or therapy is needed.
- ADHD was once believed to primarily be a childhood condition; however, mental health practitioners are now recognizing the disorder to be common in adults. According to Fayyad and colleagues (2007), the global prevalence rate of ADHD among adults is 3.4 percent, with higher prevalence rates obtained among adults living in higher-income countries. It is important to note, that one of the core diagnostic requirements for an ADHD diagnosis is that some symptoms must be present before the age of 12 years, regardless if the diagnosis is given in childhood or adulthood. According to Faraone and Biederman (2005), many adults who were diagnosed with ADHD as children report their symptoms have diminished with age; however, it is estimated that 32% to 45% of adults diagnosed with ADHD during childhood will continue to meet full criteria for the disorder. In addition, it is common for ADHD to be under recognized in adults due to comorbid psychiatric conditions and other life stressors. Nearly 80% of adults with ADHD will present with at least one psychiatric comorbidity (Fischer et al., 2007).
- There are several key differences regarding the presentation of ADHD in children versus adults. ADHD among adults appears to be characterized more by deficits in executive functioning and attention than by hyperactivity or impulsivity as is frequently observed among children and adolescents. Executive functions are a set of processes that are required to manage oneself and one's cognitive resources in order to achieve a goal. They include sustained attention, self-regulation, impulse control, planning, organization, and speed of thinking. Other core features of adult ADHD often include procrastination, a persistent sense of failure, poor time management, and a tendency to take on more tasks than can be completed. Evidence suggests that the prevalence of comorbidities with ADHD differ between children and adults. According to Kessler and colleagues (2006), conditions in the disruptive or externalizing behavior problems domain most frequently co-occur with ADHD in children versus in adults, anxiety and mood disorders are the most commonly occurring psychiatric disorders.
- ADHD during adulthood can negatively impact academic, home, social, and work functioning. According to Kessler and colleagues (2005), adult ADHD each year results in the loss of 120 million days of work in the United States and adults with ADHD also report significantly lower educational attainment (Faraone & Biederman, 2005) relative to their counterparts. These individuals may present in school and work settings as distractible, disorganized, and sensitive to stress. Adults with ADHD change employers more frequently, have less job satisfaction, encounter more difficulty completing tasks, experience more difficulty working independently, and experience more unstable long-term relationships (Barkley et al., 2008).
- Accurately diagnosing ADHD among adults can be especially challenging given that several symptoms of ADHD are similar to symptoms of depression, anxiety, bipolar disorder, etc. In general, the diagnostic process has four main parts that include the clinical intake, assessment process, interpretation/report writing, and feedback. During the clinical interview, the clinician will gather information related to current functioning in all life domains, as well as gather information on the client’s childhood development and functioning. For many adults it is difficult to remember one’s functioning prior to the age of 12, therefore, clinicians will often include family members or close friends to provide collaborative data. In terms of the assessment process, clinicians rely on several assessments (self-report measures, semistructured psychological interviews, and assessments used to measure cognitive, neuropsychological and academic functioning) to arrive to a conclusion. Clinicians will review all data from the clinical interview and assessments to make one’s diagnosis. The client will then meet with the clinician for a feedback session to review the diagnosis and report in its entirety.
- The primary purpose of assessment is to inform case conceptualization and formulate treatment goals. There are some unique differences when treating adults with ADHD versus childhood ADHD. When working with children, treatment is generally a family process in which caregivers adhere to treatment recommendations. For adults, this is not usually feasible, therefore, clinicians must provide psychoeducation regarding treatment modalities and help the client identify one’s support system. In addition, adults diagnosed with ADHD will often receive a comorbid diagnosis, therefore, treatment plans need to reflect this dynamic. Evidence based treatments for adults with ADHD include pharmacological interventions, cognitive-behavioral therapy (CBT), psychoeducational interventions, and combined treatments.
- Listed below are several helpful recommendations for adults struggling with ADHD symptoms:
- Meet with an Executive Functioning Coach to help improve tasks related to organization, planning, attention, and initiation.
- Individual is likely to work best in an environment in which extraneous stimulation and distractions are reduced.
- Focus on only one task or activity at a time.
- Chunk longer or more sustained tasks into smaller sections with scheduled breaks, rapid review, or feedback in-between.
- Repetition of verbal information; incorporate visual displays of work requirements.
- Provide planned motor breaks during sustained activities or tasks
- Teaching self-monitoring techniques
- Structure work activities in a way to keep one engaged in goal-directed behavior and reduce impulsive behavior.
- Adult Executive Functioning Workbook by Karen Fried, Psy.D. and Melissa Mullin Ph.D.