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Understanding Adult Adhd

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UNDERSTANDING ADULT ADHD
ALENE CAMP
UNIVERSITY OF THE DISTRICT OF COLUMBIA

PRINCIPLES OF PSYCHOLOGY

Orisade Awodola, M.A., Ph.D

06/04/2013

UNDERSTANDING ADULT ADHD

TABLE OF CONTENTS

ABSTRACT…………………………………………………………….…………………………3

DEFINITION OF ADHD…………………………………………………………………………4

SYMPTOMS AND DIAGNOSIS OF ADULT ADHD………………….………………………4

TREATMENT OF ADULT ADHD………………………………………………………………7

RECENT CHANGES AS DEFINED IN DSM V…………………………………….………….7

SUMMARY……………………………………………………………………………………….9

REFERENCES……………………..……………………………………………………………11

ABSTRACT

Childhood ADHD receives a lot of media attention. From opinions of faulty diagnoses to general disagreements regarding types and amounts of medication used to treat the symptoms, there is a running dialogue in the media and annals of schools and homes. However, little is known about adult ADHD. This paper will analyze current research to glean a clear idea of what exactly is Adult ADHD, symptoms and prescribed treatments and will discuss current trends and changes in the field of psychology as it relates to ADHD.

UNDERSTANDING ADULT ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) has been a topic of media, parents, educators and the community for years. Debates range from those curious about the actual definition of ADHD to those concerned with medications prescribed for its treatment. Primarily seen as a disorder that affects school aged children, little is known about ADHD as it progresses into adulthood. However, it is the ever evolving definition of ADHD that creates the disagreements of medical professionals on effective treatment.
Definition of ADHD
The current definition of ADHD as defined by the Mayo Clinic states, “Adult attention-deficit/hyperactivity disorder (adult ADHD) is a mental health condition that causes inattention, hyperactivity and impulsive behavior. Adult ADHD symptoms can lead to a number of problems, including unstable relationships, poor work or school performance, and low self-esteem.” While it has been proven through research that ADHD often progresses into adulthood even with strict adherence to prescribed treatment, there remains a void in published data on the overall effect of ADHD on the adult.
Symptoms and Diagnosis
The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) is a standard manual used and accepted by mental health professionals to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities greatly increases the chance of a universal approach to diagnoses and treatment of ADHD.
According to the current version of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000), a person has ADHD if Either A or B are true: A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
Inattention
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

Is often easily distracted.
Is often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity
Often fidgets with hands or feet or squirms in seat when sitting still is expected.
Often gets up from seat when remaining in seat is expected.
Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).

Often has trouble playing or doing leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively.
Impulsivity
Often blurts out answers before questions have been finished.
Often has trouble waiting one's turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Based on these criteria, three types of ADHD are identified:
IA. ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months
IB. ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months
IC. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.
Further studies also include symptoms that relate specifically for adults, such as: anxiety, low self-esteem, substance abuse or addiction, relationship problems, depression, disorganization, mood swings, employment problems and hot temper. While many of these symptoms may seem ordinary behaviors that many of us experience at one time or another, it is the frequency and consistency that alerts to there being a cause deeper than normal impatience.
Treatment of ADHD The best treatment for ADHD is a matter of debate in the field of psychology. However, most in the field agree that a combination of medication and behavioral modification therapy are most effective. According to research by the Mayo Clinic,
Stimulants (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These ADHD medications help treat the core signs and symptoms of inattention and hyperactivity — sometimes dramatically. However, effects of the drugs can wear off quickly, especially if you take a short-acting type rather than a long-acting type of stimulant. The right dose varies between individuals, so it may take some time in the beginning to find the dose that's right for you. Stimulants used to treat ADHD include: Methylphenidate (Ritalin, Concerta, Daytrana, Metadate), Dextroamphetamine-amphetamine (Adderall), Dextroamphetamine (Dexedrine), Lisdexamfetamine (Vyvanse)
Stimulant drugs are available in short-acting and long-acting forms.
However, as with any drug treatment, drugs effect people differently and the aforementioned drugs all have significant side effects. Side effects of these stimulants can include but aren’t limited to headache, anorexia, nausea, weight loss, increased blood pressure, arrythmia (accelerated pulse), abdominal pain and shifting moods. In rare instances, stimulants may cause seizures, high blood pressure (hypertension), delusions (psychosis), suicidal problems and even death. (Mayo Clinic Staff, 2011)
The Mayo Clinic goes on to say
Adults with ADHD often benefit from counseling. Counseling for adult ADHD also generally includes psychological counseling (psychotherapy) and education about the disorder (psychoeducation). Counseling can help you and your family members understand why ADHD occurs, how it affects your life and relationships, and how treatment works.
Psychotherapy for adults with ADHD is often focused on helping develop skills to resolve specific issues. Common types of psychotherapy for ADHD include:
Cognitive behavioral therapy. This is a structured type of counseling that teaches specific skills to control your behavior and change negative thinking patterns into positive ones. It can be helpful in dealing with specific life challenges, such as school, work or relationship problems, and is also helpful in addressing other mental health conditions such as depression or substance abuse. This type of therapy can be done one-on-one or in a group setting.
Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Problems linked to ADHD can put a lot of stress on your relationships. Your spouse or other family members may feel like you're unreliable, messy, a poor listener or not contributing equally to family responsibilities. Understanding that your faults aren't due to not making an effort to change your behavior can relieve tension and help you avoid blaming one another.
Behavior modification therapy has been proven to assist those suffering with ADHD to make life altering behavior changes. It’s an effective way of providing a holistic approach to addressing the behaviors that left untreated can prove destructive to an individual. The American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the guiding rules for diagnosing and treating mental health problems by mental health professionals nationwide, is under revision. The current DSM was written in 1994. Slated for publishing in 2013, there are a number of changes planned for the ADHD. One of the main proposed changes include the separation of AD from HD…..specifically treating Attention Deficit (AD) separate from Hyperactive Disorder (HD). Other proposed changes include removing the three sub-categories of ADHD. As aforementioned, the DSM-IV uses current criteria to identify three types of ADHD; Combined, Predominately Inattentive and Predominately Hyperactive-Impulsive. Making this change will allow for individuals to get more specialized treatment to address their specific issues. While some individuals fall in the combined category, most fall under one of the Predominately categories. It will also lower the chance of over medicating. Changing of the age of onset is also a proposed change. Current criteria has onset at on or before age 7. The changed criteria will read onset on or before age 12. This is proposed as most research indicates first notice of symptoms occur between the ages of 7 and 12. Finally, and most important for adults suffering with ADHD, is the proposed change to reduce the number of criteria an adult must meet for diagnosis. Under current guidelines, an adult must meet a minimum of six criteria from each category. This didn’t give room for the reduction of symptoms that occur as a person ages, however still suffer from the disorder. As stated in the proposal, “One can reach a point where an impaired individual no longer meets the criterion of 6 symptoms from each category”. This change would allow those adults that suffer from the disorder, but through age and the need to function, have developed to not show symptoms.
Summary
It is clear that ADHD is a complicated disorder and will remain the subject of debate and research over time. However, it is also clear that additional research on adult-specific ADHD is needed. Additional research will lead to a more definitive explanation of the disorder. As we see with the current revisions of the DSM, research has led to a number of proposed changes which will effect better diagnosis and treatment for the patient as well as a treatment plan that is more specific to the diverse symptoms experienced by the patient. As a field of study, ADHD faces new challenges as it adjusts to the current guidelines as defined by the DSM-V. Research will need to be tailored to glean the overall effectiveness of the new guidelines, clinical trials will need to be conducted to measure the effectiveness of the separation of the two disorders and treatment implications. While the new proposals appear to give a better outlook for sufferers of ADHD, one will not know the overall effectiveness until research has proven (or disproven) the expectations. As a result, the field of study of ADHD will no doubt receive increased attention from researchers as more research is indeed needed to develop further insights into adult ADHD.

REFERENCES

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Washington, DC, American Psychiatric Association, 2000. Retrieved April 7, 2011 from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383#

Center for Disease Control and Prevention: Attention-Deficit/Hyperactivity Disorder. http://www.cdc.gov/ncbddd/adhd/treatment.html Mayo Clinic Staff (2011) Attention-deficit/hyperactivity disorder (ADHD). Retrieved April 7, 2011 from http://www.mayoclinic.com/health/adult-adhd/

Mayo Clinic Staff (2010) Attention-deficit/hyperactivity disorder (ADHD). Retrieved April 7, 2011 from http://www.mayoclinic.com/health/adult-adhd/DS01161/DSECTION=treatments-and-drugs.

National Institute of Mental Health: Attention Deficit Hyperactivity Disorder. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/how-is-adhdtreated.shtml WebMD: ADHD: A Treatment Overview
http://www.webmd.com/add-adhd/guide/adhd-treatment-overview@page=2

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