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Adults can have ADHD, too, but few are diagnosed

Treatment for adults with ADHD is similar to that for children: a combination of medications and psychological therapy, particularly cognitive-behavioral therapy.

An estimated 4 percent of adults have ADHD, according to government statistics.
CC/Flickr/James Cridland

Science reporter Sharon Begley, whose day job is writing for Reuters, has an interesting article on adult attention deficit hyperactivity disorder (ADHD) in the November/December issue of the Saturday Evening Post.

As Begley points out, when most of us see or hear the acronym ADHD, we immediately think of children. But an estimated 4 percent of adults  also have ADHD, according to the National Institute of Mental Health. Yet only about a third of the adults have been diagnosed.

Many adults only become diagnosed when they take their children to be evaluated for the condition and realize that they, too, have had similar symptoms all their lives. (ADHD is believed to be highly heritable.)

A proper diagnosis can be life changing for an adult with ADHD, says Begley. “Stories of adults who finally learn that they have ADHD are as unique as the people themselves,” she writes, “but they have at least one thing in common: a sense that what was once shrouded in mystery is now lit with understanding, that a weight has been lifted and a puzzle solved.”

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As Begley reports, next spring the American Psychiatric Association will be publishing an updated edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), considered the “bible” of psychiatry. It appears as if the new manual will relax the criteria for the disorder, and fewer symptoms will be required for a diagnosis. (This action is not without controversy. Critics claim the loosening of ADHD diagnostic criteria will mean more children will be unnecessarily diagnosed and treated with drugs.)

“Even so,” writes Begley, “there are misconceptions about what it takes to qualify. For example, inability to focus and being easily distracted — with no other symptoms — wouldn’t be enough. You do not have ADHD if you simply like to flit from task to task at work. You do not have ADHD if you get bored doing housework. You do not have it if your mind wanders when reading dense, boring prose on a topic you have no interest in; if you get fidgety during boring sermons or hours-long presentations from a financial planner; or if you start reading another book or magazine before you finish the previous one you’ve started.”

“Moreover,” she adds, “the symptoms must appear in at least two settings: If you only show these behaviors at work, then you do not have ADHD. You probably just don’t like your job.”

Begley also points out that adult ADHD “is almost always ADD — that is, without the hyperactivity.” And there are other differences as well:

The adult form is characterized more by difficulties with executive functioning than by simple inattention. Executive function is basically the set of neurocognitive processes that let you organize your behavior across time to achieve your goals. These range from small goals like having dinner on the table on time to major ones, such as setting priorities at work and home.

“It’s managing your time, organizing your schedule, running your life, meeting deadlines,” said [New York psychiatrist Jeffrey] Newcorn, adding, “Adults drift off to other things when they decide the first one is boring or uninteresting. They have a lot of files and programs open on their computer. They might be unable to have a conversation without changing the topic every 30 seconds.” And since deficits in executive function lower inhibition, “an adult with ADHD is more likely to say inappropriate things at meetings,” says Newcorn. “Colleagues sometimes interpret the behavior as a need for attention or a refusal to get with the program.”

Treatment for adults with ADHD is similar to that for children: a combination of medications and psychological therapy, particularly cognitive-behavioral therapy. But, as Begley points out, a review study published in 2011 found that “the evidence supporting the use of [drugs] for adults with ADHD remains less established” than it is for children.

ADHD is a controversial topic, and it’s likely to become even more so after the DSM-5 is published. Critics, with some justification, believe that the diagnosis is being too broadly applied and that doctors and parents rely far too heavily on drugs as a treatment.  

Still,  that doesn’t mean that the symptoms aren’t real for many individuals, including adults. “Having a label affixed to their struggles allows them to finally seek help,” says Begley. “Perhaps even more important, it lets them make sense of a lifetime of bewildering experiences, of feeling hopeless or helpless in the face of their mental dysfunction, and, in many cases, wondering why they never achieved what they felt they could have.”

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You can read Begley’s article on the Saturday Evening Post’s website.