Adult ADHD (attention-deficit/hyperactivity disorder)

Adult ADHD (attention-deficit/hyperactivity disorder)

Definition:

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.

ADHD always starts in early childhood, but in some cases it's not diagnosed until later in life. It was once thought that ADHD was limited to childhood. But symptoms can persist into adulthood. For some people, adult ADHD causes significant problems that improve with treatment.
Treatment for adult ADHD is similar to treatment for childhood ADHD, and includes stimulant drugs or other medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with adult ADHD.

Symptoms:

ADHD has been called attention-deficit disorder (ADD) and hyperactivity. But attention-deficit/hyperactivity disorder is the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.
Adult ADHD symptoms can include:

• Trouble focusing or concentrating
• Restlessness
• Impulsivity
• Difficulty completing tasks
• Disorganization
• Frequent mood swings
• Hot temper
• Trouble coping with stress
• Unstable relationships

Many adults with ADHD aren't aware they have the disorder — they just know that everyday tasks can be a real challenge. Many adults with ADHD find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social engagements. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings, outbursts of anger and troubled relationships. Many adults with ADHD have a history of problems at school and at work.
All adults with ADHD had ADHD as children, even if it was never diagnosed. About 1 in 3 people with ADHD grows out of symptoms; about 1 in 3 continues to have symptoms that are less severe as adults; and about 1 in 3 continues to have significant symptoms as adults.

What's normal, and what's ADHD?
At some point in life, virtually everyone has some or all of the symptoms for ADHD. Some people simply have personalities with certain characteristics common with ADHD. But ADHD is diagnosed only when symptoms are severe enough to cause ongoing problems in multiple areas of your life. In adults with ADHD, these persistent and disruptive symptoms can be traced back to early childhood. If your difficulties are recent or occurred only occasionally in the past, you're not considered to have ADHD.
Diagnosis of ADHD in adults can be difficult because certain ADHD symptoms are similar to those caused by other conditions, such as anxiety or mood disorders. To make it even more challenging, half of adults who have ADHD also have at least one other diagnosable mental health condition, such as depression or anxiety.

When to see a doctor
If inattention, hyperactivity or impulsive behavior continually disrupts your life, talk to your doctor about whether you might have ADHD. Because signs of ADHD are similar to those of a number of other mental health conditions, you may not have ADHD — but you may have another condition that needs treatment.

Causes:

While the exact cause of ADHD remains a mystery, it increasingly appears that structural changes in the brain are linked to the disorder. Here are several factors that may play a role in developing ADHD:

• Altered brain function and anatomy. Brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, people with ADHD appear to have less activity in the area of the brain that controls attention than people who don't have ADHD.
• Inherited traits. ADHD can run in families.
• Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke, drink alcohol or use drugs are at increased risk of having children with ADHD. Likewise, women exposed to environmental poisons during pregnancy — such as polychlorinated biphenyls (PCBs) — may be more likely to have children with symptoms of ADHD.
• Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span.

Complications:

ADHD has been linked to:

• Poor school performance
• Trouble with the law
• Problems at work
• Alcohol or drug abuse
• Frequent car accidents or other accidents
• Unstable relationships

Although ADHD doesn't cause other psychological or developmental conditions, a number of other disorders frequently occur along with ADHD. These include:

• Mood disorders. Many adults with ADHD also have depression, bipolar disorder or another other mood disorder. While mood problems aren't necessarily due directly to ADHD, a repeated pattern of failures and frustrations due to ADHD can worsen depression.
• Anxiety disorders. Anxiety disorders occur fairly often in adults with ADHD. Anxiety disorder may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.
• Personality disorders. Adults with ADHD are at increased risk of personality disorders, such as borderline personality disorder or antisocial personality disorder.

Treatments and drugs:

The best treatment for ADHD is still a matter of debate. Current treatments typically involve medication, psychological counseling or both. A combination of therapy and medication is often the most effective treatment.
Medications
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.

• The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours.
• Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean you won't need to take medication as often, it can take up to three hours to start working.

Side effects of stimulants can include insomnia, anorexia, nausea, decreased appetite, weight loss, headache, increased blood pressure, faster pulse, abdominal pain and shifting moods. In some people, stimulants may cause involuntary muscle movements of the face or body (tics). Rarely, they cause seizures, high blood pressure (hypertension), delusions (psychosis) or liver problems. For most people, these medications are considered a safe long-term treatment for adult ADHD. If you have certain conditions, including high blood pressure, heart disease, or problems with alcohol or drug use, your doctor may start your treatment with a nonstimulant medication.
Other medications sometimes used to treat ADHD include:

• Atomoxetine (Strattera)
• Antidepressants such as bupropion (Wellbutrin) and venlafaxine (Effexor)

Atomoxetine and antidepressants work more slowly than stimulants and may take several weeks before they take full effect. These medications may be a good option if you can't take stimulants because of health problems, have a history of substance abuse or have a tic disorder or if stimulants cause severe side effects. Bupropion or venlafaxine may be a good choice if you have a mood disorder along with ADHD.

• Side effects of atomoxetine can include nausea, decreased appetite, insomnia, slightly increased blood pressure and heart rate, decreased sex drive (libido), sweating, and painful urination.
• Side effects of bupropion can include headache, nausea, dry mouth, insomnia, sweating, anxiety and constipation. These side effects may improve as your body adjusts to the medication. In rare cases, bupropion can cause seizures. Bupropion causes fewer sexual side effects than atomoxetine and most other antidepressants. Higher doses of bupropion have been associated with seizures.
• Side effects of venlafaxine and other commonly prescribed antidepressants can include nausea, loose bowel movements, headache and insomnia. These will likely improve as your body adjusts to the medication. For many people the most bothersome side effect is a decrease in sexual desire or ability, which may not improve. High doses of venlafaxine can increase blood pressure.

Psychological counseling
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. It can help you:

• Improve your time management and organizational skills
• Learn how to reduce your impulsive behavior
• Develop better problem-solving skills
• Cope with past academic and social failures
• Improve your self-esteem
• Learn ways to have better relationships with your family, co-workers and friends
• Develop strategies for controlling your temper

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.