While much of the published body of medical literature regarding Attention Deficit Hyperactivity Disorder (ADHD) is devoted to the diagnosis and treatment of ADHD in children, the burden of this condition in the adult population is only now being appreciated.
There are 3 general categories of childhood and adult ADHD accepted by the American Psychiatric Association and included in Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th Edition:
- ADHD, Combined Type
- ADHD, Predominantly Inattentive
- ADHD, Predominantly Hyperactive-Impulsive Type
Polanczyk et al 1 estimate that the world-wide incidence of ADHD in all age groups may be as high as 5% while Silver 2 and Wilens 3 estimate that as many as 70% of children diagnosed with this condition will continue to exhibit signs of ADHD into adulthood. It should not come as a surprise that the behavioral difficulties associated with childhood ADHD are responsible for many social difficulties experienced by adults. The more pronounced signs of adult ADHD include:
· Unstable employment history
· Easily becomes bored
· Inattention to detail
· Substance abuse including tobacco products, alcohol, and cocaine
· Low self-esteem
· Impulsive behaviors
· Marital problems secondary to any of the above
As in children, the diagnosis of adult ADHD is quite subjective in nature and should thus be made only by clinicians with considerable experience in this field. Generally, the diagnosis is based on the presence of 1) a history of ADHD as a child and 2) presence of specific signs and behaviors associated with ADHD that have been presence for a minimum of 6 months.
Adult ADHD, as in children with this condition, is most effectively treated by medication with any of a number of stimulants. 4 Additionally, adults with ADHD may benefit from psychotherapy with our without concurrent medical therapy. Unlike childhood ADHD, the adult patient may require interventions to treat conditions known to be associated with ADHD such as substance abuse.
Resources
National Institute of Mental Health (2006): Attention Deficit Hyperactivity Disorder. Available online at http://www.nimh.nih.gov/publicat/adhd.cfm#adult
Notes
1. Polanczyk, G; de Lima, MS; Horta, BL; Biederman J, and Rohde, LA (2007): The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164 (6): 942–948.
2. Silver, LB (2000): Attention-deficit hyperactivity disorder in adult life. Child and Adolescent Psychiatric Clinics of North America 9(3): 411-523.
3. Wilens, TE; Biederman, J, and Spencer, TJ (2002): Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53:113-131.
4. Wender PH (1998): Pharmacotherapy of attention-deficit/hyperactivity in adults. Journal of Clinical Psychiatry, 59( 7):76-79.
