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Paying Attention to Attention Deficit-Hyperactivity Disorder

"in Adults"
By: Thaddeus M. Averilla, MDPaying Attention to Attention Deficit-Hyperactivity Disorder

Many of us would think that Attention Deficit-Hyperactivity Disorder (ADHD) affects only children. As mental health practitioners are starting to understand more about this neurodevelopmental disorder, experts believe that adults can have ADHD as well. In fact, in a representative sample of US adults who were 18 to 44 years of age, 5.4% of men and 3.2% of women met the criteria for ADHD. In some studies, the ratio of men to women with ADHD is close to 1:1, whereas the ratio of boys to girls with ADHD is at least 4:1.

ADHD in Adulthood

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), a standard classification of mental disorders published by the American Psychiatric Association which contains a listing of diagnostic criteria for every psychiatric disorder recognized by the US and most countries of the world, ADHD is characterized by symptoms of impulsivity, inattention, and hyperactivity that emerge in childhood3. However, there are differences in the manifestation of childhood ADHD and adult ADHD. It is believed that there is greater decrease in symptoms of hyperactivity than in symptoms of inattention in adult ADHD. These symptoms of inattention in adults such as focusing on one task, keeping dates and appointments and meeting deadlines may greatly affect several aspects of an adult life to the point that his or her interpersonal relationships are affected as well as employment and financial status. Other consequences of adult ADHD may include other psychiatric disorders such as depression and anxiety as well as an increased risk of substance abuse .

The diagnosis of adult ADHD is sometimes challenging as it can be complicated by the common co-occurrence of other psychiatric conditions such as substance-use disorders, generalized anxiety disorders, and mood disorders1. Some psychiatric conditions, such as depression and bipolar disorder, as well as other medical conditions, such as thyroid diseases and sleep disorders, may underlie ADHD symptoms6. Adults with ADHD may also be children previously diagnosed with ADHD and still present with symptoms of continuing ADHD.

Causes of ADHD

Specific causes of ADHD have yet to be identified. There are however genetic and non-genetic factors that are associated in the development of ADHD. It is believed that ADHD has a strong genetic component. Non-genetic associations include history of smoking, diabetes and obesity in mothers as well as lead exposure during childhood. Brain imaging studies conducted among persons with ADHD revealed dysfunction in dopamine pathways involved in attention, executive function, and motivation and reward10.

Managing ADHD

Managing patients with adult ADHD involves drugs as well as non-drug interventions. Drugs approved for use include stimulant and non-stimulant medications. Psychotherapeutic interventions are also recommended for adults with ADHD as adjuncts to medications.

The National Institute for Health and Care Excellence (NICE) based in United Kingdom recommends that people with ADHD require integrated care that addresses a wide range of personal, social, educational and occupational needs. Care should be provided by adequately trained healthcare and education professionals. Healthcare professionals should stress the value of a balanced diet, good nutrition and regular exercise for children, young people and adults with ADHD.


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