Adult Attention Deficit Disorder

Although Attention Deficit/Hyperactivity Disorder (ADHD) has been widely recognized for decades in children, its recognition and treatment in adults is a relatively recent phenomenon. When diagnosing and treating a child with ADHD, child and adolescent psychiatrists frequently recognize the disorder in a parent, sibling, grandparent and/or other relatives. Unfortunately, medical practitioners, including psychiatrists who treated adults, do not recognize the disorder. It is unusual for ADHD adults to be appropriately diagnosed and treated, often resulting in a considerable "burden of illness." This is especially true among professionals and executives, in part because they are, bright, hard-working and able to develop strategies that compensate for some of their ADHD symptoms.

Studies have found that 4-5% of adults in the United States meet diagnostic criteria for ADHD. More than 50% of adults diagnosed with ADHD in childhood continue to meet criteria for the disorder as adults. The most thorough study of adult ADHD found that only 11% of adults received treatment (Kessler, et al, National Comorbidity Survey Replication, 2006). The prevalence of ADHD in professionals and executives would likely compare to the 4-5% found in national samples, but it is uncertain how many of these individuals are diagnosed or seek treatment, in part because their success often does not lead individuals or providers to suspect that someone so accomplished might have ADHD. Alternatively, the individual’s difficulties may be attributed to other causes.

Symptoms of ADHD change as a child progresses to adolescence and then adulthood. The ADHD adult is not usually "hyperactive" nor is he physically impulsive in a way that a child with ADHD is. Nonetheless, the ADHD adult bears a burden of illness at home, work and in social settings. Some of the difficulties ADHD adults might experience are distractibility, difficulty with lengthy or low-interest technical reading, procrastination, forgetfulness, disorganization, faulty prioritization of tasks, inaccurate work, having their minds wander during conversations, staying on task, preparing reports in a timely fashion, a general reluctance to engage in tasks that require sustained attention, losing/misplacing objects, failure to attend to details, restlessness/fidgetiness, excessive talking, interrupting conversations or completing the sentences of others, impatience, acting without thinking, risk taking behavior, etc.

ADHD individuals often manifest deficits in "executive functioning," a set of neurocognitive processes linked to some of the core symptoms of ADHD across the life cycle. These deficits have been variously characterized as planning, working memory, problem solving, self- monitoring, maintaining motivation to sustain self-directed action, and the ability to inhibit irrelevant internal and external distractions.

One does not need to manifest all the symptoms noted above to meet criteria for the diagnosis of ADHD although ADHD adults experience many of the above-noted symptoms resulting in difficulties in multiple settings.

A number of pharmacological interventions, oftentimes augmented by cognitive behavioral therapy (CBT), have been found to be effective in the treatment of adult ADHD. There is no cure for ADHD but appropriate pharmacological and cognitive behavioral treatment can lead to a significant reduction in symptoms, resulting in noticeable improvements at work, at home, and in one’s social and marital relationships. In addition, some adults with ADHD benefit from "coaching" with a professional knowledgeable about adult ADHD and trained in this intervention.