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ADHD in Adults

ADHD in Adults. Cherinet Seid, PGY II. OUT LINE. Introduction History of ADD Etiology/Risk factors Diagnosis Comorbid disorders Management. Introduction. The only psych disorder 1 st recognized in children Under recognized in adults Affects 4-5% adults “Persistent ADHD” 15-28%

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ADHD in Adults

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  1. ADHD in Adults Cherinet Seid, PGY II

  2. OUT LINE Introduction History of ADD Etiology/Risk factors Diagnosis Comorbid disorders Management

  3. Introduction • The only psych disorder 1st recognized in children • Under recognized in adults • Affects 4-5% adults • “Persistent ADHD” 15-28% • P-ADHD male predominant, A-ADHD not • Psychiatric comorbidities

  4. History of ADD • 1930 - Minimal Brain Damage • 1960 - Minimal Brain Dysfunction • 1968 - Hyper-kinetic reaction of childhood • 1980 - ADD with/without hyperactivity • 1987 - ADHD • Amphetamines used in 1937 • Methylphenidate has been on market since 1955

  5. Myths of ADHD

  6. Common Scenarios • Adults diagnosed in childhood & stopped rx • Adolescents progressing to adult services • Undiagnosed adults with rx-resistant comorbid Psych disorders • Undiagnosed self referred adults • Undiagnosed adults recognized by others(fam members, health professionals)

  7. Effects of ADHD 1. Social & Work impairment $19.5 billion lost human capital/yr in US Increased risk to be arrested (>2x controls) 2. Marital & Parental impairment Rate of divorce & separation double that of general population 3. Accident Proneness Hospital visits & Admissions 26 % vs 18%

  8. 4.Driving Impairment

  9. Effects cont’d 5. Substance use

  10. Case • 43 yr female, chemist, married, 3 kids • Noticed similar characters as her 10 yr old son who is recently diagnosed with ADHD • Has trouble concentrating, disorganized, impulsive & forgetful • Frequently misplaces or loses objects • Procrastinates and has difficulty with punctuality • Feels overwhelmed by house hold chores although husband is supportive and calls her home ‘a disaster area’

  11. Three sub types • Predominantly inattentive type • Predominantly hyperactive-impulsive type • Combo

  12. DSM-IV criteria At least 6 symptoms of inattention Careless mistakes Not listening Not finishing projects Forgetful Not following through Being disorganized Impulsive & forgetful Frequently losing/misplacing objects

  13. DSM IV cont’d At least 6 symptoms of hyperactivity Hyperactivity-impulsivity Not able to sit still Inner feeling of restlessness Always on the go Talking too much Being impatient Interrupting Blurting things out

  14. DSM-IV cont’d • Sxs must be present before age 7 • Interfere with ability to function • Persist for more than six months • Manifest in multiple settings • Not be accounted for by other disorders

  15. Risk Factors • Biologic cause More genetic link than asthma, breast ca & schizophrenia. • Environmental • Frontal cortex hypometabolism • Dopaminergic pathways

  16. Screening for ADHD • Adult Self -Report Scale (ASRS) • 18 questions • Assesses DSM-IV symptoms of ADHD

  17. Assessment Process • Assess current ADHD symptoms (assessment scales) • Establish a childhood hx of ADHD • Assess devt’al & functional impairement • R/o other psychiatric disorders • Obtain family hx of psych disorders • Perform a physical exam, r/o medical causes • Assess pt’s insight (?same with collateral hx)

  18. DDx of A-ADHD • Learning disabilities • Mood disorders • Anxiety disorders • Mixed anxiety/depression • Secondary ADHD syndromes due to brain injury • Other causes of impaired cognitive & executive function

  19. Treatment Need to treat is always based on functionalimpairment.

  20. Multimodal Treatment • Psychoeducation • Rx of comorbid conditions • Pharmacological Rxs • Therapy (marital, individual, social skills, CBT) • Light therapy • Env’tal restructuring & appropriate physical & special interest activities

  21. Pharmacotherapy

  22. just remember… • It is worth identifying A-ADHD • Substantial burden of illness • Potential for improvement with rx

  23. Assessment Scales • www.therapeuticresources.com • www.checkmateplus.com • www.guilford.com • www.mhs.com • www.caddra.ca • www.harcourtassessment.com • www.med.nyu.edu/psych/psychiatrist/adhd.html

  24. References • Approach to ADD in adults,Canadian Family Physician, vol 52;Aug 2006 • Understanding the nature of adult ADHD, Schulich school of Medicine, CME booklet 2007 • www.uptodate.com

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