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Adult ADHD. By Dr: Ibtihal Mohamed Aly Ibrahim. Introduction:. Attention deficit hyperactivity disorder (ADHD) has primarily been considered a childhood condition.
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Adult ADHD By Dr: Ibtihal Mohamed Aly Ibrahim
Introduction: • Attention deficit hyperactivity disorder (ADHD) has primarily been considered a childhood condition. • Adults with the disorder were not recognized until the 1970s when diagnosis expanded to include ‘Adult Hyperactives’ and later ‘Attention Deficit Disorder leaving a residue’
DSM-IV Diagnostic Criteria: • Either (1) or (2): (1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention (a) often makes careless mistakes. (b) often has difficulty sustaining attention. (c) often does not listen. (d) often fails to follow through on instructions or to finish tasks. (e) often has difficulty organizing tasks and activities. (f) often avoids tasks requiring sustained attention. (g) often loses things. (h) often is easily distracted. (i) often is forgetful.
DSM-IV Diagnostic Criteria: (2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity (a) often fidgets or squirms (b) often leaves seat (c) often moves excessively (may feel restless) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often "on the go" (f) often talks excessively Impulsivity (g) often blurts out answers (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others
DSM-IV Diagnostic Criteria: B. Some hyperactive-impulsive or inattention symptoms that caused impairment were present before age 7 years. C. Some impairment from the symptoms is present in two or more settings. D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder.
Subtypes Coding note: for individuals (especially adolescents and adults who currently have symptoms that no longer meet full criteria “in partial remission” should be specified
Epidemiology: • 50% of ADHD children continue to manifest symptoms in adulthood. • Estimates of the prevalence of ADHD in adulthood range from 1% to 5%. • adults with ADHD are twice as likely to be arrested, have a two-fold increased risk of being divorced, and a 78% greater risk of being unemployed.
Disorganization and forgetfulness: • poor organizational skills (home, office, desk, or car is extremely messy and cluttered). • tendency to procrastinate. • trouble starting and finishing projects. • chronic lateness . • frequently forgetting appointments, commitments, and deadlines. • constantly losing or misplacing things (keys, wallet, phone, documents, bills). • underestimating the time it will take you to complete tasks .
Impulsivity: • frequently interrupt others or talk over them • have poor self-control • blurt out thoughts that are rude or inappropriate without thinking • have addictive tendencies • act recklessly or spontaneously without regard for consequences • have trouble behaving in socially appropriate ways (such as sitting still during a long meeting) .
Emotional difficulties: • sense of underachievement • doesn’t deal well with frustration • easily flustered and stressed out • irritability or mood swings • trouble staying motivated • hypersensitivity to criticism • short, often explosive, temper • low self-esteem and sense of insecurity
Hyperactivity or restlessness: • feelings of inner restlessness, agitation • tendency to take risks • getting bored easily • racing thoughts • trouble sitting still; constant fidgeting • craving for excitement • talking excessively • doing a million things at once
hypotheses that could help explain the high rate of co-segregationof mania and ADHD symptoms: 1- Comorbidity is a chance phenomenon. 2- Comorbidity is an artifact of overlapping criteria. 3- Comorbidity is due to a common diathesis that leaves patients vulnerable to separate illnesses. 4- Symptoms of ADHD that precede the onset of BD represent a prepubertal expression of illness antecedent to the development of a full affective episode.
Is ADHD • "Protobipolar?"
Utah criteria for Adult ADHD:(Paul Wender, University of Utah) • Retrospective childhood diagnosis: • Narrow criterion:met DSM-IV criteria in childhood by parent interview. • Broad criterion:both (1) and (2) are met as reported by the patient: • Childhood hyperactivity. • Childhood attention deficits. • Adult characteristics: five additional symptoms, including ongoing difficulties with inattentiveness and hyperactivity and at least three other symptoms: • Inattentiveness. • Hyperactivity. • Mood liability. • Irritability and hot temper. • Impaired stress tolerance. • Disorganization. • Impulsivity. • Exclusions: not diagnosed in presence of severe depression, psychosis, or severe personality disorder.
Pharmacological treatment
Self-Help for Adult ADD / ADHD • Tips for managing stress and boosting mood • Tips for getting organized and controlling clutter • Develop structure and neat habits—and keep them up • Tips for managing your time and staying on schedule • Tips for staying focused and productive at work
