Abstract
This paper reviews current knowledge about Attention Deficit Hyperactivity Disorder (ADHD) in adults. For many years ADHD was thought to only affect children, but now it is clear that almost all children with ADHD still have symptoms as adults that impair their functioning in all aspects of life. This paper reviews how these symptoms are manifested in adults, and how ADHD affects their lives. Also, this paper reviews contributing reasons that most children do not grow out of ADHD, and contributing factors to adult ADHD. Last this paper reviews how ADHD is diagnosed in adults, the importance of correct diagnosis, and effective treatments for the disorder. Understanding the past, present, and future of ADHD for adults can help lead to better treatments and more accurate diagnosis.
Many children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and there are many established treatments for children with this disorder. ADHD was generally thought to go away during young adulthood and not affect adults. However, research now shows that most children diagnosed with ADHD still have symptoms that cause them problems in adulthood, and two thirds of these children still fit the criteria for diagnosis as adults (Kooij et al., 2010). There were not many known treatments for adult ADHD, or many helpful methods for diagnosis until recently. Some researchers are concerned that there are many adults who have ADHD, but were never treated at all. Also, about a quarter of the parents who have children with ADHD have ADHD themselves, and without treating the parents it is difficult for them to use the parenting strategies that are helpful to their children (Kooij et al., 2010). Understanding how adults with ADHD are negatively affected by the disorder, contributing factors to children maintaining ADHD into adulthood, and current diagnosis and treatment for adults with ADHD is useful for developing better care for these individuals.
The symptoms of ADHD are expressed differently in adults than in children, but they still lead to cognitive and social problems (Kooij et al., 2010). For example, hyperactivity in adults may keep them from being able to sit still for any period of time, even when they are expected to such as at the movies or at the dinner table. It also may keep them from being able to relax in any way (Kooij et al., 2010). This can have obvious repercussions at home or work since adults are expected to have self-control, and being able to relax and sit still are important for many jobs and many family situations. ADHD also includes symptoms of impulsivity which affects adults by making them impatient, or doing things without thinking first. Adults with ADHD may also spend or start new jobs impulsively (Kooij et al., 2010). This can make life very difficult because not only do these individuals have to always try to make up or recover from their behavior, but they also cannot trust themselves to be responsible. The third symptom adults with ADHD often show is inattention. Adults express this by often being late and bored, not being organized, having a hard time making decisions, not dealing well with stress, always seeking something different, and being easily distracted. While many adults settle down in middle age adults with ADHD usually continue to change their jobs and relationships (Kooij et al., 2010). This symptom can be detrimental to relationships and job performance, and may make life almost always stressful and unsatisfying. It would be hard to stay in a relationship when a person could not sit and listen, or always interrupted. Also it would be hard to hold a job without being able to focus on or finish an assignment. Many adults with ADHD are often fired from their jobs and are underachievers (Biederman et al., 2008). The symptoms of ADHD and how they affect adults are clearly an impairment to being able to live a successful, or even functional, life.
Educational opportunities can also be negatively affected for adults due to their ADHD. Biederman and colleagues (2008) did a study to see if adults with ADHD had been as successful in their educational and career attempts as would be expected for someone with their intellectual abilities. They found that adults with ADHD were expected, based on IQ, to reach a much higher level of education than they did. The same was true for their career levels, and they were not nearly as far up in their careers as their IQ scores predicted they would be (Biederman et al., 2008). This study shows that adults with ADHD do not reach their full potential, and this is further proof of the serious and negative affect ADHD has on adults.
Understanding how harmful ADHD is for adults is useful because it shows the need for treatments, and it shows how important it is to develop ways of diagnosing the disorder in adults. ADHD affects adults in almost every aspect of life, and helping them is very important so that they can have a fair chance at success. Adults with ADHD are more likely to have car accidents and develop mood disorders which can further complicate their ability to overcome ADHD (Kooij et al., 2010). Also, they are more likely to have unhealthy habits such as smoking or drug abuse, and without understanding the ultimate cause of these choices it makes it more difficult to treat them (Kooij et al., 2010). Knowing how the symptoms of ADHD are manifested in adults can help when developing treatments since treatments are often aimed at reducing symptoms, and helping a person to be more functional.
Knowing how ADHD affects adults can also help researchers create assessments and tools for diagnosing the disorder, and possibly to decide on different levels of severity of the disorder. Not every adult with ADHD shows all of the symptoms in all of the ways described (Kooij et al., 2010). Maybe developing different levels of severity would lead to more effective treatments for the different types of symptoms that are most harmful for each person.
Many adults with ADHD were never treated as children, and there are children who were treated for ADHD whose symptoms went away when they get older. However, the majority of children diagnosed with ADHD still have it when they are adults, and it is likely that all adults with ADHD have had the symptoms their whole lives whether or not the disorder was ever formally diagnosed (Lara et al., 2009). Therefore, understanding the factors associated with maintaining ADHD into adulthood are important when trying to treat these adults. This can help researchers know which factors to target that may help adults improve, and help screen the children who will probably never grow out of their symptoms. Until a few years ago there was not much information about why children continue to have ADHD their whole lives, but researchers have been studying this recently because so many adults continue to have ADHD. There are now certain proven predictors of which children will still have ADHD as adults (Lara et al., 2009).
Lara and colleagues (2009) studied 6 main things that they thought contributed to adults still having ADHD past childhood. The first factor was age and gender which did not have much of an effect on whether or not children kept ADHD as adults, but they did find that there were many more men diagnosed with ADHD than women. The second factor was how severe ADHD symptoms were in childhood, and they found that the worse the symptoms in childhood were the more likely they would still have ADHD as adults. However, the third factor of childhood treatment did not have any effect on adult ADHD (Lara et al., 2009). This shows that treatment for ADHD in children has only temporary effects. Current ADHD treatment may not focus on the real cause of the symptoms, but try to relieve them through medication instead. This may be why more recent treatments focus on training behavior, and it shows why understanding adult ADHD can help overall treatment for those with the disorder.
The fourth factor Lara and colleagues (2009) studied was childhood adversity such as different types of abuse and loss, parents with mental disorders, and economic troubles. Results showed that most adults with ADHD had suffered at least one type of adversity in their childhood, and almost half had suffered two or more types of adversity. Having a father with a mood or anxiety disorder was a strong predictor of whether or not a child with ADHD would still have it as an adult (Lara et al., 2009). This shows how influential parents are on recovering from ADHD, and it implies a cycle in which adults with ADHD are likely to cause any children they have with ADHD to also maintain it into adulthood.
The fifth factor Lara and colleagues (2009) studied as a contributor to having ADHD as an adult was having another mental disorder as well as ADHD before adulthood. They found that having major depressive disorder before adulthood as well as ADHD often led to a lifetime of ADHD symptoms. No other one disorder with ADHD predicted that ADHD would last, but the more disorders a child had before the age of 16 with ADHD the more likely they would have ADHD as adults (Lara et al., 2009). Perhaps this is because having so many disorders distracts from focusing on the specific symptoms of one, or further complicates ADHD symptoms. A child with major depressive disorder could lack motivation to try to correct their symptoms, or maybe their ADHD helped them cope with depression by allowing them to always be doing something new. The last factor Lara and colleagues (2009) studied was exposure to traumatic events such as car accidents or seeing someone die, but results showed this was not related adult ADHD.
There is not much information about why adults still have ADHD and never grow out of their symptoms, and this is why studies like the previous one are so important. This information is a starting point that could lead to more effective treatment because now researchers know more about adult ADHD. Understanding adult ADHD and why symptoms persist gives clues to how to treat those symptoms, and clues to a better screening process for diagnosis. Since symptoms for ADHD are expressed differently by adults than by children these clues are important in helping to diagnose adults, and this is imperative to being able to treat them.
Diagnosing adults with ADHD is a systematic process that should not be based only on the symptoms a person is having at the time (Kooij et al., 2010). Ideally, a doctor would find out if any family members have had ADHD, look for the beginning of the symptoms in childhood, assess how the current symptoms are affecting the adult, and take into account past medical and mental health history. All of these things are important to correctly diagnose ADHD and rule out other possible mental disorders. Mood, anxiety, or personality disorders require different treatments for recovery, and although the underlying causes may be different they can affect behavior in some of the same ways as ADHD. It is also possible for a person to have ADHD and have one of these disorders, and being aware of the entire picture can help each person get the treatment that will work best for them (Kooij et al., 2010).
There are no physical tests that can diagnose ADHD, and so doctors must rely on people’s ability to rate and describe their own symptoms, as well as remember any childhood symptoms. Although a doctor can corroborate with family members, this may not always be possible and would be very time consuming. However, Murphy and Schachar (2000) found that people can accurately describe their childhood and present-day behaviors and symptoms. They also found that a person’s age does not affect their judgment of past symptoms, and this makes it much easier to use questionnaires and assessments to accurately diagnose ADHD in adults (Murphy & Schachar, 2000).
Once an adult has been diagnosed with ADHD there are both pharmaceutical and psychological treatments that are effective (Ramsay, 2007). Many of the medications used to treat ADHD in children still help with core symptoms in adulthood. However, adults have different responsibilities and requirements than children and so treating ADHD in adults requires a different range of treatments. This mainly refers to the psychological treatments available for adults with ADHD such as cognitive behavior therapy, and help learning to organize daily routines. Medications alone may not get rid of all of the symptoms of ADHD, unless the case is mild and relatively uncomplicated, and even when medication does help symptoms it may not translate to changes in how well the person functions in their daily life (Ramsay, 2007). These adults with ADHD may still not be able to function to their full potential, and cognitive treatments can help fill this gap in recovery.
Ramsay (2007) said that living with ADHD in adulthood can cause a person to develop behaviors that are maladaptive and complicate their functioning even further than their core symptoms. Cognitive treatments for adults with ADHD help teach new coping skills for stressful situations, help develop new problem-solving skills, and help to change inattentive and impulsive behaviors in a practical, gradual way. These treatments can be self-directed, one-on-one sessions, or in group settings. The combination of stimulant medications and cognitive behavioral therapies prove to be very effective, and can help adults with ADHD live fulfilling, successful lives without being disrupted by their disorder (Ramsay, 2007).
ADHD used to be considered a childhood disorder only, but now doctors and researchers have realized that ADHD is very prevalent in adults. ADHD is very disruptive and damaging for adults. Adults have responsibilities in relationships and careers, and the symptoms of ADHD make these responsibilities unmanageable and keep them from reaching their potentials. ADHD affects adults in their psychological, social, and occupational functioning, and understanding these effects can help in diagnosing and treating them. Also, understanding why children maintain ADHD when they are adults helps to correctly diagnose the disorder, and may offer new ideas for better treatments. In order to diagnose ADHD in adults a doctor must assess childhood behavior as well as adult behavior. Symptoms of ADHD usually start in childhood, and this can rule out other mental health disorders. Medication and cognitive treatments, when combined, can effectively reduce symptoms. Having a better understanding of current information about adult ADHD helps researchers to develop treatments that are more effective.
References
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