ADHD in Adults

Psychiatry
Written By Maladywise
 

Prevalence:

  • 4% of adults and 10% of kids

  • About 50% of kids with ADHD continue to have symptoms into adulthood

  • The more severe symptoms are in childhood, the greater the chance of continuation

Cause:

  • Not well understood

  • Decreased activity of dopamine and noradrenaline in the part of the brain responsible for executive function

Genetics:

  • Strong genetic component

  • The risk of ADHD in parents and siblings of kids with ADHD is increased 2 to 8 times e.g. 20 to 80% chance

Characteristics:

  • Inattention

  • Impulsivity

  • Restlessness

  • Functional impairment

Symptoms:

Problems arise in the following areas:

Executive Dysfunction

Self-directed actions to choose goals and to create, enact, and sustain efforts toward those goals.

  • Working memory

  • Task shifting

  • Initiation

  • Self-inhibition

  • Self-monitoring

Inattention

  • Remaining focused on a task, especially for long periods

  • Organizing and prioritising activities

  • Following through and completing tasks

  • Forgetfulness

  • Time management

Impulsivity

  • Excessive involvement in activities or speech that has a high potential for consequences

  • This can lead to end relationships or quitting jobs

Restlessness (Hyperactivity)

  • Feeling fidgety or restless

  • Talking too much and/or interrupting others

Emotional Dysregulation

  • Mood lability

  • Irritability

  • Anger outbursts

  • Low frustration tolerance

  • Unable to engage in appropriate behaviour when distressed (e.g. at work)

Other impairments:

ADHD leads to higher rates in:

  • Occupational difficulties

  • Criminal activity

  • Substance abuse problems

  • Traffic accidents and tickets

  • Anxiety and mood disorders

  • Overall mortality, mostly from traffic accidents

Assessment:

  • The goal of the assessment is to identify symptoms and behaviour consistent with the diagnostic criteria for ADHD and to rule out other disorders such as mood and/or anxiety disorders.

The assessment should focus of adult manifestations of ADHD including:

Hyperactivity symptoms

  • Restlessness

  • Constant talking

  • Constant activity

  • A tendency to choose very active jobs

Impulsivity symptoms – Impulsivity may have more serious consequences in adults than during childhood

  • Ending relationships

  • Quitting jobs

  • Overreacting to frustrations

  • More driving violations and accidents

Inattention symptoms

  • Procrastination

  • Difficulty making decisions

  • Poor time management

  • Difficulty in organizing activities

Management:

  • First-line treatment is a combination of medication and CBT targeting executive dysfunction.

  • For most adults, a simulation medication is preferred

  • If ADHD and depression only, consider SSRI / SNRI only initially

  • If ADHD and anxiety disorder, use a stimulant and SSRI / SNRI

  • If ADHD only, then a stimulant only

Other

  • Huberman

  • Ologies

  • No link to intelligence

  • Sugar

  • Omega-3 / EPA / DHA > 300mg

  • Oligo-antigenic diet

  • Drugs

  • Phosphatidylserine

  • Gingko

  • Modafanil

References:

 
Maladywise https://www.maladywise.org
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