Functional Mental Disorders

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

What is Attention Deficit Hyperactivity Disorder (ADHD)?

Attention-deficit hyperactivity disorder (ADHD) is a mental illness that is characterized by hyperactive behaviors and difficulty with attention. ADHD is a condition that starts in childhood, one which most experts believe begins before the age of 12. While many people with ADHD will experience a decrease in their symptoms—perhaps even a resolution of their illness in some cases—as they reach adulthood, a significant percentage of people will continue to experience dysfunction and distress during their adult years.

While the number is higher in children, multiple studies suggest that approximately one in twenty-five American adults will meet diagnostic criteria for ADHD. ADHD is more common in males and often occurs with other learning disabilities, substance abuse problems and other mental illnesses such as mood disorders and anxiety disorders.

What are the common symptoms of ADHD?

• Difficulty focusing, e.g., problems maintaining attention or “staying on task.”

• Feelings of restlessness or being “unable to just relax.”

• Problems with disinhibition, e.g., difficulty waiting one’s turn, blurting out answers, or butting into conversations.

• Trouble maintaining a schedule, e.g., frequently missing/forgetting appointments or deadlines.

It should be noted that people with ADHD experience their symptoms in multiple settings (e.g., academic, work, social or family obligations). For example, a young person who has difficulty paying attention in college classes and also struggles with completing his tasks at work would be a more classic example of an individual with ADHD than an older person who only describes an isolated difficulty with focusing during conversations with their spouse.

What are the causes of ADHD and how is it diagnosed?

Scientists have not isolated a single gene that can be said to “cause” ADHD, but scientific studies suggest that people with ADHD may have problems with the chemicals in the brain that control a person’s level of alertness and attention (catecholamines).

There is no specific test (e.g., blood test or x-ray) that can diagnose a person with ADHD. Instead, diagnosis of ADHD is made by a mental health professional based on a clinical assessment that includes a formal history and other information such as academic records, psychological testing, and discussions with parents or other loved ones. Most adults with ADHD will have already been diagnosed—and perhaps treated for this condition—during childhood. For adults that are concerned that they might have ADHD, the first step is toconnect with a properly trained mental health professional in order to schedule a face-to-face evaluation of their symptoms.

A proper psychiatric evaluation can be critical because an adult, specifically one without a prior history of ADHD, who experiences new or worsening symptoms of difficulty focusing may be more likely to be experiencing symptoms of a medical or psychiatric condition other than ADHD. These conditions could include depression, anxiety or substance abuse (e.g., marijuana or alcohol). Medical illnesses—such as thyroid disease, seizure, or stroke—can also mimic some of the symptoms associated with ADHD. Therefore, in addition to having a psychiatric evaluation, any adult with new symptoms of ADHD should have a physical exam and testing performed by their primary care physician in order to screen for common medical conditions that can cause similar symptoms.

What are the treatment options for ADHD?

Many people with ADHD will find that the same treatments that were effective for them as children will continue to be effective during adulthood. For adults who are just beginning treatment for ADHD, psychiatric medications may be indicated. All treatment decisions should be discussed with one’s physicians as the risks and benefits for each individual may vary.

Many people will choose to be treated with stimulant medications, e.g., methylphenidate (Ritalin), dextroamphetamine (Dexedrine) or amphetamine salts (Adderall). These medications are generally thought to be “first-line treatments” and may be effective in more than 50 percent of individuals. Some people taking these medications will find that they have decreased appetite or problems sleeping. Other people may be at risk for heart problems including high blood pressure, arrhythmias, or even stroke.

Some people who are not able to use stimulant medications, or for whom these medications are ineffective, may be treated with other medications for their symptoms. These can include atomoxetine (Strattera), buproprion (Wellbutrin), or other antidepressants.

Many people will also find that psychotherapy is useful in treating their ADHD. Cognitive behavioral therapy is the best-studied and most efficacious form of psychotherapy for people with this illness.

            With thorough treatment and the support of their loved ones, most people with ADHD can expect to live healthy lives and to see a significant decrease in their symptoms.