Understanding Attention Deficit Hyperactivity Disorder in adults
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which is often associated with other neurodevelopmental disorders such as autistic spectrum disorders (ASDs) and with specific learning difficulties such as dyslexia and dyspraxia.
ADHD became increasingly recognised as a disorder in children in the 1990s. During the decade that followed, it became apparent that symptoms often persist into adulthood, and that ADHD can cause significant impairment in adult life.
Although ADHD starts in childhood, symptoms sometimes don’t present until early adult life. Diagnosis and appropriate treatment can alleviate many of the problems associated with the condition in later life.
3.2% of adults have ADHD and the vast majority of those individuals are undiagnosed. In the past, attention deficit disorder (ADD) and ADHD were thought to be two separate disorders. We now recognise it as a single disorder which can manifest with:
- Mood swings
- Difficulties in motivation
- Mind wandering (inability to stop thinking with many different thoughts going through your mind)
People diagnosed with ADHD can also have non-neurodevelopmental disorders, the most common of which are depression and anxiety. Those with ADHD are also more likely to misuse recreational drugs than those who do not have ADHD.
The inattention of ADHD means that those affected are easily distractible. They find it difficult to focus and concentrate. They also have difficulties in shifting attention appropriately. This means that they can hyper focus on a particularly interesting or important task whilst ignoring less interesting tasks or the people around them.
These problems, combined with the difficulties in motivation, mean that those with ADHD have problems in:
- Domestic relationships
Those with ADHD also have an increased risk of being involved in road traffic accidents.
Treatment with medication can transform the lives of those with ADHD.
Two types of medications are used - stimulants and non-stimulants. Both types of medications exert their effects via increasing dopamine levels in the frontal lobes of the brain.
Stimulants include Methylphenidate, Dexamfetamine and their long-acting versions (Concerta XL and Elvanse) which work immediately and do not need to be taken every day. Patients can take stimulants only when they need them.
Non-stimulants such as Atomoxetine, take three to six weeks to work and have to be taken consistently every day.
Both types of medications are well tolerated but adverse effects can include:
- Loss of appetite
- Sleep difficulties
These do not cause a problem for the vast majority of patients. They can usually be managed by changing medication or using a medication which is either shorter or longer acting.
Medications can sometimes cause high blood pressure and this requires monitoring in patients who are being treated.
None of the medications used are addictive and all can be discontinued without difficulty. When patients are started on medication we begin at the lowest possible dose and titrate the dose up so that patients take the lowest effective dose of medication possible. Typically, three or four follow-up appointments are required to establish a patient on medication.
Cognitive behavioural therapy (CBT)
This treatment involves a detailed assessment of neuropsychological difficulties followed by an appraisal of personal strengths and weaknesses. The interaction of symptoms with mood and anxiety is assessed and patients are given techniques which overcome depression and anxiety.
Patients are also taught methods to structure their time and prioritise tasks. They are also given methods of problem solving and focusing attention.
This is an approach to ADHD which is based on focusing on individual strengths and allows people to use them to overcome weaknesses. This is a highly practical approach to managing the challenges of ADHD in daily life.
A diagnosis of ADHD is made following a detailed clinical assessment. A number of standardised questionnaires are completed prior to the assessment by the patient, his or her parents and the patient's romantic partner or friend.
If possible, the parent is interviewed during a part of the assessment to obtain a childhood history. School reports can also provide a detailed background history as well as psychological assessments from childhood.
Symptoms of ADHD are assessed using a semi structured clinical interview (usually the DIVA 2). We also look for evidence of co-morbidities such as depression, anxiety and ASD. An assessment of drug and alcohol use is also completed, as is an assessment of physical health.
An ADHD evaluation usually takes two hours. If this is insufficient, another hour may be required.
The 2008 National Institute for Health and Care Excellence (NICE) guidelines on ADHD recommend that medications should be the first line treatment for adults.
Priory has a nationwide network of hospitals and wellbeing centres that offer fast access to treatment and therapy to help improve the lives of those living with ADHD. For more information, you can visit our ADHD condition page.