CHARACTERISTICS OF ADULTS WITH ATTENTION PROBLEMS
Although ADHD in children has been recognized and treated for nearly a century, only within the last few decades has research unequivocally demonstrated that up to 70% of children with attention problems continue to experience similar difficulties as adults. In many cases, core symptoms of inattention, restlessness, and/or impulsivity lead parents or teachers of affected individuals to seek professional help during childhood. However, in many other cases, the symptoms of the disorder are not recognized until early or middle adulthood, prompting clinical referral at that time. In either case, attention problems likely generate a chronic pattern of impairment across multiple settings.
In addition, ADD/ADHD in adults is often obscured by memory problems, anxiety and/or depression, difficulties in relationships, lack of advancement in one's career, an unstable job history, substance abuse, and for some, a general pattern of impulsive, or "manic," behavior. Furthermore, many adults with attention problems reportedly experience low self-esteem arising from a long history of perceived failures and inadequacies. Other difficulties often reported by adults with attention problems include:
HOW COMMON ARE ATTENTION PROBLEMS AMONG ADULTS?
Research indicates that 10 to 15 percent of adults may experience attention problems at some point in their lives, and that approximately 2 to 4 percent of adults meet criteria for ADHD. Although 3 times as many boys meet criteria for ADHD as girls in childhood, among adults, many more women are recognized as having the disorder, reducing the gender ratio to 2 men for every 1 or 2 women who meet ADHD criteria.
WHAT CAUSES ADHD?
Although the precise causes of ADHD have not yet been identified, there is little doubt that heredity is the greatest risk factor for the disorder. Other risk factors include head injury, premature birth, low birth weight, and prenatal exposure to smoking or alcohol. No research supports the notion that ADHD rises from too much television, family chaos, sugar intake, or food additives.
HOW IS ADHD IN ADULTS DIAGNOSED?
Since the symptoms of ADHD are common to many other medical conditions and psychiatric disorders, as well as certain environmental stressors, adults should never self-diagnose ADHD, but rather, should seek a comprehensive evaluation from qualified professionals. A team of clinicians with expertise in ADHD and related conditions should conduct a comprehensive evaluation. This team should include a clinical psychologist and a psychiatrist and/or a behavioral neurologist. The evaluation should include a detailed clinical interview covering past and present ADHD symptoms, as well as one's developmental history, school history, work history, and personal and family psychiatric history. Importantly, this interview should not be a brief, surface-level exam, but rather should involve one-to-two hours with a clinician at a minimum. In addition, the evaluation should gather information from several informants (e.g., spouse, significant other, and/or parents, if possible) and should evaluate behavior in multiple settings (e.g., work, home, school). Furthermore, it is important for clinicians to use neuropsychological and personality testing, as well as the clinical interview, to clarify whether other psychiatric diagnoses are appropriate that may help explain the symptoms the patient is reporting (e.g., anxiety, depression, memory problems, and/or learning disorders). This comprehensive evaluation is needed for several reasons:
- To establish an accurate diagnosis
- To avoid over-diagnosis and the risk/expense of unnecessary treatment
- To evaluate possible coexisting learning or cognitive problems
- To rule out medical explanations for the patient's symptoms
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