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Attention-deficit hyperactivity disorder (ADHD) is a neuropsychological disorder marked by attentional issues, hyperactivity, and impulsivity behavior. It’s not confined to young people either; it can become a lifelong issue. So what’s the best way to pursue adult ADHD diagnosis and treatment?
First, a brief history of ADHD. In 1902, pediatrician George Still described a group children who were hyperactive, impulsive, and inattentive. It wasn’t until 1968 that the Diagnostic and Statistical Manual of Mental Disorders (DSM) adopted the term “hyperkinetic impulse disorder,” with the name being changed in 1980 to attention-deficit hyperactivity disorder. As with any new diagnosis it took time for doctors to adopt ADHD and be trained to diagnose and treat it.
WHAT IS ADULT ADHD?
In the post “Adult ADHD: Joking Aside, Do You Struggle with It? we explored the definition, causes, and symptoms of ADHD. In this companion post, explore the history of ADHD, how it’s diagnosed, and treatment options.
So why the history lesson? Well if you were a hyperactive child before 1980 or even later, you may not have received a diagnosis of ADHD in childhood. In fact, there are many adults who have lived for many years with disruptive symptoms of ADHD without knowing what it was. Often, they realize that they have ADHD when they see a TV show about it or when a family member is diagnosed.
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Adult ADHD Diagnosis
As a general rule, if your symptoms are interfering with your everyday life, then it’s worth having an assessment for ADHD. A adult ADHD diagnosis is usually made by a psychiatrist or neuropsychologist. There is no single definitive test at present. Testing may include:
- A full medical history, physical exam, and blood tests to rule out other causes of symptoms such as anemia or thyroid disease.
- Psychological testing may involve an in-depth discussion of symptoms and also the use a formal rating scale, often based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) definition (see this Centers for Disease Control and Prevention page). Cogntitive and adacemic testing may also be requested.
- Less common tests may include QEEG (Quantitative Electroencephalography/brain mapping) or SPECT scans to aid diagnosis.
Three subgroups occur within the adult ADHD diagnosis:
- ADHD predominantly inattentive presentation: Presents with problems with attention and executive function.
- ADHD predominantly hyperactive-impulsive presentation: Presents with physical hyperactivity and impulsive behavior.
- ADHD combined presentation.
Physical hyperactivity usually lessons or becomes more manageable in adults.
The CHADD directory can help you find a local practitioner who can aid you with diagnosis. CHADD stands for “Children and Adults with Attention-Deficit/Hyperactivity Disorder.”
While several self-rating ADHD scales are available, they tend not to be standardized or validated. They should not replace medical care.
SOURCES & RESOURCES
For related reading, please see:
- “Adult ADHD: Joking Aside, Do You Struggle with It?“
- CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder)
- National Institute of Mental Health
- Attention Deficit Disorder Association
- Additude Magazine
Treatment of ADHD
Medication: For a long time the mainstay of treatment for ADHD was medication.
- Stimulant medications may improve symptoms in up to two-thirds of adults with ADHD. They include methylphenidate (Ritalin, Concerta) and amphetamine/dextroamphetamine (Adderall, Adderall XR). Problems with stimulants include addiction, misuse, wearing off of effectiveness, over-arousal, and poor appetite.
- Non-stimulant medications include atomoxetine (Strattera) and guanfacine (Intuniv). They work well for some individuals, but studies show fewer people respond compared to stimulants.
- Other medications, including antidepressants and antipsychotic drugs, may be used to treat symptoms.
Your clinician will advise you if he or she thinks a trial of medication may help you.
Cognitive behavioral therapy (CBT): CBT can also be useful to help learn to manage symptoms and deal with any negative thinking, depression, anxiety, guilt, low self-esteem, or overwhelm.
Other therapies for ADHD: A 2013 report from the National Institute of Health’s Multimodal Treatment Study of Children with ADHD (MTA) concluded, “The key paradox is that whereas ADHD clearly responds to medication and behavioral treatment in the short term, evidence for long-term effectiveness remains elusive.”
In the long term, the best approach is to learn to minimize, deal with, and even harness the symptoms of ADHD. Everyone’s brain and lifestyle is different, so there is no cookie-cutter cure or treatment for ADHD. The secret is to come up with a toolbox that works for you. Interventions may include:
- Improving diet. Reducing processed foods, especially those with sugar and food colorings and increasing vegetable, fruit and healthy fat (like omega 3 fatty acids) intake, which improves overall brain health. An elimination diet, where you test the effects of removing certain types of foods such as food coloring or salicylates has been shown to be beneficial to many.
- Regular exercise. Increases dopamine and improves blood flow to the brain. The National Center for Complementary and Integrative Health (NCCIH) reports “short-term aerobic exercise, including yoga, has shown beneficial effects on core symptoms of ADHD such as attention, hyperactivity, and impulsivity.”
- Coaching. A specialised coach may be able to help you navigate your ADHD in general or address executive function deficits, social skills difficulties, career or academic problems. They may help you understand, overcome and harness symptoms. For example: Some people with ADHD are better suited to a more physically active or creative job rather than a repetitive desk job, and college students with ADHD can benefit from learning time management strategies.
- Melatonin. This naturally occurring sleep hormone can be helpful in treating insomnia associated with ADHD.
- Family or relationship therapy. This may be helpful to deal with relationship or parenting issues within your family.
- Educational intervention. Many people with ADHD may benefit from accomodations within the educational setting such as extra time for exams, a note-taker, copies of lecture notes or recordings of lectures.
- Neurofeedback and biofeedback therapy. These therapies involve the individual learning to control a bodily function. For neurofeedback this function is brain arousal and for biofeedback it might be heart rhythm or finger temperature. A 2017 paper in Lancet Psychiatry concluded, “Neurofeedback training is not superior to a sham condition or group psychotherapy.” It is an expensive and time-consuming therapy but can be very effective for some individuals.
HIDDEN FINANCIAL COSTS OF UNTREATED ADHD
Not only is having ADHD impactful to the life and the health of the individual, but untreated ADHD has significant financial costs. CHADD estimates that:
- The cost of lower household income is $10,532 to $12,189 per person per year ($90.04 billion to $104.20 billion).
- The healthcare costs are $137 to $4,100 per person per year ($1.17 billion to $35.05 billion).
- Adults (18 to 28 years old) with ADHD who engage in criminal behavior cost $1,204 to $2,742 per person ($2.52 billion to $5.74 billion per year).