ADULTS WITH ADHD
Dr. Christopher Green in his book ‘Understanding ADHD’ says “Adult ADHD first came to be noticed when paediatricians recognised that some of the parents of children in their care had the same symptoms as their children. It is believed that at least 50% of children with ADHD will take some of the features of their condition into adulthood.”
He continues: “Adults have very much the same difficulties as children with ADHD. School problems become work problems. The hyperactive-impulsive behaviours usually mellow but a restlessness remains and a tendency to impulsive actions. Those who study find it difficult to organise and finish assignments, information is not easily remembered and they forget as they read. The greatest attribute and the greatest disability of adult ADHD is the restless, circling brain. As this spins, a cascade of thoughts intrudes into the mind. Occasionally this brings immense creativity and invention but more often it distracts from the important issue of the moment. This inner restlessness is at its worst when there is boredom and lack of structure. It is at its most focused in times of crisis, imminent deadlines and the heat of battle.”
Adults with ADHD often have a busy mind and restless body; an impulsivetemperament; poor short-term memory; attention span and concentration problems; poor social skills, circular speech; difficulties with time management and organisation; and problems with relationships. Although most people experience these symptoms from time to time, people with ADHD experience these to a severe degree most of the time.
Many adults with ADHD, like children, have additional problems but in their case these tend to be things like antisocial personality, alcohol and/or substance misuse, anxiety and mood disorders, and learning difficulties. Antisocial behaviour in childhood may lead to chronic and impulsive antisocial behaviour in adult life which research suggests may be related to environmental influences.
Historically it was believed that children would grow out of the condition. Now it is accepted that this is not necessarily the case. In 2008 the government’s National Institute for Care & Excellence (NICE) included adults in its Guidelines albeit limited in its recommendations. This changed in 2013 when an updated version was released. The latest update was carried out in 2019 and can be downloaded from our NICE page. Now, finally, clinics are being established up and down the country not only to assess and treat adults who somehow slipped the net as children but to provide a transition route for adolescents still experiencing difficulties and requiring continued treatment.
Assessing Adults: There is no definitive test currently available to make a positive diagnosis and assessment has to be made by looking at the behaviours and difficulties with which the person with potential ADHD is affected and taking a careful history. It needs to be established whether any symptoms were evident in childhood which is not always possible when someone is an adult. Parents may no longer be alive to provide the information. School reports, if still available, can be helpful especially if they contain tell-tale phrases and comments that evidence the likelihood of unrecognised ADHD traits. In addition specially developed adult questionnaires aid the diagnosis process.
The NICE Guidelines recommends environmental modifications should be first line of treatment. These are changes that are made to the person’s physical environment in order to minimise the impact of ADHD on their day-to-day life. Appropriate environmental modifications will be specific to the circumstances of each person with ADHD and should be determined from an assessment of their needs. The Guidelines state that medication should be prescribed if their ADHD symptoms are still causing a significant impairment in at least one domain after environmental modifications have been implemented and only under the guidance of a psychiatrist, specialist ADHD nurse prescriber, or other clinical prescriber with training in the diagnosis and management of ADHD. Before starting drug treatment a full assessment should be completed by a clinician, which should include a mental health and social assessment together with a full history and physical examination. Drug treatment for adults with ADHD who also misuse substances should only be prescribed by an appropriately qualified healthcare professional with expertise in managing both ADHD and substance misuse. For adults with ADHD and drug or alcohol addiction disorders there should be close liaison between the professional treating the person’s ADHD and an addiction specialist.
NEW STUDY ON ADHD ADULTS WITH RECURRENT DEPRESSION – Dr Victoria Powell Research Associate, Psychological Medicine and Clinical Neurosciences. New study on ADHD in adults with recurrent depression.