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Attention Deficit-Hyperactivity Disorder
Treatment for ADHD can include counseling, medication, and assistance (coaching) in organizing and managing daily responsibilities. Because much of what is known about ADHD derives from studies of children, some clinicians who treat adults may refer adult patients with questions about diagnosing and treating ADHD to colleagues who specialize in childhood mental health. Medications for ADHD may include stimulants (which now are available in longer-acting forms), noradrenergic agents, antidepressants, antihypertensive medications, or antinarcolepsy medication.
Information about specific medications can be found at www.medlineplus.gov (click on “Drugs and Supplements”).
Attention Deficit/Hyperactivity Disorder is a treatable medical condition that makes it hard for people to regulate their attention, organize themselves, and control their impulses. For people whose ADHD symptoms include hyperactivity, keeping quiet or stopping all body movements may seem nearly impossible.
While most people have occasional moments of daydreaming, fidgeting, or forgetfulness, someone with ADHD experiences these difficulties often, in multiple settings, over a period of at least six months. These challenges can affect all aspects of a person’s life. Until recently it was assumed that ADHD is outgrown in childhood because its most noticeable symptom (hyperactivity) tends to decrease as a child matures into adulthood. It is now known that many individuals with ADHD (current studies suggest between half and two thirds) continue to experience impairing symptoms as adults.
Approximately four percent of adults are estimated to be affected. Although the disorder emerges during childhood, it may not be significantly impairing or noticeable until an individual is faced with the adult challenges of managing a job, sustaining a relationship, or running a household. Adults with ADHD are at higher risk than those without the disorder to struggle with job performance, educational achievement, personal relationships, and substance or alcohol use.
They are also at higher risk for developing depression and bipolar disorder. In children and adolescents, ADHD may significantly impair academic activities, peer relationships, and home life. Young people with ADHD typically exhibit low frustration tolerance and have trouble following rules.
Three main types of ADHD have been identified: predominantly inattentive, predominantly hyperactive/impulsive, and combined type.
Inattentive Symptoms Inattentive symptoms are characterized by forgetfulness, distractibility, and difficulty focusing and maintaining attention. They can lead to a variety of challenges, including boredom, trouble remembering instructions and responsibilities, chronic disorganization, and an aversion to mentally challenging tasks.
Paradoxically, a person who has ADHD may have great difficulty paying attention while listening to a speech or organizing a project, but may be able to focus attention for very long periods of time when engaged in pleasurable activities that require mindful attention, such as playing video games, drawing, reading books by a favorite author, or tackling complex problems that draw upon a strong interest or skill.
Adults with inattentive symptoms may have been described in childhood as “daydreamers” or “spaced out,” but they were unlikely to have been referred for treatment. Because symptoms of inattentiveness may be difficult for others to detect, many people with the inattentive type of ADHD are never identified at all, or they may not be diagnosed until a pattern of problems with maintaining focus, staying organized, or not attending to details leads to lower academic or job performance. Frequently, adults with the inattentive type become aware of their own symptoms of ADHD only after their children are diagnosed with the disorder.
Hyperactive/Impulsive Symptoms Impulsive symptoms are characterized by a tendency to act or speak before considering consequences, by restlessness, and by difficulty waiting, staying seated or resisting the need to constantly move. These symptoms are more likely to have been identified during childhood, because hyperactive/impulsive symptoms tend to cause disruption in school.
Because hyperactivity appears less commonly in females, girls and women with ADHD have been less likely to be diagnosed than males. Individuals with this type of ADHD may face consequences such as job dismissal and damaged friendships due to their inability to be patient with others or to refrain from speaking their minds.
Combined Type Symptoms Combined Type symptoms include significant difficulties with both regulating attention and controlling hyperactivity/impulsivity. The impulsiveness and inattentiveness of ADHD places adults at increased risk for automobile accidents, frequent job changes, financial problems, and divorce.
A recent study (Joseph Biederman, MD, et al., 2005) found that ADHD is responsible for an estimated $77 billion in lost household income in the U.S. each year, or an average of $10,000 per individual with the disorder. The loss in income was calculated by considering the lower educational attainment, higher rates of job loss and days absent, and overall lower job performance in adults with ADHD.
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