Volume 6 Issue 11 November, 2016
ADHD is a behavioral and neurocognitive condition characterized by developmentally inappropriate and impairing levels of gross motor over activity, inattention, and impulsivity. ADHD is usually noticed at the pre-school age. Due to hyperactivity and impulsivity, child is often termed as difficult to handle, nuisance because of disruptive and intrusive nature. This affects social relationships, learning and academics & self-esteem
Concept of Adult ADHD
Earlier, ADHD was thought to be a childhood disorder and subsides as child matures. But now, research has shown that more than 2/3rd of childhood ADHD continues to adulthood albeit hyperactivity reduces. Various surveys and studies have shown the prevalence of Adult ADHD between 2-5%. Teenager or young adult with ADHD continues to have inattention and impulsivity along with low self-esteem, identity deficits and negative world view, high novelty seeking and boredom proneness may lead to explore drug use at an early age, engage in high risk behaviors for thrill and endanger themselves and also experiment with sexuality and may involve in high risk sexual behaviors.
What is the importance of recognizing Adult ADHD?
Because of lack of awareness regarding the concept of ADHD itself in Indian scenario, many childhood ADHD cases does not get diagnosed or fail to reach medical attention. Once such children reach teenage and young adulthood, they are likely to land up into troubles which are mentioned above. If only the outcomes such as early onset substance use, sexually transmitted diseases, injuries sustained or co-morbid conditions like depression and anxiety are treated, the underlying traits of ADHD maintains the problem and leads to recurrence. Evidence bases, though not as robust as for childhood ADHD, clearly tells Adult ADHD which is often the root cause of above problems is a potentially treatable condition.
How to recognize adult ADHD?
To consider possibility of adult ADHD in any young adult presenting
- With substance use especially, early onset dependence and multiple drug use
- Aggressive behavior or bad and explosive temper, temper tantrums
- Impatient and easily agitated
- Persistent poor performance in academics and occupation resulting frequent change in settings & drop outs
- Poor inter personal relationships, multiple relationships
- High risk sexual behavior, promiscuous, casual sex and in young adults being treated for sexually transmitted diseases especially HIV infection
- Frequent injuries and frequently engaging in risky activities like rash driving, speeding
- Frequent law breaking and petty crimes
Diagnosis of Adult ADHD essentially has all the criteria required for childhood ADHD as mentioned in DSM-IV/DSM-V and ICD-10 but presentations may differ in adult life when suspected for the first time. To diagnose ADHD, onset must be in childhood and presence of ADHD in childhood is a must.
Common Screening and assessment tools for adult ADHD
- ADHD Adult Self-Report Scale V1.1 (ASRS V1.1) 6-item screener as well as 18-item symptom checklist
- Wender – Utah Rating scale
- Conners’ Adult Attention-Deficit Rating Scale (CAARS)
- The Wender-Reimherr Adult ADD Scale (WRAADS)
- Barkley’s Current Symptoms Scale–Self-Report Form
Treatment of Adult ADHD
As in children, stimulants are the main stay of pharmacotherapy in adults with ADHD. However, there is relatively less evidence base for usage of these medications in adults compared to children. Methylphenidate (MPH) belonging to the class of stimulants carries the highest evidence for treatment of adult ADHD. It is available in immediate release and sustained release formulations. Other medications with lesser evidences are Atomoxetine, Nortryptiline, Bupropion & Modafinil. Psychological Management of ADHD in adults may be done using Cognitive-Behavioural Therapy, Interpersonal therapy, Anger Management techniques, Activity scheduling and time management, Attention enhancing Tasks.
Dr. Shankar, Assistant Professor, Dept. of Psychiatry, BMC&RI, Bengaluru, shankarkjs@gmail.com
