Attention Deficit Hyperactivity Disorder and Its Treatment in Adults
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Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder often characterized by inattention, impulsivity, and hyperactivity. While it is more publicly noted as a childhood problem that is outgrown with age, many researchers have found it persists into post-pubescent stages and is a common psychiatric disorder in adults (Wender, 1995). ADHD is a chronic condition for which there is no cure, but there are ways to manage the condition. Treatment generally involves three tracks: education, medication, and therapy. Using these strategies, many people do learn to adapt and live fulfilling lives.
Until the release of the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III, APA, 1980), what we know now as ADHD was known by many other names such as “minimal brain damage,” “minimal brain dysfunction,” “minimal cerebral dysfunction,” “hyperkinesis,” and “hyperactive child syndrome.” DSM-III termed the condition Attention Deficit Disorder (ADD) and filed it under the “Conduct Disorder” category, noting its presence in adults as Attention Deficit Disorder, Residual Type. The fourth edition (DSM-IV, APA, 1994) now categorizes it under “Attention-Deficit and Disruptive Behavior Disorders” with three subtypes: ADHD, Predominantly Inattentive Type; ADHD, Predominantly Hyperactive-Impulsive Type; and ADHD, Combined type.
ADHD, except in some rare cases where it is linked to environmental factors (Nadeau, 1995,) is hereditary (Wender, Rosenthal, Kety, Schulsinger, Welner, 1973.) Since this is the case, a subject diagnosed with ADHD as an adult generally had the condition throughout childhood. Untreated, the child may withdraw from social situations and be labeled as “shy,” or become a class clown or troublemaker because of his/her symptoms. Most develop a lifelong feeling of being ”weird” or “different” (Fowler, 1994.) The child, left to deal with the symptoms without help many times develop increased feelings of low self-esteem, frustration, and failure. The child will be more likely to experiment with drugs or alcohol and engage in more stimulating activities like speeding, petty crime, and skipping school compared to his non-ADHD peers. Untreated ADHD is more dangerous to young adults, as they have usually developed set patterns that affect their daily life, leading to depression, anxiety disorder, or drug and alcohol addiction. (Murphy, 1995.)
While all people experience some of the symptoms of ADHD at some point in their lives, those with the condition live their daily lives with the continual distracted, disorganized, and impulsive behaviors that this disorder causes. Those with ADHD are easily distracted and often bored with repetitive chores, many times not finishing tasks. Some fidget, pace, and constantly move their feet around when seated. Many are excessive talkers and speak rapidly in run-on sentences. They cannot stand still in a line and are overly impulsive, spending money they cannot spare, and starting involved projects without thinking them through. Many other symptoms may be associated with ADHD, such as disorganization, lack of follow-through, thrill seeking, and impatience (Murphy, 1995.) While these are all symptoms of ADHD, diagnosis can only be made by a qualified medical professional. There are many evaluation measures available to assess a subject’s condition in studies, and several, such as the Utah Criteria and the Wender Utah Rating Scale (Ward, 1993,) that are designed specifically for adults.
Treatment of an individual optimally consists of education about his or her disorder, drug treatment, and psychotherapy (Wender, 1995.) Education about the subject’s disorder can help him/her to notice their behavior and modify it to better suit their life. Medication has provided a great deal of help to many in need, virtually removing all symptoms. Further counseling has shown, at least in limited studies (Ratey, 1991,) to improve a patient’s condition further and help to make educated lifestyle changes ad other beneficial improvements.
Initial education on ADHD plays an important role in the management of the disorder. This consists of pointing out prior symptoms the patient may have manifested earlier in life and gathering history of the patient’s prior relationships. This helps to explain how the patient’s condition may have affected others. Education also helps the patient to cope with the diagnosis, as it may be difficult at first.
Medication has shown to be extremely effective for a majority of adult patients (Wender, 1987.) In most cases, symptoms are improved dramatically shortly after medication is started. Two basic types of medication, stimulants and anti-depressants, are used to treat ADHD. Both types alter the balance of neurotransmitters in the brain, thereby allowing messages about concentration and