Adult attention deficit hyperactivity disorder

Adult attention deficit hyperactivity disorder (adult ADHD) is ADHD that persists into adulthood. It is a neurodevelopmental disorder, meaning impairing symptoms must have been present in childhood, except for when ADHD occurs after traumatic brain injury. According to the DSM-5 diagnostic criteria, multiple symptoms should have been present before the age of 12. This represents a change from the DSM-IV, which required symptom onset before the age of 7. This was implemented to add flexibility in the diagnosis of adults. ADHD was previously thought to be a childhood disorder that improved with age, but later research challenged this theory. Approximately two-thirds of children with ADHD continue to experience impairing symptoms into adulthood, with symptoms ranging from minor inconveniences to impairments in daily functioning, and up to one-third continue to meet the full diagnostic criteria.

This new insight on ADHD is further reflected in the DSM-5, which lists ADHD as a disorder and has distinct requirements for children and adults. Per DSM-5 criteria, children must display "six or more symptoms in either the inattentive or hyperactive-impulsive domain, or both," for the diagnosis of ADHD. Hyperactivity begins decreasing in adolescence. Inattention is more common than hyperactivity, manifesting as difficulty starting and completing tasks, forgetfulness, a lack of persistence, disorganization, and excessive tardiness.

ADHD can be diagnosed only by licensed clinicians. Diagnosis is made clinically, via a comprehensive, structured interview whose purpose is to get full history of the individual's current and childhood symptoms and their negative impact on daily functioning. A complete medical history should also be obtained, because the rates of coexistent conditions (comorbidities) with ADHD are high. Supplemental history from people close to the individual in different settings, such as parents, siblings, romantic partners, teachers, coworkers, and employers, can support a diagnosis. Individuals with a first-degree relative with ADHD demonstrate a risk of ADHD 4-5 times higher than the general population rate and have prevalence rates of around 20%. 34% of adults with ADHD meet criteria for the combined presentation (ADHD-C), and 21% of adults with ADHD meet criteria for the predominantly hyperactive-impulsive presentation (ADHD-HI). Despite the increasing recognition among clinicians of emotion dysregulation as a prominent symptom of ADHD, especially among adults, it is not recognized in the DSM-5 as a core symptom of ADHD for diagnostic criteria.

ADHD cannot be diagnosed using symptom rating scales, neuropsychological assessments, or brain imaging in isolation. These tools may, however, be used to screen for the disorder, support a clinical diagnosis, or help quantify symptom severity and functional impairment.

DIVA-5-ID (adapted version for people with intellectual disability)

Barriers to diagnosis of ADHD in adults

Adults face many potential difficulties in obtaining a diagnosis of ADHD. The diagnosis is often missed in the clinical setting in adults as a result of insufficient knowledge among clinicians about ADHD in adults. The symptoms of these psychiatric disorders may mask the symptoms of ADHD and lead clinicians to consider these disorders over ADHD. Males demonstrate higher levels of symptom resolution in adulthood. According to Fritz in a 2016 study, adult men with ADHD may be able to focus better on mental tasks after completing some type of physical exertion. While males are more likely to display the commonly recognized disruptive behaviors of ADHD, especially in childhood, females typically display more subtle behaviors of hyperactivity-impulsivity and/or are more likely to fit the inattentive presentation, leading to delayed diagnosis in females.

Several lines of research based on structural and/or functional imaging techniques, stimulant drugs, and psychological interventions have identified alterations in the dopaminergic and adrenergic pathways of individuals with ADHD. In particular, areas of the prefrontal cortex appear to be the most affected. Dopamine and norepinephrine are neurotransmitters which play an important role in brain function. The uptake transporters for dopamine For adults, amphetamines in particular are the most efficacious medications, and they (along with methylphenidate) have the fewest adverse effects.

Bupropion and desipramine are two antidepressants that have demonstrated some evidence of effectiveness in the management of ADHD, particularly when there is comorbid major depression, This same review reported a global combined prevalence of ADHD of 10% in boys and 5% in girls. It estimated prevalence in older adults based on three different assessment methods: research diagnosis (based on DSM-validated scales), clinical diagnosis (based on clinical interview meeting DSM or ICD criteria), and treatment.

In the 1970s, researchers began to realize that the condition now known as ADHD did not always disappear in adolescence, as was once thought.

Society and culture

ADHD in adults, as with children, is recognized as an impairment that may constitute a disability under U.S. federal disability nondiscrimination laws, including such laws as the Rehabilitation Act of 1973 and the Americans With Disabilities Act (ADA, 2008 revision), if the disorder substantially limits one or more of an individual's major life activities. For adults whose ADHD does constitute a disability, workplaces have a duty to provide reasonable accommodations, and educational institutions have a duty to provide appropriate academic adjustments or modifications, to help the individual work more efficiently and productively.

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ru:Синдром дефицита внимания и гиперактивности#СДВГ у взрослых

Barriers to diagnosis of ADHD in adults

Society and culture

References

Further reading

External links