Counseling Services of Barbara Reade, L.C.P.C.
Bel Air, Maryland 21014

Phone: 410-803-1510

Email: reade.lcpc@yahoo.com

ADHD and ADD in Adults

 Here is a list of symptoms seen in Adult ADHD:

Hyperactivity- Fidgeting and restlessness are frequent if not constant; patients report high levels of nervousness; they are not able to stay sitting at their desks or at the dinner table or at a movie or in church.

Inattention- Concentration is very difficult. Distractibility also is a major symptom. Attention span is poor.

Mood lability- Both highs and lows ,feelings of boredom; and mood is instability is described.

Temper- Outbursts of temper are common and difficult to control.

Disorganization- Organizational activities are very difficult. This is evident at school, in running a household, in vocational function.

Stress sensitivity- feeling very "hassled" about daily existence.

Impulsivity- Patients report that they interrupt others while listening to them, that they cannot think before they speak, they have anger control difficulties, some report not being tolerant drivers, and some report that they have impulse buying problems, and they may find themselves having sexually compulsive behaviors.

(This is not a total list of behaviors that can occompany ADHD in adults, but it attempts to describe what many ADHD patients experience. Please do not try to diagnose yourself, seek the help of a trained mental health professional, to make sure there are not other factors causing your present prolbems or challenges.)

How many Adults tend to have ADHD?

1 percent and 6 percent of the general population, continue to manifest appreciable ADHD symptoms into adult life, after being diagnosed and treated before the age of 7. a well conducted study done of adults in their twenties showed that at age 26, only 11 percent continued to have full or partial ADHD symptoms (Mazzulla & colleagues, 1984, 1991, 1993).

Inheritance, Genetics, and ADHD

Two adoption studies (Cantwell 1975; Deutsch) investigated the psychiatric status of the biological parents of children with ADHD, the adoptive parents of children with ADHD and the biological parents of children without psychiatric disorder. They found an increased frequency of ADHD-like psychopathology only among the biological parents of ADHD children. Taken together these studies have demonstrated the presence of genetic factors in the transmission of ADHD and suggest that children with ADHD may be at an increased risk for antisocial personality disorder and alcohol abuse. (For fuller detail, see Wender 1995.) On the subject of "inhereditability," studies with identical twins have validated this phenomena, at a 64 percent correlation rate(Goodman and Stevenson,1989a,b). Initial family studies reported an increased frequency of alcohol abuse, antisocial personality disorder and, possibly, Briquet's syndrome in the biological parents of "hyperactive" children as compared to controls; and an increased frequency of "hyperactivity" in the siblings of hyperactive children (Cantwell 1972; Morrison and Stewart; Morrison; Biederman and others 1992; Faraone and others).

Differences Between ADHD Adults and Bi-Polar Disorder Adults

The ADHD and BPD patients seemingly share symptoms of impulsivity, affective instability, angry outbursts and feelings of boredom. These symptoms, however, differ both quantitatively and qualitatively between the two diagnostic groups. The ADHD patient's impulsivity is short-lived and is thoughtless rather than "driven." The ADHD patient's anger is episodic and also short-lived compared to the brooding anger of the BPD patient. The major differences between ADHD and BPD patients is that the former do not have the intense conflicted relationships, suicidal preoccupations, self-mutilation, identity disturbances or feelings of abandonment seen in BPD. However, these differences are not clear-cut in all instances and the medications that are useful in the treatment of ADHD might be of value in such individuals' symptoms when the latter are like those seen in ADHD.

Treatment

The most effective treatment of the ADHD adult involves education about the disorder, drug treatment and psychotherapy focused on ADHD concomitants. Although medication is the main factor in my treatment of adults with ADHD, education and psychological management play important roles.

Having made the diagnosis, I help patients to recognize the ADHD aspects of their current symptoms and behavior, and, as our relationship develops and my knowledge becomes more extensive, of the role ADHD personality characteristics have played in their life history, including academic and vocational experience, friendships, sexual relationships and functioning as a spouse and as a parent. ADHD symptomatology may be intimately woven into all these aspects of life; and it takes patients much time-during continuing treatment-to identify and understand ADHD contributions to their life story.

Through education patients can be helped to see that because they have had ADHD their entire lives, they may have developed techniques for dealing with their symptoms that are no longer adaptive after the ADHD symptoms have remitted. These symptoms may resolve spontaneously or they may require psychotherapeutic intervention. Supportive problem-directed reality therapy (administered by persons sometimes referred to as "coaches") can help with these problems. Obviously, having ADHD does not prevent one from having other psychological problems and these may be more apparent and therapeutically accessible when the symptoms of ADHD have remitted. Couple therapy, with direct behavioral prescriptions and proscriptions, may also be useful.
 
  A list of the changes in symptoms seen when treatment is effective:

Hyperactivity- Fidgeting and restlessness decrease; patients are able to relax; then are able to stay at their desks or at the dinner table or at a movie or in church.

Inattention- Concentration is greatly improved. It is not only that patients can concentrate better, they can concentrate when they want to. Distractibility diminishes or disappears. Attention to spousal conversation improves and frequently is quickly manifested in better marital relations.

Mood lability- Both highs and lows decrease as do feelings of boredom; mood is described as "level" or "stable."

Temper- The threshold for outbursts is raised. Patients are less irascible and their angry outbursts are less frequent, less extreme, and frequently disappear altogether.

Disorganization- Organizational activities become manifest. This is evident at school, in running a household, in vocational function. Patients may spontaneously establish orderly strategies.

Stress sensitivity- Patients describe themselves as having their thin skin thickened, able to take life problems in stride, feeling less "hassled" about daily existence.

Impulsivity- Patients report that they do not interrupt others while listening to them (another feature that improves conversations and relationships), that they think before they speak, that they have become tolerant drivers and that they stop impulse buying.

If these symptoms do not describe your symptoms click on the links above for information on psychiatric other disorders.