Adults have lived
longer than children, and thus have had more time to develop other psychiatric
disorders. In children with AD/HD, the existence of a comorbid condition is
correlated with greater likelihood that the symptoms will persist into
adulthood. As the child moves from adolescence to adulthood, the predominant
symptoms of AD/HD tend to shift from external, visible ones to the internal
symptoms. There seems to be a
decrease in observable symptoms of AD/HD with age. Although a given adult may
not meet DSM-IV criteria for full AD/HD any longer, he or she may still
experience impairment in certain aspects of life. The individual’s perception
of his or her degree of impairment can vary. Depending on occupation or domestic
situation, the adult may need to deal with higher-level issues that involve
executive function.
There has been
increasing awareness that many adults and children with AD/HD may also meet
criteria for one or more other psychiatric diagnoses. (Comorbidity means having
two or more diagnosable conditions at the same time) There is some evidence that
the incidence of comorbidity is somewhat higher in adults than in children.
However, many of the studies looking at the issue of comorbidity are difficult
to compare. Studies used different criteria for AD/HD and bipolar disorder, and
sometimes got their subjects from different populations. For example, one might
expect to see more complex types of AD/HD in specialized hospital clinics than
one would see in a door-to-door survey or in a primary care physician’s
office. Despite the differing criteria across studies, and the lack of large
general population studies of adult AD/HD, there still convincing data that
several other psychiatric diagnoses are common among adults with AD/HD.
Substance
Abuse: (Abuse of or
addiction to alcohol or drugs) Adult attention deficit disorder seems to be
related to earlier onset of substance abuse, a longer period of active abuse,
and a lower rate of recovery. (Wilens, Biederman and Mick, Am J Addict 1998)
The risk of substance abuse (in an adolescent prospective study) may be higher
if the individual has conduct disorder in addition to the AD/HD. Conduct
Disorder is a persistent pattern of violating rules, laws and the rights of
others. (Milberger, Biederman,
Faraone, Wilens, Chu, Am J Addict 1997) A study by Biederman et al (Am J
Psychiatry 1995) suggested found that 52% of adults (versus 27% of controls)
with AD/HD met criteria for substance abuse. Other studies have found slightly
lower but still significantly elevated rates of abuse and addiction in AD/HD
adults. AD/HD by itself increased the chance of substance abuse, but if the
AD/HD were combined with another disorder such as Antisocial Personality
Disorder, Anxiety, Depression or Bipolar Disorder, the rates increased further.
It is possible that adults have the higher rate of substance abuse because their
AD/HD might not have been treated when they were children. A recent study in Pediatrics
showed that AD/HD children and adolescents treated with stimulant medication
were less likely to develop later problems with drugs or alcohol.
Antisocial
Personality Disorder: This is a personality style characterized by a tendency to violate the rights
of others, to flout societal rules, and to lack remorse for misdeeds. About
18-25% of AD/HD 25-year-olds studied were found to have this disorder. Only 2%
of the general population has Antisocial Personality Disorder (ASPD.) Children
who have AD/HD accompanied with aggressive destructive tendencies seem to be the
ones most likely to develop adult ASPD. AD/HD children lacking those tendencies
do not seem to have a greatly increased risk of developing ASPD. The individuals
with AD/HD and ASPD may end up in the penal system. An impulsive individual
might be more likely to get caught than one who plans his criminal activity more
carefully.
Learning
Disabilities are present in
Adults as well as children. Often they are less evident when an individual
leaves school and finds a career that matches his or her strengths and
weaknesses. However, some individuals continue to experience the effects of
learning disabilities in college and at work. When an individual has a learning
disability, he or she may have a vague sense of shame because it seems that he
or she is not able to perform certain tasks ash well as others.
Mood
disorders: Mood Disorders include Major Depression, Dysthymia (Chronic low-level
depression) and Bipolar Disorder (Manic Depressive Disorder.) These are present
in many individuals with AD/HD. Usually, depression starts later than the first
onset of the AD/HD. There has been some debate about the incidence of Bipolar
Disorder in individuals with AD/HD. Some might say that rapid mood shifts and
frequent irritability are characteristics of AD/HD. Others diagnose a rapid
cycling mood disorder. Recurrent major depression is more common in adults with
ADHD than in non-ADHD adults. However, one must also be aware that depression
can be a side effect of stimulants and several other medications. Because
stimulants have been known to exacerbate depression and mania, one should
usually treat the mood disorder before treating the AD/HD.
Diagnosing AD/HD
in adults can be quite complicated. In order to meet criteria for the diagnosis,
one should have evidence of symptoms dating back to age seven. It may be
difficult for some individuals to give an accurate, unbiased history of these
early events. Often it is useful to get outside corroboration on childhood
behavior. The high incidence of comorbid disorders also complicates the picture.
Inattention itself is a fairly non-specific finding. Even when the diagnosis of
AD/HD is clear, one must be alert for other disorders. One study found that only
12% of adults referred to their clinic had pure AD/HD without any other major
psychiatric diagnoses.
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Collection of Reviewed Links to Other ADHD Web Sites
Strattera: Where should it fit in with AD/HD treatment?
Girls with AD/HD
Women
with Attention Deficit Disorder: How ADD can affect your home.
Adult Attention Deficit Disorder:
Diagnosis, Accommodation and Mastery
Gifted Student with ADD: Between Two Worlds
Adult
ADHD: It Rarely Travels Alone
Stimulant
Medications for Children and Adults
Non-Stimulant
Medication for Children and Adolescents
New Medications for Adults with AD/HD
the Basics
When a Grandchild Has ADHD
Helping Your
Child Succeed in School
Coping Styles in ADD
Adults
Women and Attention Deficit Disorder
Practical
Hints for Raising and Educating an ADHD Child
Taking
Your ADD To College
the Adult with ADHD
Neurobiological
Diagnosis and Personal Responsibility: How Does Morality Fit in with ADD?
Gifted
Women
How Computers Can Help Individuals
with ADD
Book Reviews: Attention Deficit Hyperactivity
Disorder
slides from our presentation on AD/HD in Adults
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