Attention Deficit Disorder: Diagnosis, Accommodation and Mastery
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Adult Attention Deficit Disorder
Diagnosis, Coping and Mastery
Glenn Brynes Ph.D., M.D.
and Carol Watkins, M.D.
Deficit Disorder was believed to be a condition that affected children and some
adolescents. Although it was known that children with AD/HD were more likely to
have difficulties in adulthood, clinicians usually diagnosed and treated these
as other conditions. During the past two decades, we have recognized attention
deficit disorder in older adolescents and adults.
diagnosis of Attention Deficit Disorder in adults can be a complex process. By
definition, AD/HD is a condition that has its onset in childhood. Not everyone
has an accurate recall of his or her early life. Often it is useful to get
information from relatives, spouse or old school records.
the child moves from adolescence to adulthood, the predominant symptoms of AD/HD
tend to shift from external, visible ones (such as physical hyperactivity) to
internal symptoms. There seems to be a decrease in observable symptoms of AD/HD
with age. Although a given adult may not meet the full DSM-IV criteria for full
AD/HD any longer, he or she may still experience significant impairment in
certain aspects of life. Depending of professional or domestic situation, the
adult may need to deal with more complex, abstract issues. A given
individual’s perception of his or her degree of impairment may vary.
adults were never correctly diagnosed, even when they were children. Sometimes
this was because their main symptoms were inattention and impulsivity rather
than physical hyperactivity. In other cases, the individual used his or her high
intelligence or great determination to mask the AD/HD symptoms. Often this
compensation occurred at great emotional cost Many high-functioning individuals
with AD/HD may harbor feelings of poor self-worth. They may see themselves as
failures and feel that they constantly let others down. Over the years,
the individual adapts to the situation. These adaptations, positive or negative,
become part of one’s personality, layered over the AD/HD symptoms.
with AD/HD are often bored with tedious, repetitive tasks. They may also trouble
with planning and organization. Procrastination is common. Impulsivity may lead
to frequent job changes, troubled romantic relationships, financial problems and
a tendency to interrupt others. College students may have trouble staying
focused on paperwork or lectures. The AD/HD adult often becomes frustrated or
angry rapidly, but may cool off equally quickly. He or she is then left
wondering why everyone else is still upset at the blow up. Because of
difficulties following through on commitments, the individual is often called
selfish and immature.
is no magic cure for AD/HD, but many adults learn to manage it successfully.
Treatment is often multi-modal. The most important starting point is an accurate
diagnosis of the AD/HD and any associated medical and psychiatric conditions.
Following the diagnosis, the individual should educate himself about the
condition. Self-knowledge is necessary in order to learn coping and develop
mastery. Adults often respond to the same medications
used to treat AD/HD children. However, one may need to consider the adult’s
size, and associated medical conditions and his or her other medications.
medications are expanding our ability to treat AD/HD with fewer side
involves teaching the adult to structure his or her life, while allowing for
some spontaneity. Time management and planning are important skills. Daily
planners and task lists are beneficial. Often the individual can enlist the help
of family or coworkers to help him stay organized. It is important that the
adult with AD/HD chose a vocation that suits his or her interests and
personality style. It is often best to avoid jobs that emphasize weaknesses such
as repetitive tasks, and find jobs that focus on one’s energy, and ability to
shift from task to task. Individuals who experience physical restlessness should
try to schedule regular exercise or work breaks. College students who need
accommodations need to inform their school early, before problems arise.
Examples of accommodations include untimed tests, the use of tape recorders in
lectures or the right to take attests in a less distracting setting. Schools
often require psychological testing to support special accommodations.
has been increasing awareness that adults and children with AD/HD are at
increased risk for other psychiatric disorders. Adults have lived longer than
children, and thus have had more time to develop
other associated psychiatric disorders. Often one must treat the other
conditions before treating the AD/HD.
AD/HD can be a burden for some, it can also be a gift. If it were an entirely
negative trait, it would have died out thousands of years ago. Individuals with
AD/HD are often energetic, creative and willing to take risks. Often this gift
comes into focus after the individual acquires a degree of self-knowledge and
learns to channel his energy and creativity.
County Psychiatric Associates
Offices in Monkton and Lutherville,