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Attention Deficit Disorder in Adults: 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.

In

the past,

Attention

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.

The

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.

As

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.

Many

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.

Adults

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.

There

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.

New

medications are expanding our ability to treat AD/HD with fewer side

effects.

Treatment often

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.

There

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.

While

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.    

Northern

County Psychiatric Associates

Offices in Monkton and Lutherville,

Maryland