Adults with ADHD - Coursework Example

Adults with ADHD ADHD is most often diagnosed in children as the symptoms generally become evident in the early school years. Patients do return to mental health professionals as adult presenting with an earlier diagnoses of AD/HD. They may find that while the symptoms may look different in the adult years they are still just as frustrating and they want help dealing with them. There are also those individuals who believe they have always had AD/HD but have never been diagnosed that want help as adults as the consequences of the untreated symptoms maybe more severe in adulthood. Generally AD/HD is considered to be a lifelong disorder. It is currently believed that 2% to 4% of the adult population has AD/HD. Different diagnostic criterion is not available for different ages. There is no one test that shows definitively that an individual has AD/HD. AD/HD is a neurobiological condition that affects 3-7 percent of the population. The common symptoms are poor attention, restlessness and hyperactivity, impulsivity, saying or doing things without thinking. There is likely to be excessive or chronic procrastination, difficulty starting tasks and completing tasks, frequently losing things. Along with that you can expect to see poor organizational skills, inability to plan and the inability to manage time. These individuals may also be very forgetful (Goldstein and Ellison 2002). Diagnosis of Adult AD/HD There is no one test that can diagnose AD/HD. It must be diagnosed by a qualified mental health professional or a physician. Those individuals will need to gather information from multiple sources to make a diagnosis. Those sources include a detailed history of past behaviors and current functioning. A family medical history is also important as AD/HD does run in families. The diagnostician will also want symptoms checklists, and current functioning. Close family members or a spouse will also be asked for the same information about the patient. This is a condition that is ever present so one would expect to see evidence of past issues with the symptoms even though they may not have been diagnosed. There is no evidence that AD/HD first appears in adulthood. The symptoms are clearly listed in the American Psychiatric Association’s diagnostic manual. The diagnosis is determined based on the number and the severity of the symptoms found in all of the data collected from the patient and the family. The adult should be careful about using internet self rating scales as these are not scientifically proven for validity and/or reliability (Murphy and Gordan 2004). Comorbid Disorders It is also important to screen for comorbid diagnoses or other psychiatric disorders that may look like AD/HD. Research has shown it is common to have more than one disorder. The most common comorbid disorders with AD/HD are depression, anxiety disorders, learning disabilities and substance use disorders. These disorders can either mimic AD/HD or exist along with AD/HD. Failure to treat the co-existing disorders often leads to failure in treating the AD/HD (Brown 2004). Medical disorders must also be ruled out so a general medical physical is necessary if the patient has not had one recently. Occasionally other learning disabilities may also be considered (Brown 2004). Adaptive Functioning and Workplace Issues Adults with AD/HD face many challenges in the work place. The areas most affected by AD/HD are time management, attention and concentration, poor memory, organizational skills, problem solving abilities and environmental distractions. These are called executive function. Any or several of these is likely to be among the reasons an adult seeks professional help (Murphy & Grodon 2004). Behavioral Treatment There are behavioral protocols for what is called executive function. This is the Bbrain’s cognitive processes that regulate and manage learning activities and behavior. Since AD/HD adults have trouble with organization, sense of time and their working memory they will need to learn to supplement their executive functioning. One skill is learning to use a day planner. Writing everything in one place helps not only memory it can be properly organized by time and thereby manage time better as well. This is a skill that can be taught to the individual. Daily planners have been suggested to AD/HD students for a long time but they are often unsuccessful because training must go along with them. This process happens in steps so the individual learns one thing at a time and makes it a habit. Often coaches help with this process. The steps are: Find a planner that includes a calendar, space for a to do list, a space for phone numbers, addresses and reference information. Place in a single accessible space Enter basics in the planner Carry the planner all the time Refer to the planner daily Use the calendar for everything, personal and professional Use the planner as a brain dump to hold ideas Make a daily to do list (prioritize the list) Similar protocols are available for all of the executive functions causing the ADHD adult difficulty. Many therapists think the adaptive functioning and skill building is the most important for adults (Goldstein and Ellison 2002). Neuropsychology and Medication for the AD/HD Adult There is considerable research on the effectiveness of medication for children but very little on its effectiveness for adults. The most commonly used medication is stimulants. Several factors have been found to contribute to an adult’s response to stimulants. Adults appear to have greater success with higher doses of the medication. Early studies with adults showed stimulants as not effective with adults; when higher doses are given results have demonstrated the efficacy of the use of stimulants in 70% of adults trying the medication ( Murphy & Gordon, 2004). Since the availability of brain imaging, researchers have been able to look at the function of the brain and not just watch symptoms of the disorder. Brain imaging shows not only the structure of the brain but the processing of the brain. This imaging gives more information about the neurochemistry of the disorder. In ADHD the catecholamine-rich fronto-subcortical systems appear to malfunction. There seems to be a catecholamine disruption (Brown, 2000). The Journal of the American Medical Association (2002) reports that ADHD brains are 3-4% smaller that those of children who do not have the disorder. They have also ruled out medication as the cause of the smaller brains. Neuroimagine continues to be tested but is not yet definitive enough to be used as a diagnostic tool but it does imply this is indeed a neurological disorder that should be treatable to some degree with medication. Intelligence and Intellectual Functioning. Individuals with AD/HD have been shown to have the same range in IQ as the general public. They tend to have areas of greater deficit. The scales within the verbal portion and the performance portion of the IQ assessments tend to vary more than the average public. The time in which intellectual functioning becomes an issue with adults is in the transition into the college setting. Students should look for colleges that accommodate learning disabilities and students with AD/HD. There are guides to colleges which make these accommodations (Mangrum, & Strichart 2006). Conclusion It appears to this writer that an adult diagnosed with Ad/HD us indeed a legitimate diagnosis. Certainly if research show that AD/HD is a disorder that can not be cured but can be treated there must be adults with this order. There is evidence as to the efficacy of stimulant use with these adults and there are also behavioral programs that are effective. Diagnosis may use different language such are referring to behavior in the work place or relationships with a spouse rather than parents but the behaviors of difficulty are basically the same. Certainly these adults deserve our care as much as the children. This writer would also advocate for further research with adults so care and treatment can be approved. References American Academy of Pediatrics (2000). Clinical practice guidelines: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder. Journal of Pediatrics, 105, 1158-1170. Brown, T,E. (Ed.) (2004). Attention Deficit Disorders and Comorbidities in Children, Adolescents and Adults. Washington DC: American Psychiatric Press. Goldstein, S. & Ellison, A. (Eds.) (2002). Clinician’s Guide to Adult AD/HD: Assessment and Intervention. New York: Academic Press. Murphy, K.R. & Gordon, M. (2004). Assessment of Adults with AD/HD. In Barkley, R. (Ed.) Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. (pp345-369) New York: Guilford Press. Mangrum, C.T. & Strichart, S.S. (2006). Peterson’s Colleges With Programs for Students with Learning Disabilities or Attention Deficit Disorders, eighth edition. Retrieved August 13, 2007 from www.peterson.com. Read More