Attention Deficit Hyperactivity Disorder (ADHD), Also In Adults
He ADHD is a behavioral syndrome which affects, according to estimates, between 5% and 10% of the child and adolescent population. The key that is currently used to understand the wide spectrum of manifestations that characterize individuals with ADHD is the concept of deficit in inhibitory response control.
That is, the notorious inability to inhibit impulses and thoughts that interfere with executive functions, the performance of which allows us to overcome distractions, set goals, and plan the sequences of steps necessary to achieve them.
Now, this psychological alteration is often talked about as if it were only a child’s thing. Is that so? Does ADHD exist in adults? As we will see, the answer is yes.
For more than 70 years, research into attention deficit hyperactivity disorder has focused on children. But starting in 1976, it was shown that this disorder can exist in 60% of adults, the symptoms of which already began before the age of seven (Werder PH. te. 2001). This diagnostic gap meant that the symptoms and treatments of childhood and adolescent ADHD were better known and more targeted than in adults, despite the fact that the clinical parameters were similar. Besides, in adults, complications, risks and comorbidities are more common and nuanced than in children, with the risk that the symptoms are confused with another psychiatric condition. (Ramos-Quiroga YA. te. 2006).
A common biological origin allows adults to be diagnosed with the same criteria adapted from the DSM-IV-TR, but due to the fact that in the adult the observer is only one, diagnostic difficulties are encountered, since it facilitates a greater dispersion and bias in the opinions.
Although less epistemological data is available in adults, ADHD manifests itself with great frequency in adults. The first works found prevalence in adults between 4 and 5%. (Murphy K, Barkley RA, 1996 and Faraone et. al., 2004)
Symptoms, diagnosis and evaluation of ADHD in adults
The diagnostic criteria for ADHD in adults are the same as those for children, recorded at DSM-IV-TR. Since the DSM-III-R, the possibility of making the diagnosis of these is formally described.
Signs and symptoms in adults are subjective and subtle, with no biomedical test that can confirm the diagnosis. In order to diagnose ADHD in an adult, the disorder must have been present since childhood, at least from the age of seven, which is essential for the diagnosis, and a clinically significant alteration or deterioration must persist in more than one area. important part of their activity, such as social, work, academic or family functioning. Therefore, it is very important that the childhood history be noted in the medical history along with the current symptoms and their repercussions on current life, family, work and social relationships.
Adults with ADHD mainly report symptoms of inattention and impulsivity, since symptoms of hyperactivity decrease with age. Likewise, symptoms of hyperactivity in adults tend to have a slightly different clinical expression from those found in children (Wilens TE, Dodson W, 2004) since it manifests as a subjective feeling of restlessness.
The most common problems of attention deficit hyperactivity disorder in adults are the following: problems concentrating, lack of memory and poor short-term memory, difficulty organizing, problems with routines, lack of self-disciplineimpulsive behavior, depression, low self-esteem, inner restlessness, poor ability to manage time, impatience and frustration, poor social skills and the feeling of not achieving goals, among others.
Self-assessment stairs are a good diagnostic tool for the most general symptoms (Adler LA, Cohen J. 2003):
Adult Self-Assessment Scale (AAS): (McCann B. 2004) can be used as a first self-assessment tool to identify adults who may have ADHD. Copeland Symptom Checklist: Helps assess whether an adult has characteristic symptoms of ADHD. Brown Attention Deficit Disorder Scale: explores executive functioning aspects of cognition that are associated with ADHD. Wender-Reimherr Adult Attention Deficit Disorder Scale: measures the severity of symptoms in adults with ADHD. It is especially useful for assessing ADHD mood and lability. Conners’ Adult ADHD Rating Scale (CAARS): Symptoms are assessed with a combination of frequency and severity.
According to Murphy and Gordon (1998), to carry out a good evaluation of ADHD, one must take into account whether there is evidence on the relationship between ADHD symptoms during childhood and a significant and chronic subsequent deterioration in different areas, if there is a relationship between the current ADHD symptoms and a substantial and conscious deterioration in different areas, if there is another pathology that justifies the clinical picture better than ADHD, and finally, if for patients who meet the diagnostic criteria for ADHD, there is any evidence that there are comorbid conditions.
The diagnostic procedure is guided by guidelines for performing diagnostic tests according to the clinical situation. This procedure begins with a complete medical history including a neurological examination. The diagnosis has to be clinical, supported by the self-assessment ladders, discussed above. It is essential to evaluate psychiatric conditions, rule out possible comorbidities and certain medical conditions such as hypertension, and rule out substance abuse.
As Biederman and Faraone (2005) very well highlight, in order to make a diagnosis of ADHD in adults, it is essential to know which symptoms are typical of the disorder and which are due to another comorbid pathology.
It is very important to keep in mind that comorbidity in adult ADHD is quite common (Kessler RC, at al. 2006). The most common comorbidities are mood disorders such as major depression, dysthymia or bipolar disorder, which has a comorbidity with ADHD ranging from 19 to 37%. For anxiety disorders, comorbidity ranges between 25 and 50%. In the case of alcohol abuse it is 32 to 53% and in other types of substance abuse such as cocaine it is 8 to 32%. The incidence rate for personality disorders is 10 to 20% and for antisocial behavior is 18 to 28% (Barkley RA, Murphy KR. 1998).
Pharmacological treatment
The drugs used to treat this disorder are the same as in childhood. Of the different psychostimulant drugs, methylphenidate and atomoxetine have been shown to be effective in adults with ADHD.
Immediate-release methylphenidate inhibits dopamine release; and atomoxetine, its main function is to inhibit the collection of norepinephrine. Currently, and thanks to several studies carried out by Faraone (2004), methylphenidate is known to be more effective than placebo.
The explanatory hypothesis from which ADHD therapy based on psychostimulants such as methylphenidate is based is that this psychological disorder is caused (at least in part) by a constant need to keep the nervous system more activated than it is by default, which It results in the repetitive search for external stimuli with which to engage in activities. Thus, methylphenidate and other similar medications would activate the nervous system so that the person is not tempted to look externally for a source of stimulation.
Non-stimulant drugs for the treatment of ADHD in adults include tricyclic antidepressants, amino oxidase inhibitors, and nicotinic drugs, among others.
Psychological treatment
Despite the high effectiveness of psychotropic drugs, on certain occasions it is not enough when it comes to managing other factors, such as disruptive cognitions and behaviors or other comorbid disorders. (Murphy K. 2005).
Psychoeducational interventions help ensure that the patient obtains knowledge about ADHD that allows him not only to be aware of the interference of the disorder in his daily life, but also for the subject himself to detect his difficulties and define his own therapeutic objectives (Monastra VJ , 2005). These interventions can be carried out in an individual or group format.
The most effective approach to treating ADHD in adults is the cognitive-behavioral approach.both in an individual and group intervention (Brown, 2000; McDermott, 2000; Young, 2002). This type of intervention improves depressive and anxious symptoms. Patients receiving cognitive behavioral therapy along with their medications managed persistent symptoms better than using medications combined with relaxation exercises.
Psychological treatments can help the patient cope with the associated emotional, cognitive and behavioral problems, as well as better control of symptoms refractory to pharmacological treatment. For this reason, multimodal treatments are considered to be the indicated therapeutic strategy (Young S. 2002).
