Adult attention-deficit disorder
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:''This article is intended to focus on the condition in adults. See also main article, [[Attention-deficit hyperactivity disorder]].''
Although the exact prevalence of ADHD is unknown, studies thus far reveal that the condition, marked by inattentiveness, difficulty getting work done, [[procrastination]], and/or organization problems, according to epidemiological data, involves approximately 3% to 5%<ref>[http://www.additudemag.com/adhd/article/688.html How Many People Have ADHD?], <i>ADDitude</i> magazine, 2007</ref> of the U.S. population. It usually persists throughout a person's lifetime; approximately one-half to two-thirds of children with ADHD will continue to have significant problems with ADHD symptoms and behaviors as adults, which impacts their lives on the job, within the family, and in social relationships.
<ref>[http://www.add.org/articles/factsheet.html Fact Sheet On Attention Deficit Hyperactivity Disorder (Adhd/Add)<!-- Bot generated title -->]</ref>
The conditions present in adulthood follow the same diagnostic criteria as ADHD in children. The neurological basis of ADHD is a lifelong condition. The prevalence in adults as a clinical disorder is difficult to gauge because individuals differ in their level of affliction. Those who seek treatment as children, and others, over time, may develop [[coping skill]]s which make the disorder less noticeable; indeed, if the underlying conditions do not cause functional problems in their lives, they may no longer meet the diagnostic criteria at all. However, those whose symptoms continue to significantly negatively affect their functioning in adulthood can be labeled as having the adult version of ADHD. Although the disorder may not have been diagnosed in an individual during childhood, for adults to be diagnosed, the criteria require that they must have had symptoms in childhood.
"Adult ADD" or AADD are alternate terms commonly used to describe the neurological disorder [[attention-deficit hyperactivity disorder]] (ADHD) when it occurs in [[adult]]s. Clinically speaking, ADD and ADHD constitute a single disorder. The ADHD label was an update to the overall syndrome in the DSM-IV (the [[Diagnostic and Statistical Manual of Mental Disorders]], Fourth Edition); ADD (Attention-Deficit Disorder) with or without hyperactivity is the older term from the DSM-IIIR. <ref>[http://www.adhd.com/adults/adults_whatis_add.jsp What is Adult ADD?<!-- Bot generated title -->]</ref> '''Approximately one-third of people with ADHD do not have the hyperactive or overactive behavior component.''' This leads to some preference for using the ADD and AADD terminology when describing individuals lacking the hyperactivity component, and some clinical professionals believe Adult ADD should be categorized as a separate condition, even though it may have arisen from a childhood ADHD diagnosis.
AADD (aka ADHD in adults) is recognized as a disability under U.S. federal legislation including the [[Rehabilitation Act of 1973]] and the [[Americans With Disabilities Act]] (ADA). Appropriate and reasonable accommodations are sometimes made in the workplace for adults with ADHD, which help the individual to work more efficiently and productively. <ref>[http://www.add.org/articles/factsheet.html Fact Sheet On Attention Deficit Hyperactivity Disorder (Adhd/Add)<!-- Bot generated title -->]</ref>
== History ==
In the 1970s researchers began to realize that the condition now known as ADHD did not always disappear in adolescence, as was once thought. At about the same time, some of the symptoms were also noted in many parents of the children under treatment. The condition was formally recognized as afflicting adults in 1978. Current research indicates that up to 60% of children with ADHD carry their symptoms into adulthood. <ref>[http://www.adhd.com/adults/adults_whatis_add.jsp What is Adult ADD?<!-- Bot generated title -->]</ref>
==Prevalence==
In the context of the [[World Health Organization]] World Mental Health Survey Initiative, researchers screened more than 11 thousand people aged 18-44 years in ten countries in [[the Americas]], [[Europe]] and the [[Middle East]]. On this basis they estimated adult ADHD prevalence to average 3.5% with a range of 1.2% to 7.3%, with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). They said that adult ADHD often co-occurs with other disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for the co-occurring disorders.<ref>Fayyad J., De Graaf R., Kessler R., Alonso J., Angermeyer M., Demyttenaere K., De Girolamo G., Haro J.M., Karam E.G., Lara C., Lepine J.-P., Ormel J., Posada-Villa J., Zaslavsky A.M., Jin R., "Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder"
''[[British Journal of Psychiatry]]'' 190, May 2007, pp402-409</ref>
== Symptoms ==
ADD and ADHD are somewhat difficult to diagnose as symptoms can be present in adults, as well as children, in at least 16 different ways.
In the book ''Driven To Distraction''<ref>Hallowell, Edward M, and Ratey, John J. ''Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood''</ref>, Edward M. Hallowell described an experience of the "hyperactive" aspect of the ADHD disorder from a patient's perspective:
<blockquote>...It's like being super-charged all the time. You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sorts of impolite words that miss the point completely. Because you're trying really hard. It's just that you have all these invisible vectors pulling you this way and that, which makes it really hard to stay on task. Brain feels "cluttered", or sometimes light in weight (slightly light-headed). Sometimes difficult to sleep.</blockquote>
Many people express that they feel this way in their lives, but that does not necessarily mean that the person has ADD or ADHD. It is important to be tested if you choose to seek treatment. It is also important to note that ADD and ADHD are not the same thing. ADD stands for "Attention Deficit Disorder". ADHD stands for "Attention Deficit Hyperactivity Disorder". ADD can be likened a bit more to inattention, without the hyperactivity. The people typically diagnosed with it are not hyperactive at all. They typically miss important information, have papers everywhere and are unable to keep things tidy, but many of them are very calm and less hyperactive than those with ADHD.{{Fact|date=May 2007}} (Actually, ADHD is the official [[DSM-IV]] umbrella term for what are commonly known as ADD and ADHD, grouping both subtypes into one more general condition.)
The combined subtype of ADHD is characterized by symptoms of inattention, impulsivity, and hyperactivity with childhood onset, although the condition may not have been diagnosed in childhood. Hyperactivity symptoms tend to be less noticeable in adults than in children. Some adults do not exhibit hyperactivity/inattentiveness and, rarely, adults exhibit only hyperactivity/impulsivity symptoms.
ADHD in adults can cause moderate to extreme difficulties in functioning at work, home, or school<ref>[http://www.fda.gov/fdac/features/2004/604_adhd.html ADHD: Not Just for Kids Anymore<!-- Bot generated title -->]</ref>. In adults the problem can manifest as an inability to structure their lives and plan simple daily tasks. ADD/ADHD can also lead to loss of relationships, job hopping, or difficulty with people or work. The difficulty is not due to the ADD person's direct behaviour, but usually more due to the simple things that the ADD person will miss, especially when an adult of their age or experience should catch onto or know.
Generally, symptoms may manifest themselves differently in adults than in children.<ref>[http://findarticles.com/p/articles/mi_pric/is_200112/ai_1545187408 Adults with Attention Deficit Hyperactivity Disorder (ADHD) | ERIC Educational Reports | Find Articles at BNET.com<!-- Bot generated title -->]</ref> Adults with hyperactive-impulsive symptoms feel extremely driven, sometimes restless. To calm themselves down, they tend to stay constantly on the go and attempt to do but usually fail to complete multiple tasks at once. They are often perceived as not thinking before they act or speak. Generally, the biggest problem is developing self-regulation. The mechanism for self-regulation is delayed or deficient in people with ADD or ADHD. <ref>[http://findarticles.com/p/articles/mi_m1249/is_1_72/ai_53889667 Toward an understanding of ADHD: a developmental delay in self-control]</ref> This is what is treated medically in the ADD/ADHD person. This lack of self-understanding and what looks like a lack of control affects an adult's ability not just to do tasks, but to determine when and how they need to be done, as well as how other people perceive them. <ref>[http://www.fda.gov/fdac/features/2004/604_adhd.html ADHD: Not Just for Kids Anymore<!-- Bot generated title -->]</ref>
Symptoms of ADHD can vary widely between individuals and throughout the lifetime of an individual. The most prominent characteristic in ADHD often is difficulty with the brain activity known as executive functioning, which oversees the ability to monitor a person's own behaviour by planning and organizing. Other symptoms include inattention, impulsivity, and restlessness as well as frequently accompanying behavioral problems and learning disabilities. Growing up with all these deficits often leads to emotional problems.
The Hallowell Center identifies the following indicators to consider when ADHD is suspected and recommends that individuals with at least twelve of the following behaviours since childhood—provided these symptoms are not associated with any other medical or psychiatric conditions—consider professional diagnosis<ref>[http://www.drhallowell.com/resources/articles/diagnostic_adults.html Article: Suggested Diagnostic Criteria for AD/HD in Adults<!-- Bot generated title -->]</ref>:
#A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).
#Difficulty getting organized.
#Chronic procrastination or trouble getting started.
#Many projects going simultaneously; trouble with follow through.
#A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
#A frequent search for high stimulation.
#An intolerance of boredom.
#Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
#Often creative, intuitive, highly intelligent
#Trouble in going through established channels and following proper procedure.
#Impatient; low tolerance of frustration.
#Impulsive, either verbally or in action, as an impulsive spending of money.
#Changing plans, enacting new schemes or career plans and the like; hot-tempered.
#A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
#A sense of insecurity.
#Mood swings, mood lability, especially when disengaged from a person or a project.
#Physical or cognitive restlessness.
#A tendency toward addictive behavior.
#Chronic problems with self-esteem.
#Inaccurate self-observation.
#Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.
== Diagnosis ==
{{Main|Attention-deficit hyperactivity disorder#Diagnosis}}
The diagnostic criteria for ADHD in adults are identical to those for children. It is important to note that adult diagnosis requires establishing whether the symptoms were also present in childhood, even if not previously recognized. [http://www.mja.com.au/public/issues/171_8_181099/trollor/trollor.html] Diagnosis must also exclude other medical or psychiatric causes of symptoms. The diagnostic criteria<ref>[http://www.behavenet.com/capsules/disorders/adhd.htm BehaveNet Clinical Capsule: Attention-Deficit/Hyperactivity Disorder<!-- Bot generated title -->]</ref> require multiple symptoms observed in multiple settings (school, home, work, etc.) within the preceding 6 months.
Assessment of adult patients seeking a possible diagnosis can be better than in children due to the adult's greater ability to provide their own history, input, and insight. The therapeutic process may also see more benefit in behavioral solutions because they can be designed more collaboratively with mature individuals.
BUPA says: “Aggressive or disobedient behavior can get worse if ADHD is left untreated, so early diagnosis and management is important”{{Fact|date=May 2007}}
== Treatment ==
{{main|Attention-deficit hyperactivity disorder treatments}}
Generally, treatments that have proved effective for children have been observed to work equally well or better in adults with a similar diagnosis. Studies show that adult ADD/ADHD is treated successfully with a combination of medication and behavior therapy.<ref>[http://www.additudemag.com/adhd/article/815.html You've Got Adult ADD… Now What?], <I>ADDitude</i> magazine, 2007</ref>
== Controversy ==
{{main|Controversy about ADHD}}
==See also==
* [[Attention-deficit hyperactivity disorder]] for main article
* [[ADHD predominantly inattentive]]
* [[Controversy about ADHD]]
* [[Attention]]
From the "Born to Explore" website, examples of studies that show the link between nutrition and ADD:
A 1994 study at Purdue University found that boys diagnosed with ADHD had lower levels of the omega-3 essential fatty acid DHA (American Journal of Clinical Nutrition)
1997 study found that 95% of ADHD children tested were deficient in magnesium (Magnesium Research, 1997,10)
A 1996 study found that ADHD children had zinc levels that were only 2/3 the level of those without ADHD (Biological Psychiatry 40, 1996)
==References==
{{reflist|2}}
==Further reading==
*Amen, Dr. Daniel G., ''Healing ADD: The Breakthrough Program That Allows You to See and Heal the Six Types of ADD''
*Doyle, Dr. Brian B, <em>Understanding and Treating Adults with Attention Deficit Hyperactivity Disorder</em>
*[[Edward Hallowell (psychiatrist)|Hallowell, Edward M]], and Ratey, John J., ''Answers to Distraction''
*Hartmann, Thom, ''Attention Deficit Disorder: A New Perspective''
*Hersey, Jane, ''Why Can't My Child Behave?''
*Lawlis, Frank, ''The ADD Answer''
*Matlen, Terry. (2005) "Survival Tips for Women with AD/HD". ISBN 1886941599
*Solden, Sari, ''Women with Attention Deficit Disorder''
*Mate, Dr. Gabor, "Scattered Minds"
*Brown, Dr Thomas E. "Attention Deficit Disorder: The Unfocused Mind in Children and Adults", Yale University Press, Sep 2005.
==External links==
*[http://www.nimh.nih.gov/publicat/adhd.cfm National Institute for Mental Health official website]
*[http://www.nmha.org/go/information/get-info/ad/hd/ad/hd-and-adults National Mental Health association, AADD webspage]
*[http://www.add.org/ National Attention Deficit Disorder Association]
*[http://www.chadd.org CHADD] Support groups, national education devoted to helping and supporting people with ADD and ADHD
*[http://www.livingwithadd.org/ Living with ADD/ADHD]
*[http://www.add.org.au/ ADDults with ADHD (Australian)]
*[http://video.yourtotalhealth.ivillage.com/player/?id=259833&ice=th%7Cvid_tout%7C1 [[Today (NBC program)|Today Show]] segment on adult ADHD, June 5, 2008]
*[http://www.aadd.org.uk www.aadd.org.uk] Adults with Attention Deficit Disorder UK
[[Category:Attention disorders]]
[[Category:Mental illness diagnosis by DSM and ICD]]
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