Various longitudinal follow-up studies have shown that up to 40-60% of children suffering from ADHD have persistent symptoms and impairment in adulthood too. Brain imaging, neurocognitive, pharmacologic and genetic studies in adults with ADHD have virtually replicated the findings demonstrated in children with ADHD. Increased public awareness and treatment studies within the last decade have led to widespread acceptance of the need for diagnosis and treatment of adults with ADHD.
The etiology of adult ADHD is same as that of childhood ADHD and is believed to be largely transmitted genetically and thus to run in families. Research studies are ongoing to identify the risk genes which may lead to ADHD and also to study the link of ADHD with brain chemistry especially the catecholamine neurotransmitters - norepinephrine and dopamine which regulate the individual's activity, impulsivity and attention. Also the differences in brain structure and function of brain parts that affect impulse and attention are seen in those suffering from ADHD. ADHD may also result from early brain injury, head trauma and or other developmental delay due to prenatal exposure to alcohol, cigarette smoke, other harmful drugs, premature/preterm birth, high serum lead levels or certain birth complications. Also those with epilepsy are at a higher risk for ADHD.
The common symptoms of ADHD in adults include motor hyperactivity leading to restlessness, difficulty in relaxing, excessive nervousness, difficulty in settling down, inability to continue in any of the activities like watching TV or reading the newspaper. When inactive, they tend to be dysphoric.
They may also have attention deficits leading to easy distractibility, inability to concentrate on any ongoing conversations, inability to filter out outside/extraneous stimuli, difficulty in maintaining attention on reading or tasks causing repeated forgetfulness, often misplacing or losing things, forgetting plans, appointments, purse, car keys etc.
Their impulsivity may lead to minor manifestations like interrupting others conversations or impatience like while driving. The major manifestations may include poor occupational performance, abrupt initiation as well as rapid termination of relationships and so multiple marriages and separations, an excessive involvement in the pleasurable activities without identifying risks of harmful after-effects like foolish business investments, making quick and easy decisions without reflection, often based on insufficient information and to their disadvantage, reckless driving or impulsive buying. They may have a lack of organizational ability and this affects their performance on the job or in running a household.
Due to their emotional over-reactivity, they cannot handle ordinary stress easily and thus react to it excessively or inappropriately with depression, uncertainty, confusion, anger or anxiety. All these symptoms lead to secondary depressive disorder associated with low self-esteem related to their impaired performance and which affects both, their occupational and social functioning.
The treatment for adult ADHD requires a multi-pronged approach. Mainly a combination of medications and behavioral treatments is often required. Various stimulant medications which have proved useful in ADHD include methylphenidate, amphetamine and amphetamine salts. Non-stimulant medication like atomoxetine have also shown good results in managing ADHD. Various psychological interventions and cognitive behavior therapy has also seemed useful for such patients. Various behavioral treatments like stress management skills and different relaxation techniques may help to reduce stress, anxiety and secondary depression. Behavioral coaching for teaching the individual with strategies to organize home and work activities as well as mentoring or job coaching for improving job performance and supporting better working relationships. Organizing one's self and activities by maintaining a diary, controlling the impulsive behavior by counting till 10 along with slow breathing and try to minimize one's distractions can help further in life to avoid any chaos.
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