Attention deficit/hyperactivity disorder (ADHD) is a neuropsychiatric pathology with high prevalence estimates, both in the child and adolescent population and in adults, which causes important alterations in different vital areas.
Until a few decades ago, it was considered that the disorder did not manifest itself beyond adolescence, but that it remitted or led to other problems, such as personality disorders. It was from the 1960s onwards that studies appeared showing the persistence of symptoms in a significant proportion of adults diagnosed with ADHD during their early years, highlighting the chronicity of the disorder.
In fact, the scientific literature shows that two thirds of children with ADHD continue with symptoms of the disorder into adulthood, reaching a prevalence of between 3 and 5%.
How does an adult with ADHD think and act?
In relation to the clinical manifestations in adulthood, it should be noted that attentional problems and executive dysfunction are manifested by difficulty in getting organized, establishing priorities, structuring time and completing assigned projects or tasks.
Hyperactivity usually manifests as an inner sense of motor restlessness, difficulty sitting still or excessive body movement, particularly of the hands and feet. They also tend to talk excessively and in a high pitch.
Impulsive symptoms are those that, if they persist, generate serious social, family and even legal repercussions. Adults with this pathology show difficulty waiting their turn, respond hastily and interrupt others. In addition, they are more likely to prioritize immediate rewards over those delayed in time, so that thoughtless or impulsive decisions are frequent.
Finally, it should be noted that emotional instability and difficulties in temper control are other frequent symptoms in adult ADHD, although they are not included in the various diagnostic manuals.
Could ADHD in adults be “prevented” if it is detected as a child?
The prevalence of ADHD in children ranges between 4-12%. The scientific literature indicates that, of these, two thirds will continue with symptoms in adulthood: 15% will maintain the full diagnosis and 50% will be in partial remission.
Cognitive stimulation programs aimed at exercising attention and cognition in school-aged children with ADHD have shown structural and functional brain changes. In fact, several studies have shown improvements in measures of inhibitory response, sustained attention, working memory, executive functions and academic achievement, as well as in the core symptoms of ADHD.
The diagnosis of ADHD in adults
The diagnosis of adult ADHD is based on the patient’s medical history. To make an accurate assessment of adult ADHD, it is necessary to answer four essential questions:
1) Is there clinical evidence of the presence of ADHD symptoms in childhood, as well as clinically significant and chronic impairment in different domains?
2) Is there evidence about the relationship between current ADHD symptoms and substantial and consistent impairment in different domains?
3) Is there another psychiatric or medical disorder that further explains the symptomatology reported by the patient?
4) Are there other comorbid disorders that play a role in the pathology described?
To answer these questions more accurately, it is necessary to use diagnostic interviews, self-administered scales and hetero-administered scales. Most of them are based on the diagnostic criteria of the DSM-IV-TR, which is a diagnostic and statistical manual of mental disorders.
How is ADHD treated in adults?
According to the recommendations of the European Consensus of the European Network Adult ADHD, it is considered that treatment should be multimodal, combining pharmacological, psychological and psychosocial interventions.
Pharmacological treatment: methylphenidate shows high efficacy and safety in the treatment of adults, as well as amphetamines and non-stimulant treatments such as atomoxetine.
Psychological treatment: one of the most empirically supported models is that of Safren et al. (2010), which combines cognitive-behavioral and motivational techniques. It includes psychoeducation, where the patient is informed about the disorder, learning skills to reduce distraction, social skills, cognitive restructuring to develop adaptive thinking, and emotional self-regulation.
How to act if someone close to you has ADHD?
First of all, it is important to know in depth the disorder, its characteristics and repercussions in patients who suffer from it. This is essential in order to develop and practice empathy, since many times living with a person with ADHD can be complex.
It is necessary to remember that people with this disorder have certain difficulties in sustaining attention, so we can anticipate these limitations with some attitudes: for example, instead of verbally listing some of the errands to be done, we can make a list. Also, it is not good to interrupt them when they are concentrating on an activity, as it will be very difficult for them to resume it. Finally, it is important to show love and affection, as they tend to be people with a poor self-concept and low self-esteem.