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In an overview
of ADHD in adults, Wender, Wolf, and Wasserstein
(2001) note that of the 3 to 10% of children
diagnosed with ADHD, one- to two-thirds (somewhere
between 1 and 6% of the general population)
continue to have symptoms of ADHD in adulthood.
Because ADHD was
generally viewed as a childhood disorder, it is
really only within the last decade or so that any
significant attention has been paid to diagnosing
and treating adults with ADHD. In addition to the
files in the main ADHD section, then, I thought
I would include some material that is
specifically oriented to adults with ADHD
("ADDults"). Just as there is no "typical" child
with ADHD because there are different subtypes and
various patterns of comorbidity, so, too, is there
no "typical" adult with ADHD. While some of the
data on long-term outcomes was provided in the
overview
, let's consider other data on adults
here.
In a report by Dutch
investigators, 141 adults who were diagnosed with
ADHD in a clinical setting were assessed for
comorbidity, functioning, and their response to
either clonidine or methylphenidate by using
reports from case histories and school reports. The
most frequent reports of comorbid problems
concerned mood swings, rage outbursts,
sensation-seeking behavior, sleep disorders, and
anxiety and depressive symptoms. In 94% of the
sample, childhood onset of ADHD symptoms was
confirmed by a family member, and the investigators
report that the distribution of ADHD subtypes was
comparable to the distribution in children (Kooij,
Aeckerlin, & Buitelaar, 2001). Similarly,
Montano (2004) reports that the majority of adults
with ADHD exhibit at least one comorbid psychiatric
disorder, such as major depressive disorder,
anxiety disorder, personality disorder, substance
abuse disorder, or bipolar
disorder.
The Kooij study was
certainly not the first to note that ADDults often
experience the same types of comorbid problems as
children with ADHD. As but one example, Murphy and
Barkley (1996) had compared 172 adults diagnosed
with ADHD to 30 adults seen in the same clinic who
did not have ADHD. The ADHD group exhibited a
significantly greater prevalence of oppositional,
conduct, and substance abuse disorders, and greater
illegal substance use than control adults (note:
you would not expect to see the last problem in the
Dutch study because marijuana use is legal there).
Murphy and Barkley also reported that adults with
ADHD reported greater psychological maladjustment,
more driving risks (speeding violations), and more
frequent changes in employment. ADHD adults were
significantly more likely to have their driver's
license suspended, to have been fired or resigned
from their job, and to have had more problems in
school (in terms of disciplinary actions and poorer
educational performance) than non-ADHD adults.
Multiple marriages were more likely in the ADHD
group as well. Contrary to previous studies, they
did not find that anxiety and mood disorders were
more prevalent in the ADHD than in the control
group.
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Almost any ADDult or
their spouse may lament all the time spent looking
for lost keys, the number of times the ADDult has
"forgotten" to do something, or starts a project
but never finishes it, etc. These types of problems
are often indicative of neuropsychological
dysfunctions in working memory or executive
functions, as discussed in the section on
executive
functions. An
ADDult who has executive dysfunctions is not being
"lazy" or "irresponsible." That individual has a
neurologically based deficit and needs to learn
strategies to work around the deficits, and/or may
need medication to help them "put on the brakes" if
they are having problems with impulsivity,
distracted attention, or other aspects of response
inhibition.
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