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Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

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ADHD – Attention Deficit Hyper activity disorder in adults

It is known to many that ADHD or attention deficit hyperactivity disorder is a common neurodevelopmental disorder in children. It can be found in adults also and it can affect their social, professional and personal lives.

What is ADHD?

ADHD is a neurodevelopmental disorder which may have onset in childhood and continue in teens and adulthood. It is characterized by inattention, hyperactivity and impulsivity. ADHD symptoms may be present in the combined form or as single entities such as inattention or lack of focus only; or as hyperactivity symptoms only.

  Various daily activities are difficult or challenging to adults with ADHD. These include getting up in the morning, getting ready for going to work, arriving at work on time, and being productive in career or work place etc. These adults may have a history of problems with school, work, and relationships. Adults with ADHD may seem restless and may attempt to do several things at the same time but they are unable to fulfil any task.

Adult ADHD has been associated with poorer driving and a higher incidence of motor vehicle accidents [5]. 

What is the cause of ADHD?

The exact cause is not known. It is believed that genes as well as environmental factors contribute to the occurrence of ADHD.

Neuroimaging studies[MRI] shows that there are differences in volume and activity in the frontal lobe of brain, which is responsible for attention, behaviour selection, and emotion in persons having ADHD. Studies of neurotransmitters have also  points out abnormalities in dopamine (DA) and norepinephrine (NE) signaling in adults with ADHD [7]. 

 What are the Symptoms of ADHD?

·       Difficulty in paying attention to something for a long time. Sustained attention or focusing is difficult.

·       Challenges with obeying instructions and orders at workplace. Problems happen in work and duties.

·       Problems with organizing, time management and in finishing works.

·       Losing objects like keys, wallet etc. due to inattention.

·       Distraction of mind from work and duties.

·       Forgetfulness in daily activities

·       Hyperactivity- restlessness and difficulty to sit at one place.

·       difficulty waiting one’s turn, particularly in a queue.

·       Frequently interrupting a conversation

·       Excessive talking

·       Fidgeting hands or legs. tapping on table.

    In some cases, individuals having ADHD right from childhood may remain undiagnosed till adulthood because teachers or family failed to recognize the mild form of ADHD, or they managed fairly well during childhood.

However, when they experienced challenges with the demands of adulthood, particularly increasing work load of studies ADHD symptoms of distraction, forgetfulness, inattention etc. are manifested.

Sometimes, young adults with undiagnosed ADHD have academic problems in higher classes because of the intense concentration demanded by the studies or work. Some other studies categorize adult ADHD as a distinctive psychiatric illness with no history in the childhood. However, more extensive research is needed to confirm it.

Adult ADHD can have negative consequences for individuals’ self-esteem and the quality of interpersonal relationships.

ADHD & Co- morbidities [other co existing mental illnesses].

Often, adult ADHD is manifested with a wider spectrum of emotional dysregulation and functional impairment. About 80% of adults with ADHD have at least one coexisting psychiatric disorder such as mood and anxiety disorders, substance use disorders (SUD), and personality disorders. This can complicate the recognition and diagnosis of ADHD in adults [4].

The National Comorbidity Survey reported that adults with ADHD are three times more likely to develop major depressive disorder [6].

Another study shows that Individuals with anxiety disorders  along with comorbid ADHD shows more severe anxiety symptoms. There may be earlier age of onset of anxiety, and more frequent occurrence of additional psychiatric diseases and substance use than those who do not have ADHD [8].

Reports suggest that personality disorders are present in more than 50% of adults with ADHD, most commonly cluster B and C personality disorders, and 25% of individuals have two or more personality disorders [9].

 How to diagnose ADHD in adults?

Adults who are diagnosed with ADHD must have experienced several symptoms of ADHD before the age of 12. In adulthood, they currently experience at least five persistent symptoms of inattention and/or five persistent symptoms of hyperactivity-impulsivity. These symptoms must be present in two or more settings (for example, home, work, or school; with friends or relatives; in other activities) and interfere with, or reduce the quality of, social, school, or work functioning.

To conclude the diagnosis of ADHD, the health care provider or mental health professional will examine factors including the person’s mood, medical history, and whether they have problems with other issues, such as alcohol or substance misuse. The doctor would collect data on the individual’s history of childhood behavior and school experiences also from family members.

A mental health professional may use standardized behavior rating scales or ADHD symptom checklists to determine whether an adult meets the criteria for a diagnosis of ADHD.

What is the treatment for ADHD in adults?

Treatment or intervention includes medications and behavioural therapy.

Stimulants are the most common type of medication used to treat ADHD. Stimulant medications include methylphenidate, mixed amphetamine salts, and lisdexamfetamine dimesylate. Non-stimulants used in ADHD treatment include atomoxetine and alpha-2-adrenergic agonists. Antidepressants such as venlafaxine and bupropion have also been evaluated as treatment options for ADHD, with some evidence of benefit in addressing ADHD symptoms.

Individuals taking other medications for diseases such as diabetes, high blood pressure, anxiety, and depression must reveal about the drugs to the consulting doctor as these drugs may interact with stimulants. Your doctor can suggest other medication options suitable to both conditions.

Psychotherapy

Cognitive behavioral therapy, can help an adult with ADHD to be more aware of attention and concentration challenges and work on skills to improve organization and use of time in completing daily tasks.

 It can also help adults with ADHD to gain confidence and control their impulsive and risky behaviors.

Complementary &alternative medicine treatment

Various alternative medicine treatments are available to manage symptoms of ADHD. Enough evidences are yet to emerge regarding the results of these therapies based on the standards of evidence-based medicine. However, several case reports are available related to their ability to modify the symptoms of ADHD.

Homeopathy

Homeopathy offers some treatment options in the form of nutrition and dietary intervention, cognitive behavioral therapy along with some medications.

 Homeopathic medications may help to improve symptoms of ADHD. The medications include tarentula, tuberculinum, carcinosin, natrum muriaticum etc.

Homeopathy offers medications for stress management of caregivers also along with counselling.

Nutritional intervention

MIND diet has crucial role in improving brain health.

Please follow the link  http://siahmsrwellness.in/mind-diet-for-your-brain-health

Mind -body exercises for ADHD

Mind relaxation and focusing exercises help to reduce symptoms of ADHD

Mind relaxation yoga

Mind work-outs or brain training or cognitive training

Physical exercise

Promote physical activity for adults with ADHD. It has good effects in reducing ADHD related problems.

References

1.      https://www.nimh.nih.gov/health/publications/adhd-what-you-need-to-know

2.       https://www.psychiatry.org/patients-families/adhd/what-is-adhd

3.         https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

4.      https://pubmed.ncbi.nlm.nih.gov/16500798/

5.      https://pubmed.ncbi.nlm.nih.gov/12164675/

6.      https://pubmed.ncbi.nlm.nih.gov/16585449/

7.      https://pubmed.ncbi.nlm.nih.gov/18416663/

8.      https://pubmed.ncbi.nlm.nih.gov/10405074/

9.      https://pubmed.ncbi.nlm.nih.gov/23469326/

10.                             https://pubmed.ncbi.nlm.nih.gov/16649828