Adult ADHD

Adult ADHD


The myth that impulsivity, hyperactivity and attentional difficulties in children always resolve in adolescence has now been well and truly overturned. It does make sense that these should often improve as myelination of white matter tracts (particularly those connecting the frontal lobes to other parts of the brain) proceeds through adolescence, but another reason for the apparent improvement is that the disorder manifests differently in adulthood to how it presents in primary school children (and the DSM-5 criteria are based more on that earlier presentation). 

Estimated prevalence is about 5%, and it is estimated more than one half of those diagnosed with Attention Deficit Hyperactivity Disorder as children will continue to show signs of this disorder in their 20s, probably with gradually diminishing prevalence thereafter. It is a true mental health condition which will typically affect, at least to a degree, occupational and relationship functioning and cause subjective symptoms (depending on the subtype). Self report on instruments such as the CAARS (Connors) scales or other questionnaires (eg the DIVA) has been found relatively reliable in a range of studies, some from Australia.

Commonly, adult ADHD is complicated by other secondary disorders especially substance use disorders, anxiety or depression, and impulse control problems such as binge eatiing or gambling. There is a complex and not well understood relationship between ADHD, autism spectrum disorders, and bipolar II disorder. It is important to be clear about whether a substance use disorder is producing attentional deficits and disruptive behaviour or whether true ADHD is present.

There is a kind of culture war in play currently, comented on in my blog, with some considering that everyone is "a bit ADHD" due to the modern infomrational environment. There does seem to be good evidence that office workers, for example, shift attention more frequently than every minute, whether this is expected or induced, and clearly the attentional systems in the brain are not designed for this. However, ADHD as a neuropsychiatric condition is associated with measurable inefficiencies, and potentially - though not in routine clinical practice - biomarkers such as task related functional MRI changes. 

As the diagnosis becomes more accepted and widely known, more adults are being treated for this condition, but generally outside the publicly funded mental health system although some community mental health services have limited availability. 

In adults, following a thorough assessment, the basics of treatment are to control the underlying attentional disorder, hyperactivity and impulsivity with medication, then apply cognitive behavioural strategies and coaching to assist the individual in repairing the personal damage (to self and others) from years of untreated symptoms, and to assist them in developing more functional coping strategies to replace those which they have developed over the years to help them get by as best they can.

Support from a local organisation can be very helpful, including the ADHD Association and the online support group adhd.org.nz both for the affected individuals but also their friends and family. Also ADDitude Magazine is a useful resource, with this advice in booklet form developed by the ADHD Foundation in the UK generally applicable in New Zealand. The new edition of Ed Hallowell's book ADHD 2.0 and his bite sized TikTok advice is recommendable and easily digested. 

If you think that perhaps you have undiagnosed ADHD then we would suggest you complete this ADHD screen and discuss with your GP whether a referral would be indicated.

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