ADHD in Adults - When to Treat?

Adult Attention Deficit Hyperactivity Disorder (ADHD) has been in the news more lately. This may be because several medications have been approved for use specifically in adults with ADHD, when in the past the medications were usually approved for children and adolescents.

It shouldn't be a surprise, however, that ADHD which develops in childhood (by definition) could be carried into adulthood. Many illnesses, including psychiatric disorders, first manifest in childhood or adolescence, and then persist into adulthood.

Symptoms in adults are often different from what we see in kids, but they are (again, by definition) disabling in some way before the diagnosis can be properly given. In other words, while most adults with ADHD have distractibility, not all who get distracted have ADHD.

There are three major categories of symptoms seen in adults with ADHD: impulsivity, hyperactivity, and distractibility. Impulsivity is difficulty controlling reactions to situations-speaking before thinking, acting before considering. Now, we all know people with this problem who do not have ADHD, so this is just one of the things to consider when diagnosing this disorder in adults. Hyperactivity is seen less often in adults than kids, and when it is seen it is often in the form of fidgeting or restlessness. Distractibility is what most adult patients complain about-they can't keep focused, start lots of things and don't finish lots of things, get bored easily, and can't seem to be organized.

When looked at from a symptoms point of view, it is easy to see how adult ADHD can be disabling. Like anything else, there are mild, moderate, and severe cases, but even a small amount of distractibility and decreased focus can cause problems in the workplace. We used to consider ADHD a child's disease, but we are not so rigid any longer and believe that moderate and severe cases in adults should be treated. Not only does the patient's life improve, but adults with treated ADHD are less likely to be depressed or use drugs/alcohol to "self treat," which is, of course, a good thing.

So, in my clinic, if I diagnose ADHD by history, mental status exam, and testing, and if the symptoms cannot be explained by another mental or physical illness, I treat it. Mild cases can be managed with therapy focused on improving organizational skills, but moderate and severe cases usually require medications to improve. Stimulants are the "gold standard" for treating ADHD, but stimulating antidepressant medications are also used in less severe cases. Some patients can't take stimulants (they may have heart/blood pressure problems, a seizure disorder, can't take the weight loss or the risk disrupted sleep) and every patient has to be warned of the risks and the benefits, but when the potential benefits outweigh the risks, we treat.

If you are having these symptoms and they are causing difficulty in your life, I think you should contact your psychiatrist for an ADHD evaluation. It doesn't take long and it may be one of the better things you've ever done for yourself.