powerpoint presentation

Adult ADHD

Del Larkin, LCSW, CAADC, MBADirector of Quality Assurance and Strategic Planning

The Salvation Army Harbor Light CenterChicago, IL

How common is ADHD?A 2013 report estimated that 11% of

children 4-17 have been diagnosed with ADHD at some point in their lives.

Boys are nearly three times more likely to have been diagnosed with ADHD (13.2%) than girls (5.6%)

The estimated adult rate of ADHD is 4.4%, but experts caution that adults not diagnosed in childhood are more likely to remain undiagnosed, so the true prevalence of adult ADHD may be significantly higher than reported

Myth #1: ADHD is not a real disorder

FACT: Brain imaging research has revealed differences in the brains of people with ADHD

Russell A. Barkley, PhD, a leading ADHD expert has stated:

“ ADHD is a chronic disorder that has a negative impact on virtually every aspect of daily social, emotional, academic and work functioning”

Myth #2: Most children with ADHD outgrow it

FACT: At least 60% of children diagnosed with ADHD as

children will continue to have ADHD symptoms as adults

Adult ADHD seems to affect men and women equally

This does not include all adults who are diagnosed with ADHD as adults and were not diagnosed as children

Myth #3 Adults with ADHD don’t need treatment – they just need to try harder and get organized

FACT:Effort and some behavioral strategies

can help with some ADHD obstacles but Air Tuckerman, PsyD, ADHD expert explains

“ Telling someone with ADHD to work harder is like telling someone with bad vision to try harder to see well”

Myth #4: All adults with ADHD are hyperactive

FACT:Only some people with ADHD have hyperactivity.

While it can be the most visible symptom, it often declines in adolescence and adulthood.

People with inattentive type of ADHD do not struggle with hyperactivity but do struggle with distractibility, forgetfulness, poor time management, disorganization and other symptoms.

Myth #5: Everyone has ADHD these days

FACT:While everyone can have periods of

distractibility and feeling overwhelmed, adults with ADHD have these problems daily

Adults with ADHD have a complex disorder that involves impairments with focus, organization, motivation, emotional modulation, memory and other functions of the brain’s management system that interferes with many areas of their lives on a daily basis.

Myth #6 : Too much sugar causes ADHD or makes symptoms worse

FACT: There is no evidence that sweets cause ADHD or make its

symptoms worse. Research in children indicates switching to a sugar substitute, such as aspartame, does not reduce symptoms of ADHD.

Some experts believe foods that provide quality brain fuel could reduce symptoms of ADHD. High-protein foods, including nuts, meat, beans, and eggs, may improve concentration. Replacing simple carbs with complex carbs, like whole-grain pasta or brown rice, can help ward off mood swings and stabilize energy levels.

Myth #7: ADHD medication does not work and causes substance

abuse problemsFACT:Adults with mild ADHD may be able to manage without

medication80-90% of adults diagnosed with ADHD will benefit from

treatment with medicationIf you have a problem with poor eyesight, glasses will make

your life easierHaving untreated ADHD puts a person at greater risk of

having a drug or alcohol problem. People with ADHD who take stimulant medication tend to have LOWER rates of substance abuse than people with ADHD who do not take medication

What Causes ADHD? In people with ADHD, brain

chemicals called neurotransmitters are less active in areas of the brain that control attention.

Researchers don't know exactly what causes this chemical imbalance, but they think genes may play a role, because ADHD often runs in families.

Studies have also linked ADHD to prenatal exposure to cigarettes and alcohol

There are Three Types of ADHD1. Inattentive type (DSM requires 6 of the 9 in children and

5 of the 9 in adults)• Not paying attention to details• Making careless mistakes• Failing to pay attention and keep on task• Not listening• Being unable to follow or understand directions• Avoiding tasks that require sustained effort• Being distracted• Being forgetful• Losing thing that are needed to complete tasks

There are Three Types of ADHD

2. Hyperactive-Impulsive Type (6 of 9 or 5 of 9 for adults)• Fidgeting• Squirming• Getting up often when seated• Running or climbing at inappropriate times ( maybe limited to

restlessness in adults)• Having trouble playing quietly ( quiet leisure activities)• Talking excessively• Talking out of turn or blurting out (completes other’s

sentences)• Interrupting (in adults may intrude or take over what others are

doing)• Often “on the go” as if “driven by a motor” (in adults can be

difficulty sitting still)

There are Three Types of ADHD

3. Combined Type• Criterion are met for both Inattentive Type and Hyperactive-Impulsive type

for the past 6 months (DSM-5)• Suggested that this is most common of three types.

Proposed Criteria for ADHD in AdultsRussell A. Barkley, et al ADHD in Adults; What the Science Says, 2008

Proposed criteria for DSM-V for adults ( 6 or more for a period of at least 6 months)1. Often easily distracted by extraneous stimuli or irrelevant

thoughts2. Often makes decisions impulsively3. Often has difficulty stopping activities or behavior when he or

she should do so4. Often starts a project or task without reading or listening to

directions carefully5. Often shows poor follow-through on promises or commitments

he or she may make to others

Proposed Criteria for ADHD in Adults

Russell A. Barkley, et al ADHD in Adults; What the Science Says, 2008

Proposed criteria for DSM-V for adults6. Often has trouble doing things in their proper order or

sequence7. Often is more likely to drive a motor vehicle much faster than

others ( excessive speeding) [ Alternate symptom for those adults with no driving experience: Often has difficulty engaging in leisure activities or doing fun things quietly]

8. Often has difficulty sustaining attention in tasks or play activities

9. Often has difficulty organizing tasks and activities

Additional Study findings“ ...items which emphasize distractibility, impulsiveness, poor concentration or persistence and problems with working memory and organization will be the best constructs for identifying adults with ADHD. Items reflecting hyperactivity proved much less useful for doing so in both studies”

“... adults with ADHD are far more likely to complain of difficulties involving EF [executive functioning] than they are of hyperactivity. Difficulties with impulsive decision making, stopping, starting and organizing activities, persistence toward goals and planning for future events will prove to be among the most significant complaints in identifying these adults with ADHD.”

p. 204 Russell A. Barkley, et al ADHD in Adults; What the Science Says, 2008

What Is Executive Function Disorder (EFD)?

People with executive function disorder exhibit a pattern of problems with daily tasks, and commonly lack the ability to: Handle frustration Start and finish tasks Recall and follow multi-step directions Stay on track Plan, organize and self-monitor Balance tasks (like sports and academic demands)It's estimated that as many as 90% of kids with ADHD also have executive function disorder.

Executive Function Disorder

Deficient Emotional Self Regulation (DESR)

• More than half of people with attention deficit hyperactivity disorder (ADHD) also have trouble regulating their emotions, and that difficulty may be passed through families, a new study shows.

• Researchers are calling this cluster of symptoms deficient emotional self-regulation (DESR). It involves quick bursts of outsized anger, frustration, impatience, or excitability in response to everyday events.

• Study researcher Craig B. H. Surman, MD. Surman is an instructor in psychiatry in the Massachusetts General Hospital Pediatric Psychopharmacology and Adult ADHD Program says

• “Folks who have deficient emotional self-regulation, we feel, don’t have inhibitory capacity to censor emotional reactions even when they’re not under these kinds of stresses

•


ccf.buffalo.edu/pdf/BarkleySlides_CCFSpeakerSeries0910.pd

Overview of Adult ADHD Symptoms

What might it look like Excessive talking - talks “too much”, finishes others

sentences, excessive interruptions, can have trouble listening to others and verbal instructions

Poor Driving Record – speeding, impatient, road rageProblems at Work – unproductive, takes more time

to get things do despite working hard, change or lost jobs, misses deadlines, problems getting along with coworkers

Overview of Adult ADHD Symptoms

What might it look likeRestlessness, Inattentiveness – has difficulty sitting through

(long) meetings, paying attention in lectures or meetings that are not interesting, may fidget with pen or other objects

Lateness – trouble getting to work on time, trouble remembering appointments or getting to meetings on time, problems with time management, procrastination

Organizational problems – misplaces items at work or home (more than average), trouble organizing files, papers, paying bills on time

Overview of Adult ADHD Symptoms What might it look like

Difficulty Concentrating – more easily distracted by noise or other activity, more prone to careless mistakes, moves from one project to the next, can have trouble finishing tasks to completion once the “interesting” part is done

Trouble Relaxing – can report feeling “driven by a motor”, trouble with solitary, quiet activities (e.g. reading, fishing, crafts or other hobbies), struggle to relax and unwind

Bad Moods – tense, stressed, “on edge”, over-react, quick temper, struggle to stay in a good mood, may have a history of failed relationships

Overview of Adult ADHD Symptoms Less Obvious or “Soft” Symptoms

Hypersensitivity/ Sensory Overload – Very emotionally sensitive, take on the feelings of others

Overwhelm or Overstimulation – Response to stress, feelings of anxiety

Hyperfocus – Once focused on something, may be hard to stop or change tasks, especially if task if of interest, likely related to triggering of dopamine.

Overview of Adult ADHD Symptoms Less Obvious or “Soft” Symptoms OCD-like coping skills –coping skills to manage the

chronic disorganization and feelings of overwhelm, rigidness, perfectionism

Rejection Sensitive Dysphoria – Not in DSM-V, a term coined by William Dodson, MD, one of the top experts in the field of ADHD. Similar to atypical depression, which means not truly depression but dysphoria or “difficult to bear”. Not and adulthood reaction stemming from earlier experiences, but Dodson attributes it to “ hard-wiring”, and that about half of his patients have shown improvement with medication.

Co-Morbid DisordersAs many as 50% of adults with ADHD also

report problems with depression and/or anxietyAbout 20% of the people with ADHD also have

a mood disorder on the bipolar spectrum

Co-Morbid DisordersCommonly reported co-morbid disorders of adults with ADHD:DepressionAnxietyBipolar II – more often than bipolar IDrug abuse or dependenceAntisocial or borderline personality disordersLearning disabilitiesSleep ProblemsHealth problems related to behavior associated with

ADHD, such as smoking

Girls and Women with ADHD

Boys are three time more likely to be diagnosed with ADHD than girls In a Harris Interactive survey, nearly 50% of moms of tween girls with

ADHD first considered their daughter’s behavior to be a part of adolescence and 59% hesitated to consult a doctor because they thought their daughter would outgrow the behavior.

In a survey by the University of California at Irvine of the general public, parents of children with ADHD, teachers and children with ADHD – 85% of the teachers and more than half of the general public believed that girls are more likely to be undiagnosed with ADHD

Girls often do not fit the stereotype of: out of control, defiant, unorganized, fidgety, unfocused and aggressive.

Girls tend to have the Inattentive type of ADHD Common symptoms of girls/women with ADHD - disorganized, day

dreaming, low self-esteem, talkativeness, forgetfulness, feeling anxious and/or depressed, seem to fade into the background

Substance Abuse and ADHD

Research has shown that children with ADHD have an elevated risk of becoming abusers of drugs and alcohol

11% of the boys and 3% of the girls without ADHD report drinking alcohol 21 % of the boys and 13% of the girls with ADHD report abusing alcohol

Children who were medicated for their ADHD were less likely to become substance abusers during a 4 year follow up than children with ADHD who were not medicated

Administering ADHD medication to adults with ADHD who were cocaine users reduced their cocaine use

Why does medication reduce the risk? Not clear – but may decrease impulsivity that results in risky behavior

Cocaine users may start using as a way of “self-medicating” ADHD symptoms

ADHD is 5 to 10 times more common in adult alcoholics than it is in adults without ADHD

Up to 45% of adults with ADHD have a history of alcohol use or dependence and about 33% have a history of illegal drug abuse or dependence.

Treatment – Use of Screening tools (self report) WRAADDS

good for adults, deals with emotional as well as attention/hyperactivity

ASRS-vI.I was developed in conjunction with the World Health

Organization (WHO) ; does not deal with emotional component, easy to complete and score

Wender Utah Rating Scale has questions regarding emotions, focuses on “when I

was a child”Copeland Symptoms list

has questions regarding emotions, wording of questions can be overly negative sounding “Immaturity” “Bosses other people” “Lacking in leadership”

All are available for free on the internet

TreatmentStimulant Medication is usually the first line medication ( Ritalin,

Adderall etc.) prescribedNon-stimulant medication (Strattera) can be effective, especially if

stimulant medication needs to be avoided.CBT can be effective in helping with improving thinking and behavior

patternsDBT and mindfulness exercises are also increasingly being used to

help with ADHD symptomsADHD Coaching can help with time management and organizational

issues related to ADHD which can affect work performancePsychotherapy can assist in issues related to fluctuations and

management of emotions, low self-esteem and relationship issues and addressing issues related to co-morbid disorders or substance abuse.

Take AwaysMedication, while effective, does not solve or is not the total

treatment for adults with ADHDAdult ADHD often interferes with multiple areas of an individual’s

lifeAdults diagnosed with ADHD are often relieved to learn they are just

not “stupid” or “lazy” or just need to “try harder”Unlike bipolar disorder, symptoms of ADHD are continual, they do

not “come and go”The symptoms of girls and women with ADHD can be different from

the symptoms of boys and men with ADHDThere is often an Emotional/Self Regulation or Executive Functioning

problem with adults with ADHD that should not be ignored.Adult ADHD may not “look” like childhood ADHD and many adults

with undiagnosed ADHD have developed ways to “work around” their symptoms and can have success in work and/or family life,

but can struggle in some situations or environments

Books for learning about and coping with Adult

ADHD• By Edward M. Hallowell MD and John J Ratey MD

Driven to Distraction Delivered from Distraction

• By Kate Kelly and Peggy Ramundo You Mean I’m Not Lazy, Stupid or Crazy

• By Ari Tuckman More Attention, Less Deficit

Thank YouDel Larkin, LCSW, CAADC, MBADirector of Quality Assurance and Strategic PlanningThe Salvation Army Harbor Light CenterChicago, IL [email protected]

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