8 adhd in adults Flashcards
What are general clinical features of adhd in adults?
DSM-III: attention deficit disorder with or without hyperactivity
4/5 version: ADD → ADHD with 3 subtypes
applying childhood criteria to adulthood presentations
very few adults meet hyperactive-impulsive criteria
What are the DSM-5 diagnostic criteria for adhd in adults?
A. pattern of inattention
6+ symptoms
- failure to give close attention to details
- difficulty sustaining attention
- does not seem to listen
- does not follow through on instructions
- difficulty organising tasks
- avoids mental effort tasks
- loses things necessary for tasks
- easily distracted
- forgetful
AND/OR hyperactivity
6+ symptoms
- fidgets or taps body parts
- leaves seat when remaining seated is expected
- runs or climbs inappropriately
- unable to play or engage in leisure activities quietly
- restless, on the go
- talks excessively
- interrupts
- blurts out stuff
- difficulty waiting
B. several symptoms present prior to age 12
C. several symptoms are present in two or more settings
D. symptoms interfere with quality of functioning
E. symptoms don’t occur only during course of other mental disorder
What does presentation if inattention symptoms look like?
primary complaint
development of compensatory strategies has most often happened
symptoms might be more apparent to environment than the individual themselves
external distractions are common → results in multitasking
What does presentation of hyperactivity look like?
less apparent in comparison with children
increased levels of motor control
adverse learning - punishment of overactivity
internal - feeling of restlessness, not able to relax
excessive talking
What does presentation of impulsivity symptoms look like?
can affect give-and-take in conversations
response inhibition
hyp/imp is very rare
What functional impairment do adults with adhd present?
- Work or occupational difficulties
- Leisure and recreational activities
- Social interactions
- Relationships
- Management of money
- Driving
- Offending behaviour.
What are common additional symptoms in adult adhd?
- emotional liability
- over-focusing
- procrastination
- sleep problems
What are global prevalence rates of adult adhd?
- Prevalence children ADHD = around 5% (WW)
- Prevalence adult ADHD = 2.5%
- Less diagnosed in females (children and adults)
But
- Prevalence of persistent adult ADHD = 2.58% (WW) > continuation into adulthood for between 15% and 65% of individuals
- Prevalence of symptomatic (not necessarily persistent) adult ADHD = 6.76% (lifetime, WW) > not always a continuation?
What are some facts around the aetiology of adult adhd?
ADHD - most heritable psychiatric disorder
MZ - 80%
parents with ADHD - 50% more likely to have child with ADHD
25% of children with ADHD have parents who meet the criteria
Which neurotransmitter systems play a large role in adult adhd?
several candidate genes
dopamine noradrenaline functions
can be considered a disorder of neurotransmitter function associated with dysregulation of dopamine and noradrenaline
dopamine: working memory, regulating learning, maintaining response set and motivation
noradrenaline: maintaining alertness and attention
What are common comorbidities of adults with adhd?
MDD
dystymia
BP
social phobia
specific phobia
GAD
Drug abuse
alcohol dependence
BPD
ASD
What can be said about the average trajectors of adhd?
decrease in symptoms with age
stable for high severity subgroups tho
hyperactivity decreases!!
inattention remains stable!!
over time 80% of children and adolescents demonstrate a low level of adhd
What is the preferred treatment for adhd in adults?
CBT
- psychoeducation and organising/planning
- problem solving
- coping with distractibility
- adaptive thinking
