Mastering Your Adult ADHD
Attention deficit hyperactivity disorder (ADHD) is a neurocognitive disorder present in childhood that continues into adulthood and leads to various levels of impairment depending on the individual. It is a common condition diagnosed and treated by pediatricians, psychiatrists, and family physicians. ADHD affects roughly 11.4% of children (1) and 2-5% of adults (2). While many individuals learn to manage their symptoms as they progress into adulthood, 30-80% of afflicted individuals continue to meet the diagnostic criteria for ADHD and benefit from treatment. ADHD is divided into 3 types: inattentive, hyperactive/impulsive, and combined type. Symptoms commonly seen with ADHD include difficulty with sustained attention and focus, being easily distracted and impulsive with behaviors and decisions, difficulty with general organization, trouble planning and following through with those plans, needing frequent reminders to stay on task or oriented to the goal at hand and/or frequent daydreaming. Other psychiatric conditions can mimic ADHD symptoms including mood disorders, anxiety/stress, substance intoxication/withdrawal, developmental disorders and general medical conditions. It is important that if there are concerns for ADHD that they be discussed with your doctor for further evaluation to rule out other causes as proceeding with general treatment for ADHD can exacerbate or worsen other issues. The most common example of misdiagnosis and its complications that I encounter continues to be where a patient is struggling with significant anxiety only to get placed on medication for ADHD (stimulant) and began having worsened anxiety and panic attacks. Despite the services offered for screening from other online providers- a quick evaluation without a proper history or detailed discussion is not a thorough enough evaluation for safe and effective treatment.
Medications (stimulants) are considered the first line treatment for ADHD, have been in use since the 1940’s, and are considered safe when under the care of a physician. Most stimulants belong to either the methylphenidate family (Examples: Ritalin, Focalin, Concerta) or the amphetamine family (Examples: Adderall, Vyvanse, Mydayis) and come in shorter and longer acting formulations. Both stimulant families work primarily by promoting the release of dopamine and norepinephrine from their presynaptic storage sites. Think of dopamine and norepinephrine in this context as being brain chemicals that are promoting alertness, attention, concentration, and energy; but they do have other functions and effects within the body. Other medications used for ADHD include clonidine and guanfacine (a “alpha 2 agonists”), Strattera (a presynaptic norepinephrine reuptake inhibitor), wellbutrin (generally considered an “antidepressant” that is a dopamine and norepinephrine reuptake inhibitor). These “nonstimulant” medications are used often in conjunction with a stimulant, in cases where a stimulant can not be used due to other health conditions or side effects, or to target symptoms not best addressed by a stimulant such as sleep (ex: clonidine).
Even when ADHD is treated with medications, responders can expect 50% or less of a reduction in ADHD symptoms demonstrating the need for therapy to further assist with symptom control and improve functioning in day-to-day life. Cognitive behavioral therapy for ADHD is an intervention that has been shown to further decrease symptoms. “Mastering Your Adult ADHD- a Cognitive-Behavioral Treatment Program” is a very helpful client workbook that goes along with clinician led CBT therapy sessions. The following blog posts will be discussing ADHD, CBT and this great patient resource.
Danielson ML, Claussen AH, Bitsko RH, et al. ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. J Clin Child Adolesc Psychol. Published online May 22, 2024.
2. Ayano G, Tsegay L, Gizachew Y, et al. Prevalence of attention deficit hyperactivity disorder in adults: umbrella review of evidence generated across the globe. Psychiatry Res 2023;328:115449. https://doi.org/10.1016/j.psychres.2023.115449 PMID:37708807
