Attention deficit hyperactivity disorder (ADHD), also in adults

the ADHD is a behavioral syndrome which affects, according to estimates, between 5% and 10% of the population of children and young people. The key currently used to understanding the wide range of manifestations that characterize people with ADHD is the concept of control deficit of the inhibitory response.

That is, the notorious inability to inhibit impulses and thoughts that interfere with executive functions whose performance helps overcome distractions, set goals, and plan the sequences of steps necessary to achieve them.

However, this psychological disorder is often spoken of as if it were just a child. Is it like that? Does ADHD exist in adults? As we will see, the answer is yes.

    ADHD: Does It Also Occur In Adults?

    For more than 70 years, research on Attention Deficit Hyperactivity Disorder has focused on the infant population. But from 1976, it was shown that this disorder can exist in 60% of adults whose symptoms have already started before the age of seven (Werder PH. Et. 2001). This diagnostic delay made it possible to better understand and target the symptoms and treatments of ADHD in children and adolescents than in adults, even if the clinical parameters were similar. Outraged, in adults, complications, risks and co-morbidities are more common and nuanced only in children, with the risk that the symptoms could be mistaken for another psychiatric condition. (Ramos-Quiroga JA. Et. 2006).

    A common biological origin allows adults to be diagnosed with the same criteria adapted from the DSM-IV-TR, but the fact that in adults the only observer is diagnostic difficulties, this facilitates a greater dispersion and a bias of opinions. .

    Although less epistemological data is available in adults, ADHD is very common in adults. The first studies found prevalences in adults between 4 and 5%. (Murphy K, Barkley RA, 1996 and Pharaoh et al., 2004)

    Symptoms, diagnosis and evaluation of ADHD in adults

    The diagnostic criteria for ADHD in adults are the same as in children, listed in the DSM-IV-TR. From the DSM-III-R, the possibility of diagnosing them is formally described.

    Signs and symptoms in adults are subjective and subtle, with no biomedical evidence that can confirm their diagnosis. In order to diagnose ADHD in an adult, the disorder must be present from childhood, at least from the age of seven, essential for diagnosis, and clinically significant alteration or deterioration in more than one must persist. Their activity, such as social, professional, school or family functioning. Therefore, it is very important that the child’s history is recorded in the medical history along with current symptoms and their impact on current life, family, work and social relationships.

    Adults with ADHD primarily report symptoms of inattention and impulsivity, as symptoms of hyperactivity decrease with age. Likewise, hyperactivity symptoms in adults tend to have a slightly different clinical expression from that seen in children (Wilens ET, Dodson W, 2004) as they manifest as a subjective feeling of restlessness.

    The most common problems related to Attention Deficit Hyperactivity Disorder in adults are: problems with concentration, lack of memory and poor short-term memory, difficulty getting organized, problems with routine, lack of self-discipline, Impulsive behavior, depression, low self-esteem, inner restlessness, poor ability to manage time, impatience and frustration, poor social skills and feelings of not achieving goals, among others.

    Self-report scales are a good diagnostic tool for the most general symptoms (Adler LA, Cohen J. 2003):

    Adult Self-Report Scale (AAVA): (McCann B. 2004) can be used as the first self-report tool to identify adults at risk for ADHD. Copeland Symptom Checklist: Helps assess whether an adult has symptoms characteristic of ADHD. Brown’s Attention Deficit Disorder Scale: Explores executive functioning of aspects of cognition associated with ADHD. Wender-Reimherr Adult Attention Deficit Disorder Scale: Measures the severity of symptoms in adults with ADHD It is particularly useful for assessing ADHD mood and lability. Conners’Adulto ADHD Rating Scale (CAARS): Symptoms are rated with a combination of frequency and severity.

    According to Murphy and Gordon (1998), in order to make a good assessment of ADHD, one needs to ask whether there is evidence for the relationship between ADHD symptoms in childhood and subsequent significant and chronic deterioration in different areas, whether there is a relationship between current ADHD symptoms and substantial and conscious deterioration in different areas, whether there is another condition that better justifies the clinical picture than ADHD, and finally, whether for patients who meet the criteria diagnosis of ADHD, there is some evidence that there are comorbid conditions.

    The diagnostic procedure is guided by guidelines for performing diagnostic tests depending on the clinical situation. This procedure begins with a complete medical history, including a neurological exam. The diagnosis must be clinical, supported by the self-report scales mentioned above. It is essential to assess psychiatric conditions, rule out possible co-morbidities and certain medical conditions such as hypertension, and rule out drug addiction.

    As Biederman and Faraone (2005) point out very well, in order to be able to diagnose ADHD in adults, it is essential to know which symptoms are specific to the disorder and which are due to another comorbid pathology.

    It is very important to note that comorbidity is quite common in adult ADHD (Kessler RC, et al. 2006). The most common comorbidities are mood disorders such as major depression, dysthymia or bipolar disorder, the comorbidity of which with ADHD ranges from 19% to 37%. For anxiety disorders, the comorbidity ranges from 25 to 50%. In the case of alcohol abuse it is 32 to 53% and in other types of substance abuse such as cocaine it is 8 to 32%. The incidence rate for personality disorders is 10-20% and for antisocial behavior 18-28% (Barkley RA, Murphy KR. 1998).

    pharmacological treatment

    The drugs used to treat this disorder are the same as in childhood. Among the various psychostimulant drugs, the efficacy has been demonstrated in adults with ADHD of methylphenidate and atomoxetine.

    Immediate-release methylphenidate inhibits dopamine reuptake; and atomoxetine, the main function of which is to inhibit the reuptake of norepinephrine. Currently, and thanks to several studies carried out by Faraone (2004), methylphenidate is known to be more effective than placebo.

    The explanatory hypothesis behind ADHD therapy with psychostimulants such as methylphenidate is that this psychological disorder is caused (at least in part) by a constant need to keep the nervous system more active than it is by default, which results in looking for external stimuli with which to engage in activities. Thus, methylphenidate and other similar drugs would activate the nervous system so that the person would not be tempted to look outside for a source of stimulation.

    Nonstimulant drugs for the treatment of ADHD in adults include tricyclic antidepressants, amino oxidase inhibitors, and nicotinic drugs, among others.

    psychological treatment

    Despite the great effectiveness of psychotropic drugs, it is sometimes not enough to manage other factors, such as cognitions and disruptive behaviors or other disorders. comorbid. (Murphy K. 2005).

    Psychoeducational interventions help the patient to acquire knowledge about ADHD that not only allows him to be aware of the interference of the disorder in his daily life, but also of the subject himself to detect his difficulties and to define his own goals. therapeutic (Monastra VJ, 2005). These interventions can be performed in an individual or group format.

    The most effective approach to treating ADHD in adults is cognitive-behavioral, In individual and group intervention (Brown, 2000; McDermott, 2000; Young, 2002). This type of intervention improves symptoms of depression and anxiety. Patients receiving cognitive behavioral therapy, along with their medications, had better control of persistent symptoms than with medication combined with relaxation exercises.

    Psychological treatments can help the patient cope with the associated emotional, cognitive and behavioral problems, as well as better control of symptoms refractory to drug treatment. This is why multimodal treatments are considered the indicated therapeutic strategy (Young S. 2002).

    Bibliographical references:

    • Franke, B., Faraone, SV, Asherson, P., Buitelaar, J., Bau, CH, Ramos-Quiroga, JA, Mick, E., Grevet, EH, Johansson, S., Haavik, J., Lesch, KP, Cormand, B., Reif, A. (2012). The genetics of attention deficit / hyperactivity disorder in adults, a review. Molecular psychiatry. 17 (10): 960-87.
    • Miranda, A., Jarque, S., Soriano, M. (1999) Attention deficit hyperactivity disorder: current controversies over its definition, epidemiology, etiological bases and intervention approaches. REV Neurol 1999; 28 (Supplement 2): S 182-8.
    • Ramos-Quiroga JA, R. Bosch-Munsó, X. Castells-Cervelló, M. Nogueira-Morais, E. García-Giménez, M. Casas-Brugué (2006) Attention deficit hyperactivity disorder in adults: clinical and therapeutic characterization. REV NEUROL 2006; 42: 600-6.
    • Valdizán, JR, Izaguerri-Gràcia AC (2009) Attention deficit hyperactivity disorder in adults. REV Neurol 2009; 48 (Supplement 2): S95-S99.
    • Wilens, TE, Dodson, W. (2004) A clinical perspective of attention deficit / hyperactivity disorder in adulthood. J Clin Psychiatry. 2004; 65: 1301-11

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