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The capacity for self-control, whether of attention, behaviors, or impulses, is essential for social adaptation (Freud, 1930/2010). With the complex demands and ever-present distractions of modern-day societies, success in many life tasks depends on this capacity for self-control (Moffitt et al., 2011). Yet, this can be very trying for individuals with Attention-Deficit/Hyperactivity Disorder (ADHD).
ADHD as A Neurodevelopmental Disorder
ADHD is currently understood to be a heritable and heterogeneous neurodevelopmental disorder associated with delays and deficits in executive functions central to self-control, among other abilities. The condition is thought to be rooted in early developmental alterations to the nervous system (Frick & Nigg, 2012). It is also common, affecting an average of 5.3% of children (Polanczyk, de Lima, Horta, Biederman & Rohde, 2007) and 3.4% of adults globally (Fayyad et al., 2007).
According to the American Psychiatric Association’s (APA) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 2013), ADHD is defined by a persistent pattern of inattention and/or hyperactivity-impulsivity across multiple settings that is inconsistent with developmental level and interferes with functioning with some symptoms present before the age of 12. According to the DSM-5 (APA, 2013), symptoms include:
Inattention:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
- Often has trouble holding attention on tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
- Often has trouble organizing tasks and activities
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
- Is often easily distracted
- Is often forgetful in daily activities
Hyperactivity-impulsivity:
- Often fidgets with or taps hands or feet, or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
- Often unable to play or take part in leisure activities quietly
- Is often “on the go” acting as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has trouble waiting their turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
Not all symptoms are experienced by everyone with ADHD. Depending on an individual’s symptom profile, one of the following three ADHD presentations is specified: the Predominately Inattentive presentation, the Predominately Hyperactive/Impulsive presentation, and the Combined presentation.
Adult ADHD
While ADHD was once considered a childhood condition that would dissipate with age, it is now recognized that at least 50% of individuals with ADHD do not grow out of it (Ramsay, 2010), with symptoms manifesting differently in adulthood. For instance, compared to children, adults with the disorder tend to show subtler signs of physical restlessness such as fidgeting or talking excessively (Ramsay & Rostain, 2008). Motor hyperactivity also becomes a more internalized sense of inner restlessness expressed as the need to be always active as seen in overworking or discomfort in low-activity situations such as difficulty sitting through meetings (Mapou, 2006; Weiss & Weiss, 2004) or yet still as a sense of mental restlessness like having a train of thought being easily disrupted by new ideas (Ramsay & Rostain, 2008). Impulsive behaviors tend to diminish in adulthood (Biederman, Mick, & Faraone, 2000) with impulsivity often manifested as irritability, impatience, poor decision making, frequent job changes, or impulse shopping (Asherson et al., 2012; Weiss & Weiss, 2004); yet, even infrequent but salient impulsive actions like speeding can have devastating consequences (Gibbins et al., 2010)!
In adults, as in children, inattention is manifested as forgetfulness, distractibility, difficulties with organization, etc. (Weiss & Weiss, 2004). For instance, adults with ADHD may have challenges from organizing a busy work and social schedule to physically organizing paperwork and personal belongings; they may also have trouble sustaining attention and effort in work-related tasks and household chores (Mapou, 2006). Not only so, affected adults often experience other symptoms of inattention not included in the DSM diagnostic criteria such as excessive procrastination, inconsistent effort, poor time management, low motivation, trouble with multitasking, and difficulties initiating and completing tasks (Adler, 2008; Brown, Reichel, & Quinlan, 2009; Weiss & Weiss, 2004).
The impact of ADHD also appears to amplify as life’s demands increase with age, often leaving adults with impairments across various life domains, especially in the areas of employment, relationships, daily activities, financial management, physical health, and psychological well-being (Brod, Perwien, Adler, Spencer, Johnston, 2005).
Diagnosis and Management
While ADHD symptoms may persist into adulthood, affected individuals often gain a better insight into their behaviors and make adjustments as maturity and self-awareness develop with age (Weiss & Weiss, 2004). Adults also tend to have greater freedom in tailoring their environment to ease their difficulties (Asherson et al., 2012). In other words, ADHD can be managed once diagnosed!
Adult ADHD can be diagnosed through clinical interviews, review of archival records of impairments, symptom rating scales, and in some cases, medical evaluation as well as neuropsychological testing (Barkley & Murphy, 2006) by trained mental health professionals. As for treatment, a comprehensive approach is essential and often involves medication, education, skills training, psychotherapy, and environmental accommodations to help cope with symptoms and improve daily functioning.
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References:
Adler, L. (2008). Epidemiology, impairments, and differential diagnosis in adult ADHD: Introduction [Supplemental Material]. Primary Psychiatry, 15, 4-5.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Asherson, P., Akehurst, R., Kooij, J., Huss, M., Beusterien, K., Sasané, R., … Hodgkins, P. (2012). Under diagnosis of adult ADHD: Cultural influences and societal burden [Supplemental material]. Journal of Attention Disorders, 16, 20S-38S. doi:10.1177/1087054711435360
Barkley, R. A., & Murphy, K. R. (2006). Attention-deficit/hyperactivity disorder: A clinical workbook (3rd ed.). New York, NY: Guilford Press.
Biederman, J., Mick, E., & Faraone, S. V. (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: Impact of remission definition and symptom type. The American Journal of Psychiatry, 157, 816-818. doi:10.1176/appi.ajp.157.5.816
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Freud, S. (2010). In J. Strachey (Series Ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud: Vol. 21. Civilization and its discontents. New York, NY: W. W. Norton & Company, Inc. (Reprinted from Civilization and its discontents by J. Riviere, Trans., 1930, New York, NY: Cape and Smith)
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Ramsay, J. (2010). ADHD in adulthood. In Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 9-35). Washington, DC: American Psychological Association. doi:10.1037/12056-001
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