Adult ADHD

The myth that impulsivity, hyperactivity and attentional difficulties in children always resolve in adolescence has now been well and truly overturned. It does make sense that these should often improve as myelination of white matter tracts (particularly those connecting the frontal lobes to other parts of the brain) proceeds through adolescence, but another reason for the apparent improvement is that the disorder manifests differently in adulthood to how it presents in primary school children (and the DSM-IV criteria are based on that earlier presentation). An estimated one third to one half of those diagnosed with Attention Deficit Hyperactivity Disorder as children will continue to show signs of this disorder in their 20s, probably with gradually diminishing prevalence thereafter. It is a true psychiatric disorder which will typically impair, at least to a degree, occupational and relationship functioning and cause subjective symptoms (depending on the subtype). Self report on instruments such as the Wender-Utah scale or other questionnaires has been found relatively reliable in a range of studies, some from Australia.

Commonly, adult ADHD is complicated by other secondary disorders especially substance use disorders, anxiety or depression, and impulse control disorders. There is a complex and not fully understood relationship between ADHD, autism spectrum disorders, and bipolar II disorder. It is important to be clear about whether a substance use disorder is producing attentional deficits and disruptive behaviour or whether true ADHD is present.

As the diagnosis becomes more accepted and widely known, more adults are being treated for this condition, but generally outside the traditional mental health public system. The addition of atomoxetine, a noradrenaline reuptake inhibitor, to the range of medications for ADHD is potentially a significant advance as it should have continuous action yet not impair sleep onset or quality. Details are accessible on the medication page. This is not funded in New Zealand, but the long acting methylphenidate preparation Concerta, short and intermediate acting methylphenidate and short acting dexamphetamine are funded on a special authority. In adults, the basics of treatment are to control the underlying attentional disorder and impulsivity with medication, then apply cognitive behavioural strategies to assist the individual in repairing the personal damage from years of untreated disorder, and to assist them in developing more functional coping strategies to replace those which they have developed over the years to help them get by.

Support from a local organisation can be very helpful, including the ADHD Association and the online support group adhd.org.nz both for the affected individuals but also their friends and family.