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ADHD having known to affect children in big percentage, adults have also fallen into victims of the same problem. It is known to cause t learning problems and behavior in an adult person and in most cases the problem can be genetic. However some of the factors that can make one identify the problem are such as low self-esteem, poor memory especially when working, learning becomes a challenge to them inflexibility and many more which are the among the main symptoms of ADHD

However, with this kind of problem in place, there has been no medication for such and what are recommended for a person suffering from the problem are the diagnosis measures. This requires a specialist who is in a position of monitoring such a person with lots of keenness. With a proper diagnosis, then that specialist is also in a position of prescribing some important medication that will control the problem of that person hence boosting his/her focus on whatever work he/she will be doing. Nevertheless, as much as drugs for such problem have been suggested by the profession, people are yet to agree with those hence preferring to use the stimulants when it comes to short term treatment. Despite this short-term treatment, it has also been realized that this kind of treatment has some of its side effects to an adult who will be taking those drugs. Some of those side effects are such as social withdrawal, lack of the needed sleep, headaches, loss of appetite and even jittering and that is why it is recommended that, a person suffering from such problem need the needed attention to avoid bigger repercussions.

Nevertheless, it is believed that the best method for such problem is non-pharmacological methods which involve cognitive behavior therapy. This therapy is known to associate itself with behavior and it is the best method needed by an adult person undergoing through such problem.

 

Adult Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder: is it real?

Introduction

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For this problem to be diagnosed as ADHD, they must be out of the normal range. ADHD is not a new disorder and it was first described in 1902. A British physician, Frederic Still, described ‘abnormal psychical conditions’ in children and the concept of ‘deficit in moral control’. It is one of the most common conditions in childhood, affecting as many as 5% of school-aged children who end up with the condition up to adulthood. Some research has been carried out to determine the prevalence of ADHD in adults shows that, 2.9%-4.4% of adults are affected by the condition. In the United States alone, it is estimated that about 5% of the adult population are affected by the condition. On average, it has been reported that, 1.2%-7.3% of adult population in Europe, Middle East and America are affected by the condition. Several studies have suggested that most cases of ADHD in adults may have by-passed childhood recognition due to lack of symptoms that are indicative of the condition leading to failure of detection through diagnosis. As far as gender is concerned, it has been observed that the ratio of male to female who are affected by the condition is 1.0-1.5 where by in children it has been observed that boys are 3-4 more likely to be affected by the condition than girls.

Historically, a number of terms have been used to describe the disorder presenting with the symptoms of ADHD. These include Minimal Brain Dysfunction or Damage (MBD), Hyperkinetic, Reaction and Hyperkinesis. ADHD is also referred to as ADD (Attention Deficit Disorder). The two terms are often used synonymously but in real sense, they refer to different but very similar or related conditions. People with ADHD have difficulties with attention span and are impulsive and hyperactive. Those with ADD do not have hyperactivity but share the problems associated with impulsiveness and attention deficit. In both cases the symptoms are present to degree that is abnormal for the age and intellectual ability of the person.

Over the past five to ten years, there has been an increasing awareness of this condition resulting into many more referrals to adult psychiatrists. Recent clinical experience and research has documented the continuation of symptoms into adulthood. Much more is known about ADHD as it presents in childhood and adolescence, than how it appears later in life. ADHD occurs in two different forms: one that is mainly a learning difficulty and another that mainly affects behaviors.

Causes of ADHD

Genetic factors are known to play a significant role.

Environmental factors which include pre- and postnatal factors, chemical toxins and psychosocial stressors.

Types of ADHD

Three types of this condition exists’ and are: Inattentive, Hyperactive and a combination of both.

 

Hyperactive- Impulsive type of ADHD

Impulsivity

Adults with the impulsive type of ADHD have great difficulty stopping to think before they act. Adults with this form of ADHD often do the first thing that comes in their mind for example they me have tremendous difficulty waiting their turn.

Due to this impulsivity they do not learn from their mistakes. The problem is not necessarily that patients with ADHD do not know the correct thing to do. They will be able to explain in great detail what they should have done. They may also be quick to notice when others break the rules that they themselves do not obey.

The mechanisms that control behaviour in the brain seem to be unreliable in the patient with ADHD. An expert in this condition was once quoted saying ‘ADHD is not a matter of not knowing what to do, but of not being able to do what you know. ADHD is a problem of performance, not of knowledge.

Over activity

Some patients with ADHD are always on the go. Such patients often can not remain seated, even for a few moments. They may wander around the place and the people around may have great difficulty keeping them on their seats. In the past, such a condition was considered essential feature of ADHD. Even those who are very active when young may become less active than their peers as they get older a transformation that has been described as changing from being  ‘flipper to a ‘flopper’.

Noisiness

Patients with the hyperactive-impulsive type of ADHD are often boisterous and loud. They find difficult to engage in activities quietly. Some talk excessively. Some patients have a habit of making all manner of repetitive noises. They may be quiet for a short time if reprimanded, but the noises return, often without the patients being aware that they are making them.

Features in inattentive type of ADHD

Task impersistence

A common complaint is that patients with ADHD do not complete tasks. At home relatives find that they need to supervise their loved one more closely. Simple chores like getting dressed in the morning, take a long time. These patients often forget what they are asked to do.

 

Disorganization

Patients with ADHD find it very difficult to follow sequences without a great deal of supervision. When such supervision is not available, they become muddled and disorganized.

Forgetfulness

An excellent memory for what happened last year, but they cannot remember what happened yesterday is a common description of the patient with ADHD. Such patients may have a problem following an instruction with more than one part, becoming distracted or lost midway through carrying it out. They are often very absent minded to an extent that they forget anything that they had in their possession when they were moving around.

Features present in either type of ADHD

Low self-esteem patients with ADHD are very hard on themselves. They may say negative things about themselves such as ‘I am dumb’. They may be easily offended. They may feel dissatisfied with themselves even when they succeed.

Poor working memory

The memory difficulties of patients with ADHD are not confined to forgetfulness described earlier. A type of short-term memory known as ‘working memory’ may also be impaired in patients with ADHD. A patient with ADHD who has a poor working memory will experience great difficulty keeping any set of instructions or sequenced information in his mind. He will therefore find it difficult to plan ahead. He will also experience difficulty following the plot when reading a book, or even when writing a story of his own.

Many of the learning difficulties experienced by patients with ADHD that affect skills such as reading comprehension, sequencing and written expression are due to impairment in working memory.

In addition, some of the behavioral problems seen in this condition, such as lack of foresight and failure to learn from experience, are also due, in part, to problems with working memory. Poor working memory makes it difficult for the patient to guide his behaviour by ‘self-talk’, the inner monologue that we use to keep us on track.

Social clumsiness

Patients with ADHD have difficulties reading social situations. They are often ‘socially tone deaf’. They do not mean harm, but have a tendency to say very tactless things without realizing the effect they are having. They seem to have difficulty predicting the consequences of their actions and responding appropriately to the occasion. They may ‘come on too strongly’. These patients do not pick up the same cues as other people of the same age. They often do not read facial expressions and may be oblivious to whether someone is angry or upset with them.

Although such abnormal behaviour may be apparent to all who meet the patients, the people who are most likely to notice are patient’s peers. With them, the patient with ADHD often sticks out like a sore thumb. Typically such patients have little or no insight into how differently they are perceived. They do not seem to be able to learn the skills that are required to mix with others. They often become loners.

 

Learning difficulties

All patients with ADHD under-achieve academically. Most patients with ADHD will have difficulties in primary school with skills such as reading, spelling and mathematics. Many have very untidy handwriting. Other common areas of difficulty are in reading comprehension and written expression

Some patients with mild ADHD may do well during primary school. However, during high school and college, such patients often start to fall behind, as greater skills in concentration and organization are required.

Inflexibility

Patients with ADHD are often very literal, and ‘black and white’ in their understanding of the world around them. They find it difficult to compromise. As a result, relatives often find themselves in conflict with their patient over many issues. Relatives say that ‘every discussion is an argument’. Once a patient with ADHD takes up an attitude to something, it is often impossible to let him to change. Patients with ADHD may become very fixated on certain rules and follow these rigidly. They have difficulty understanding when such rules can be reasonably bent.

Insatiability

Patients with ADHD may be insatiable in their activities, not knowing when to stop, the way another person of their age would. This may be seen when they become over-excited in a fun occasion and cannot calm down again when it is time to be serious. Instead they become more and more excited and non-compliant. They may even become excessively defiant and provocative despite reasonable request to calm down.

They may show their insatiability by never being satisfied with any treat and in nagging for more things they want. This difficulty is related to patients with the inattentive type of ADHD.

In adults, ADHD causes some adverse effects to the person affected which include: physical and mental problems where by the patient may be forced to turn to substance abuse, work and financial constrains which makes the individual to undergo a lot of difficulties at work place which in extreme situations can result to the loss of job. Finance management is also an issue, issues regarding relationships are also affected in ADHD conditions. This comes as a result of the constant pressure that is put on the individual pushing him/her to tidy up or to get more organized. Most serious effects of the condition can end up causing embarrassment, disappointment, frustrations, loss of confidence and hopelessness.

Diagnosis and Treatment

There is no single medical, physical or genetic test for ADHD. However, a diagnostic evaluation can be provided by a qualified mental health care professional or physician who gathers information from multiple sources. These include ADHD symptom checklists, standardized behaviour rating scales, a detailed history of past and current functioning and information obtained from family members or significant others who know the person well.

The American Psychiatric Association diagnostic manual provides clinical guidelines for diagnosis of ADHD commonly referred to as the DSM-IV-TR (Diagnostic and statistical Manual of Mental Disorders). During diagnosis, the clinician is advised to determine the extent of the symptoms apply to the individuals life at present and in his childhood. The DSM-IV-TR contains a list of symptoms for all the types of ADHD to assist the clinician in the diagnosis process. The clinician uses the symptoms to determine the number and severity of the symptoms, their duration and extent of impairment caused by the condition in various life domains. It is also important to determine whether this impairment is as a result of other conditions that represent themselves in the same manner as ADHD.

Treatment

Certain medications, stimulants and behavioral therapies have been shown to be very effective in the treatment of ADHD by controlling their activity level and impulsiveness, boosting their attention and improving their focus on tasks.

Generally, medication is taken as the primary intervention for the treatment of the condition but it has been met with a lot of criticism where several people have argued that medication is not the best option.

Stimulants have proven to be very effective in short term treatment of the condition with few side effects although some produce some adverse side effects to the user. The side effects that have been observed are reported to occur during the early stages of treatment where by they present as mild and short-lived. The side effects that are mostly associated with stimulants include, social withdrawal, interferences with sleep, headaches and at times stomachaches, loss of appetite, and jitteriness. Management of these side effects can be achieved through the adjustment of the dose being administered. Stimulants such as Ritalin, Adderall and Dexedrine have been found out to cause heart problems and to some extend reading to addiction to the user. Strattera is a non-stimulant that is used for the treatment of the condition and it has been linked to liver problems and possibility of inducing suicidal thoughts to the patient. Commonly prescribed include short-, intermediate and long-acting methylphenidate, dextroamphetamine and amphetamine.

The most preferred method of treating the condition is the use of non-pharmacological methods and to be specific, cognitive behavior therapy. This method of treatment is based on the theory that stipulates that, much of human feelings are highly influenced by our thoughts. According to this therapy, majority of mental disorders are associated with thoughts and beliefs that are faulty. Psychiatrists believe that, any intervention that is undertaken to correct this faulty beliefs and thoughts brings about the improvement of the emotional state of the patient. The therapist who attends to such kind of patients works towards challenging the thinking errors that the patient is suffering from. The therapist provides the patient with a different way of view situations which subsequently changes the persons’ mood and behaviour. To be more effective, the therapist is advised to teach the patient on to deal with the symptoms when they represent themselves. It has also been observed that, cognitive therapy is most effective when the treatment is given based on the patient’s age, current symptoms and specific needs. This method is highly dependent on constant monitoring of the patient to check for any behavior change and emotional state. Cognitive therapy has come out clearly as an effective way of treating ADHD and has equal potential as medication over a prolonged period of treating ADHD.

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