ADHD Grows Up: New perspectives on ADHD

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ADHD, Executive functions, emotions, and comorbidities.New perspectives on ADHD plus a Video tour

Compiled by Joan Jager

 

ADHD or Attention Deficit Hyperactive Disorder looks different in adults. This realization has been slowly changing how we understand ADHD and its expression throughout the lifespan. 

Inattention, hyperactivity, and impulsivity have long been considered the classic hallmarks of ADHD, but those symptoms change as the brain matures. We once thought that children with ADHD “outgrew” it in their teens. Any lingering problems were dismissed or thought to be better explained by other disorders. However, further research has shown that about 60% to 75% percent of children with ADHD continue to demonstrate symptom persistence and impairment in some area of their adult life. (1) Researchers and other experts on ADHD began to realize that Adult ADHD presented as a much more complex disorder than was reflected by the current diagnostic guidelines for ADHD in children. Furthermore, these discoveries are rewriting our entire perspective on ADHD.

We now realize that the symptom called inattention is better described as Variable Attention. This is true both for children and adults. When a person with ADHD is interested, challenged, or under the right amount pressure, they can indeed focus. Indeed, they may be so involved that they go into hyper-focus and ignore everything else. This explains how kids can spend hours playing Minecraft and other video games, but feel overwhelmed by homework that has no intrinsic reward.

ADHD has long been thought of as neurobehavioral condition but has since been reclassified as a neuro-developmental disorder. —- That is, certain brain structures are up to 10% smaller in someone with ADHD and connections in the brain’s neural network are underdeveloped.  (2) New research posits that ADHD is a disorder of self-regulation.  That is, the ability to control one’s attention, impulsivity, and emotions, is significantly delayed in the ADHD brain. Research has also shown that although “ADHD is a genetic disorder, DNA is not working alone. Stress, diet, and environmental toxins change the brain as well” according to researcher Joel Nigg, Ph.D., writing for ADDitude Magazine. (3)

The core issue with ADHD is perhaps better described as Executive Dysfunction.  These are constructs that describe “problems of a neurobiological nature that particularly affect “planning, flexibility, organization, and self-monitoring.” (4) Getting out the front door on time, being able to find the tools that you need, attending to the work of the day without getting off track, and finishing small tasks that lead to project completion over time are all important skills. This is called self-regulation, the ability to control your attention and take action towards future goals. Russell Barkley, Ph.D. explains this concept well in this 3-minute video.

ADHD and Executive Function

Most notably, by adulthood, Hyperactivity and Impulsivity are often no longer overtly physical. Instead, they become internalized with age and are better described as Emotional Dyscontrol, a major, albeit often overlooked symptom of ADHD.  Emotional dysregulation, as Steven V. Faraone, Ph.D. describes it, is “the failure to modify emotional states in a manner that promotes adaptive behavior and leads to the success of goal-directed activities.” This may involve just feeling impatient and getting frustrated. Or you may be paralyzed by not knowing how to proceed, lose your temper or be so overwhelmed that your ability to get started or to finish a project is short-circuited. In other words, our ability to suppress our emotions or express them appropriately is poor. (5)

For further information, watch this 3 ½ minute video with Dr. Farraone.

ADHD and Emotionality: What’s the Connection?

 

It’s important that we acknowledge that ADHD is a  complex and highly comorbid disorder. (Comorbidity or co-occurring, means having two or more diagnosable and related conditions at the same time) (6) Indeed, researchers are discovering that ADHD “seldom rides alone.” Studies suggest comorbidity rates of between 50% and 90%. This complex interplay between ADHD and its commonly occurring comorbid psychiatric disorders complicates diagnosing and treating ADHD. (7) “Knowing that ADHD symptoms transform over time, offers researchers and clinicians new opportunities for treating ADHD symptoms and ADHD adults new opportunities for understanding their own gifts and challenges.” (8)

Getting diagnosed and treated in adulthood can change lives. This 3-minute video depicts one man’s  Adult ADHD Treatment Success Story.

Medication can help. Learning coping skills adds to our bag of treatment ideas – Writing everything down, setting timers, creating habits and routines to help with organization and planning all help. But we’d be remiss if we focused merely on improving our ability to get things done. Too often being productive is the only measure by which we judge a man. But success can come in many forms. Focusing on our inner values and strengths is another way to approach finding our purpose in life.

 David Giwirec of the ADD Coach Academy (ADDCA) notes “Who you are and your associated self-worth is not based on how well you do things. Who you are is who you choose to be based on your important, heartfelt, character values and strengths. Learn how to focus on what’s important, so you don’t get emotionally hijacked by the expectations of inconsistent performance.” (9) His 3-minute video explains more.

Cultivating Habits of the Heart

Ron Kessler, Ph.D. of Harvard and the World Health Organization promoted his presentation comparing ADHD in kids to their behavior of kids with ADHD to adults at the American of Professional Society of ADHD and Related Disorders (APSARD) conference in 2015.  I have hit the high points above, but the video is also worth watching. This video was used to Much of it is presented as slides accompanied by the transcribed interview. If you prefer reading to watching, APSARD offers a full transcription. (9)

 How ADHD Grew Up as ADHD Kids Grew into ADHD Adults   (11-minutes)

References

  1. Could my Child’s ADHD Symptoms follow Him or her into Adulthood? (60%) (U.S.News & World Report, April 26, 2017)…” (Link works) http://health.usnews.com/health-care/patient-advice/articles/2017-04-26/could-my-childs-adhd-symptoms-follow-him-or-her-into-adulthood Harvested August 31, 2017 – Also see CHADD’s Fact Sheet about ADHD (75%) http://www.chadd.org/Portals/0/Content/CHADD/NRC/Factsheets/aboutADHD.pdf  Numbers have changed over time and can vary by how it is measured. – Harvested October 24, 2017
  1. Is there an ADHD Spectrum? By ADDitude Editors, Janice Rodden, Joel Nigg. Ph.D. https://www.additudemag.com/is-there-an-adhd-spectrum/ Harvested August 31, 2017)
  2. More Than Just Genes: How Environment, Lifestyle, and Stress Impact ADHD by Joel Nigg, Ph.D. ADDitudeMag https://www.additudemag.com/epigenetics-and-adhd-how-environment-impacts-symptoms/ Harvested August 31, 2017
  3. Lazy Kid or Executive Dysfunction –  LD online – http://www.ldonline.org/article/6311 – Harvested June 13, 2017
  4. Emotional Dysregulation and ADHD in Adults by Steven V. Faraone – http://adhdinadults.com/emotional-dysregulation-and-adhd/ – Harvested June 13, 2017
  5. ***ADHD and Comorbidity: What’s under the tip of the iceberg? by Carol Watkins – I recommend this quite readable exploration of a difficult subject.  http://ncpamd.com/add-comorbidity/– Harvested June 13, 2017
  6. ADHD in Children With Comorbid Conditions: Diagnosis, Misdiagnosis, and Keeping Tabs on Both – By Stephen V. Faraone, PhD; Arun R. Kunwar, MD – Medscape  (Link works) http://www.medscape.org/viewarticle/555748 Harvested June 13, 2017 – See list of common co-existing conditions below.
  7. YouTube description of Cultivating Habits of the Heart – Harvested June 24, 2107 https://www.youtube.com/watch?v=5LUJv1Wnfbc
  8. YouTube description of How ADHD Grew Up. – Harvested June 13, 2017 https://www.youtube.com/watch?v=KBx9QTtcvC0

Common conditions that often co-exist with AD/HD (10)

Disruptive Behavior Disorders
(CD, ODD)
Learning disabilities
Mood disorders
Tourettes
Tourettes/OCD
Anxiety

Health Risk Behaviors:
Smoking
Abnormal risk-taking and impulsive behaviors
Risk for injury (what types)
Substance abuse
Criminality

There’s a good Venn Diagram from an article by Joseph Biederman and Stephen Faraone, Harvard Mahoney Neuroscience Institute LetterWinter 1996 Volume 5 Number 1 – Found at http://ncpamd.com/add-comorbidity/ July 20, 2017 – I wasn’t able to copy it.

10. From ADHD Long-term Outcomes: Comorbidity, Secondary Conditions, and Health Risk Behaviors – Center for Disease Control –  https://www.cdc.gov/ncbddd/adhd/workshops/outcomes.html – Harvested June 13, 2017

Photo Credits:

 

(Title photo from facebook/Credit unknown) Modified on Canva

 

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