ADHD in Adults

ADHD in Adults Written for AskTheNeurologist.Com by ADHDNeuroMD

ADHD is a loaded term

Attention deficit hyperactivity DISORDER

Regarding ADHD in adults

Most have “managed to get by” for many years

Often have high IQ, successful careers

ADH D -like behavior does not = ADH D !

“ There must be clear evidence of significant impairment in social, school, or work functioning ”

Diagnosis dependent on the environment

For simplicity use the term “ADHD” to refer to ADHD-like thinking even when no “impairment”

Definition of “impairment” problematic

Fulfilling potential

Adults with ADHD, especially those with high IQ have most likely missed diagnosis during childhood

Although they be functioning at normal or even increased levels by objective standards they may be performing well below their potential.

Sensitivity to this fact is essential in order to understand whether “impairment” is occurring.

DSM-IV Criteria for ADHD I. Either A or B: A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). Is often easily distracted. Often forgetful in daily activities. B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless ). Often has trouble playing or enjoying leisure activities quietly . Is often "on the go" or often acts as if "driven by a motor". Often talks excessively. Impulsiveness Often blurts out answers before questions have been finished. Often has trouble waiting one's turn . Often interrupts or intrudes on others (e.g., butts into conversations or games). II. Some symptoms that cause impairment were present before age 7 years. III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). IV. There must be clear evidence of significant impairment in social, school, or work functioning. V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

“ Has trouble waiting one's turn” S ocially acceptable? …depends where ? “ Often gets up from seat when remaining in seat is expected " Click to play

ADH D -like behavior does not = ADH D !

Some aspects are dependent on what’s considered “normal” in society

Attention is always “selective”

Reward centers direct attention

Brain constantly searches for “rewarding” material

Attention will drift to search for rewarding material

Attention will “lock on” if rewarding enough

Model to understand Observe environment Focus on a new stimulus Interesting or important ? YES YES NO NO Keep focus Still interesting or important ?

Model to understand Observe environment Focus on a new stimulus Interesting or important ? YES YES NO NO Keep focus Still interesting or important ? Focus on a new stimulus

Model to understand Observe environment Focus on a new stimulus Interesting or important ? YES YES NO NO Keep focus Still interesting or important ? Focus on a new stimulus Focus on a new stimulus

Model to understand Observe environment Focus on a new stimulus Interesting or important ? YES YES NO NO Keep focus Still interesting or important ? Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus

Model to understand Observe environment Focus on a new stimulus Interesting or important ? YES YES NO NO Keep focus Still interesting or important ? Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus Focus on a new stimulus “ Environment” can be internal (“ADD”) or external (“ADHD”)

Interesting or important ? Still interesting or important ? Dependent on reward pathways in brain Interesting or important = “Rewarding”

“ Could try harder”

Was well established that people with ADHD can function on very high levels when they are stimulated

Less aware teachers may get very frustrated

“ it’s not that he can’t do it…he just can’t be bothered to put in the effort

“ attitude problem”

“ not motivated enough”

“ But doesn’t everybody focus more when the material is interesting? ”

“ But doesn’t everybody focus more when the material is interesting? ” YES ! Everyone pays attention less when bored and more when interested. But…

Those with ADHD do much, much better when interested! In te re sti ng Boring

What is at the root of ADHD and ADHD-like thinking ?

Differences in the reward system

Dopamine receptor activation is the “currency of reward” in the brain

Dopamine is like money…the “payment” for “doing good”

Receptors are like “hands” grabbing the money

Genetic studies of families with ADHD:- People with ADHD have receptors that “don’t grab so well” ….so they get “paid” less. This rule only applies to “smaller” payments. Substances such as caffeine & ritalin “add a bonus” to each payment.

People with ADHD are ambitious by nature

May be “perfectionists”

Things that those with ADHD may say

“ Simple things please simple people”

“ Jack of all trades master of none”

“ Feel they are meant for better things”

“ If it’s not a challenge there’s no point doing it”

“ Avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time " Easily distracted Inappropriate comments Can be highly effective when motivated Click to play

Best jobs

Highly challenging

No routine boring stuff that anyone could do (assistants / secretaries do that).

Ability to be creative and innovative

Need to have autonomy

Feel appreciated

Flexibility to focus only on what you feel is interesting or important

Or you can choose to do only stuff you find really interesting

Companies actively recruiting “ADHD-type thinkers” Click to play

Some get a job where they only have to do things they consider to be “important”

Some people dislike their job

Some are forced to do jobs that are just not for them (army is typical situation) Does not follow instructions ! Click to play

Has trouble focussing?

Wrong!

ADHD thinking is hyperfocussed thinking!

“ Non ADHD thinking” “ ADHD thinking”

Narrower focus = bigger shadow

Distractions (ADHD type) x x x x .

Distractions (non – ADHD) x x x x .

Distractions In other words, when some-one with ADHD gets “distracted” they lose the ability to keep their (hyper) focus on what they were doing and need to “lock-on” again once the distraction has passed (they may have to take time to reconstruct complex thoughts or ideas which can be very frustrating…therefore they may “snap” at people when they get distracted.) Those without ADHD are able to “attend to a distraction” without losing their “lock” on their initial focus. x x x x . x x x x .

Distractions

The plus-side is that those with ADHD (or ADHD-like thinking) are frequently able to “hyperfocus” and when locked-on to the task without distractions can focus a degree of mental energy which others are incapable of.

May be very good at analyzing complex situations

May train themselves to quickly “separate the forest from the trees” as the “trees” bother them more than others!

x x x x . x x x x .

Distractions

A sniper cannot function at a high level if he needs to be aware of everything in his immediate vicinity.

He needs to ignore the entire world except for his target

x x x x . x x x x .

ADHD Hyperfocus

Some people with ADHD report they get into a “trance-like state” when successfully hyperfocussing and are unaware of anything except for the task they are performing