In this seminar, I will be exploring some research studies discussing how the ADHD symptoms manifest in adults and cause problems and impairment in different domains, ex. home, work, social and personal, of an Adult ADHD person’s life leading to family distress. Further, I will discuss about assessment and management of family distress.

1. Presenter
Tejas Shah
Chair
Dr. Arun Kumar
Association between
Adult ADHD symptoms
and family distress

2. SEMINAR OUTLINE
Conceptualizing Adult ADHD
Adult ADHD Symptoms and Family Distress
Assessment and Diagnosis of Adult ADHD and
Management of Family Distress
1
2
3

3. CONCEPTUALIZINGADULT ADHD
1SECTION

4. ADHD is a genetic, neurobiological disorder
that affects ones ability to regulate impulse
control, motor activity, and attentiveness
(i.e. a disorder of executive function).
“the core problem in ADHD seems to
be with response inhibition”
CONCEPTUALISING ADULT ADHD
Cognitive Process of Attention:
1. Detecting a stimulus
(focusing)
2. Processing the detected
information.
3. Sustaining attention to the
relevant stimulus.
4. Inhibiting involuntary
shifting (distractibility)
5. Organizing a response to
the stimulus.
WHAT IS ADHD?

5. IMPAIRED ATTENTIVENESS
IMPAIRED IMPULSE CONTROL
IMPAIRED MOTOR ACTIVITY
CONCEPTUALISING ADULT ADHD

6. DSM5 DIAGNOSTIC CRITERIA FOR ADULT ADHD
Five or more of the following for Adults
 Lack of attention to details / careless
mistakes
 Difficulty sustaining attention
 Does not seem to listen
 Does not follow through on
instructions (easily side-tracked)
 Difficulty organizing tasks and
activities
 Avoids sustained mental efforts
 Loses and misplaces objects
 Easily distracted
 Forgetful in daily activities
Five or more of the following for Adults
 Fidgetiness (head or feet) / squirms in seat
 Leaves seat frequently
 Running about / feeling restless
 Excessively loud or noisy
 Always “on the go”
 Talks excessively
 Blurts out answers
 Difficulty waiting his or her turn
 Tends to act without thinking

7. 12

8. ICD-10 CRITERIA FOR ADULT ADHD
ICD-10 Codes DSM5
F90.0 - Disturbance of activity and
attention
Predominantly inattentive presentation
F90.1 – Hyperkinetic conduct disorder Predominantly hyperactive / impulsive
presentation
F90.8 – Other hyperkinetic disorders Other Specified ADHD
F90.9 – Hyperkinetic disorder,
unspecified
Unspecified ADHD
F90 – Hyperkinetic conduct disorder

9. EPIDEMIOLOGY
Prevalence of Adult ADHD Compared
with other Major Psychiatric Disorders
in Adults!
Schizophrenia 1%
Bipolar Disorder 2.5%
Generalized Anxiety Disorder 3%
Adult ADHD 4.5%
Major Depression 7%
Some Stats!
 ADHD affects 4-5% of the
adult population
 Half of the children with
ADHD still meet full
criteria in adulthood
 Men are more likely than
women to be diagnosed
with Adult ADHD

10. EPIDEMIOLOGY
India 5.4%

11. THEORIES AND MODELS OF ADHD
1. Causal Theories
 Genetic causes
 Non-genetic causes
• Twin studies indicate that the
disorder is often inherited from
one's parents with genetics
determining about 75% of cases.
• Siblings of children with ADHD are
three to four times more likely to
develop the disorder than siblings
of children without the disorder.
• Genetic factors are also believed to
be involved in determining whether
ADHD persists into adulthood.

12. THEORIES AND MODELS OF ADHD
2. Social Construct Theories
The hunter vs. farmer hypothesis
proposes that the high frequency of
ADHD in contemporary settings
"represents otherwise normal
behavioural strategies that become
maladaptive in such evolutionarily novel
environments as the formal school
classroom.“
Hyperfocus is an
intense form of mental
concentration or
visualization. It is like
tunnel vision where the
rest of the world is cut
off, blocking out potential
distractions.
thing.
(Thom Hartmann in his book Attention Deficit Disorder: a Different Perception)

13. THEORIES AND MODELS OF ADHD
3. Diathesis–Stress Model
Disorder
“diathesis means predisposition”
“environment is the social construct”
“attitude is the personal schema”
Diathesis
Environment Attitude

14. DIFFERENTIAL DIAGNOSIS
 Bipolar disorder (Bipolar II)
 Unipolar depressive disorder
 Anxiety disorders
 Obsessive–compulsive
disorder
 Impulse control disorders
 Personality disorders
(Borderline)
 Alcohol and substance abuse
Psychiatric disorders

15. DIFFERENTIAL DIAGNOSIS
Medical disorders
 Endocrine and metabolic disorders (thyroid disorders)
 Neurological disorders (including traumatic brain injury)
 Sleep disorders (obstructive sleep apnea)
 Side effects of drug treatment

16. COMORBIDITIES IN ADULD ADHD
Adults with ADHD have 3-7 times the rate of comorbid psychiatric
disorders compared with the general population
 Mood Disorders (depression, bipolar)
38% prevalence of any mood disorder
 Anxiety disorders
47% prevalence of any anxiety disorder
 Substance use disorder
15% prevalence of any substance use disorder

17. ADULT ADHD SYMPTOMS AND
FAMILY DISTRESS
1SECTION 2

18. PRE-SCHOOL
SCHOOL-AGE
ADOLESCENT
COLLEGE-AGE
ADULT
o Behavioral disturbance
o Behavioral problems
o Academic problems
o Poor social interaction
o Co-morbidities
o Academic impairment
o Poor social interaction
o Lower self-esteem
o Smoking / alcohol / drugs
o Antisocial behaviour
o Academic failure
o Not able to cope with daily tasks
o Occupational difficulties
o Low self-esteem
o Alcohol & substance abuse
o Co-morbidities
o Forensic problems
o Unable to cope with daily tasks
o Unemployment
o Low self-esteem
o Relationship problems
o Alcohol & substance abuse
o Mood instability
o Co-morbidities
o Forensic problems
DEVELOPMENTAL COURSE OF ADHD

19. HYPERACTIVITY “can’t sit still, always on the go, climbs
or runs at inappropriate time”
RESTLESSNESS “can’t stay focused on one thing,
fidgety, impatient”
Hyperactivity in childhood often changes to inner
restlessness in adulthood.
ADULT ADHD SYMPTOM MANIFESTATION

20. PHYSICAL IMPULSIVITY “doing things that result in a lot of
injuries, problems waiting one’s turn”
VERBAL IMPULSIVITY
“saying the ‘wrong thing’ or speaking
out of turn, interrupting others
excessively”
Physical impulsivity in childhood often changes to
verbal impulsivity in adulthood.
ADULT ADHD SYMPTOM MANIFESTATION

21. ADULT ADHD SYMPTOM MANIFESTATION
INATTENTION “problems paying attention in class or
completing school work”
INATTENTION “difficulty concentrating at work,
problems finishing tasks”
Inattention in childhood often remains inattention in
adulthood but carries more severe consequences.

22. RESTLESSNESS1
Leading to family distress…
HYPERACTIVITY
in childhood
often changes
to inner
restlessness in
adulthood.
 Self-selects very active job
 Needs constant activity,
leading to family tension
 Is overscheduled/
overwhelmed
 Is a workaholic
ADULT ADHD SYMPTOM MANIFESTATION

23. IMPULSIVITY2 IMPULSIVITY in
childhood often
carries more
serious
consequences
in adulthood
 Low frustration tolerance
 Quits jobs
 Ends relationships
 Drives too fast
 Loses temper
 Talks excessively
ADULT ADHD SYMPTOM MANIFESTATION
Leading to family distress…

24. INATTENTION
in childhood
often carries
more serious
consequences
in adulthood
 Procrastination
 Difficulty organising
 Being late
 Forgetting things or
appointments
INATTENTION3
ADULT ADHD SYMPTOM MANIFESTATION
Leading to family distress…

25. ADULT ADHD SYMPTOMS AND IMPAIRMENT
The UMass Study
• Adult ADHD sample (148)
• Psychiatric disorders (97)
• General population control
group (109)
They evaluated the
functioning of these adults in
numerous major life
activities.
Barkley, Murphy, & Fischer (2008) UMASS study

26. SYMPTOM
MANIFESTATION “behavioural expressions of a disorder”
IMPAIRMENT
“impairments are the consequences
that result from the symptoms”
DISTRESS
ADULT ADHD SYMPTOMS AND IMPAIRMENT
“unpleasant
consequences”

27. CONCEPTUALISING FAMILY DISTRESS
FAMILY DISTRESS is defined as an
unpleasant or disorganized state which
arises from an actual or perceived
demand-capability imbalance leading to
an imbalance in the family’s functioning
and which is also characterized by a
multidimensional demand for
adjustment or adaptive behavior.
(Hamilton I. McCubbin, Marvin B. Sussman, 1993)
Stress becomes
distress when it is
subjectively defined
as unpleasant or
undesirable by the
family unit.

28. PERSONAL
WELL-
BEING
HOME
SOCIALWORK
ADULT ADHD BURDEN

29. ADULT ADHD SYMPTOMS AND FAMILY DISTRESS
SOCIAL1
 Lack of Social skills
 Problems with Law
 Increased risky behaviour
 Substance-abuse
 Social withdrawal

30. ADULT ADHD SYMPTOMS AND FAMILY DISTRESS
WORK2
 Frequent layoffs
 Frequent change of jobs
 Financial crisis
 Incomplete projects
 Procrastination
 Unorganised
 Late for meetings

31. THE FAMILY STRESS MODEL

32. ADULT ADHD SYMPTOMS AND FAMILY DISTRESS
PERSONAL DYSFUNCTION3
 Psychological distress
 Feelings of worthlessness
 Hostility, depression and anxiety
 Low self-esteem
 Low self-confidence
 Diminished sense of self-efficacy
 Sense of shame and guilt

33. ADULT ADHD SYMPTOMS AND FAMILY DISTRESS
HOME4
 Relationship issues
 Marital discord
 Frequent breakups
 Multiple marriages
 Child rearing issues
 Unorganised
 Caregiver distress

34. CAREGIVER DISTRESS MODEL
(Anne Y. Branscum)

35. Burden of Care
Subjective
Worry Guilt Depression
Objective
Financial
Problems
Relationship
Issues
BURDEN OF CARE AND FAMILY DISTRESS
Cognitive behaviour therapy-based psychoeducational groups for adults with ADHD and their significant others
(PEGASUS): an open clinical feasibility trial.

36. ASSESSMENT AND DIAGNOSIS OF
ADULT ADHD AND MANAGEMENT
OF FAMILY DISTRESS
1SECTION 23

37. ASSESSMENT AND DIAGNOSIS
 Adult ADHD Rating Scales
oWHO’s Adult ADHD Self-Report Scale (ASRS)
oConners' Adult ADHD Rating Scales (CAARS)
 Monitoring Quality of Life in Adults with ADHD
oADHD Impact Module - Adult™ (AIM-A)
 Measuring Family Distress
o Brief Family Distress Scale

39. MANAGING FAMILY DISTRESS
Psychotherapy and Psychoeducation for Adult with
ADHD and the Family Members
 Cognitive Behavior Therapy
 Skill Based Therapy
 Family Therapy

40. MANAGING FAMILY DISTRESS
Psychoeducation for Managing Family Distress
 It is essential for Adults with ADHD and family members
to have a good understanding of the condition.
 Most adults need to ‘stop fighting the symptoms’ and
learn to manage them.
 Books, seminars and counselling sessions can be a useful
for psychoeducation.

41. MANAGING FAMILY DISTRESS
Cognitive Behaviour Therapy for Management of Family
Distress
 Addressing Communication Problems
 Overcoming Anxiety and Depression
 Developing Family Routines
 Addressing Family ‘Stress Management’
 Coping with the Adversities and the Practical Life Conditions
 Coping to Live with the Partner with the Adult ADHD Symptoms

42. MANAGING FAMILY DISTRESS
 Optimism
 Altruism
 Moral compass
 Faith and spirituality
 Humour
 Role model
 Social supports
 Face fears
 Life mission
 Training
Enhancing Resilience

43. SUMMARY
 Adult ADHD is highly prevalent relative to other
psychiatric disorders
 The ADHD symptoms which manifests in adults cause
problems and impairment in multiple life domains
 There is high association between Adult ADHD
symptoms and family distress
 Managing ADHD in Adult is difficult for both the care-
receiver and the care-giver

44. THANK YOU