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Many adults suffer from ADHD without knowing it: how to detect and cope with it


Published in

The Conversation Spain

Gonzalo Arrondo

researcher Ramón y Cajal, group Mente-Cerebro del Institute for Culture and Society (ICS), Universidad de Navarra

Driven by his impulsive and reckless behavior, David climbs on a crane and falls into the void. This is a turning point in the life of this young university student, as he is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) as a result of the accident.

This is the plot of a story I wrote some time ago that was later adapted as a short animated film to raise awareness of the fact that, like David, there are many people who suffer from ADHD without knowing it. Identifying and treating ADHD can greatly reduce the impact it has on the lives of those who suffer from it. That is why it is so relevant to review its main characteristics, as we will do below.

Attention to the following symptoms
ADHD is characterized by three main sets of symptoms:

  • Inattention. Difficulty paying attention to details, making careless mistakes, forgetting daily tasks and losing important objects.

  • Hyperactivity. Restlessness, inability to sit still in situations where sitting is expected, and difficulty participating in leisure activities in a calm manner define this behavioral subject .

  • Impulsivity. It is reflected in making decisions without considering the consequences, continuous interruptions and difficulty to wait for a turn in social situations that require it.

Other frequent symptoms are emotional dysregulation, which can show up as leave frustration tolerance, irritability and emotional lability; and difficulties in executive functions, which translate, for example, into a leave ability to plan activities.

Although ADHD symptoms typically appear in childhood, they tend to persist and manifest in adulthood. Approximately 50% of affected children will continue to meet the criteria for the disorder into adulthood.

Over time, symptoms of impulsivity usually decrease, while symptoms of inattention are maintained or even increased. Moreover, as with David, ADHD often goes unnoticed during childhood and is detected in adulthood, when challenges associated with work performance, interpersonal relationships and overall quality of life intensify.

The best programs of study indicate that the frequency of ADHD in adults would be around 3%, although many of these cases remain undiagnosed. In addition, most people diagnosed in childhood but not in adulthood are thought to have subclinical symptoms (i.e., not sufficient for a diagnosis). This invites an understanding of ADHD as a stable trait in the individual's way of being whose negative consequences can be minimized, as he or she matures, through habit formation.

This is how ADHD interferes with daily life.
It is important to emphasize that these symptoms occur on a continuum in the general population. That is, many individuals may experience certain Degrees of inattention, hyperactivity and impulsivity at some point in their lives. ADHD is perceived as the "tail" of this distribution, where symptoms reach clinically significant levels that affect daily life and functioning.

A disorder is only considered to exist when the traits associated with the disorder substantially interfere with daily activities, interpersonal relationships, and academic or work performance. A common criticism is to say that there is no exact point at which people can be considered to be in or out of normality, but the same is true, for example, with weight problems or blood pressure.

The reality is that ADHD symptoms in adults are associated with poorer performance at work, personal and family conflicts, a higher frequency of mental disorders(anxiety, depression), substance use, physical alterations(obesity or sleep disorders) and higher risks of traffic accidents or committing crimes.

Timing of diagnosis and treatment
So, if a person believes they are suffering from these symptoms and they are significantly interfering with their daily life, what do they need to do?

Although general practitioners can potentially refer to a specialist or even make the diagnosis themselves, they are often reluctant due to lack of time or knowledge. In such cases it may be necessary to use a private specialist.

In any case, it should be emphasized that the diagnosis is clinical and that the tool par excellence should be the interview. Other methods such as symptom questionnaires or cognitive tests (including computerized ones) can complement the former, but their efficacy is moderate. Finally, the usefulness of techniques such as electroencephalography has not been demonstrated.

Treatments considered effective can be classified into three categories:

  • Psychoeducation. It focuses on providing information and educational resources to improve understanding of the disorder and develop management strategies.

  • Cognitive-behavioral therapy. Addresses thinking and behavioral patterns, teaching skills to cope with the challenges associated with ADHD.

  • Prescription of pharmacological treatments to control symptoms. They are usually divided into stimulants or non-stimulants.

Although there is some social controversy surrounding the use of these psychotropic drugs for ADHD, experts agree agreement that they are very safe treatments and can greatly help in the management of primary and secondary symptoms. In a study we conducted, we showed that children with ADHD had a lower risk of accidents, injuries and poisonings when they were taking the medication. Other research shows similar effects in adults and driving or drug use risk.

In Spain, for example, the first line treatment in adults is non-stimulant medications such as atomoxetine. Stimulants are generally reserved for those who have continued taking them since childhood with a good response.

As in the case of identification, there are also different therapies that, despite being popular, have not shown their usefulness, such as neurofeedback. neurofeedback or executive function training exercises similar to video games andbrain training workbooks.

At summary, knowing how ADHD manifests itself in adults is crucial for early identification, effective interventions, reducing stigma and providing support in work and personal settings. However, as we concluded in David's video, by identifying and treating this disorder we do not seek to change the sufferer, but to keep him/her the same, but happier.

This article was originally published in The Conversation. Read the original.

The Conversation