Adult ADHD Diagnosis: what we know and what we don’t
By Michelle Morris
It has been increasingly recognised that ADHD is taking hold into adulthood. But to date there has been a paucity of research with a focus on adults diagnosed with ADHD.
Unfortunately, there are relatively few studies of adults with ADHD. Much of this research focused on the identification of the disorder, potential comorbidity with other mental health problems or psychiatric disorders in adults with ADHD and the use of appropriate medication treatments.
The prevalence of adults with ADHD is ambiguous. Investigative results vary according to the research criteria is used, and client symptomatology. It is a working hypothesis as to the specific diagnostic criteria for adult ADHD. Procedures for evaluating adult ADHD include current and past self-reports as well as collaborative reports of the same symptoms from parents and/or spouses, checklists, interviews and reviews of past records (i.e., school report cards, medical transcripts, medical records).
The diagnostic criteria for ADHD criteria in the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM IV) is more child-appropriate than adult-appropriate. Existing protocols have been modified by changing the wording of symptoms and the number of symptoms required for cutoffs.
Other co-morbid disorders such as anxiety, depression, bipolar disorders may cause additional uncertainty to a greater degree than when making a diagnosis in childhood.
Differentiating ADHD from other mental disorders in adults may prove to be difficult. Many of the symptoms of adult ADHD are also found in other disorders. For example, difficulty with focus or concentration is characteristic of anxiety disorders and mood disorders.
Researcher S. Goldstein reported that a diagnosis of adult ADHD in adulthood may be variable. He divided adults with histories of ADHD into three categories:
(1) Individuals who may function well as adults although they have had childhood diagnosis of ADHD;
(2) Individuals who have significant problems with ADHD may also experience stresses that involve interpersonal relationships, emotional lability, workplace difficulties, anxiety and panic disorders and issues with self esteem.
(3) Individuals who develop serious mental ill -health and psychiatric problems may become dysfunctional to varying degrees.
The following sections contain outcome information about academic and occupational functioning, social skills, and family functioning in individuals with adult ADHD.
Adults with childhood histories of ADHD and/or a diagnosis of ADHD made in adulthood, on average, have more difficulty achieving in school and in their employment. They are less likely to proceed to higher education and are more likely to be employed in skilled labour positions and to change jobs more often. Adults with ADHD may do better in occupations that are fast-paced and involve a degree of risk-taking with an outgoing style of communication. These workplace characteristics seem to match the characteristics found in many adults with ADHD.
Some studies have examined how adults with ADHD function in social interactions. Symptoms such as inattention and impulsivity may to contribute to social difficulties. Adults with ADHD are often described as having difficulty with the give and take of conversation. They may ramble, unaware of cues given by the person(s) they are conversing with. This may mean that perhaps they should alter thwir communications styles.. Drs. Gabrielle Weiss and Lilly Hechtman found that young adults in the ADHD group they studied were significantly worse at social skills in job interviews and other situations which required assertiveness and oral communication. Dr. Michele Novotni in her book, What Does Everybody Else Know That I Don’t?, gives many illustrations of how ADHD symptoms can impact on adult social interaction and offers strategies for improvement.
Due to the high heritability of ADHD, adults with ADHD who become parents are more likely to have children who also have ADHD. As a result, these parents have a double challenge. They must manage their own ADHD symptoms and they must help their child with manage theirs. ADHD can interfere with a parent’s patience and ability to use effective parenting strategies. Children with ADHD have a greater need for a parent who has a clear and consistent parenting style, established routines and structure in the home. Parents may have to implement different behavioral treatment programs requiring consistent delivery of rewards and consequences. They may have to be good time managers to keep their ADHD child on track so they have time for schoolwork, household responsibilities and recreation. Often treatment of ADHD symptoms in a parent leads to improvements in parenting skills. Unfortunately, ADHD may have a negative impact on marital stability as higher rates of separation and divorce have been found in adults with ADHD.
Michelle Morris is the principal psychologist at Life Resolutions Caroline Springs in Victoria. She has over 30 years experience working in private practice and holds several qualifications. In additional to being a registered psychologist, she is a qualified nurse, midwife and holds postgraduate qualifications in law and family therapy. Michelle has a special interest in family relationships. She is passionate in helping family members access skills to manage difficult and challenging times.