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Adult ADHD Diagnosis: what we know and what we don’t

January 21, 2013

diagnosing adult adhd

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.

Adult Achievement

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.

Social Skills

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.

Family Functioning

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.

 

 

Post Traumatic Stress Disorder In Soldiers

January 17, 2013

exit wounds john cantwell

By Laurie Lumsden

Some of my clients – ex-service, police and civilian – have asked me about General John Cantwell’s recent autobiography Exit Wounds – One Australian’s War On Terror.

John retired from the Australian Army in 2011 after operational service in a number of war zones.  Despite being myself an Army Reserve officer who worked on the Regular Army operational 1st Division Head Quarters during the tidal wave in Papua New Guinea and the operation in East Timor, I found the book disturbing in terms of the amount of combat detail he described.

I think perhaps he was more exposed to trauma because his initial combat in Iraq was away from his unit and social support (the reference to no further contact from the two soldiers he worked with there is very significant) and the US military context and philosophy was a shock to him.

I could be wrong but I suspect that he would not have come across quite such a matter-of-fact approach to killing in the Australian or British context.   Maybe we just avoid talking about it in quite such a frank way.

The experiences he had are textbook examples of those capable of causing post-traumatic stress disorder (PTSD).  I wondered why his PTSD had not been picked up earlier and I think part of the point of the book is to explore this; to encourage servicemen and women to be more open about their “demons” and to seek out the help that is available.  (I note his use of the word demons.  It is very descriptive and I will continue to use it.)

This book shows his humanity, and respect for life and family.  For him, recovery is a long and gradual process, as for everyone who makes this journey.  He talks about the important supports of family and friends.  He describes himself as a “survivor” not a victim.

It’s a tough read, but inspirational in that other soldiers suffering undisclosed PTSD might come forward, and because it might be used by the Defence Force to rebuild psychological supports that I suspect have been eroded since I was in the Army.

I hope the Defence Force employs General Cantwell in a post-retirement role doing just that.

Laurie Lumsden is the principal psychologist at Life Resolutions Kenmore in Queensland.  He was Australia’s first police psychologist, and also worked as a psychologist for the Australian Army testing and selecting soldiers and later in operational work in the preparation for deployment and return of soldiers from overseas. 

How to live longer (at a price)

January 16, 2013

living longer

What if the capability to live longer came with a “small” price?

Side effects could include the inability to focus on details, having problems holding attention, the inability to follow directions, to become easily distracted and  forgetting to complete some activities of daily living on a regular basis.

Oh, and you could have or develop an unhealthy addiction.

New research published in the Journal of Neuroscience may have discovered a form of the fountain of youth. DRD4 is a gene that is responsible for the dopamine system. It is also often referred to as the “thrill-seeking” gene. It has been linked to infidelity, alcohol and gambling addictions, ADHD and most recently, a long lifespan.

The study suggests that 66% of the time DRD4 is common in people who live to be 90 and older. Does this mean we will move toward recreating the gene? Maybe a once-weekly shot in the arm, so people can live longer? Perhaps. But does the benefit outweigh the risk?

This post was written by Natasha Ace from Bridges Aligned Services Inc.

An orphan Christmas

December 14, 2012

Australian Santa

by Adam Lea

This year is my first Christmas in 12 years that I will be spending not in my marriage and the first in 9 years without my kids.

I have them for part of Christmas Day which is great, but I have no family in Australia so I am effectively having an orphan Christmas this year.

Luckily for me Melbourne is a great place to be an orphan if you have money. There are lots of people in a similar situation and I have had 3 offers for the main days and I will be travelling to Sorrento with friends from Boxing Day till just after New Year’s so don’t worry about me!

Anyway, this situation has led me to think a great deal more about Christmas and the purpose of it, after the obvious commercial ones.

The work we do at Life Resolutions is really important, and never less so than at Christmas time. But I’m not a psychologist and only a marketing person could spin what I do into having some ‘good’ effect in our community!

So, not out of guilt but more out of a new found awareness for the orphans of Australia, I will be donating the money my Mum and Dad have decided to send me and I’m going to donate my presents (and any other gift money too) to kids who aren’t as privileged as I am, and definitely need Christmas to mean something special.

And I urge you to do the same through The Smith Family.

Adam Lea is the National Sales & Marketing Director for Life Resolutions Australia.

The dangerous pursuit of happiness

December 3, 2012

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Chin up, mate.

Cheer up, it may never happen.

You need to be more positive!

How many times have you heard phrases like the above?  While having a positive outlook on life can be a good thing, there’s a fine line between finding silver linings in clouds and falling prey to Pollyanna syndrome.

Actively pursuing happiness at any price is not always a good choice for your wellbeing, according to this report from Psychology Today:

A number of researchers have found that the pursuit of happiness might sometimes be a fool’s errand. Being happy can lead you to ignore potentially dangerous consequences of your choices, to be more gullible, and to think in more simplistic and stereotyped terms. And an active desire to make yourself happy can lead you to be disappointed with your real life. Iris Mauss is a social psychologist at U.C. Berkeley who studies the possible negative consequences of seeking happiness. In earlier research, she found that people who place a great value on being happy actually have more mental health problems, including, sadly enough, depression. In a follow-up experiment, she found that reading a newspaper article singing the praises of happiness led them to actually feel less happy, because thinking about that ideal state of bliss tends to make people feel disappointed.

The key, as ever, is balance.  Letting happiness find its way to you, rather than seeking out false hopes.

Searching for meaning and satisfaction in your everyday life leads to happiness, not the other way around.

Feeling ugly? Try the swimsuit test

December 3, 2012

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How much of your self-worth is based on your appearance?

If you feel good about the way you look, this may not be such a bad thing.  But if you don’t feel good about your body image, the results can be mentally damaging.

Take a look at the results of this study, as reported in Psychology Today:

In a famous set of studies, female participants were randomly assigned to try on either a swimsuit or a sweater and complete a series of tasks. Women in the swimsuit condition felt more body shame, which in turn led them to engage in more restrained eating (i.e., leaving part of a cookie behind rather than finishing it off, suggesting that they liked the cookie but felt guilty eating all of it). They also performed worse on a math test, suggesting that their attentional resources may have been drained by the experience of trying on the swimsuit.

That last piece of data is particularly striking – can negative self-image actually make you appear less intelligent?

Attractiveness is subjective.  How can we learn to ignore or at least filter the messages about the “perfect” body that come at us through mainstream media and become more comfortable with who we are?

The number one fast track to divorce

December 3, 2012

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Is it sex?  Infidelity?  Arguments over the kids?  No.

Fights over money are the biggest predictor of divorce, according to new research.

A study by Jeffrey Dew at Utah State University found that the more often couples argued about money, the more likely they were to split.

Psychology Today author Leon F Seltzer theorises that this is because arguments about money usually boil down to two irreconciliable positions: the spender vs. the saver.  How can you avoid these damaging battles?

In discussing money issues with your partner, it’s critical that you keep an open mind. Remember, this isn’t about winning a mortal battle, or endlessly debating whose “talking points” are superior. No, it’s about recognizing that your partner’s outlook on money (unless, that is, it’s flagrantly illogical or self-contradictory) may have just as much validity as your own. And, additionally, may be held with just as much pride, conviction, and commitment. Consider also that the two of you may possess different inborn tendencies, temperaments, and experiential histories—and in growing up  have received from your caretakers extremely disparate messages about money. Viewing your marital money problems in such a greatly expanded light may well help you realize that what earlier struck you as simply wrong-headed about your spouse now makes a lot more sense, is more warranted and legitimate.

And of course, the golden rule for any point of difference that threatens to lead to an argument: look for the common ground between you in finding a way forward.