ADHD is estimated to affect threenine percent of children worldwide. Approximately 50% of these children will have symptoms that persist into adult life.  Thus nearly eight million Americans (4.5%) may have ADHD. The original research on this question underestimated the impact of ADHD on girls and adults of both sexes because it focused on hyperactivity as the index symptom. We now know that ADHD in most girls and adults is characterized by inattention and impulsivity, as opposed to hyperactivity.  Unfortunately the newer research has not caught up with clinical practice, as nearly 80% of adults with ADHD are estimated to have never been diagnosed. Of the 20% who were diagnosed, only half (10% of the total afflicted population) are receiving appropriate treatment. Increasing the efficiency of the recognition and treatment of this disorder involves a practical understanding of the three C’s of adult ADHD.Cognitive DysfunctionThis is the most likely hallmark of adult ADHD.

This is characterized by money management problems (not balancing checking accounts, neglecting bills, impulsive spending), chronic tardiness (due to poor planning), inability to finish projects or forgetting obligations, easy distractibility in conversations (with Recognizing Adult ADHD resultant communication problems due to ineffective listening), spatial orientation problems (chronically lost), emotional impulsivity (with resultant temper outbursts/irritability) and chronic underachievement at school and work.  These cognitive problems are reflective of documented problems in dopamine and norepinephrine rich areas of the brain such as the anterior cingulate cortex. This causes executive function problems with response prevention, working memory, self-regulation of emotion and self- observation and editing of behavior that underlie the cognitive problems. Co-morbidity This is the association of ADHD with a variety of other psychiatric problems.

In fact the co-morbid or co-existing problems can be so prominent that they obscure the recognition of the ADHD. This has led some to call adult ADHD a “shadow” syndrome because it exists in the shadows of anxiety disorders (30-40%) and mood or depressive disorders (20-30%).  Traditional addictive problems such as cannabis, alcohol, opiate and tranquilizer abuse are over-represented in this population, who may use these substances to self-medicate. “Soft” addictions to nicotine and caffeine are more likely and can cause major medical problems such as irregular heartbeats. Compulsive sexual behavior is also emerging as a possible Christian Counseling Today 2004 Vol. 12 No. 4 69 co-morbid and over-represented problem in this population. Chronic Cost The emotional/psychological and spiritual costs of untreated adult ADHD are significant. Self-esteem is greatly damaged after years of financial, marital and vocational failure.

Children suffer from poorly executed and inconsistent parenting. Poor frustration tolerance leads to quitting jobs, ending relationships and dropping out of educational pursuits prematurely. Poor concentration leads to excessive motor vehicle accidents. As one of my patients put it, kids with untreated ADHD flunk math, but adults with untreated ADHD flunk life. The level of depression and anxiety that accompany this kind of life is immeasurable.  The treatment of adults is not dramatically different than children, involving a combination of pharmacotherapy, psychotherapy, education, and life coaching. Pharmacotherapy options for the core ADHD symptoms include stimulants such as Dexedrine, Ritalin, Adderall, Concerta, Focalin and Metadate. Non-stimulant options include Strattera, Wellbutrin, Tofranil, Desipramine and Provigil. At the time of this writing, Strattera was the only FDA approved drug for adult ADHD in this group. Adderall recently received its approvable letter and may also be FDA approved for adult ADHD by the time of this publication.

The other drugs are used commonly off-label alone or in combination for adult ADHD. Many other drugs, such as antidepressants, are used to manage the co-morbid conditions such as depression and anxiety. However, treatment is irrelevant if the syndrome is not ever recognized. Therefore adult ADHD should be suspected in patients with treatment resistant depression, severe anxiety and insomnia problems, addictive behavior, chronic marital or job problems, financial chaos and explosive temper problems. Take help from internet counseing .

Think about it in patients with sexual addiction, especially if they are doing poorly in treatment. A family history of bipolar disorder in a parent increases the chances of ADHD in his or her children. Frequent motor vehicle accidents should trigger a consideration of adult ADHD. If it is present and not treated, one will have a very difficult time achieving any success with the other problems that are being targeted for treatment. Clinical Pearl Traumatic brain injuries and sleep disorders, such as sleep apnea, can present with ADHD symptoms and should be ruled out in the history before diagnosing ADHD.