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Adult ADHD

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Keywords: ADHD, ADHD and Alcoholism, Attention Deficit Hyperactivity Disorder, ADD, ADHD and EEG, Neuro cognitive training, Car accidents, Cognitive behavioral therapies, Concerta, Divorce, executive functions, Addiction, Ritalin, Working memory, Cognitive skills, ACEclinics, Social interactions and Workplace.

Our understanding of ADHD (Attention Deficit Hyperactivity Disorder) has grown tremendously over the past 10 years, and we have developed excellent therapies to help school-age children recover their learning skills and self-esteem. While ADHD affects 5 to 8% of the school-age children in USA, clinical evidence shows that 80% of these children continue to experience significant psychopathologies as adolescents, and nearly 50% continue into adulthood [1, 2].
These numbers may be even higher, because many adults learn to work around their cognitive deficiencies thus giving them the perception that they function better than they actually do. Typically, if you had ADHD as a child you will, most likely have it, in full or in part, as an adult.

Does ADHD Really Affect My Adult Life?

The symptoms of ADHD in adults may be more subtle because some have instinctively adapted their lives to suppress the symptoms, including inattention, hyperactivity and impulsiveness [3]. They typically experience difficulty concentrating on a task, remembering information, following instructions, organizing and completing their work and adhering to deadlines. Left unmanaged, this condition can cause severe emotional distress, impair social interactions and limit career options. Because these individuals have a normal or above average IQ, they live daily with the frustration of being misunderstood and not living up to their true potential. As such, they are at high risk of turning to substance abuse or engage in high-risk behaviour to control their impulses. At times, they just feel depressed because of their inability to measure up to their expectations and to the expectations of their pears and employers.

Adults with ADHD are more prone to:

  • Perform poorly at work, be fired or leave a job on impulse
  •  Have driving misconduct violations (license suspended, speeding, car crashes or road rage)
  •  Divorce or domestic violence
  •  Becoming alcoholic or drug addicts
  •  Smoking cigarettes
  •  Spending money on unimportant things

In milder cases, they experience impatience, low frustration tolerance, depression and anxiety.

Assessing ADHD in Adults

There are a number of tests used by clinicians to assess ADHD

• A simple questionnaire
• Brain scans: computer tomography (CT), magnetic resonance imaging (MRI) or electroencephalogram (EEG)
• Psycho-educational assessment
• Neuro-cognitive assessment

Currently, CT and MRI are not approved for the diagnosis of ADHD, but they can rule out other neurological conditions [8]. On the other hand, inattention and hyperactivity generate abnormal brain waves, which can be detected by an EEG using external electrodes [9, 10] or the newer technology of infra red EEG. The brain emits four types of waves: alpha, beta, delta or theta. Patients with ADHD typically generate higher theta oscillations, and lower beta oscillations, than normal subjects [11]. Infra red EEG checks how well the frontal lobes, which are responsible for attention, focus, executive functions, reasoning and more, engage. Finally, the psycho-educational evaluations will diagnose learning disabilities typical for ADHD.

A neuro-cognitive assessment developed at the ACEclinic in Toronto Canada is regarded a more dynamic way to assess three problematic areas typical to attention deficit hyperactivity disorders (ADD, ADHD) and learning disabilities (LD). They include:

1. Testing frontal lobe function using EEG technology
2. Core cognitive skills (you can see the complete list these core cognitive skills here)
3. Working memory

Are Current Therapies Appropriate for Adults with ADHD?

Clinical studies showed that the same pharmaceutical drugs are given to children, adolescents and adults with ADHD, but the doses are adjusted accordingly [12]. The current options are different formulations of the two original compounds: methylphenidate (i.e. Ritalin; 3-4 hours) and amphetamine (i.e. Dexedrine; 3-4 hours). Adults taking an ADHD drug are considerably less likely to get involved in a car accident, unless the drug effect wears off. This is why the new long-lasting formulations of methylphenidate (i.e. Ritalin® LA, 6-8 hours; Concerta®, 10-12 hours) and amphetamine (Adderall XR™, 8-12 hours; Vyvanse, 12-14 hours) can be useful. Unfortunately, drugs may cause many uncomfortable sometimes even life threatening side-effects, therefore many adults try to avoid taking them.

It is important to understand that these drugs do not cure ADHD and do not completely alleviate all the symptoms. Recent clinical trials showed that many adults with ADHD experience significant symptoms even with optimal doses of these drugs [13]. There is no medication that can address that. Furthermore, because they do not offer cure, a person needs to take them every day in order to maintain the results. Lastly, these medications can only improve cognitive function to a certain degree and cannot compensate for lack of adequate cognitive skills, including poor working memory typically deficient with most individuals with ADHD, or deficient auditory process, visual tracking and so on.

Neuro-cognitive Therapy and Training

ADHD is a neuro-cognitive disorder and therefore only a neuro-cognitive approach can correct some or all the problems related to the condition. Neuro cognitive therapy and training has shown excellent results treating attention deficit disorders and learning disabilities with marked improvement on all levels. One such program developed at the ACE clinics in Toronto, Canada, consists of improving brain regulation combined with developing all core skills such as visual processing, auditory processing, divided attention, multitasking, working memory and more. Training the frontal lobes of the brain to improve engagement improves general attention as well as improving executive functions, including organization, prioritizing, inhibition control, decision-making, time management and motivation. This type of multi-level neuro cognitive training can contribute to considerable and permanent gains in cognitive performance and significant reduction in ADHD related symptoms.

Taking Back Control of Your Life

Neuro cognitive therapy will allow ADHD adults to perform better at work and at home. In addition, the renewed self-esteem improves social interactions and relationships, reducing the need for addictive substances, like alcohol. With the proper treatment, you can stop struggling and get back control over your life.

About the author:

Bob Gottfried, PhD is the clinical director of ACEclinics located in Toronto, Canada. He specializes in neuro-cognitive treatments for Attention Deficit hyperactivity Disorder (ADD, ADHD), learning disorders (LD), non-specific neuro-cognitive deficiencies and memory disorders.

References:

1.Biederman, J. (1998) Attention-deficit/hyperactivity disorder: a life-span perspective. J Clin Psychiatry. 59, 4-16
2.Knouse, L. E., Cooper-Vince, C., Sprich, S. and Safren, S. A. (2008) Recent developments in the psychosocial treatment of adult ADHD. Expert Review of Neurotherapeutics 8, 1537-1548
3.Reimherr, F. W., Marchant, B. K., Williams, E. D., Strong, R. E., Halls, C. and Soni, P. (2010) Personality disorders in ADHD Part 3: Personality disorder, social adjustment, and their relation to dimensions of adult ADHD. Ann Clin Psychiatry. 22, 103-112
4.Haavik, J., Halmøy, A., Lundervold, A. J. and Fasmer, O. B. (2010) Clinical assessment and diagnosis of adults with attention-deficit/hyperactivity disorder. Expert Rev Neurother 10, 1569-1580
5.Almog, M., Gabis, L. V., Shefer, S. and Bujanover, Y. (2010) Gastrointestinal symptoms in pediatric patients with attention deficit and hyperactivity disorders. Harefuah 149, 33-36
6.Suwan, P., Akaramethathip, D. and Noipayak, P. (2011) Association between allergic sensitization and attention deficit hyperactivity disorder (ADHD). Asian Pac J Allergy Immunol 29, 57-65
7.Fasmer, O. B., Halmøy, A., Oedegaard, K. J. and Haavik, J. (2011) Adult attention deficit hyperactivity disorder is associated with migraine headaches. Eur Arch Psychiatry Clin Neurosci. in press
8.Bush, G. (2008) Neuroimaging of attention deficit hyperactivity disorder: can new imaging findings be integrated in clinical practice? Child and adolescent psychiatric clinics of North America 17, 385-404
9.Linden, M., Habib, T. and Radojevic, V. (1996) A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self Regul 21, 35-49
10. Barry, R. J., Clarke, A. R. and Johnstone, S. J. (2003) A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clin Neurophysiol 114, 171-183
11. Abibullaev, B. and An, J. (2011) Decision support algorithm for diagnosis of ADHD using electroencephalograms. J Med Syst. in press
12. Taurines, R., Schmitt, J., Renner, T., Conner, A. C., Warnke, A. and Romanos, M. (2010) Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2, 267-289
13. Benkert, D., Krause, K. H., Wasem, J. and Aidelsburger, P. (2010) Effectiveness of pharmaceutical therapy of ADHD (Attention-Deficit/Hyperactivity Disorder) in adults – health technology assessment. GMS Health Technol Assess 6, Doc13

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