Help for Adult Attention Deficit Disorder
Adult ADHD (Attention Deficit Hyperactivity Disorder) affects
4.4 % of adults. Hallmark symptoms are inattention, distractibility, and
impulsivity. If you have adult ADHD, the symptoms were present in childhood but
may not have become a prominent problem until adulthood. As adults, we
accumulate an increasing burden of responsibilities. These responsibilities
include marriage, family, job, and finances. Our brain's ability to filter and
prioritize the multitude of demands placed upon it may be overwhelmed. Expectations of us as
mature, responsible adults include modulating our anger and fears, listening to
and hearing our spouses and bosses explicit and implied instructions, and to be
able to focus and concentrate to read required reports and instructions. If we
have the drag of ADHD present, we may become "stressed out", depressed, overly
anxious, or turn to alcohol, drug, or medication abuse. If the patient presents
for help at this point, the overlying problem of depression, anxiety, or
substance abuse may be diagnosed and treated. However, the foundational problem
of ADHD may be missed. Unless the ADHD is successfully treated, the person may
improve temporarily but still struggle unnecessarily and be more prone to
relapsing to another bout of depression, anxiety, or substance abuse.
The following is the official diagnostic criteria from the
American Psychiatric Association manual.
AmericanPsychiatric Association's
Diagnostic and Statistics Manual (DSM-IV)
criteria for Attention Deficit (ADHD)
This file contains American Psychiatric Association's Diagnostic
and Statistics Manual (DSM-IV) criteria for Attention Deficit (ADHD), which will
now be broken into three distinct categories.
This is provided for information purposes only. An accurate
diagnosis is the important first step in addressing any needs; such a diagnosis
can only be performed by a qualified professional who's familiar with the
individual's history.
Attention-deficit/Hyperactivity Disorder
A. Either (1) or (2):
-
Inattention: at least *6* of the following symptoms of
inattention have persisted for at least 6 months to a degree that is maladaptive
and inconsistent with developmental level:
-
often fails to give close attention to details or makes
careless mistakes in schoolwork, work, or other activities;
-
often has difficulty sustaining attention in tasks or play
activities;
-
often does not seem to listen to what is being said to him/her;
-
often does not follow thru on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional behavior
or failure to understand instructions);
-
often has difficulties organizing tasks and activities;
-
often avoids or strongly dislikes tasks (such as schoolwork or
homework) that require sustained mental effort;
-
often loses things necessary for tasks or activities (e.g.,
school assignments, pencils, books, tools, or toys);
-
is often easily distracted by extraneous stimuli;
-
often forgetful in daily activities;
-
Hyperactivity-Impulsivity: at least *4* of the following
symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a
degree that is maladaptive and inconsistent with developmental level:
Hyperactivity:
-
often fidgets with hands or feet or squirms in seat;
-
leaves seat in classroom or in other situations in which
remaining seated is expected;
-
often runs about or climbs excessively in situations where it is
inappropriate (in adolescents or adults)
-
may be limited to subjective feelings of
-
restlessness);
-
often has difficulty playing or engaging in leisure activities
quietly.
Impulsivity:
-
often blurts out answers to questions before the questions have
been completed;
often has difficulty waiting in lines or awaiting turn in games or group
situations.
-
Onset no later than age 7.
-
Symptoms must be present in 2 or more situations (e.g., at
school, work, and at home).
-
The disturbance causes clinically significant distress or
impairment in social, academic, or occupational functioning.
-
Does not occur exclusively during the course of PDD,
Schizophrenia or other Psychotic Disorder, and is not better accounted for by
Mood, Anxiety, Dissociative, or Personality Disorder.
Code based on type:
-
314.00 ADHD, Predominantly Inattentive Type if criterion A(1) is
met but not criterion A(2) for the past 6 months.
-
314.01 ADHD, Predominantly Hyperactive-Impulsive Type: if
criterion A(2) is met but not criterion A(1) for the past 6
months.
-
314.01 ADHD, Combined Type: if both criteria A(1) and (2) are
met for past 6 months [note: should this be 314.02? It's not clear - RDF]
-
314.9 is ADHD NOS, for other disorders with prominent symptoms
of attention-deficit or hyperactivity-impulsivity that do not meet criteria
above.
If a child has the inattentive symptoms without hyperactivity,
they are much less apt to be detected as having the disorder. Since a higher
proportion of girls than boys have the inattentive symptoms without the
hyperactivity, they are much less likely to be diagnosed. Those who have
hyperactivity in childhood tend to lose some or much of the hyperactivity as
they mature into adulthood. Hence, the diagnosis is more often missed in adults.
However, the inattention symptoms do not tend to diminish from childhood to
adulthood as hyperactivity symptoms do.
Our medicines often help inattentiveness somewhat more than
hyperactivity. Since the adult form of ADHD is predominantly inattention, our
medicines are usually quite helpful. Psychotherapy of different forms is
usually non-effective in improving the core inattention, hyperactivity,
and impulsivity. Psychotherapy may be quite helpful in resolving psychological
and social consequences of the disorder, especially if medications have first
reduced the core symptoms of inattention, impulsiveness, and distractibility.
There are two groups of medications, group I and group II.
Group I are the psychostimulants. There are two psychostimulants.
The generic names are methylphenidate and amphetamine. Methylphenidate is
marketed under brand names Ritalin, Metadate, Methylin, Focalin XR, Concerta,
and Daytrana (patch). Amphetamine is marketed under the brand names Vyvanse, Adderall,
Adderall XR, Dexedrine, Dextrostat, and Dexedrine spanules. Read more
about the new Vyvanse on my
blog.
The pros of group I:
-
They work quickly, i.e. in one hour
-
They leave the blood quickly. These medication's effects are
gone within 4-12 hours. These medications can be taken on the day that you
want their assistance and do not need to be taken every day
-
Psychostimulants have a higher response rate than group II, i.e.
75-80% of people that have ADHD improve with this group.
Cons of group I:
-
These medicines only work for 4-12 hours. Therefore, the problem
with poor concentration and focus to do work or study in the late afternoon or
evening require additional doses.
-
These medicines do not work for the first hour in the morning
until they are absorbed into the blood. If you have trouble responding to the
alarm clock, getting up and getting organized to get ready for the day, you have
to wait for the medicine to start working.
-
Psychostimulants have a significant risk for abuse and/or
addiction.
Group II are the nonstimulant ADHD medications. They include
Wellbutrin, Strattera, Provigil, and Aricept.
Pros of group II
-
These medicines work around the clock. Therefore, they are
working when the alarm clock goes off in the morning, when you are getting
ready and when you are trying to "get it together" to get out of the house in
the morning. They are also working throughout the day and into the evening and
up until bedtime. Hence, you can study or work with the benefit of these
medicines throughout the evening.
-
These medications may be missed for a day or so without losing
the benefit of the medication after you have been on it for weeks or months.
-
These medications do not have the abuse and addiction potential
of group I.
Cons of group II:
-
You have to wait 2-4 weeks for this group of
medications to have much benefit. You may have to wait 2-3 months to get a 100%
of the benefits of these medications.
-
Only 50-70% of people may respond to medications in this group
Studies have found that people with ADHD have more motor vehicle
accidents than those who have ADHD but are on medications for treatment of
symptoms. If you take the
medication every day, then you are always ready to read, study or work if the
need arises--even when you were not expecting to need to perform well. There is an
increasing body of knowledge and consensus in the field that relationships are
enhanced by the medication. If you are paying attention to your partner,
children, boss, and customers, you are much more apt to grasp the explicit and
implicit feelings and requests from the other person.
Diagnosing the condition may be a challenge for many reasons.
One of the common reasons is that the symptoms of ADHD frequently overlap other
disorders such as bipolar disorder. ADHD and bipolar occur together 30% of the
time. Dr. Darvin Hege sees 10 patients each day for new patient evaluations or
follow-up for ADHD. They have ADHD as the primary diagnosis or secondary
diagnosis. This volume of experience hones his skills for diagnosing the
condition, treating it with the best choice of medication, and being familiar
with side effects. Every day Dr. Hege learns more about the nuances of adult ADHD's effects
on patients' lives. He sees the deepening satisfaction in patient relationships and
careers when the correct medicine, optimal dose, and best timing of dosing are
discovered.
For treatment of Adult ADHD, call Dr. Hege
today for the expertise and relief you need!
Self-Pay Patients--Mention this website for 10%
off your first visit!
Darvin Hege MD, PC
2150 Peachford Road, Suite P
Atlanta, GA 30338-6521
770-458-0007
Map and Directions To Dr. Darvin Hege
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