Attention Deficit/Hyperactivity Disorder (AD/HD) no longer has a “poster child”--not even a “poster person,” for that matter. The image of AD/HD in past decades has been the frenzied, elementary-aged boy dangling from the monkey bars, disrupting his class and disobeying all authority. This behavior drove his desperate parents and teachers to seek an understanding of his symptoms. As more has been learned, what was thought to be a disorder of childhood, of males, and of hyperactivity alone, has undergone significant revision.
AD/HD is a disorder of excessive inattention, distractibility, hyperactivity and impulsivity that begins in childhood and has a negative impact on the individual’s performance at school, work and home. AD/HD is estimated to affect six to eight percent of children, and persist into adulthood between 30 and 60 percent of the time. Four to five percent of American adults are afflicted. Although symptoms change in severity over time, they do not disappear and often continue to impair daily life.
AD/HD symptoms are not identical in every individual. Though hyperactivity and behavioral problems are common in childhood AD/HD, these symptoms generally decline with age. In adults, inattentive symptoms, poor focus, disorganization, and problems with motivation are typical.
More than an inconvenience, the condition adversely affects the individual’s relationships, both at work and with family. An adult suffering with AD/HD may have difficulty sitting through a business meeting, exhibit an inability to listen to others’ concerns, or not be responsive to family needs at home. Spouses and partners of AD/HD individuals complain of poor follow-through and unmet promises. When the AD/HD partner has difficulty holding a job, the family’s finances may suffer, bringing additional tension to the household. Partners may have limited tolerance with an overdrawn bank account or forgetting about carpool responsibilities.
An individual may have difficulty waiting at a red light, or in a line at a restaurant. He or she may become bored so easily that intimate relationships are in perpetual turmoil. AD/HD sufferers also have lower rates of high school and college completion. Individuals with untreated AD/HD have a higher risk than their non-AD/HD peers of divorce, car accidents, gambling and general money management issues, substance abuse, and legal difficulties. Awareness of these public health and social implications sheds light on the importance of consistent identification of the disorder and proper treatment.
What Help is Available?
A therapist with experience in adult AD/HD issues will assess the client’s symptoms, physical and mental health history, family history, goals for treatment, previous medications and academic and professional history. The therapist will likely ask about past behavior and any problems from childhood or adolescence, as the disorder would have been a factor earlier in life, even if left undiagnosed.
Family history can be particularly insightful for the therapist, because if a sibling, parent or child of the client has an AD/HD diagnosis, there is a higher probability of the diagnosis for the client undergoing assessment.
Further, the therapist may ask: Is there discord between the client and partner? Are there strained relationships with the children due to impatience or lack of follow-through? What are the client’s goals for improving family relationships?
The therapist may also use screening tests or questionnaires for further assessment and diagnosis. These are helpful in determining if other mental health concerns are present along with AD/HD. Generally speaking, most individuals suffering with AD/HD will have other mental health issues present. These may include anxiety, depression, mood disorders, sleep disorders, substance use, conduct disorder, oppositional defiant disorder, eating disorders, antisocial personality disorder, and problems with impulse control.
Treatment Options
Research shows that the most effective treatment is one that includes pharmacological treatment in combination with psychotherapy. Patients taking medication will benefit most from a coordinated treatment plan between their primary physician and psychotherapist. It is important to note that medication alone is not the preferred way to treat adult AD/HD.
Marriage and family therapists can create a treatment plan for the whole family; they may need to educate the family so they better understand their family member’s behaviors in the proper context--offering insight into patterns of thoughts and feelings that drive the client’s behaviors, as well as any underlying mental health diagnoses that may compound the picture. With this knowledge in hand, the family is better to able to work with the clinician to determine the most effective ways to support their loved one’s positive change. The therapist may be one of the few people in the client’s life who can understand the many difficult aspects of living with this disorder.
Treatment can be further expanded by becoming involved in local AD/HD support groups and meetings. There are several national organizations available that can provide information and support.
This text was written by Joel L. Young, MD, and Jaime Saal, MA.