At present, ADHD is considered the most common psychiatric disorder not diagnosed in adults. Frequently, adult cases are diagnosed when their children have been diagnosed and parents are asked for family background. At that moment, mother or father make a review of their personal history and feels identified with what is currently happening with his/her son/daughter. They even start realizing that they have become used to living with symptoms that make daily life much more difficult. Until some time ago, it was believed that children and adolescents suffering from ADHD improved as they grew up and when reached adulthood ,symptoms were reduced and disappeared. However, in the last years, it has been accepted that many adults carry ADHD into adulthood, therefore, they are sensitive to interventions that allow them a better life and a reduction of symptoms. Present research estimates that approximately 65% of ADHD children may carry symptoms such as lack of attention, impulsivity and hyperactivity into adulthood; these symptoms are typical of the disorder and are present since before age 6 in 2-4% adults. While in childhood it appears in a 3 boys to 1 girl relation, in adults the relation is 2 men with ADHD to each woman, or even less.
Nowdays, we know that ADHD has a heritage component, that makes it more frequent between parents and children of parents who suffered it, this is why it`s more frequently found among parents of diagnosed children.
If there is any doubt of suffering o having suffered from ADHD, before consulting with a specialist, there are some questions that should be made:
- “Do I have trouble to remain focused?
- Am I constantly moving?
- Do I feel this since I was a child?
- Do I find it difficult to control my temper?
- Am I frequently in a bad mood?
- Does this happen at home, at work, in the street, almost everywhere?
- Does my family or friends say that I might have this kind of problem?”
If most of the answers are affirmative, it is recommended to see a specialist since the diagnosis is not easy. Once the person has been diagnosed, there are a variety of measures that should be taken to improve the situation. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the current diagnosis criteria for adults are very similar than for children, and can be defined as:
- Difficulty to pay attention to details or negligence at work.
- Constant movement of hand or feet, restlessness on a chair o when supposed to remain seated.
- Difficulty to remain attentive to tasks, even during spare time.
- Incapability to remain still in social situations in which you are expected to do so.
- Feeling that they don`t hear even when they are directly spoken to.
- Feeling of concern and worry.
- Difficulty to follow instructions and complete tasks.
- Difficulty to enjoy peaceful activities during spare time.
- Difficulty to organize daily life activities (planning and managing time)
- Feeling of constant movement, “like having an engine inside”
- Avoidance of activities that require a sustained mental effort and chronic postponing of tasks (“I`ll do it later”).
- Excessive talkativeness.
- Easily looses things.
- Impulsive answers, even before the question is finished.
- Easily distracted.
- Difficulty to take turns.
- Frequent oversight of daily obligations.
- Constant irruptions and meddling in someone else`s conversations and activities.
Not every person with ADHD present all symptoms or the same level of seriousness. Each person will have their own symptomatic profile, which will result in better or worse quality of life, and these factors must be considered at the moment of deciding the best treatment for each individual. Many will be able to have a happy and productive life.
A general psychiatrist with certain experience in the disorder is the ideal specialist to carry out an exhaustive clinical evaluation, which is the definite method of diagnosis. A psychologist with experience in this field or even a family doctor may provide guidance, although, at final instance, a psychiatric evaluation is recommended to confirm the diagnosis. There are no definitive complementary explorations (not MRI, electroencephalogram or blood test) that can guarantee diagnosis, since the evaluation criteria is purely clinical, as we jut saw.
The clinical evaluation includes an exhaustive review of clinical history, especially in early development, school record, professional background and social relationships. This is usually carried out in an interview of about two hours, in one session or divided in two or three sessions. It would be ideal if some other member of the family could go to the session to input additional information (parents or a sibling that may complement the early development background and to corroborate the current perception of the patient). It is important to gather information regarding his coping in different environments (which can be oriented to the classic diagnosis scales used by specialists)
As we already mentioned in other sections, both diagnosis and treatment must be carried out individually, taking into account the particular features of each person, the family composition, type of work and resources available.
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