Attention Deficit Hyperactivity Disorder
Contrary to popular belief, attention deficit hyperactivity disorder (ADHD) is not outgrown in adulthood. At this stage in human development, the disorder presents unique problems related, but not identical to that in childhood. Additionally, neurological research involving S.P.E.C.T. and other brain scans (most popularly presented by Dr. Daniel Amen) has identified multiple types of ADHD in childhood and adulthood that better capture the spectrum of difficulties inherent in ADHD. Finally, ADHD can be present with other disorders that complicate its diagnosis and treatment, including substance or process addictions.
In the past ADHD was believed to be outgrown after childhood, because traditional symptoms of impulsivity, hyperactivity, attention and organizational problems seemed to diminish. Recent findings reveal developmental maturation of the brain after adolescence provides more flexible coping mechanisms to compensate for the neurological deficits of ADHD. However, adults diagnosed as children (and adults diagnosed for the first time), are still working exponentially harder than others to accomplish general life tasks. For instance, someone with ADHD often struggles with sensing the passage of time. This creates difficulty managing time and operating with an adequate understanding of how long tasks take to be accomplished. Someone who struggles in this area could have difficulty estimating departure times in order to arrive at a given hour, or strain to accurately gage how much time a certain task will take. Another frequent struggle pertains to processing multiple stimuli, such as trying to type a paper while the radio is on, or following a conversation in a noisy room. This same difficulty could also hinder simultaneous processing of different stimuli, such as reading while eating a meal or trying to take down a phone number while watching a movie. Another problem can arise with sustaining prolonged amounts of focus or attention even in the absence of distracting stimuli, such as reading an uninteresting book in a quiet library, or following through a complete train of thought while alone in the shower. Adults with ADHD often struggle with the tyranny of the urgent or with living too much in the moment, even as they did in childhood. In this case, momentary experiences tend to speak loudest, while memory or anticipation of negative consequences connected with a certain choice may be distant or drowned out. This can result in impulsive choices with negative consequences available to the struggler in hindsight, but which constantly elude awareness beforehand in order to enable redirection of choices.
Often in adulthood, the turmoil and chaos of these struggles can be managed through mental capacities available to adults that were not available as children. However, the underlying energy, endurance and toleration needed to operate in life with this excess eventually take their toll, and anxiety or depression can result. Consequently, a tendency to be overwhelmed or reach personal limits of cognitive endurance before others frequently occurs. This may happen in particular instances where personal strengths are more average rather than gifted, such as a manager handling multiple requests at once. Or it can happen through loss of endurance over time in the midst of a string of challenges or tasks, such as diminishing capacity to engage in long amounts of data entry, which had earlier been relatively easy. Additionally, adults with ADHD may be able to cope with these deficits in some areas of their lives but not others. Over time, the areas devoid of this coping can begin to break down, and problems develop: Work performance can suffer, or marital relationships can become strained. Oftentimes some sort of crisis or trial arises that begins a breakdown in emotional or daily functioning. These can be of a positive or negative nature: the death of a close friend or relative, the birth of a new child, the loss of a job or a promotion to greater responsibilities. It is also not uncommon for those living or working in proximity to the adult with ADHD to be more aware of these symptoms than the adult him or herself. Sometimes the initial crisis that brings attention to this problem can be someone else in the family: a spouse’s emotional breakdown in depression or anxiety, a child’s behavioral or learning problems in school (which can frequently unveil the existence of ADHD running in the family).
As was mentioned earlier, neurological research has revealed multiple styles of ADHD: Besides the classic Non-Attentive and Hyperactive types, styles of ADHD with obsessive and ruminating qualities (Over-Focused), listlessness and lethargy (Limbic), mood instability and learning/memory problems (Temporal Lobe) or explosiveness and cyclical mood swings (Ring of Fire) have also been identified by Dr. Daniel Amen and his colleagues at the Amen Clinics. For each of these types, some differences in approach to diet and medication exist. For instance, in the Over-Focused type of ADHD, the preferred medical treatment of some form of Ritalin or stimulant can sometimes exacerbate anxiety and other emotional conditions until the obsessive or anxious component is treated with something like Effexor or one of the SSRI’s. A couple of factors in Dr. Amen’s approach have broad appeal: He discusses nutritional and herbal supplements appropriate to each condition as well as medication. He also bases his approach on the physical evidence of the brain scan, based on the commonly known functions of different parts of the brain such as the Temporal Lobe and the Pre-frontal Cortex. Unlike traditional psychiatry, which relies on observed or self-reported symptoms to make a diagnosis, this approach is neurologically based on the same techniques that diagnose brain trauma and dementia in the medical field. It combines this neurological approach with the reported and observed clinical symptoms, in order to more specifically target the selection of medications.
Unfortunately, this neuro-psychiatric approach is not widely available, can be expensive and is not broadly accepted in the medical and psychiatric communities. However, the discovery of the different categories and their delineation of nutritional supplements and medications for each type can still be useful. Dr. Amen also has self-report diagnostic tests available on his website which can identify the likelihood each type may be prevalent. Also, presenting detailed personal symptoms based on each appropriate category to a traditional psychiatrist can facilitate recommendations for medications similar to Dr. Amen’s research findings.
In addition to these neurological variations of ADHD, other independent conditions can coexist such as Obsessive Compulsive Disorder, Depression or Anxiety. The latest research also shows coexisting problems with various forms of substance or process addiction can sometimes develop for those struggling with ADHD. Particular attention has fallen on how those with process addictions such as compulsive gambling or sexual addiction frequently have preexisting conditions of ADHD, anxiety or depression. (It is significant to note that this prevalence does not go the other way around: those with ADHD, depression or anxiety DO NOT predominantly have, by nature, coexisting problems with process or substance addiction.) These episodes of depression, anxiety, substance abuse or process addiction can sometimes be the “crisis” or break down that occurs from coping with ADHD over time, or they can be part of an inherited cluster of conditions that might run in the family history. This history may be formally diagnosed. It may also be informal and recognized in family members by their characteristics: such as the uncle who was never able to hold down a job and always seemed to be living off the kindness of other family members, or the mother who stayed in her room bedridden for several months after a difficult childbirth, etc. Whatever their source or nature, these “co-morbid” conditions will need their own treatment with medication and/or counseling. For any of the addiction problems, a more targeted therapeutic approach separate from treatment for ADHD may be needed. For the non-addiction related conditions, including ADHD itself, research has shown that the most effective treatment is a combination of counseling and medication, rather than counseling or medication alone.
Whether for adults or children, the best approach in counseling someone with ADHD includes teaching time management skills, effective problem solving, impulse control, and help in setting up external structures that aid the person in areas such as motivation, organization, executive functioning and decision making. Good counseling will also provide support, education and coping strategies for spouses and other significant family members of the adult with ADHD.
Associates in Professional Counseling offers treatment for children and adults dealing with ADHD. Whether it be an adult, a child or a parent, we help clients to understand and better manage the difficulties that can come with ADHD. We treat problems with impulse control, ruminations, organizational skills, time management and hyperactivity. We work with parents to better manage their children. We also identify and treat complicating conditions such as depression, anxiety or obsessive compulsive traits. We also have experienced specialists in treating substance addiction or sexual addiction. We are willing to work with psychiatrists in medication management and to provide recommendations for such treatment.
For Further Reading: Driven to Distraction, by E. M. Hallowell & J. J. Ratey
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Healing ADD: The Breakthrough Program that Allows You to See and Heal the 6 Types of ADD, by Daniel G. Amen, M.D.