ADHD in Adults
Particularities in Adults
Section titled “Particularities in Adults”Adults with ADHD who are still in education have considerable problems:
- As students, they tend to stand up and walk around after short periods of intensive studying
- Listening to longer lectures is agonizing
- Content not presented at the beginning is often only incompletely grasped
- Reluctance to read despite above-average intelligence and education
- Even reading the newspaper is done only as “scanning the headlines”
What Suggests ADHD in Adults?
Section titled “What Suggests ADHD in Adults?”- History: Typical characteristics already in primary school age (review report cards, interview parents)
- Disorganization: Inability to finish things
- Motor hyperactivity: Restlessness, restless sleep
- Attention deficits: Inability to concentrate on written material, daydreaming
- Hot temper: Outbursts, loss of control
- Antisocial behavior: Problems with police and courts
- Traffic: Increased car accidents and traffic tickets
- Relationships: Marital problems, lower career success than expected
- Forgetfulness: Frequently losing and misplacing things, forgetting appointments
- Activity: Always active and restless, bad mood when inactive
- Impulsivity: Speaks without thinking, lack of self-control
- Stress intolerance: Feeling overwhelmed
- Authority: Oppositional behavior toward authority figures
Differential Diagnosis
Section titled “Differential Diagnosis”Distinguishing Features
Section titled “Distinguishing Features”| Feature | ADHD | Other Disorders |
|---|---|---|
| Mood swings | Change from day to day | In bipolar disorders: weeks/months |
| Depressive features | Usually milder in nature | In depression: persistently severe |
| Impulsivity | Short-lived, thoughtless | In borderline: more driven |
| Anger | Short-lived, episodic | In borderline: often persistent |
| Relationships | Less intensely conflictual | In borderline: typically short and conflictual |
| Suicidality | Less common | In borderline: more common |
| Self-harm | Rare | In borderline: typical |
| Identity disturbances | Rare | In borderline: common |
| Feelings of abandonment | Rare | In borderline: typical |
Typical Accompanying Features
Section titled “Typical Accompanying Features”Handwriting and Fine Motor Skills
Section titled “Handwriting and Fine Motor Skills”- Difficult-to-read handwriting that becomes increasingly illegible under time pressure (dysgraphia)
- Can be tested through rapid dictation
Decisions
Section titled “Decisions”- Often made without careful consideration
- Above-average frequency of job resignations
- Frequent partner changes
Organization
Section titled “Organization”- Disorder and chaotic organization in both professional and private life
- The messy children’s room becomes the chaotic apartment
- Desk with multiple layers of piled-up papers
- Started tasks are not completed
Motor Skills
Section titled “Motor Skills”- Feel uncomfortable sitting still for extended periods
- Problems relaxing
- Extreme agony during forced bed rest
- Long-haul flights very unpleasant
- Constantly moving at a quick pace
- Typical: foot bouncing, finger drumming
Common Consequences of ADHD in Adulthood
Section titled “Common Consequences of ADHD in Adulthood”Personal Problems
Section titled “Personal Problems”- Poor concentration
- Frequently losing things (car keys, tools)
- Poor academic performance and grades
- Often school dropouts
- Poor career prospects
- Marital instability
Workplace Problems
Section titled “Workplace Problems”- Low earnings
- Not more frequently unemployed, but worse jobs
- Restlessness, difficulties with desk jobs
- Difficulties listening and understanding instructions
- Oppositional behavior toward authority figures
- Loss of jobs due to poor performance
- Attention and organizational problems
- Some quit due to boredom
Psychiatric Problems
Section titled “Psychiatric Problems”- Anxiety and mood swings
- Depression
- Increased addiction risk
- High rate of substance abuse (especially alcohol and cocaine)
- Personality disorders
- Antisocial behavior and problems with police and courts
- Increased car accidents and traffic tickets
Diagnosis in Adults
Section titled “Diagnosis in Adults”Wender Utah Rating Scale (WURS)
Section titled “Wender Utah Rating Scale (WURS)”The WURS provides only an indication of the presence of the disorder in adults. The differential diagnosis must always be considered.
Diagnostic Steps
Section titled “Diagnostic Steps”- Detailed psychiatric history
- Collateral history (parents, partner)
- School reports and documents from childhood
- Standardized questionnaires
- Neuropsychological tests
- Ruling out other disorders