Posted by: counselorcarmella | August 24, 2011

ADD: History and Diagnostic Issues

More than 8 million adults, or 4.3% of American adults, suffer from ADHD. Researchers estimate that only about 600,000 are taking medication for the condition. ADHD in adults is  often misunderstood and  underdiagnosed.  A lot of people still don’t believe in the condition at all, including medical and mental health professionals. 

 

Undiagnosed ADD can cause significant problems related to work, family, financial, and educational goals.  Those with untreated ADD often have greater difficulty with  maintaining  stability in their lives,  have substance abuse or legal issues, and generally experience greater difficulty  managing adult responsibilities.  Their problems focusing, settling down, being organized, and controlling their anger or other impulsive behaviors can interfere with efforts to   achieve personal and professional success. Better understanding and  information can help those  experiencing ADD to get the help they need to lead  happier, more productive lives.    

 

Adults with ADD often  talk about how hard it is for them to stay focused on a task.  They describe patterns of  disorganization and unfinished projects. They talk about  blurting  things out without thinking about what they’re saying, frequently interrupting other people, and  how much they hate waiting in line at the grocery store or at traffic lights.  They often admit to more frequent car accidents and  speeding tickets. They talk about procrastination, lateness, and  problems  with structured activities. They describe  problems with motivation, underachievement, and substance abuse.  They are often accused of being lazy. They   seem obviously frustrated at their inability to read something and actually take in the content without having to  go back and read it again, unless it is something really interesting to them.  They feel restless and fidgety and  may have problems with anger,  spending, or  other problems related to acting without thinking. People with ADD get bored easily. They often quit jobs, try and start their own businesses,  and can’t settle into a stable career.  

 

From time to time, we all experience at least a mild form of each of these symptoms as we go through life. Occasionally we are distracted from the task at hand. In business meetings, we may fidget a little as we long to get on with other projects that carry pressing deadlines. And none of us are strangers to bad moods, occasional impulsive gestures, or taking on a task without being well organized. But, for the person with ADD, it’s not a matter of occasionally.  Its all the time and it causes problems in their daily functioning at home, work, school, or leisure activities.

 

The belief used to be that what became ADD was mostly about hyperactivity  and that symptoms began to  resolve themselves by the time these children, mostly boys,  hit their teen years. It is now known that symptoms continue into adulthood in  50% to 70% of cases. In the late 1970s, the first studies were done into adult ADHD. Individuals were retrospectively diagnosed through assessment interviews. In other words,  clinicians would track present symptoms back to  childhood symptoms. As a result, standardised criteria were set down to help specialists diagnose ADHD in adults, called the Utah Criteria.

 

The name Attention Deficit Disorder was first introduced in 1980 in DSM-III. In 1994, when DSM-IV was released,  the definition was altered to include three groups within ADHD: the predominantly hyperactive-impulsive type; the predominantly inattentive type; and the combined type. DSM-IV includes the category of ADHD in partial remission for persons (especially adolescents and adults) who currently have symptoms but no longer meet full criteria. Although this reflects the true remission of the disorder to some extent, it may also be because of the use of insensitive diagnostic criteria. 

 

According to current DSM diagnostic criteria, ADHD develops in childhood, with at least some symptoms present prior to age 7. Prevalence in children is estimated at 3 to 5%. Adults were not included in the ADHD field trials for DSM-IV. Thus, there was no attempt to assess the developmental appropriateness of the ADHD symptoms for diagnosing the disorder in adults. For example, DSM-IV symptoms such as “runs and climbs excessively” are clearly inappropriate for adults. Similarly, the cutoff score of 6 of 9 symptoms was based on pediatric data, which may be too restrictive for adults. Changes are expected in DSM V that will help with this problem.  They include different diagnostic criteria and  recognition that symptoms can  appear at a later age.

 

Thousands of adults recognized themselves or  other family members in the people with attention deficit disorder portrayed in the 1994 best-selling book Driven to Distraction by Edward Hallowell, M.D., and John Ratey, M.D. The authors not only publicized that adults suffer from attention deficit disorder (ADD) but went a step further by acknowledging that they had the disorder too. Though not the first psychiatrists to recognize that adults have ADD or to write about it, Hallowell and Ratey were the first to write a comprehensive book for the public that made it to the New York Times best-seller list.

 

Researchers also began  focussing on  gender differences. Girls with attention deficit disorder are often less rebellious, less defiant, and generally less “difficult” than boys who have the disorder. They  tend to internalize their symptoms whereas boys manifest symptoms externally. Because they’re less likely to be disruptive, the symptoms they do show frequently get overlooked at home and at school. In the  mid and late 90s, several books on  ADD in  females came out, including Understanding Women with ADHD and Gender Issues and ADHD: Research, Diagnosis, and Treatment. In 1997, the National Center for Gender Issues in ADD, a resource for women and girls with ADHD (NCGIADD.org) was founded by Kathleen Nadeau, PhD. And Patricia Quinn, MD.

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