Attention Deficit Disorder
What is Adult Attention Deficit Disorder?
Attention deficit disorder (ADD) is the most common neuropsychiatric disorder of childhood. Studies have found that the majority of individuals diagnosed with ADD have symptoms that persist well into adulthood. Many who are affected by ADD evade diagnosis as children, and come to The Midtown Practice with complaints of focusing difficulties that date back to school age. Together, with your clinician, we will work to diagnose the reason for your difficulties with attention, and identify any comorbid psychological disorders such as anxiety, depression, or substance abuse. Once we have a clear picture of your symptoms and condition, we will work collaboratively to design a treatment that addresses your focusing issues. Our goal will be to see tangible improvements in your relationships and educational and/or occupational functioning.
Causes of ADD
The cause of ADD in adults is not completely known. Certain biological risk factors have been identified. These include first degree relatives with a diagnosis, exposure to environmental toxins such as lead paint, prenatal exposure to drugs, alcohol, or smoking, and premature birth.
Although there is no one imaging study that is FDA approved to diagnose ADD, imaging studies in adults have found some structural brain abnormalities in individuals with ADD. These include smaller brain volumes in the frontal cortex, cerebellum, and other subcortical structures. These structural changes might lead to dysfunction in the neural circuitry underlying executive function, inhibition of behavior, and reward pathways.
Clinical Symptoms of Attentional Deficit Disorder
There are three subtypes of ADD: predominantly inattentive type, predominantly hyperactive/impulsive presentation, and combined presentation. In adults, symptoms of hyperactivity and impulsivity are sometimes less overt, as maturity and socialization diminish these aspects. Inattention is most often prominent, and impulsivity might be seen more in verbalizations such as frequently “putting your foot in your mouth” rather than physical behavior such as inability to sit quietly in school.
Many of the deficits of ADD are classified as deficits in executive functioning. Executive functioning is defined as the ability to choose and create goals and enact, and sustain behavior in order to complete those goals. Executive functioning deficits in ADD include problems with working memory, or the ability to retain information for a brief period of time while performing mental operations on that information. An example of working memory would be holding a person’s address in mind while learning how to get there. In addition, individuals with ADD have difficulty with self monitoring or screening out information unrelated to a project or goal, initiating tasks, and self inhibition. These deficits in executive function contribute to inattention problems such as remaining focused on a task for long periods of time, organizing activities, following through, forgetfulness, and poor time management.
Although many of us feel distracted by the panoply of demands and sources of information in our modern world, individuals with ADD have much greater struggles with forgetfulness and completing tasks. They frequently wander off while working, lack persistence, and cannot sustain focus. Often children and adults with these problems are labelled defiant, which is extremely frustrating and leads to feelings of low self esteem and identity confusion.
Impulsivity is often one of the more challenging symptoms of ADD since it can interfere with healthy relationships and lead to more dangerous behaviors. Impulsivity refers to an individual’s inability to self monitor or filter themselves. This might lead to behaviors such as interrupting conversations, and saying things we later regret. Individuals with ADD are impatient are more likely to have driving accidents, overspend,, and engage in other risky behaviours such as using drugs or unprotected sex. Mood lability, angry outbursts, and low frustration tolerance are common.
Although overt physical hyperactivity is more common in children, adults with ADD tend to report more subjective symptoms such as a feeling fidgety, or like a motor is running inside of them. Adults might also report talking too much, interrupting others, and having difficulty sitting through meetings.
During your assessment at The Midtown Practice, your clinician will do a thorough history to identify symptoms consistent with a DSM 5 diagnosis of ADD. We will also rule out other disorders that might interfere with attention such as a depression, anxiety disorder, or a nonpsychiatric medical issue. In those individuals not diagnosed in childhood, we will do a careful evaluation to see if your symptoms date back to school age. When appropriate, we might ask you to obtain collateral history from your parents or other family members with familiarity of your academic and peer development. This history is especially important, because ADD is not something that you acquire as an adult, but rather something that can be traced back to early childhood. History is therefore central to obtaining a proper diagnosis.
A diagnosis of ADD is based on the number and severity of symptoms, the duration of symptoms, and the degree to which these symptoms cause impairment in life. In order to meet the criteria for ADD, we look for significant negative impact in at least two major settings in a person’s life. Examples of the severity of impairment include failure to pay bills in a timely manner, being put on academic or occupational probation due to failing performance, or repeated driving offenses due to distraction and impulsivity.