Adult ADHD: What It Is and How to Assess and Treat It

Authors

  • Lawrence Martin, MD Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON

DOI:

https://doi.org/10.58931/cpct.2024.2337

Abstract

4.4% of the adult population, and is also prevalent in 10% of those with depressive or anxiety disorders and in 20% of those with chronic low mood. Among patients referred for treatment-resistant depression, one in three may have undiagnosed ADHD. Overall, ADHD is poorly understood, significantly undertreated, and a common reason for poor response to treatment in mood and anxiety disorders.

ADHD is not a consequence of poor parenting, indulged laziness, or excessive consumption of sugar or food dyes. It is a neurodevelopmental disorder, a “hardwiring” problem, marked by delayed maturation of the Prefrontal Cortex and allied subcortical regions that constitute the “adult” brain.

When we are young, we have limited self-control: we take what we want, say what we think, get excited, cry, and live in the moment. As our brains mature, we learn to control our behaviours, manage our emotional reactions, prioritize tasks, plan, and follow through on those plans. In individuals with ADHD, this maturation is delayed and too often remains incomplete.

Author Biography

Lawrence Martin, MD , Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON

Dr. Martin has been an active member of the McMaster Department of Psychiatry and Behavioural Neurosciences for more than 25 years and has acted as Director of Resident Training and Vice Chair responsible for Education. He has been a Royal College Examiner and Vice-Chair of the Examination Committee. Dr. Martin has had a broad range of clinical administrative responsibilities, including Assistant Chief of Psychiatry at St. Joseph’s Healthcare and was Clinical Director of the Regional Mood and Anxiety Disorders Program at St. Joseph’s Healthcare for more than 10 years. He is deeply committed to adult learning and has lectured across Canada and internationally on diagnosis and treatment of mood disorders and of Adult ADHD.  For the first half of his career Dr. Martin systematically misdiagnosed patients with ADHD as Bipolar Disorder NOS and treated their mood instability with a wide range of misdirected strategies. After a modest epiphany 12 years ago he realized that a large portion of his mood disorder patients were in fact suffering from ADHD. He is sorry he is apparently a rather slow learner. Dr. Martin is now focusing his clinical and education work on direct mentoring of family physicians wishing to increase their skills diagnosing and managing Adult ADHD.

References

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716

Sternat T. Abstract S2-10. Anxiety and Depression Association of America (AADA); 2016 March 31 to April 3; Philadelphia PA.

Shaw P, Malek M, Watson B, Greenstein D, de Rossi P, Sharp W. Trajectories of cerebral cortical development in childhood and adolescence and adult attention-deficit/hyperactivity disorder. Biol Psychiatry. 2013;74(8):599-606. doi:10.1016/j.biopsych.2013.04.007

Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS, et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Jama. 2002;288(14):1740-1748. doi:10.1001/jama.288.14.1740

Di Lorenzo R, Balducci J, Poppi C, Arcolin E, Cutino A, Ferri P, et al. Children and adolescents with ADHD followed up to adulthood: a systematic review of long-term outcomes. Acta Neuropsychiatr. 2021;33(6):283-298. doi:10.1017/neu.2021.23

Steele M, Jensen PS, Quinn DM. Remission versus response as the goal of therapy in ADHD: a new standard for the field? Clin Ther. 2006;28(11):1892-1908. doi:10.1016/j.clinthera.2006.11.006

Retz W, Stieglitz RD, Corbisiero S, Retz-Junginger P, Rösler M. Emotional dysregulation in adult ADHD: what is the empirical evidence? Expert Rev Neurother. 2012;12(10):1241-1251. doi:10.1586/ern.12.109

Hirsch O, Chavanon M, Riechmann E, Christiansen H. Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). J Affect Disord. 2018;232:41-47. doi:10.1016/j.jad.2018.02.007

Moukhtarian TR, Reinhard I, Moran P, Ryckaert C, Skirrow C, Ebner-Priemer U, et al. Comparable emotional dynamics in women with ADHD and borderline personality disorder. Borderline Personal Disord Emot Dysregul. 2021;8(1):6. doi:10.1186/s40479-021-00144-y

Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, et al. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord. 2018;226:85-91. doi:10.1016/j.jad.2017.09.027

Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2007;257(7):371-377. doi:10.1007/s00406-007-0712-8

Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256. doi:10.1017/s0033291704002892

Arnsten AF. The Emerging neurobiology of attention deficit hyperactivity disorder: the key role of the prefrontal association cortex. J Pediatr. 2009;154(5):I-s43. doi:10.1016/j.jpeds.2009.01.018

Boland H, DiSalvo M, Fried R, Woodworth KY, Wilens T, Faraone SV, et al. A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. J Psychiatr Res. 2020;123:21-30. doi:10.1016/j.jpsychires.2020.01.006

Zhang L, Li L, Andell P, Garcia-Argibay M, Quinn PD, D’Onofrio BM, et al. Attention-deficit/hyperactivity disorder medications and long-term risk of cardiovascular diseases. JAMA Psychiatry. 2024;81(2):178-187. doi:10.1001/jamapsychiatry.2023.4294

Arnsten AF, Pliszka SR. Catecholamine influences on prefrontal cortical function: relevance to treatment of attention deficit/hyperactivity disorder and related disorders. Pharmacol Biochem Behav. 2011;99(2):211-216. doi:10.1016/j.pbb.2011.01.020

McCabe SE, Dickinson K, West BT, Wilens TE. Age of onset, duration, and type of medication therapy for attention-deficit/hyperactivity disorder and substance use during adolescence: a multi-cohort National study. J Am Acad Child Adolesc Psychiatry. 2016;55(6):479-486. doi:10.1016/j.jaac.2016.03.011

Brams M, Moon E, Pucci M, López FA. Duration of effect of oral long-acting stimulant medications for ADHD throughout the day. Curr Med Res Opin. 2010;26(8):1809-1825. doi:10.1185/03007995.2010.488553

Hodgkins P, Shaw M, Coghill D, Hechtman L. Amfetamine and methylphenidate medications for attention-deficit/hyperactivity disorder: complementary treatment options. Eur Child Adolesc Psychiatry. 2012;21(9):477-492. doi:10.1007/s00787-012-0286-5

Published

2024-12-19

How to Cite

1.
Martin L. Adult ADHD: What It Is and How to Assess and Treat It. Can Prim Care Today [Internet]. 2024 Dec. 19 [cited 2024 Dec. 21];2(3):40–45. Available from: https://canadianprimarycaretoday.com/article/view/2-3-Martin

Issue

Section

Articles