ADHD in adulthood
18 important questions on ADHD in adulthood
Adult presentation of ADHD: pharmocalogical treatment
- Stimulants
- first choice
- releases norepinephrine and dopamine
- methylphenidate (ritalin, concerta, equasym), amphetamine (Adderall)
- 30% does not respond or are able to tolerate the stimulants - non-stimulants
- antidepressants
- antihypertensive agents
- etc. - compliance better in adults than in children, but discontinuation due to:
- disorginazation
- difficulty with persistence
- negative and uninformed media
- fears over dependency
- mistaking the treatment as the cause of stigma or disorder
- lack of knowledge on long-term effects
Adult presentation of ADHD: non-pharmocalogical treatment
- counseling
- education
- psychotherapy
- skills training programs
- cognitive training programs
- coaching
But, are time consuming and have small effects
Adult presentation of ADHD: Attention
- is not a unitary entity
- refers to a broad range of cognitive and behavioural processes
- is a fundamental function of other cognitive abilities such as speaking, memory, orientation, problem solving
- is crucial for internal planning
- is crucial for external control of behaviour
- Higher grades + faster learning
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Adult presentation of ADHD: multi-dimensional models of attention
- alertness
- vigilance/sustained attention
- selective attention
- divided attention
- strategy/flexibility
sustained attention deficit is the most prominent distubance of attention in ADHD
it enables the subject to direct attention for a long and unbroken period of time
Adult presentation of ADHD: continious performance test (CPT)
- adults and children are impaired in:
- commission errors
- omission errors
- reaction time
- variability of reaction time - reaction time decreases with time in healthy individuals, but there is a greater decrease in individuals with ADHD
- A SUSTAINED ATTENTION DEFICIT IN ADHD CANNOT BE CONCLUDED IN STUDIES
Adult presentation of ADHD: vigilance
- ability to maintain attention over a prolonged period during which infrequent response-demanding events occur
- individuals with ADHD have an impairment of vigilance compared to healthy individuals, but the slope is the same.
- no evidence of a sustained attention deficit in children and adults with ADHD
- on methylphenidate improves omission errors in CPT compared to not using methylphenidate
Adult presentation of ADHD: Alertness
- tonic alertness:
- refers to a relatively stable level of attention which changes slowly according to diurnal (during the day) physiological variations of the organism - phasic alertness
- the ability to enhance the activation level following a stimilus of high priority
Is unimpaired in individuals with ADHD
Adult presentation of ADHD: selective attention
- the ability to focus attention in the face of a distraction
- selective attention matches with the term concentration
Adult presentation of ADHD: divided attention
- divided attention is required to respond simultaneously to multiple tasks or multiple task demands
Adult presentation of ADHD: flexibility
Adult presentation of ADHD: Methylphenidate
- vigilance
- selective attention
- divided attention (unimpaired)
- flexibility
Adult presentation of ADHD: executive functions
- problem solving
- planning
- flexibility
- abstract thinking
- concept formation
- etc.
Adult presentation of ADHD: problem solving
- process to attain a goal
- no immediate apparent approach to solve the problem
- to attain goal, obstacles have to be surmounted
- distinction between open en closed problems
Adult presentation of ADHD: Closed problems
- both initial state and goal state clearly defined.
- goal state can only be achieved by a certain solution
- actions and rules are known
- requires inimpaired convergent thinking
- transformation tasks (Tower of hanoi/london)
Improvement on MPH
Adult presentation of ADHD: open problems
- initial state or goal state not defined
- requires divergent thinking (fluent and original thinking process)
- verbal and figural fluency tasks
No effect MPH (most real world problems are open problems)
adults with ADHD suffer from
- impaired social and sexual relationships
- occupational problems
- impaired leisure functioning
- problem in financial matters
Adult presentation of ADHD: Memory
- prospective memory
remembering to remember. To perform actions in the feature
planning (executive functions) -> retention (retrospective memory) -> self-initiation (prospective remembering) -> execution (executive functions)
Planning deficit in adults with ADHD
Adult presentation of ADHD: Neuropsychological markers
- evidence for impairment in numerous functions
- no significant or conclusive results
regularily found impairments
- vigilance
- inhibition
- working memory
Adult presentation of ADHD: Conclusion
- convincing evidence of cognitive dysfunction
- no reliable test profile
- unique profiles in neuropsychological functioning in individuals
- patients differ from healthy individuals, but there is no distinctive marker
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