Saturday, 8 October 2016

Is ADHD a disorder of childhood only or does it progress into adulthood as well?

Attention deficit hyperactivity disorder (abbreviated as ADHD) is a neurobiological disorder that is characterized by neurodevelopmental deficits. As such it manifests itself during early childhood through delayed achievement of developmental milestones, especially in the domains of speech and motor coordination. For this reason, it is considered as a pediatric condition (Barkley, 2014). Nonetheless, there have been discussion and deliberations that aim to find out if there is an adult variant of ADHD, or if ADHD persists till adulthood if it is not properly managed during childhood (Franke et al., 2012). This paper focuses on both pediatric ADHD and adult ADHD, as well as answers the question; Is ADHD a disorder of childhood only or does it progress into adulthood as well? The aim of the study is to show that childhood ADHD, if not appropriately managed during childhood, does progress and persist till adulthood where it manifests as adult ADHD.
Photo Credit: Friendship Circle
The discussion will progress as follows. To begin with, ADHD is described in brief, as well as in relation to its diagnostic criteria and symptoms. Thereafter, childhood ADHD will be explored in detail, with emphasis also placed in its progression throughout childhood into adolescence. Then, ADHD is considered in relation to adolescents. Finally, adult ADHD is explored. This way, the discussion will delineate the progress of untreated, or poorly managed, ADHD from its earliest manifestation till adulthood, as well as trace the persistence of symptoms throughout the lifespan of the affected individual.
ADHD is a neurobiological condition characterized by neurodevelopmental deficits which manifest themselves by the age of six years, and then persist for a period exceeding six months. The three main symptoms of the condition are inattention, hyperactivity and impulsivity. Inattention usually manifests itself as attentional shift, which means that the affected child has problems paying attention or focusing on a single task. Hyperactivity manifests itself as excessive activities, which usually cause the affected child to experience difficulty in controlling his or her behavior. Impulsivity causes the affected person to exhibit sudden and inappropriate behaviors. Therefore, these symptoms affect the ability of the ADHD child to interact properly with his or her home and school settings. Moreover, the affected children experience difficulties when engaging in recreational activities (Mash & Barkley, 2014).
According to statistics provided by the World Health Organization (WHO) in 2013, an estimated 39 million children were affected by ADHD across the globe. This makes ADHD the most prevalent psychiatric disorder in the pediatric population (Vos et al., 2015). No single cause has been attributed to ADHD, and presently the condition is hypothesized to be caused by a combination of factors, with the main ones being genetic predisposition, environmental factors, and drug use (Gordon, 2010).
The main diagnostic criterion used to diagnose ADHD is outlined in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (commonly abbreviated as DSM-V or DSM-5).  DSM-V categorizes ADHD into three subtypes depending on the predominant symptoms. These subtypes are described below.
The ADHD predominantly inattentive subtype (abbreviated as ADHD-PI) is characterized by inattention, disorganization, forgetfulness, daydreaming; and the affected individual is easily distracted, hence (s)he cannot maintain focus in any single task. The ADHD predominantly hyperactive-impulsive subtype (abbreviated as ADHD-PH) is characterized by impulsivity, restlessness, hyperactivity and immature behavior. Finally, there is the ADHD combined subtype (usually abbreviated as ADHD-C), which manifests itself as a combination of the symptoms that characterize both ADHD-PI and ADHD-PH. The DSM-V criterion applies to the diagnosis of ADHD in both children and adults. Nonetheless, adult ADHD usually presents alongside a number of other psychiatric conditions, including bipolar disorder, cyclothymia, dysthymia, or borderline personality disorder (Barkley, 2014).
ADHD is usually managed through combined therapy, as this is the most efficacious form of therapy as compared to pharmacotherapy and psychotherapy (Hinshaw & Arnold, 2015). Single modality therapy usually manages to suppress the most predominant symptoms of the condition, but this suppression only lasts for a short period of time (La Cruz et al., 2015). However, combined therapy manages to achieve long-term suppression of the symptoms of ADHD, hence allowing the affected individual to engage in normal daily activities (Hinshaw & Arnold, 2015). Therefore, combined therapy restores the functional status of the affected individual.
Childhood ADHD
The traditional understanding that the symptoms of the condition abate as the affected child ages has been discredited. As mentioned earlier, ADHD is diagnosed during childhood, usually when the affected child is about six years old. This is because during this age, the child has already enrolled in school and their symptoms clearly manifest themselves during social interactions and academic tasks. Before joining school, the symptoms can be masked by lack of social interactions, save for that with the immediate family members (Verkuijl, Perkins & Fazel, 2015). This means that the condition predominantly affects the social functioning of the child.
The main symptoms that are used to diagnose the condition are described hereafter. The affected child is usually easily distracted, forgets instructions, misses details, and has poor concentration. This frequently manifests itself as late submission of homework, or submission of incomplete homework. Also, the affected child quickly switches from one task to another and this means that he or she cannot focus on any particular task. Thus, the child cannot focus on either reading and writing; and this leads to poor educational performance - which is one of the effects of the condition. Daydreaming usually makes the affected child to fail to respond to verbal commands, and this may be considered as lack of responsiveness to environmental stimuli. For this reason, the affected children find themselves being punished frequently by their teachers (Visser et al., 2013).
The hyperactivity spectrum of the condition manifests itself in the ways described hereafter. The affected child usually squirms in his or her seat, and frequently fidgets. The affected child usually has a habit of talking non-stop, as well as dashing around classes and playgrounds. Moreover, the affected child is quite impatient and normally blurts out inappropriate comments without due regard to the consequences. The comments usually express his or her emotional state, and since the affected child cannot appropriately control his or her emotions, he or she ends up behaving inappropriately. Such behaviors, if they persist, are quite noticeable to the teachers and other children; and it is usually at this point that the parents of the affected child are informed that there is something wrong with their kid, and asked to seek professional help (if the parents are not already aware of the condition of their child) (Klein et al., 2012). Usually, the aforementioned symptoms tend to abate as the child ages and learn about social norms and appropriate behavior. However, if the child is not managed properly for ADHD, these symptoms may recur during the adolescent period (Feldman & Reiff, 2014).
During the adolescent period, untreated ADHD usually manifests itself as inappropriate behavior and poor educational achievement (Hodgkins et al., 2012). The affected individual usually exhibits immature behavior characterized by non-stop talking with the content of the speech sometimes being inappropriate for the occasion. Moreover, the affected individual has poor social skills which make the process of creating and maintaining friendship difficult, and as such, these individuals tend to be loners. The loneliness is compounded by the fact that poor educational achievement may force them to repeat classes and thus learn alongside strangers whom he or she is unfamiliar with; and this implies that the affected adolescent would have difficulty participating in group discussion or peer-related activities (Feldman & Reiff, 2014). This further affects his or her academic performance.
The inability of the affected individual to interact appropriately with his or her peers sometimes leads to rejection, and this form of social rejection aggravates their anger. Moreover, the individual usually has poor control over his or her emotions and this may drive him or her to blurt out; and when he or she does so, then he or she experiences further rejection. This leads to the building up of internalized anger compounded by social rejection. Social rejection usually leads to loneliness. This leads to poor maturation of social skills, which have detrimental impacts on the adult life of the affected individual (Pingault et al., 2015).
The ADHD-PH subtype is the least prevalent subtype of ADHD in the adolescent cohort, with the predominant subtype being ADHD-C (Dalsgaard et al., 2015). The explanation for this observation is that the hyperactivity symptoms of the condition tend to abate as the affected individual ages and thus the affected individual tends to be mainly inattentive. However, the social rejection that the affected individual usually leads to internalization of anger, which due to poor control over emotions, may drive the adolescent to exhibit mood swings or anger burst which are usually accompanied by destructive behavior; thus leading the individual to be considered to be hyperactive (Shaw et al, 2016). Thus, the affected adolescent exhibits predominantly the symptoms associated with ADHD-PI but the anger burst and destructive behaviors lead to the symptoms being categorized under the ADHD-C subtype (Pingault et al., 2015).
If the ADHD is not appropriately managed, the symptoms persist into adulthood; and the affected individual experiences difficulties in social interactions. This leads to inability to get employment, or if he or she is employed, then maintaining the job becomes difficult. Moreover, the affected individuals also experience family problems (Lahey et al., 2016).
Adult ADHD
It is estimated that about 65% of all individuals who were diagnosed with ADHD during childhood end up suffering the condition during adulthood (Kolla et al., 2016). Therefore based on the statistics provided by the WHO in 2013, it can be deduced that approximately 25 million adults are affected by ADHD (Vos et al., 2015). Adult ADHD has serious impact on the life of the affected individuals as explained hereafter.
Adult ADHD manifests itself as difficulty in focusing in tasks due to inability to filter out or ignore distractions. Moreover, the affected individuals experience difficulty in either organizing or prioritizing their work, and this usually leads to poor quality of work which results in substandard work output. Additionally, the affected adults have poor judgment which means that they usually seek immediate gratification, and some of their actions do indicate that they were undertaken without prior proper considerations (Adler, Spencer & Wilens, 2015).
According to a study done on the effects of ADHD on adults, the following findings were documented. To begin with, adults suffering from ADHD were twice more likely to have been arrested as compared to normal individuals. Moreover, the affected adults had a 78% more chance of being addicted to narcotics as compared to normal adults, and twice as likely to have discontinued their education during high school, and this means their rate of achievement of tertiary education is less than the normal average. This implies that they tend to have non-specialized skills, and are thus less likely to be employed as skilled laborers. Additionally, the affected adults had a prevalence rate of divorce which was 200% higher than the population average. Finally, the study also showed that the affected adults were twice as likely to have lost an average of 7 jobs in the past decade (Pliszka, 2016). This implies that are more likely to have a lower income than the average person. In another study, it was shown that adult ADHD affect females more than males (Reimherr et al., 2015).
Nonetheless, it is more difficult to diagnose ADHD in adults as compared to diagnosing the condition in children. This difficulty is caused by the factors described hereafter. First of all, the DSM-V criteria used for diagnosis is structured and inclined more to diagnosing ADHD in children. Secondly, there are no objective verifiable tests that could be used to diagnose adult ADHD. Thirdly, primary care-givers lack clear guidelines for ADHD diagnosis among adults. Finally, in adults ADHD co-exists with other co-morbidities and this makes the process of diagnosis difficult. For this reason, ADHD in adults is usually diagnosed as part of the differential diagnoses rather than as the definitive diagnosis; and this is indicative of the fact that in adult psychiatric care, ADHD is considered as comorbidity rather than the only disease. The main comorbidities associated with adult ADHD are antisocial personality, major depression, substance abuse, and anxiety disorders (Barkley, 2014).
Even so, it is quite evident that using the information provided above, it is possible for one to recognize an adult suffering from ADHD. Nonetheless, the most noticeable facts that define an adult suffering from ADHD are discussed hereafter. To begin with, the affected adults have difficulty in either starting or completing any project, and this can be attributed to poor planning, disorganization, poor time management (which may manifest itself as frequent procrastinations), and frequent forgetfulness. Secondly, impulsive decision making tends to drive them to act inappropriately; and if compounded by poor anger control, then they may say inappropriate comments. This usually creates problems for them and most tend to lose their jobs mainly due to inappropriate behaviors. Also, their poor social skills mean that they cannot form and maintain cordial relationship with other workers in the workplace, and if the issue of marriage is concerned, then the affected individuals would be unable to maintain their marital relationship for long. Finally, their inability to concentrate or pay attention to detail means that they find it difficult to obtain employment as they are more likely to fail the interview (Barkley, 2014). Hence, it is clear that adult ADHD exists and is caused solely by non-management of childhood ADHD (Hodgkins et al., 2012). The most appropriate form of management for adult ADHD is combined therapy suing both pharmacotherapy and psychotherapy (Barkley, 2014).
ADHD is a neurodevelopmental condition which usually manifests itself during childhood, and most diagnoses are made when the affected child has joined school. The condition causes impairment in social functioning as well as impedes the learning process. It can be managed using combined therapy. However, poor management, or lack of management, allows the symptoms to persist throughout adolescence and into adulthood where the affected individual experiences difficulties in maintain employment as well as maintaining social and marital relationships. This thus confirms that childhood ADHD if not appropriately managed during childhood does progress and persist till adulthood where it manifests itself as adult ADHD.
Adler, L. A., Spencer, T. J., & Wilens, T. E. (Eds.). (2015). Attention-deficit Hyperactivity
            Disorder in Adults and Children. Cambridge University Press.
Barkley, R. A. (Ed.). (2014). Attention-Deficit Hyperactivity Disorder: A Handbook for
            Diagnosis and Treatment. Guilford Publications.
Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015).
            Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder:
            a nationwide cohort study. The Lancet385(9983), 2190-2196.
Feldman, H. M., & Reiff, M. I. (2014). Attention deficit–hyperactivity disorder in children and
            adolescents. New England Journal of Medicine370(9), 838-846.
Franke, B., Faraone, S. V., Asherson, P., Buitelaar, J., Bau, C. H. D., Ramos-Quiroga, J. A., &
            Lesch, K. P. (2012). The genetics of attention deficit/hyperactivity disorder in adults, a
            review. Molecular Psychiatry,17(10), 960-987.
Gordon, J. (2010). Attention Deficit Hyperactivity Disorder Handbook. A Physician's Guide to
Hinshaw, S. P., & Arnold, L. E. (2015). Attention-deficit hyperactivity disorder, multimodal
            treatment, and longitudinal outcome. Wiley Interdisciplinary Reviews: Cognitive
            Science6(1), 39-52.
Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012). A
 systematic review and analysis of long-term outcomes in attention deficit hyperactivity
disorder: effects of treatment and non-treatment. BMC medicine10(1), 99.
Klein, R. G., Mannuzza, S., Olazagasti, M. A. R., Roizen, E., Hutchison, J. A., Lashua, E. C., &
            Castellanos, F. X. (2012). Clinical and functional outcome of childhood attention-
            deficit/hyperactivity disorder 33 years later. Archives of general psychiatry69(12),
Kolla, N. J., van der Maas, M., Toplak, M. E., Erickson, P. G., Mann, R. E., Seeley, J., &
            Vingilis, E. (2016). Adult attention deficit hyperactivity disorder symptom profiles and
concurrent problems with alcohol and cannabis: sex differences in a representative,
population survey. BMC Psychiatry, 16(1), 1.
La Cruz, D., Fernández, L., Simonoff, E., McGough, J. J., Halperin, J. M., Arnold, L. E., &
            Stringaris, A. (2015). Treatment of children with attention-deficit/hyperactivity disorder
 (ADHD) and irritability. Journal of the American Academy of Child and Adolescent
Psychiatry54(1), 62-70.
Lahey, B. B., Lee, S. S., Sibley, M. H., Applegate, B., Molina, B. S., & Pelham, W. E. (2016).
            Predictors of adolescent outcomes among 4–6-year-old children with attention-
            deficit/hyperactivity disorder. Journal of abnormal psychology125(2), 168.
Mash, E. J., & Barkley, R. A. (Eds.). (2014). Child Psychopathology. Guilford Publications.
Pingault, J. B., Viding, E., Galéra, C., Greven, C. U., Zheng, Y., Plomin, R., & Rijsdijk, F.
            (2015). Genetic and environmental influences on the developmental course of attention-
            deficit/hyperactivity disorder symptoms from childhood to adolescence. JAMA
            Psychiatry, 72(7), 651-658.
Pliszka, S. R. (2016). Attention-Deficit Hyperactivity Disorder Across the Lifespan. FOCUS.
Reimherr, F. W., Marchant, B. K., Gift, T. E., Steans, T. A., & Wender, P. H. (2015). Types of
            adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial
            response, and long-term response to treatment with methylphenidate. ADHD Attention
            Deficit and Hyperactivity Disorders7(2), 115-128.
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2016). Emotion dysregulation in attention
            deficit hyperactivity disorder. FOCUS.
Verkuijl, N., Perkins, M., & Fazel, M. (2015). Childhood attention-deficit/hyperactivity
            disorder. BMJ350, h2168.
Visser, S. N., Danielson, M. L., Bitsko, R. H., Perou, R., & Blumberg, S. J. (2013). Convergent
            validity of parent-reported attention-deficit/hyperactivity disorder diagnosis: a cross-
            study comparison. JAMA pediatrics167(7), 674-675.
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., & Duan, L. (2015).
            Global, regional, and national incidence, prevalence, and years lived with disability for
            301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic
            analysis for the Global Burden of Disease Study 2013. The Lancet386(9995), 743-800.

No comments:

Post a Comment