Feeling distracted or disorganized? Having trouble waiting your turn in line? Are you fidgety? Maybe you have adult attention deficit disorder (ADD) and need to see your doctor. That's the new marketing message from pharmaceutical giant Eli Lilly and Company. Lily has the only drugs with Food and Drug Administration (FDA) approval to treat adults with ADD. For decades individuals with ADD symptoms were under-diagnosed. Today, the disorder may be over-diagnosed. It surely will be over-diagnosed if the proposed changes in criteria for the disorder are approved by the American Psychiatric Association.
What exactly is Adult Attention Deficit Disorder?
Adult ADD is a nervous system disorder characterized by people who experience difficulties with executive functions (a set of cognitive abilities that control and regulate abilities and behaviors). These functions include attention, planning, concentration, managing time and tasks, maintaining focus, and making thoughtful decisions; symptoms that many people have had to some degree at some point in their lives. However, to qualify for a psychiatric diagnosis of ADD/ADHD, an individual's executive difficulties must basically be life-long, and there must be no other condition present to explain them. Adults with ADD usually have difficulty following directions, remembering information, concentrating, organizing tasks or completing work on time. If these symptoms are not managed appropriately, they can cause associated behavioral, emotional, social, relationship, and vocational problems.
People with adult ADD have serious problems in one or more of the following areas: screening out distractions and keeping focused; starting, remembering or completing tasks; organizing information and belongings; being or fulfilling obligations on time; and setting priorities.
How prevalent is ADD?
The most common factor in ADD is heredity, which is responsible for 75% of all cases. ADD is reported consistently in about 7% of children and about 4% of adults in various cultures throughout the world. An estimated 60% of children who were diagnosed with ADD or ADHD will maintain their disorder into adulthood. Recent studies suggest that 4.4% of the USA adult population has ADD/ADHD.
How Is Adult ADD Diagnosed?
It is important to note that ADD is not an adult-onset disorder and must be verified from childhood; specifically symptoms must have started before the age of 7. Additionally, these symptoms must have caused significant problems in two or more settings (school, home), and that the symptoms occur in the absence of a different mental health disorder. The DSM-IV lists nine symptoms to constitute the diagnosis of ADD and nine symptoms to constitute the diagnosis of ADHD. If an individual presents with six of either or both of these symptoms they are diagnosed by a mental health clinician has having ADD or ADHD. For a complete list of criterion for the diagnosis of ADD/ADHD click the link below. If you believe you may have adult attention deficit disorder that was not diagnosed in childhood you can take a self test also linked in below.
Diagnosing ADD in the Near Future: Lowering the Bar
In May 2013 the APA will release a revised version of the DSM-IV, cleverly calling it the DSM-V. There will be numerous changes related to diagnosing a mentally ill individual. The proposals for ADD/ADHD are significantly important.
- Fewer symptoms will be required for a diagnosis of adult ADD.
- Changing the age of onset of the disorder from before the age of seven to before the age of twelve.
- Doing away with the ADD/ADHD subtypes developed in DSM-IV, and reverting back to a single diagnosis of ADHD.
How Adult ADD/ADHD is Treated
Stimulant drugs are the most commonly used treatment for the symptoms of short attention span, impulsive behavior, and hyperactivity associated with the diagnosis of ADD/ADHD. These drugs improve ADHD symptoms in about 70% of adults and 80% of children shortly after starting treatment. They may be used alone or in combination with behavior therapy. Stimulants work by increasing dopamine levels in the brain; dopamine is a neurotransmitter associated with pleasure, movement, and attention. The most commonly prescribed stimulants are Concerta, Adderall, Vyvanse, Dexadrine, Metadate CD, Ritalin LA, and Focalin. In severe cases methamphetamine hydrochloride (Desoxyn) may be prescribed. Stratterra is the only non-stimulant medication approved by the FDA for the treatment of ADD/ADHD in both children and adults.
There are some inherent difficulties in treating adults ADD/ADHD with stimulants. Stimulants are controlled substances (Schedule II) and it is not uncommon for adults with ADHD to have substance abuse problems. Any prescribed stimulant has a high potential for drug dependency and abuse. These medications are closely related to illegal street drugs.
Stimulants have also been abused for both performance enhancement and recreational purposes. Stimulants allow an individual to lose weight, increase wakefulness, and increase focus and attention. The euphoric effects of stimulants usually occur when they are crushed and then snorted or injected.
There are serious side effects when an individual is taking a stimulant: increased blood pressure, heart rate, body temperature, and decreased sleep and appetite. Additionally, repeated use of stimulants can lead to feelings of hostility and paranoia. At high doses, stimulants can lead to serious cardiovascular complications, including stroke.
Problems with the Proposed Lowering of the ADD/ADHD Diagnostic Bar
The reasons for changing the criteria for any mental health disorder is the concern that individuals were under-diagnosed due to overly cautious mental health clinicians and/or the stigma of having a psychiatric diagnosis. However, when you decrease the criteria for a diagnosis, you also decrease its specificity. Lowering the ADD criteria has the strong potential for misidentifying adults with fairly mild attention problems as having ADD. Giving stimulants to individuals who do not need them will result in an increased risk of substance abuse as well as harmful, even fatal, side effects. Additionally, lowering the criteria will make it easier for adults to access stimulants simply for performance enhancement (athletes and college students) and/or recreational purposes. Finally, a rush to a diagnosis of ADD will result in misdiagnosing a more accurate mental illness. The symptoms of ADD are quite nonspecific. These symptoms are also found in many other mental health disorders: substance abuse, bipolar disorder, depression, anxiety disorders, OCD, autistic disorders, psychotic disorders, and personality disorders.
ADD/ADHD and Problems for Law Enforcement
Studies have shown that an adult with ADD/ADHD has more difficulties with law enforcement than the average citizen. These individuals are more likely to suffer from substance abuse; alcohol and marijuana are the most commonly abused substances. On a smaller scale, they are more likely to have multiple speeding tickets and minor traffic collisions. The impulsivity that accompanies these disorders makes individuals more likely to have impaired judgment when dealing with difficult situations, such as being confronted by officers. Impulsivity and anger management issues, including domestic violence, are also more prevalent than in the general population.
There has become a large secondary market for prescription stimulants. It has been reported that 30% of college students use stimulants. If a prescribed patient does not use the stimulant, they can be sold for a hefty profit. This leads to the societal concern that there will inevitably be greater abuse of stimulants and to their illegal sales. This will impact law enforcement agencies and officers.
