Adult attention deficit hyperactivity disorder (ADHD)

What is ADHD?

teacher-professionalAdults with ADHD have problems regulating themselves.  They often have poor self-motivation, are easily distracted, have difficulty initiating tasks, are poorly organized, and have difficulty with making a task a priority. There are two types of ADHD, the inattentive type and the hyperactive or impulsive type.

Causes

ADHD is a medical disorder. While its exact causes are not fully known, genetic and environmental factors are understood to play a part. It is becoming increasingly accepted that individuals with ADHD have difficulty with executive functioning. In humans, these functions are in the frontal lobes of the brain. The frontal lobes remember and prioritize tasks that need to be done, organizes to accomplish these tasks, assesses potential consequences of actions, prioritizes thoughts and actions, keeps track of time, promotes awareness of interactions with surroundings, maintains the ability to focus despite competing stimuli, and adapts to changing situations. Various kinds of brain scans have revealed frontal lobe structural alterations in the neurotransmitters, dopamine and norepinephrine.

Symptoms

Symptoms for inattentive ADHD in adults include avoiding tasks or jobs that require concentration, difficulty making decisions, difficulty Initiating tasks, difficulty organizing, difficulty recalling details, difficulty multitasking, poor time management, losing track of time, indecision and doubt, hesitating in the execution of a task, difficulty persevering or completing and following through on tasks, impaired ability to stop one thing and start doing another.

For the hyperactive/impulsive form of ADHD, symptoms include choosing highly active stimulating jobs, avoiding sitting still, choosing to work long hours or two jobs, seeks constant activity, is easily bored, impatient, intolerant and frustrated, easily irritated, impulsive, snap decisions, irresponsible behaviors, loses temper easily, and angers quickly.

Adults with ADHD are often perceived as chaotic and disorganized, with a tendency to need high stimulation to be less distracted and function effectively. Additionally, up to 80% of adults with ADHD suffer from associated conditions such as depression or anxiety. Many adults with ADHD also have associated learning disabilities, such as dyslexia, which contributes to their difficulties.

In North America and Europe, it is estimated that three to five percent of adults have ADHD, but only about ten percent of those have received a formal diagnosis. In a 2004 study it was estimated that the yearly income discrepancy for adults with ADHD was $10,000 less per year than high school graduate counterparts and $4,300/year lower for college graduate counterparts. The study estimates a total loss in productivity in the United States of over $77 billion because of adult ADHD. By contrast, yearly loss estimations in productivity are $58 billion for drug abuse, $85 billion for alcohol abuse, and $43 billion for depression. Adult ADHD is a major unrecognized problem in the US.

A number of free online tests can give you an idea if you have ADHD.

Medical treatment

Prescription medications use in adult ADHD depends on the severity of the disorder and how much it is interfering with life. The first-line treatments are the stimulants, like Adderall, Vyvanse and Ritalin. Strattera is also an effective treatment for adult ADHD. It is particularly effective for those with the predominantly inattentive type of ADHD. Sometimes the antidepressant Wellbutrin is used for ADHD if depression is also present.

Supplements

A few complimentary supplements have been tried with ADHD with varying success. Almost all the studies are in children with ADHD. Some studies show that eliminating food coloring dyes have a good effect but that may be because more fresh fruits and vegetables are eaten as a consequence of eliminating food dyes.

One adult study showed that S-Adenosyl methionine or SAMe had a good effect on ADHD symptoms.1 Doses should be between 800 and 1600 mg/day. A number of studies have shown that fish oil, especially EPA, has beneficial effects, including positive results from a large meta-analysis.2 Magnesium supplements were also shown to help ADHD symptoms.3

Dimethylaminoethanol (DMAE), also referred to as deanol, is believed to be an endogenous precursor of choline and thus the neurotransmitter acetylcholine and has several studies showing it helps.4 Zinc, iron and thyroid supplements may help in deficient individuals.

Vitamin D has never been tried in ADHD but its effects on the brain are profound so expect to be put on vitamin D. Likewise, the amino acid cysteine, increases production of the master antioxidant in the brain, glutathione, so a diet high in cysteine will be part of your baseline dietary and supplements treatment.

However, for moderate to severe ADHD, supplements may help but medications are usually needed and usually work very well.

References

  1. Shekim WO, Antun F, Hanna GL, et al. S-adenosyl-L-methionine (SAM) in adults 
with ADHD, RS: preliminary results from an open trial. Psychopharmacol Bull 1990;26:249–53.
  2. Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2011; 50(10):991–1000.
  3. Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with ADHD: positive response to magnesium oral loading test. Magnes Res 1997;10:149–56.
  4. Lewis JA, Young R. Deanol and Methylphenidate in minimal brain dysfunction. Clin Pharmacol Ther 1975;17(5):534–40.