ADHD IN YOUNG ADULTS

Elizabeth Lefler, Ph.D.UNI Psychology Department &Licensed Psychologist, IowaMay 27, 2015

Slides and citations available upon request

NEW RESEARCH AREA

• 75% of studies on adult ADHD have been published in the last 10 years

• More research needed now that DSM-5 is out, and has changed the ADHD cutoff for adults• From 6 to 5 symptoms• Age of onset from 7 to 12 years• Some new parenthetical examples

• Forgetfulness symptom now includes examples of forgetting to return calls or pay bills

ADULT ADHD

• Myth: kids “grow out of it”

• Current research: 60-80% of children with ADHD become adults with ADHD or ADHD-related impairment• 2.5-5% rate in adulthood• 2-8% prevalence rate in college• Many adults fall below the threshold, but still have

several symptoms and impairment

IMPAIRMENT

• Lower academic achievement

• Lower rates of college graduation (and thus lower incomes)

• Higher rates of conflict with work supervisors

• More frequent job changes

• Greater relationship discord

• Lower rates of exercise

• Higher levels of pessimism

IMPAIRMENT

• Higher rates of substance use/abuse

• Higher teen pregnancy rates/more unsafe sex/more STDs

• Higher rates of (and more serious) automobile accidents

• Higher rates of comorbid disorders

• Lower rates of saving and investing money

• Higher rates of impulse spending

INATTENTION CRITERIA

• Fails to give close attention to details

• Difficulty sustaining attention

• Does not seem to listen

• Does not follow through on instructions

• Difficulty organizing tasks or activities

• Avoids tasks requiring sustained mental effort

• Loses things necessary for tasks

• Easily distracted

• Forgetful in daily activities

HYPERACTIVITY-IMPULSIVITY CRITERIA

• Fidgets with hands or feet or squirms in seat

• Leaves seat inappropriately

• Runs about or climbs excessively

• Has difficulty playing/engaging in leisure quietly

• Is “on the go” or “driven by a motor”

• Talks excessively

• Blurts out answers before questions are completed

• Has difficulty awaiting turn

• Interrupts or intrudes on others

PROBLEMS W/ DSM SYMPTOMS

• Symptoms are not developmentally scaled• Assessing Intellectual Disability?

• No requirement for corroboration by others

• To be in the 93rd Percentile:• Age 17-29 – 5 of 9 symptoms• Age 30-49 – 4 of 9 symptoms• Age 50+ - 3 of 9 symptoms

CHANGES FROM CHILDHOOD

• Gender Difference• Largely disappears• From 4:1-10:1 in children to 2:1-1:1 in adults• Impairment comparable across men and women

• Etiology• No reason to suspect any changes here• Dopamine in frontal lobe • Smaller, less developed brain regions

• Orbital-Prefrontal Cortex• Basal Ganglia• Cerebellum

• Heritability (80%)• Pre- or postnatal insults (lead, alcohol, premature birth)

CHANGES FROM CHILDHOOD

• Assessment• Developmental and family history; Clinical Interview• Behavior ratings from two parties (from parent

&teacher to self & collateral)• Cognitive and Achievement Testing• Behavioral Observation?• Neuropsych measures?• Measure of malingering?

CHANGES FROM CHILDHOOD

• Treatment• Medication• Parent Training in Child Management

• Children: 65-75% respond• No equivalent for adults

• Family Therapy for Teens: Problem-Solving, Communication Training

• Classroom Behavior Modification • Special Education (IEP, 504)• Residential Treatment• For adults specifically? Much more work needed.

• CBT, Academic and work accommodations?

SPECIAL ISSUES

• Overlap of Symptoms• Inattention is a common symptom to many mental

health problems (e.g., anxiety, depression, and even psychosis).

• Comorbidity concerns

• Malingering• We rely on self-report measures where the items are

very face-valid• Many young adults are now interested in getting a

prescription for stimulant medications• College students are motivated to get extra test taking

time• Weight loss as a motivator

SPECIAL ISSUES

• Medication Considerations• Transition out of parents’ home; stop taking meds• Morning classes through late-night study sessions• Self-imposed medication holidays

• Lots of leftover medication• Diversion of medication to peers• Taking higher doses than prescribed to study all night

or “party”

QUESTIONS/COMMENTS?

Please contact me if you wish:

elizabeth.lefler@uni.edu

(319) 273-7637