Adult ADHD Issues

Written by HealthyPlace.com Staff Writer

Dr. Joyce Nash, psychologist and author discusses adult ADD, ADHD diagnosis, along with treatment and ADDult work and relationship issues.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

Conference Transcript

David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Adult Attention Deficit Disorder Issues." Psychologist, Joyce Nash, Ph.D. is our guest. Dr. Nash has a private practice in Menlo Park, California. She is the author of 7 self-help books, along with having a private practice. One of her specialties is treating Adults with ADD, ADHD (Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder).

We'll be starting with the Adult ADD diagnosis and treatment issues, then moving on into ADDult relationship and work issues. And, of course, Dr. Nash will be taking questions from the audience.

Good evening Dr. Nash. Welcome to HealthyPlace.com. Thank you for being our guest tonight. Most of the attention on ADD has been on children and adolescents. Still, many adults with ADD are being overlooked, misunderstood, undiagnosed, and untreated. Why is that? Is it difficult to diagnose ADD-ADHD in adults?

Dr. Nash: Good evening. For a long time, mental health professionals have believed that ADHD disappeared at about age 12. We now know that isn't true, although some people still doubt the diagnosis. Making the diagnosis of ADHD in adults is difficult. There are no definitive tests that say "yes, you've got it." What we do is a combination of things to decide "by the weight of the evidence" if ADHD or ADD is present.

Let me pause for a moment and say that there are now two subtypes of ADHD (Attention Deficit Hyperactivity Disorder) that are recognized. One is the primarily Inattentive type and the other is the primarily Hyperactive-Impulsive type. It is possible for a person to have either/or or a combination of both. The way we go about diagnosing is through a combination of:

1. a clinical interview that takes into account childhood history;

2. use of paper-and-pencil self-report measures, such as the Connors;

3. watching what the person does in the interview, i.e., observation; and

4. seeing what changes happen as the result of treatment, specifically ADD medication treatment.

David: There are medications, private therapy, support groups available to help adults with ADD. Which do you recommend as a first line of treatment and why?

Dr. Nash: Probably the best bet is to find a psychologist who is trained to assess ADD (Attention Deficit Disorder) and start there. He or she should then be able to refer for a medication evaluation to a psychiatrist if that seems appropriate. Many people who do appear to have ADD don't want to start with medication, however. Therapy that does not use medication can focus on how to cope with ADD symptoms. Support groups are great, especially CHADD, which has chapters all over and a web site. It is a good place to get initial information.

David: Because of the difficulty in obtaining an ADD, ADHD diagnosis, would you recommend that a person get a second opinion, if they aren't satisfied with the first diagnosis?

Dr. Nash: Getting a second opinion is okay. A problem is that many people have read the popular literature on ADD and have memorized the ADD symptoms. They, then, rattle these off to the interviewer, who may take them on face value. It is important that whomever the person sees for diagnosis be trained and understand Attention Deficit Disorder in adults.

David: Here are some audience questions, Dr. Nash

val1: I have ADHD, so do all 4 of my children. How common is this?

Dr. Nash: It is believed that between 2 and 5% of children have ADHD, but estimates vary depending on the study and the criteria used. Often an adult "discovers" that he or she has ADD when the child has been diagnosed. ADD does tend to run in families.

David: Does ADD start in childhood and progress into adulthood? Or can it arise in adulthood without appearing in childhood?

Dr. Nash: ADD never arises in adulthood. Some symptoms of Attention Deficit Hyperactivity Disorder are always present in childhood, usually before age 7. The ADHD symptoms in childhood may be overlooked, however, and become a problem progressively. The key is to understand what is age-appropriate behavior and distinguish that from behavior that is "not normal."

David: Here's an audience comment, then more questions:

Starsdancing: I've shown ADHD symptoms all of the 40 years of my life, even before most doctors knew what it was. Only after looking at the 3 of 5 of my kids that have it, was I able to find a doctor who would consider me to have ADHD.

Stacie: Why are so many doctors hesitant to start an adult on Ritalin, even when the signs point to ADHD?

Dr. Nash: Ritalin is a stimulant drug and as such is closely monitored by the government. In addition, there are side-effects that can cause problems. Usually, the first intervention with adults with ADD is an antidepressant. This is generally a good idea because by the time an adult with ADD is "of age", they are often depressed as well. If the antidepressant doesn't help (usually an SSRI like Prozac), then the doctor may move to a stimulant.