Adults diagnosed with attention-deficit hyperactivity disorder (ADHD) tend to have a different pattern of symptoms than do children with the disorder, according to a study from the Massachusetts General Hospital (MGH). The report in the current issue of Journal of Attention Disorders describes that adults with ADHD report symptoms of inattention -- including difficulty following directions, easy distractability, shifting activities and frequently losing things -- more frequently than they report symptoms of hyperactivity and impulsivity. The study is believed to be the first to examine how ADHD is most commonly manifested in adults.
"People most commonly think of ADHD as "hyperactivity," but our results suggest that would be a misnomer in most adults," says Timothy Wilens, MD, of the MGH pediatric psychopharmacology clinic, the study's principal investigator. "Understanding that inattention is the most common symptom among adults should help more people be properly diagnosed and get the help they need."
For many years it was thought that children with ADHD would "outgrow" their disorder, but in recent years it has become clear that, for many individuals, symptoms persist into adulthood. This new understanding has enabled individuals who have struggled throughout their lives with persistent problems paying attention, controlling their impulses, sitting still or other classic symptoms to be diagnosed with ADHD and treated. However, without a research-supported description of how ADHD usually presents in adults, some physicians and counselors have been reluctant to assess adults for the disorder.
To get a better picture of ADHD in adults, the researchers reviewed information gathered on 149 adults with ADHD who had been referred to the MGH psychopharma-cology clinic. Patients ranged in age from 19 to 60; 59 percent were male and 41 percent, female. The data was taken from interviews conducted as part of the clinic's standard patient assessment. Those conducting the interviews did not know that participants were being evaluated for ADHD. Among the symptoms screened for in the interviews were 14 that are recognized as being associated with ADHD; six of those are classified as inattention symptoms and eight are regarded as hyperactive symptoms.
The researchers found that, while many participants reported a combination of both inattention and hyperactive symptoms, 93 percent of participants reported a preponderance of inattention symptoms; those most frequently reported were difficulty sustaining attention, shifting activities and difficulty following through on tasks. While hyperactive symptoms were reported less frequently, those most commonly reported were fidgeting, interrupting or intruding, speaking out of turn and difficulty waiting one's turn.
The researchers also found that participants who reported symptoms of other psychiatric or behavioral disorders were more likely to have hyperactive symptoms than those with no additional disorders. Although women with ADHD typically report fewer hyperactive symptoms throughout their lifetimes than do men, this study found no significant difference in current reported symptoms between male and female participants.
Wilens notes that currently available data suggest that 2 to 5 percent of the adult population may have ADHD. "Anyone reading a list of ADHD symptoms might recognize some of those qualities in themselves, but the difference for people with ADHD is the vast number of symptoms, their continuation throughout life, and their magnitude. Instead of losing things about once a month, for example, someone with ADHD may misplace things four or five times a day," he says.
"People diagnosed with ADHD as adults tell consistent and compelling stories about them-selves, about feeling that they were misunderstood, never fit in or were somehow "spinning their wheels" throughout their lives," Wilens continues. "Everyone I've worked with has been relieved to hear their diagnosis; they only wish they could have been diagnosed and treated years earlier."
Wilens' co-authors are Rachael Millstein, the paper's first author; Thomas J. Spencer, MD; and Joseph Biederman, MD, director of the MGH pediatric psychopharmacology clinic.