ADHD: Diagnose in Adults, Treatments, and Long-TermResearch Paper

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ADHD: Diagnose in Adults, Treatments, And Long-Term Effects

What is ADHD?

ADHD is a neurodevelopmental disorder and affects both adults and children. It is an ongoing or 'persistent' inattention pattern and/or a pattern of hyperactivity-impulsivity that has interference on daily life or normal development. People having ADHD might find it difficult to maintain attention and perform executive function ability of the brain, i.e. start an activity, organize and manage the tasks constituting the activity). They also have problems with working memory.

ADHD exists in three ways:

Inattentive

Hyperactive-impulse

Combined inattentive & hyperactive-impulse (APA, 203).

The condition begins in childhood -- experts say that this particular condition might set in before the child turns twelve. While a majority of the ADHD patients register lower symptoms of ADHD as adulthood sets in, some people carry with them the symptoms into adulthood (Duckworth & Freedman, 2013).

The symptoms that can be observed in adults include:

Having problems focusing e.g., difficulty maintaining a level of attention

Restlessness or the inability to relax.

Difficulty with inhibition -- one finds it difficult to await their turn e.g. In conversations.

Difficulty sticking to a schedule e.g., frequent missing of appointments and deadlines (Duckworth & Freeman, 2013).

ADHD symptoms show in a variety of situations (e.g., work, social, family as well as social obligations). For instance, someone young who finds it difficult to pay attention in class in college and also has problems finishing tasks at his job would make a better example of someone with ADHD than someone much older who just finds it difficult maintaining focus when talking to their spouse.

How is ADHD diagnosed/determined?

An assessment is done and covers formal history plus other useful information like academic records, doing psychological tests and holding discussions with loved ones or parents. People having ADHD in adulthood are likely to have been diagnosed and/or treated for the same condition in childhood. Adults worried that they are showing symptoms of ADHD should consider a meeting with a trained mental health practitioner as the first step of evaluating if indeed the symptoms are those of ADHD (Duckworth & Freedman, 2013).

A good psychiatric examination may be very useful since an adult, especially one that has not had ADHD before, who is experiencing fresh symptoms of problems maintaining a healthy focus might be suffering from a psychiatric or medical condition and not ADHD. Such conditions might be anxiety, depression or drug abuse. Medical conditions -like stroke, seizure or thyroid disease -- might also have symptoms linked to ADHD. So, besides carrying out a psychiatric examination, physical testing and examination should also be carried out to establish whether the symptoms are being caused by a condition other than ADHD (Duckworth & Freedman, 2013).

No one definite biological or psychological test exists for ADHD. The diagnosis of ADHD is a result of many investigation strands that are directed at finding out:

the severity or extent of the main symptoms and other associated issues the characteristics of the various symptoms in various settings the developmental history of the evident symptoms how the symptoms compare with the ones identified at the same level of development in other individuals the existence of some other mental or physical health disorders.

Because the assessment is pretty complex, it is important that various professionals cooperate and various techniques be used. The approach needed should be multi-modal, multi-agency and also multi-professional (NICE, 2008).

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), as published by the American Psychiatric Association is a guide which puts forth the criteria to be made use of by mental health professionals, doctors as well as other qualified clinical professionals in the making of ADHD diagnosis. In its update in 2013, the guide gave ADHD a new definition which will influence the way the disorder is diagnosed in adults and children (APA, 2013).

What about ADHD has been altered by DSM-5?

Adult ADHD: For several years, the criteria for the diagnosis of ADHD stated that only children were diagnosed with ADHD. The criteria therefore implied that adults and teens having ADHD could suffer from it for several years without knowing the cause of the symptoms. DSM-5 ensured that there was a change to this and teens and adults can be diagnosed officially with ADHD now. The criterion now mentions and illustrates the way the disorder might present itself in teens and adults (APA, 2013).

In adult diagnosis, the medics consider middle childhood (age of 12) and the years as a teen and not as far back as childhood (age 7) (APA, 2013).

In DSM-IV TR, a previous edition, the three kinds of ADHD were called subtypes. They are now called "presentations"; and the "presentations" can change in the course of the life of an individual. This gives a better description of the way the disorder has an effect on an individual at the different phases of life (APA, 2013).

The key aspects of a full assessment covers clinical interview, carrying out a medical examination and administering rating scales to teachers and parents (for instance, self report). Other facets like cognitive, literary skills, neuropsychological, developmental assessments may be indicated or left out (NICE, 2008).

Clinical Interview

Clinical interviews are always done by psychiatrists, specialty nurses, psychologists or pediatricians; and are often semi-structured, format-wise, to allow systematic investigation of the major issues. While interview instruments that are fully structured are always made use of in research, their inflexibility has limited their usage. The main aim of the interview is detailing the full range of issues and their history as well as demographic information regarding family, education and health. It is useful to know the way the patient and their family have previously tried to deal with the issue over time and the effect the problems have had on the family and the child. The design of the interview allows for the highlighting of further assessments which could help in facilitating diagnosis as well as intervention planning (NICE, 2008).

Standardized Rating Scales

They assist in evaluating mental health, behavioral and social problems and have normative data enabling comparisons with other members of the population, particular clinical groups or both. Three main kinds exist:

1.

Broad-band instruments made use of in evaluating psychosocial and behavioral functioning: the Strengths and Difficulties Questionnaire (Goodman, 2001) is an example that is used widely. Achenbach scales is also another example (Achenbach, 2003) that covers the ages of 18 months up to 59 years with parent, adult, adolescent and teacher self-report versions. Conners' Rating Scales' (CRS) long version can be used by teachers and parents.

2.

Narrow-band scales specific to ADHD symptom-atology: examples are the Brown Attention Deficit Disorder Scale, Human Situations Questionnaire and the Brown Attention Deficit Disorder Scale.

3.

The other scales used for rating are made use of in evaluating other kinds of mental health symptoms which coexist, or have some association with ADHD like self-esteem, conduct problems, depression and anxiety.

The scales are limited in such ways as just having a moderate level of inter-rater reliability (Verhulst & Van der Ende, 2002) and also incomplete specificity and sensitivity in comparison with full diagnostic assessments. Several scales give a description of only the symptoms and remain silent on the developmental appropriateness or impairment level. If developmental appropriateness is taken into account, then it is through requesting the rater to make a judgment as per what can be taken to be normal for someone of a similar age. This can be difficult for someone who is not an expert at rating and errors as regards interpretation may arise (NICE, 2008).

Educational and Occupational Adjustment

A crucial aspect of the assessment process is understanding the adjustment of a young individual or child at school or the functioning of adult at their workplace. Besides giving information collected by the questionnaire, it can be requested of teachers to provide particular information regarding academic and social functioning. If certain problems exist as regards functioning in the school environment, the assessing clinicians may undertake direct observation in a classroom environment or some other situations that are less structured (NICE, 2008).

Medical Assessments

People who have been referred for ADHD assessment are attended to by pediatricians or psychiatrists. A major objective is ruling out those disorders that may have symptoms similar to those of ADHD. Some of the disorders include thyroid disorder, epilepsy, iron deficiency anemia and hearing impairment. By doing this, the medics note early the contributions that the symptoms of these disorders might have contributed. The assessments carried out also include the parents of the child being asked about the response to the risk factors. Physical signs registered by various genetic conditions that may raise the risk of developing ADHD are also identified. Some other neurological, developmental and physical disorders that should be noted might also exist. Such conditions include sleep disorders, chronic tic disorders, dyspraxia as well as developmental coordination disorder. These disorders influence the nature of later management. Following the diagnosis, if there is confirmation of ADHD, and drug therapy is on… [END OF PREVIEW]

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