ADHD in Adults: Diagnosis, Impairments, and Long-Term Management (Russell Barkley)

Learning objectives:

Discuss the history and prevalence of ADHD in adults.
Describe how the symptoms of adult ADHD represent a disorder of executive functioning and self-regulation.
List the steps in the assessment of adult ADHD.
Explain the role of clinical judgment in the evaluation of ADHD in adults.
Summarize two evidence-based therapies for management of ADHD symptoms and associated executive functioning deficits in adults.
Discuss two categories of FDA-approved medications for use with adults with ADHD.
Provide four specific recommendations to assist the adult client with ADHD in achieving more effective functioning in major life activities such as work, school, home management, and managing finances.

Introduction

1990s+ aware ADHD not just disorder of children; persists 50-65% into adulthood (total = 3-5% adult population)
90% diagnosed at adult did not get diagnosed. 25% received treatment for ANY condition

Driven to Distraction 1994 book drove interest in ADHD
1960s adults linked to Minimal Brain Damage or Dysfunction (MBD)
Utah criteria (7 symptoms in adult)s proposed in 1995: 1) inattentiveness; 2) hyperactivity; 3) mood lability; 4) irritability and hot temper; 5) impaired stress tolerance; 6) disorganization; and 7) impulsivity
- for retrospective childhood diagnosis, ongoing difficulties with inattentiveness and hyperactivity, and at least 2 of remaining five symptoms
- now declining in use, favoring DSM-5 criteria
FDA approval for first medication for adult ADHD, non-stimulant Strattera.
- Later: osmotic pumps (Concerta®), variable timed-release pellets (Focalin XR®, Metadate CD®, Ritalin LA®, Adderall XR®, et al.), and skin patches (Daytrana®), besides the earlier-available but clinically disappointing wax-matrix sustained release formulation of methylphenidate (Ritalin SR®)