ADHD Across the Lifespan - Adults

Kathleen Nadeau, Ph.D.

Agenda

Diagnosing adults

Creating an ADHD-friendly Living Environment

Executive functioning challenges facing adults with ADHD

Relationship challenges

Workplace challenges

Parenting challenges

Issues in later adulthood

Diagnosing Adults with ADHD

Clinical interview to review

Family history

Developmental history

Academic history

Workplace history

ADHD questionnaires

Brown ADD Scales

Best if significant other can also complete questionnaires

Presenting Issues for Undiagnosed Adults

Constant stress

Feeling of overwhelm

Anxiety and depression common

Can’t manage demands of daily life

Under-functioning at work

Constantly creating dilemmas that increase daily stress

Self-reported Adult Criteria

Disorganized

Distracted

Avoid mental effort

Lose things

Fail to follow/finish

Forgetful

Poor sustained attention

ADHD symptom profiles in Medication-Treated Adults Entering a Psychosocial Treatment Program. Knouse, Sprich et al. Journal of ADHD and Related Disorders, Vol. 1, #1, 2010. pp. 34-48.

Most adults can’t find psychiatrists that recognize and treat their ADHD

Undiagnosed adults commonly diagnosed with

Generalized anxiety

Recurrent depression

Bipolar disorder

Significant Under-diagnosis of Females

“Underdiagnosis of females is a significant public health issue” - Biederman et al., 1999

Girls currently studied not representative of larger population of girls with AD/HD (Gaub & Carlson, 1997)

Current diagnostic criteria more descriptive of males (Ohan & Johnston, 1999)

Parallel Issues in Diagnosis of Adults & Females

AD/HD in adults considered a “residual” form of AD/HD in children

AD/HD in girls considered a “paler” version of AD/HD in boys

Such views result from use of inappropriate diagnostic criteria.

Strong need to develop diagnostic criteria derived from the populations being diagnosed, not derived from studies of young, hyperactive boys.

Diagnosis of Women More Likely than Diagnosis of Girls

Self-referral increases chance of diagnosis

In school, inattentive type overlooked.

Among “inattentives,” boys more likely to be referred than girls.

Course of AD/HD may be different in females - with later onset of clear symptomatology

“Associated Features” of ADHD may be more descriptive of females

Mood lability

Bossiness,

Stubbornness

Demoralization

Dysphoria

Rejection by peers

Poor self-esteem

Diagnosing High Achieving Adults with ADHD

Compare to peers, not average adult

Often function well in one arena at expense of all other arenas

History of extraordinary effort to reach current level of achievement

High Functioning Adults Should be Compared to Peers

Legal “disability” concept leads to under-diagnosis of highly intelligent adults

Need to take not just achievement, but effort into account

Often able to engage in high-level thinking, but still struggle with daily life management issues

May impact interpersonal interactions more than work/career tasks

Some examples of gifted adults with ADHD

David Neeleman – former CEO of Jet Blue

Kary Mullis, Ph.D. – Nobel prize winner

Steven Stanley, Ph.D. – paleo-biologist at Johns Hopkins and Smithsonian

Helping Adults with ADHD to Succeed

Optimizing Brain Power

Who can help?

ADD coaches

Adult Tutors

Speech Therapists

Psychotherapists

Career counselors

Professional organizers

Life partners

Physicians

Approach the Challenges from a Brain-based Perspective

ADHD-friendly environments

Brain-friendly Daily Habits

Accommodations

Technology tools and supports

Brain-friendly Choices

Strategies to build Executive Functioning Skills

Solution-focused Psychotherapy

Reframe ADHD in balanced, constructive terms;

Help partner to understand and reframe ADHD conflicts

Set reasonable, reachable goals that build self-esteem

Rewrite life story to include a focus on gifts and talents

Collaboratively monitor medication response

Engage in problem-solving rather than self-blame

Supporting Better Executive Functioning Skills

ADD Coaching

Professional Organizing

Using day planners

Learning Time Management

Building reminder systems

Creating daily habits

Individual’s Role in Managing ADHD

Developing Executive Functioning Skills

Executive Functioning

These higher cognitive functions include the ability to: Organize, Plan, Self-monitor, Control impulses, Analyze Compare current and past events Working memory

Improve Executive Functioning with Brain-friendly Daily Habits

Sleep management – sleep deprivation has direct impact on functioning of pre-frontal lobes

Nutrition – protein to stabilize blood sugar levels, nutritional supplements, neuro-toxins

Exercise

Exposure to nature

Stress management

Improve Executive Functioning through Managing your Living Environment

Creating an ADD-friendly Living Environment User-friendly furnishings

Uncluttered

Organized

Working with a professional organizer

The Three S’s of ADD-friendly Organizing

Structure

Support

Strategies

Paperwork Procrastination – work with someone to develop:

Mail systems

Bill paying systems

Tax info systems

Getting the help you need – you don’t need to do it all alone Reading about ADD-friendly system

Help from family and friends

Help from a coach or organizer

ADD-friendly Dig-outs

Make it fun – music, companionship, encouragement

Offload immediately – charity donations go into bags in the car; throw-aways go into bags by the outdoor trashcans

“Age” reluctant off-loads in out-of-the-way storage or even paid storage

Dig-outs should be incremental

Define small area

Tie the bow – complete the entire organizing project in one work session

Use inexpensive, but attractive storage containers

Use label maker

Don’t keep working until overwhelm takes over

Too many interests, too little time

ADD pattern of “too much at once”

If you can’t “give up” an old dream (involving never or rarely used items) set a schedule of “rotating” activities

Set a plan to either use the items at the time of scheduled rotation or lose them (agree to give them up).

Look for ways to improve mood and increase organizing productivity

Color

Lighting

Convenience

Adequate storage

Micro and Macro Organizing

ADD adults have a tendency to:

over-complicate organizational tasks

move into micro-focus while ignoring larger issues

ADD-friendly Ways to Organize Your Life

Many of the ideas in this presentation come from

ADD-friendly Ways to

Organize Your Life

coauthored with

Judith Kolberg, Professional Organizer

ADHD-friendly Relationships

May be attracted to those with same tendencies

Best relationship is with someone that complements areas of weakness

But is NOT overly dependent or critical

ADD-friendly Social Environment

Choose people that Understand ADD

Support your strategies for change

Appreciate the best in you

Help you problem-solve

Help you laugh at your foibles

Don’t add to the chaos

Choosing A Career That’s Right for You

Career Assessment for Adults with ADHD

What is an ADD-friendly job?

One that Minimizes paperwork and record-keeping

Provides adequate structure to stay on track

Provides adequate stimulation to maintain interest

One that calls on your strengths with minimal demands in areas of weakness

One with a supportive and accommodating supervisor

Multi-part Career Assessment

Putting together the pieces of the puzzle:

Your strengths

Your challenges

Your temperament

Your interests

How you are affected by ADHD and what job characteristics will accommodate them best.

To find good career match – all the puzzle pieces need to fit together

Strengths

Challenges

Interests

Temperament

To find a good job match within your career

Minimize paperwork or have adequate admin support

Look for a well-organized, employee-friendly employer

Look for a job with variety and flexibility

Look for a job with adequate structure and supervision

Self-employment vs. Working for Others

Self-employment appeals to many with ADHD due to freedom and flexibility

Need to find ways to have structure and support within self-employment

Dangers are disorganization, poor time management, lack of direction

Many with ADHD are not suited for self-employment – need more structure and support

ADHD Parenting Challenges

Difficult to parent consistently until own ADHD patterns are better managed

Parents may respond too emotionally to frustrations of parenting

May over-identify with child and not set firm limits and expectations

Double-challenge When parent and child has ADHD

Parenting groups VERY helpful –provides support and realistic comparison

Your children AREN’T like children without ADHD

Need professional support to change parenting patterns that are:

too lenient,

too inconsistent,

too emotional or

too negative

Family can provide young adults with a model

Provides a model for ADD-friendly Living

Parents with ADD become role models for their children with ADD

ADD is treated with Understanding

Patience

Humor

Appreciation

ADD Challenges Later in Life

Three S’s Suddenly Removed

Retirement removes the

Stimulation of the workplace

Structure of having a job

Support network of the workplace

Surveys Suggest Two Very Different Pictures for Retired Adults with ADHD

Active Enjoyment Loneliness/Withdrawal

What are the determining factors?

Environment that Supports Engagement

Over-50 active adult communities

Elderhostel

Community volunteer activities

Range of interests that promotes interaction and activity

Relationships with Others

Hard to initiate and maintain relationships

Sleep patterns often shift and contribute to isolation – up all night, sleeping all day

Needs involvement with groups that provide organized social activities

Needs are similar at every age

Structure, Support and Strategies to manage daily life challenges

Find or create environment that will promote optimal functioning

Need supportive social environment

Make life choices that don’t over-tax EF abilities and that tap abilities and interests

Meet some Adults with ADHD Learning to Take Charge of Their Lives

Mark – challenged by sleep, time management, money management and anger outbursts

Jason –job losses despite education and effort; juggling work and family responsibilities; seeking career direction

Amy – “hiding” at home and at work – procrastinating and avoiding until she learns to communicate and advocate

Spencer – falling into anger and isolation as ADHD increases and retirement is looming