Add vs adhd adults
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Understanding ADD and ADHD in Adults
Prevalence and Continuation into Adulthood
Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are neurodevelopmental disorders that often persist from childhood into adulthood. Research indicates that up to 60% of children diagnosed with AD(H)D continue to exhibit symptoms as adults1. This persistence underscores the importance of understanding and addressing these conditions beyond childhood.
Neuromorphological and Neurofunctional Differences
Recent studies have highlighted distinct neuromorphological and neurofunctional differences in adults with ADD and ADHD. Structural MRI and magnetoencephalography (MEG) have revealed that both ADD and ADHD are associated with reduced gray matter volumes in the left Heschl’s gyrus (HG), leading to diminished left HG/planum temporale (PT) ratios. In the right hemisphere, ADHD is characterized by lower right HG/PT ratios, while ADD shows similar right HG/PT ratios compared to controls. These findings suggest that both conditions exhibit unique neuro-auditory profiles, with ADHD showing a notable left-right asynchrony1.
Executive Function Impairments
ADD and ADHD are fundamentally cognitive disorders characterized by impairments in executive functions (EFs), which are crucial for self-management and daily task execution. Adults with these conditions often struggle with chronic difficulties in organizing, planning, and completing tasks. This impairment in EFs is a core feature of ADD/ADHD and can significantly impact daily life and productivity2.
Diagnostic Challenges and Tools
Diagnosing ADHD in adults is complex and requires a comprehensive approach that includes retrospective assessment of childhood symptoms, evaluation of current psychopathology, and consideration of functional impairments and comorbidities. Various rating scales, such as the Wender-Utah Rating Scale (WURS) and the Connors Adult ADHD Rating Scales (CAARS), are used to systematically assess symptoms and track the course of the disorder. These tools help clinicians to quantify symptoms and evaluate the impact on the individual's quality of life5.
Medication Adherence Issues
Medication adherence is a significant challenge in managing ADHD in adults. Studies have shown that nonadherence rates range from 13.2% to 64%, with many patients discontinuing medication due to difficulties with disorganization and planning. Immediate-release formulations are particularly associated with higher nonadherence rates compared to extended-release versions. However, the long-term consequences of medication nonadherence in adults remain underexplored, highlighting the need for further research in this area6.
Adult-Onset ADHD: A Controversial Topic
The concept of adult-onset ADHD is controversial, with some studies suggesting that adults can develop ADHD symptoms without a childhood history of the disorder. However, the methodologies of these studies have been criticized for their lack of rigor, making it difficult to draw definitive conclusions. Possible explanations for late-onset symptoms include previously unnoticed childhood symptoms, adult-emergent symptoms due to changing environmental demands, or misdiagnosis of other conditions4.
Conclusion
ADD and ADHD in adults are complex conditions that require careful diagnosis and management. Neuromorphological differences, executive function impairments, and challenges with medication adherence are key aspects that need to be addressed. While the persistence of symptoms from childhood is well-documented, the notion of adult-onset ADHD remains contentious and warrants further investigation. Effective management strategies, including the use of appropriate diagnostic tools and adherence to medication, are essential for improving the quality of life for adults with ADD and ADHD.
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Most relevant research papers on this topic
Neuromorphological and Neurofunctional Correlates of ADHD and ADD in the Auditory Cortex of Adults
Adults with ADHD and ADD show distinct neuro-auditory profiles, with reduced gray matter volumes in the left hemisphere and similar right hemisphere ratios compared to controls.
Observational StudyADD/ADHD and impaired executive function in clinical practice
ADD/ADHD is a cognitive disorder characterized by impaired executive functions, involving chronic difficulties in executing various daily tasks, and can be effectively treated in clinical practice.
Highly CitedADHD in adults.
ADHD in adults can be caused by a combination of genes, environment, and brain differences, and can affect individuals regardless of their childhood diagnosis.
Highly CitedAdult-Onset ADHD: A Critical Analysis and Alternative Explanations
Adult-onset ADHD symptoms may exist, but their source remains unclear due to insufficient methodologies in existing studies.
Systematic Review
Very Rigorous JournalPsychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD)
This paper reviews various rating scales for adult ADHD diagnosis, highlighting their usefulness in assessing symptoms, evaluating course, and assessing comorbidity.
Literature ReviewHighly CitedReview of Medication Adherence in Children and Adults with ADHD
Medication nonadherence is common in both childhood/adolescent ADHD and adult ADHD, with more research needed on the issue and its impact on symptoms and impairments.
Systematic ReviewHighly CitedUpdated European Consensus Statement on diagnosis and treatment of adult ADHD
This updated European Consensus Statement highlights the need for increased awareness, proper diagnosis, and effective treatment of adult ADHD, addressing the stigma and promoting better understanding and treatment options.
Rigorous JournalHighly CitedPharmacological and non-pharmacological treatment of adults with ADHD: a meta-review
Pharmacological treatments are more effective than placebo for adults with ADHD, but non-pharmacological treatments and multimodal treatments need further evidence.
Meta-AnalysisHighly CitedEuropean consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD
ADHD in adults is often underdiagnosed and undertreated, leading to ineffective treatment and higher costs of illness in many European countries.
Rigorous JournalHighly CitedPsychological Treatments in Adult ADHD: A Systematic Review
Psychological interventions, particularly Cognitive Behavioral Therapy, show significant positive effects on ADHD symptoms in adults.
Systematic ReviewRigorous Journal