Diagnosing ADHD in Adults
Š2012 Professional Development Resources | http://www.pdresources.org | email: ceinfo@pdresources.org
Title of Course: Diagnosing ADHD in Adults CE Credit: 3 Hours Instruction Level: Intermediate Author: Ari Tuckman, PsyD, MBA Abstract: This course will describe the unique ways in which the symptoms of ADHD manifest in adults, including the distinction between attention deficit and attention regulation. It also includes a discussion about the difficulties of accurately diagnosing ADHD in adults and the reasons the disorder is simultaneously over- and under-diagnosed. The DSM-IV diagnostic criteria for ADHD – as they apply to adult functioning – are placed into a context of the actual “soft signs” that can help clinicians identify areas of functional weakness for clients with ADHD. The author lists and details the components of a comprehensive diagnostic interview and emphasizes the value of collateral sources of historical information needed to establish an accurate diagnosis. Various formal assessment instruments are described, along with commentary about their utility in the diagnosis of adult ADHD. Finally, there is a section on the important area of comorbid conditions like depression and anxiety that frequently obscure and/or accompany ADHD. 2007
Learning Objectives: 1. 2. 3. 4. 5. 6.
Identify ways in which the symptoms of ADHD manifest in adults List factors that can complicate the diagnosis of ADHD in adults Name the components of a comprehensive diagnostic interview for adult ADHD Identify “soft signs” that are unofficial but common areas of dysfunction in adults with ADHD Describe the place of formal assessment instruments in the diagnosis of ADHD in adults Identify three factors that are important differentiators between ADHD and other psychiatric disorders
©2012 Professional Development Resources | http://www.pdresources.org | email: ceinfo@pdresources.org
Diagnosing ADHD in Adults
Diagnostic Criteria, Assessment Instruments, and Comorbid Conditions This continuing education course was adapted from Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians. By Ari Tuckman (2007). New Harbinger Publications: Oakland, CA. Used by permission.
Introduction The key to any effective treatment is an accurate diagnosis. This is as true for mental health and medical care as it is for automotive repair. An accurate diagnosis allows the professional and client to select and target interventions in the ways that are most likely to yield positive results. The alternatives are to shoot blindly or to pursue a path that is unlikely to prove beneficial. This is especially true of adult ADHD since it’s a condition that’s easy to misdiagnose—both by missing the diagnosis and by giving it when it is not truly present. The high level of comorbidity means that it takes finesse to tease apart the origins of various symptoms, particularly when longstanding conditions such as anxiety and depression are secondary to a lifetime of ADHD-related struggles. I would like to say that even as an ADHD specialist, I have never missed a diagnosis of ADHD in a client who came in for other reasons, but it happens. Clients who have a complicated situation or more obvious reasons for their difficulties, such as an extremely dysfunctional upbringing, may obscure another important cause for their struggles. As an example, an ADHD child with a verbally abusive parent may have attracted more abuse than a sibling would have because of her greater likelihood to be off task. Granted, this doesn’t undo or excuse the effect of the abusive parent’s actions, but it may offer an alternative explanation both for events that took place in childhood and any subsequent difficulties that cannot otherwise be sufficiently explained.
The History of the Diagnosis What we call ADHD today has had a presence throughout the diagnostic classification systems of the last century. The evolution of the diagnosis shows an increasing understanding of the subtle and myriad effects of the disorder that go beyond the obvious problematic behavior. Unfortunately, until the last couple decades, ADHD was seen exclusively as a disorder of childhood that disappeared in late adolescence. This has had important implications for those who continue to struggle with the symptoms as adults. The symptoms of ADHD change less in late adolescence than do the environments in which these adults find themselves. Unfortunately for ADHD youngsters, the classroom is an excellent screening tool for difficulties with inattention, hyperactivity, and impulsivity. When we enter the world of work and enjoy a greater latitude in choosing our environments, we tend to choose situations that favor our strengths and minimize the impact of our weaknesses. So, the child who could not sit still becomes a deliveryman who doesn’t have to. This doesn’t mean that all of his ADHD difficulties have disappeared, but rather that, at least in this aspect of his life, his ADHD difficulties may be less apparent. One of the first official references to what we now call ADHD was made by G. F. Still in 1902 when he dubbed it “moral deficit disorder” (Weiss, Hechtman, & Weiss, 1999). This plainly pejorative interpretation of ADHD behavior is well known to those who suffer from the disorder. ©2012 Professional Development Resources | http://www.pdresources.org | email: ceinfo@pdresources.org
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Š2012 Professional Development Resources | http://www.pdresources.org | email: ceinfo@pdresources.org