Adult ADHD

Slide 1: Written for AskTheNeurologist.Com by ADHDNeuroMD

Slide 2: ADHD is a loaded term

• Attention deficit hyperactivity DISORDER

• Regarding ADHD in Adults – Most have “managed to get by” for many years – Often have high IQ, successful careers

Slide 3: ADHD-like behavior does not = ADHD! “ There must be clear evidence of significant impairment in social, school, or work functioning ”

• Diagnosis dependent on the environment • For simplicity use the term “ADHD” to refer to ADHD-like thinking even when no “impairment” • Definition of “impairment” problematic

Slide 4: Fulfilling potential

• Adults with ADHD, especially those with high IQ have most likely missed diagnosis during childhood • Although they be functioning at normal or even increased levels by objective standards they may be performing well below their potential. • Sensitivity to this fact is essential in order to understand whether “impairment” is occurring.

Slide 5: DSM-IV Criteria for ADHD I. Either A or B: A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

does not give close attention to details or makes careless Often

mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly.

Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).

Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). Is often easily distracted. Often forgetful in daily activities. B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected.

Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). Often has trouble playing or enjoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively. Impulsiveness Often blurts out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g., butts into conversations or games). II. Some symptoms that cause impairment were present before age 7 years. III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). IV. There must be clear evidence of significant impairment in social, school, or work functioning. V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Slide 6: “Has trouble waiting one's turn” Socially acceptable? …depends where ? “Often gets up from seat when remaining in seat is expected"

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Slide 7: ADHD-like behavior does not = ADHD!

• Some aspects are dependent on what’s considered “normal” in society

Slide 8: Attention is always “selective”

• Reward centers direct attention • Brain constantly searches for “rewarding” material • Attention will drift to search for rewarding material • Attention will “lock on” if rewarding enough

Slide 9: Model to understand Focus on a Observe environment new stimulus

NO Interesting or YES Keep important ? focus

NO Still interesting YES or important ?

Slide 10: Model to understand Focus on a Observe environment Focus on a new stimulus new stimulus

NO Interesting or YES Keep important ? focus

NO Still interesting YES or important ?

Slide 11: Model to understand Focus on a Observe environment Focus on a new stimulusa Focus on new stimulus new stimulus

NO Interesting or YES Keep important ? focus

NO Still interesting YES or important ?

Slide 12: Model to understand Focus on a Observe environment Focus on a new stimulusa Focus on new stimulusa Focus on new stimulus new stimulus

NO Interesting or YES Keep important ? focus

NO Still interesting YES or important ?

Slide 13: Model to understand Focus on a Observe environment Focus on a new stimulusa Focus on new stimulusa Focus on new stimulusa Focus on new stimulusa Focus on new stimulusa Focus on Interesting Focus YES Keep new stimulusa NO Focus on new stimulusa or on new stimulusa Focus on important ?new stimulusa focus Focus on new stimulusa Focus on new stimulusa Focus on new stimulusa Focus on new stimulusa Focus on new stimulusa Focus on new stimulus NO Still interesting YES new stimulus

or important ?

“Environment” can be internal (“ADD”) or external (“ADHD”)

Slide 16: Interesting or important ? Dependent on reward pathways in brain

Still interesting or important ? Interesting or important = “Rewarding”

Slide 17: “Could try harder”

• Was well established that people with Adult ADHD can function on very high levels when they are stimulated • Less aware teachers may get very frustrated – “it’s not that he can’t do it…he just can’t be bothered to put in the effort – “ attitude problem” – “ not motivated enough”

Slide 19: “But doesn’t everybody focus more when the material is interesting? ”

Slide 20: “But doesn’t everybody focus more when the material is interesting? ”

YES! Everyone pays attention less when bored and more when interested. But…

Slide 21: Those with ADHD do much, much better when interested!

Boring Interesting

Slide 22: What is at the root of Adult ADHD and ADHD-like thinking ? Differences in the reward system

Slide 23: Dopamine receptor activation is the “currency of reward” in the brain • Dopamine is like money…the “payment” for “doing good” • Receptors are like “hands” grabbing the money

Slide 24: Genetic studies of families with ADHD:- People with ADHD have receptors that “don’t grab so well” ….so they get “paid” less.

This rule only applies to “smaller” payments. Substances such as caffeine & ritalin “add a bonus” to each payment.

Slide 25: People with ADHD are ambitious by nature

• May be “perfectionists”

Things that those with Adult ADHD may say

• “Simple things please simple people” • “Jack of all trades master of none” • “ Feel they are meant for better things” • “ If it’s not a challenge there’s no point doing it”

Slide 26: “Avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time" Easily distracted

Inappropriate comments

Can be highly effective when motivated

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Slide 27: Best jobs

• Highly challenging • No routine boring stuff that anyone could do (assistants / secretaries do that). • Ability to be creative and innovative • Need to have autonomy • Feel appreciated • Flexibility to focus only on what you feel is interesting or important

Slide 28: Or you can choose to do only stuff you find really interesting

Slide 29: Companies actively recruiting “ADHD-type thinkers”

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Slide 30: Some get a job where they only have to do things they consider to be “important”

Slide 31: Some people dislike their job

Slide 32: Some are forced to do jobs that are just not for them (army is typical situation) Does not follow instructions!

Click to play

Slide 33: Has trouble focussing?

Slide 34: Has trouble focussing?

Wrong! ADHD thinking is hyperfocussed thinking!

Slide 35: “Non ADHD thinking”

“ADHD thinking”

Slide 36: Narrower focus = bigger shadow

Slide 37: Distractions (ADHD type) x x

x

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Slide 38: Distractions (Adult ADHD type) x x

x

x

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Slide 39: Distractions (Adult ADHD type) x x

x

x

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Slide 40: Distractions (non – ADHD) x x

x

x

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Slide 41: Distractions (non – ADHD) x x

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x

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Slide 42: Distractions x x x x x x x

x .

. In other words, when some-one with Adult ADHD gets “distracted” they lose the ability to keep their (hyper) focus on what they were doing and need to “lock-on” again once the distraction has passed (they may have to take time to reconstruct complex thoughts or ideas which can be very frustrating…therefore they may “snap” at people when they get distracted.) Those without Adult ADHD are able to “attend to a distraction” without losing their “lock” on their initial focus.

Slide 43: Distractions x x x x x x x x . .

• The plus-side is that those with Adult ADHD (or ADHD-like thinking) are frequently able to “hyperfocus” and when locked-on to the task without distractions can focus a degree of mental energy which others are incapable of. • May be very good at analyzing complex situations • May train themselves to quickly “separate the forest from the trees” as the “trees” bother them more than others!

Slide 44: Distractions x x x x x x x . x

. • A sniper cannot function at a high level if he needs to be aware of everything in his immediate vicinity. •He needs to ignore the entire world except for his target

Slide 45: Adult ADHD Hyperfocus

• Some people with Adult ADHD report they get into a “trance-like state” when successfully hyperfocussing and are unaware of anything except for the task they are performing • ADHD-like hyperfocus is an advantage in when this sort of focus is required.

Slide 46: May compensate for susceptibility to distractions with “obsessive tidiness”

Slide 47: Learning creative tricks

• Adult ADHD, Throughout life learn to look for short-cuts to make laborious tasks quicker and more interesting

Slide 49: 15 13 11 9 7 5 3

• Count all?....much too boring! • Look for shortcuts – “ 6 pyramids, each I higher than last ,7 lines, common bricks” • (3,5,7,9,11,13,15)X7 -common • 15+3 = 18 • 13+5 = 18 • 7+11 = 18 • 18/2 = 9

• (18 x 3 + 9 -6) X7 • 57 X 7 • = 350 + 49 • = 399

Slide 50: Summary • ADHD-like behavior does not = ADHD! • ADHD-like thinking - Encourages hyper-focused analysis - Creativity • All can benefit from optimizing their environment (right school / job, coaching for organizational skills, diaries, palm pilots, supportive spouse) • Some self-medicate without knowing (e.g. coffee) • Some can benefit from medical treatment in certain situations

Slide 51: ADHD “hyperfocussing” can be a powerful force

• Adult ADHD, Recognizing it, is only the first stage

• Real challenge is understanding how to channel it to good use

Slide 52: Use the force

Adult ADHD Thanks for your attention !

Slide 53: THE END (Adult ADHD)

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