4yr
High-strung and strung-out: Clinically relevant questions regarding adult ADHD and comorbid bipolar and substance abuse disorder | Yellowbrick
Attention Deficit Hyperactivity Disorder (ADHD) is characterized by a pattern of hyperactivity, forgetfulness, distractibility, impulsiveness and/or inattention, depending on the type of ADHD. Despite a symptom profile that affects critical executive functions, as well as, emotional and self-regulation, clinicians often question the long-term consequences of childhood and adolescent ADHD.
• Source: Yellowbrick
• Conclusion/Relevance: “[T]his paper reviewed current issues relevant to the diagnosis and treatment of ADHD in emerging adulthood. We attempted to emphasize the significance of diagnosing ADHD during these critical years because it has the potential to persist from youth into adulthood without notice. Lack of recognition of this disorder in emerging adulthood will permit functional impairments to persist and reduce quality of life in emerging and later adulthood. ADHD may be difficult to differentially diagnose from bipolar disorder; and it may be over-shadowed when substance abuse is also present. But, treatment of ADHD can reduce the risk of substance abuse and other psychiatric comorbidities. In terms of treatment, it appears unwarranted to withhold stimulants for the treatment of ADHD. And therapeutic support to reduce associated impairments is also recommended to achieve long-term positive outcomes.”
• Studies indicate that 75% of cases of adult ADHD first emerged in childhood/adolescence.
• Long-term impact of ADHD on quality life is great, with severe functional impairments present. For instance, data demonstrate that adults with ADHD reach fewer educational milestones past high school, are less likely to be employed full-time, have lower incomes, are more likely to be dependent on tobacco, and are more likely to have a sexually transmitted infection.
• The diagnosis of ADHD in adults is different from that in children, with hyperactivity decreased and comorbid psychiatric disorders increased, including major depressive disorder, generalized anxiety disorder, and alcohol/substance misuse. These comorbidities can cloud diagnosis and treatment of ADHD. Of note, adult ADHD diagnosis can be confused with that of bipolar disorder.
• A challenge in treating ADHD in adults and adolescents prone to substance misuse is the use of medications.
• Discussion question: How do you approach prescription therapy for adult ADHD in those with substance misuse disorders? What insights can you provide?