Attention-Deficit/Hyperactivity Disorder in Adults E-Book

Brian P Daly

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch
• Veröffentlichungsjahr: 2024

Seitenzahl: 223

Beschreibung

The new edition of this popular text incorporates the latest research on assessment and treatment practices for adults with attention-deficit/hyperactivity disorder (ADHD). The presentation of symptoms may differ considerably in adulthood and without appropriate symptom management, ADHD can significantly interfere in many aspects of life. When properly identified and diagnosed, however, outcomes in adults with ADHD who receive appropriate treatment are encouraging. This volume is both a compact "how to" reference for use by professionals in their daily work and an ideal educational reference for students, informing the reader of all aspects involved in the assessment and management of ADHD in adults. This edition also explores how psychosocial adversity factors impact the development and functional impairments associated with ADHD and highlights strategies used in the multimodal treatment of ADHD in adults. Best practice approaches are offered for common problems encountered when carrying out treatments. A companion volume Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents is also available.

Leseprobe

Advances in Psychotherapy – Evidence-Based Practice, Volume 35

Attention-Deficit/Hyperactivity Disorder in Adults

2nd edition

Brian P. Daly

Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA

Michael J. Silverstein

Center for Cognitive Behavioral Therapy, Media, PA

Ronald T. Brown

School of Integrated Health Sciences, University of Nevada, Las Vegas, NV

About the Authors

Brian P. Daly, PhD, is associate professor and department head of psychological and brain sciences at Drexel University. Dr. Daly is past president of the Philadelphia Behavior Therapy Association and recipient of grant funding from the Pew Charitable Trusts, W. K. Kellogg Foundation, Sixers Youth Foundation, Shire Pharmaceuticals, and Justice Resource Institute. He currently serves on the editorial board of Professional Psychology: Research and Practice, as well as on the advisory committees for several nonprofit organizations.

Michael J. Silverstein, MS, is a postdoctoral fellow at the Center for Cognitive Behavioral Therapy in Media, PA. His research interests include etiology of trauma symptoms after exposure to acute, chronic, and systemic stressors and the relationship between attention-deficit/hyperactivity disorder and posttraumatic stress disorder in youth. Clinically, Mr. Silverstein is interested in providing empirically based interventions to toddlers, children, adolescents, and their families.

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, Professor Emeritus, University of Missouri–Saint Louis, MO

Associate Editors

Jonathan S. Comer, PhD, Professor of Psychology and Psychiatry, Director of Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL

J. Kim Penberthy, PhD, ABPP, Professor of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Continuing Education Credits

Psychologists and other healthcare providers may earn five continuing education credits for reading the books in the Advances in Psychotherapy series and taking a multiple-choice exam. This continuing education program is a partnership of Hogrefe Publishing and the National Register of Health Service Psychologists. Details are available at https://www.hogrefe.com/us/cenatreg

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

Ronald T. Brown, PhD, ABPP, is the Dean of the School of Integrated Health Sciences at the University of Nevada, Las Vegas. Dr. Brown has been the past president of the University of North Texas at Dallas and also is the past president of the Association of Psychologists in Academic Health Centers and the Society of Pediatric Psychology of the American Psychological Association. Dr. Bown has published over 300 articles and chapters as well as 12 books related to childhood psychopathology and pediatric psychology.

Library of Congress of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2023951194

Library and Archives Canada Cataloguing in Publication

Title: Attention-deficit/hyperactivity disorder in adults / Brian P. Daly, Department of

Psychological and Brain Sciences, Drexel University, Philadelphia, PA, Michael J. Silverstein,

Center for Cognitive Behavioral Therapy, Media, PA, Ronald T. Brown, School of Integrated Health

Sciences, University of Nevada, Las Vegas, NV.

Names: Daly, Brian P., author. | Silverstein, Michael J. (Of the Center for Cognitive Behavioral

Therapy in Media), author. | Brown, Ronald T., author.

Series: Advances in psychotherapy--evidence-based practice ; v. 35.

Description: 2nd edition. | Series statement: Advances in psychotherapy--evidence-based practice ;

volume 35. | Includes bibliographical references.

Identifiers: Canadiana (print) 20230586627 | Canadiana (ebook) 20230586686 | ISBN 9780889375994

(softcover) | ISBN 9781613345993 (EPUB) | ISBN 9781616765996 (PDF)

Subjects: LCSH: Attention-deficit disorder in adults—Handbooks, manuals, etc. | LCGFT: Handbooks

and manuals.

Classification: LCC RC394.A85 D35 2024 | DDC 616.85/89—dc23

© 2024 by Hogrefe Publishing

www.hogrefe.com

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

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Acknowledgments

Brian P. Daly is grateful for the love, grace, and laughter from Tina, Leo, Sofie-Mathilde, and Colt. Having the puzzle pieces fit so snuggly together makes me happy every day.

Michael J. Silverstein wishes to thank his wife Gila, parents Aliza and Len, and mentor Dr. Daly for their support and guidance.

Ronald T. Brown recognizes the extraordinary mentorship of Lorene C. Pilcher who began to ignite the flame of a love for scholarship and the study of individuals with attention-deficit/hyperactivity disorder.

Contents

1  Description

1.1  Terminology

1.2  Definition

1.2.1  Diagnostic Criteria

1.2.2  Applicability of Criteria for Adults

1.3  Epidemiology

1.3.1  Prevalence and Incidence

1.3.2  Sex

1.3.3  Age

1.3.4  Ethnicity

1.4  Course and Prognosis

1.5  Differential Diagnosis

1.5.1  Disruptive, Impulse-Control, and Conduct Disorders

1.5.2  Depressive Disorders

1.5.3  Anxiety Disorders

1.5.4  Trauma- and Stress-Related Disorders

1.5.5  Bipolar and Related Disorders

1.5.6  Personality Disorders

1.5.7  Substance-Related and Addictive Disorders

1.5.8  Neurodevelopmental, Physical, and Medical Conditions

1.5.9  Environmental and Psychosocial Factors

1.6  Comorbidity

1.6.1  Oppositional Defiant and Conduct Disorders

1.6.2  Depressive Disorders

1.6.3  Anxiety Disorders

1.6.4  Learning Disabilities

1.6.5  Bipolar and Related Disorders

1.6.6  Substance-Related and Addictive Disorders

1.6.7  Personality Disorders

1.6.8  Sleep–Wake Disorders

1.7  Diagnostic Procedures and Documentation

1.7.1  Diagnostic Interviews

1.7.2  Rating Scales

1.7.3  Psychoeducational Testing

1.7.4  Neuropsychological Testing

1.7.5  Laboratory Testing

2  Theories and Models of ADHD in Adults

2.1  Neurobiological Factors in ADHD

2.1.1  Genetic Contributions

2.1.2  Neurological Factors

2.1.3  Cognitive Determinants

2.2  Environmental Risk Factors

2.2.1  Biological Adversity Factors

2.2.2  Environmental Toxins

2.2.3  Food Additives/Dietary Factors

2.3  Psychosocial Adversity Factors

2.4  Interactions Between Neurobiological, Environmental, and Psychosocial Adversity Factors

3  Diagnosis and Treatment Indications

3.1  Assessment Procedures

3.1.1  General Considerations

3.1.2  Developmental History

3.1.3  Clinical Interview

3.1.4  Behavioral Rating Scales

3.1.5  Differential Diagnosis/Comorbidities

3.1.6  Testing

3.2  The Decision-Making Process

3.3  Treatment Considerations

4  Treatment

4.1  Methods of Treatment

4.1.1  Psychopharmacology

4.1.2  Stimulant Medications

4.1.3  Nonstimulant Medications

4.1.4  Psychosocial and Psychological Therapies

4.1.5  Coaching and CBT

4.1.6  Metacognitive Therapy: Time-Management and Organizational-Skills Training

4.1.7  Supportive and Family Therapies

4.1.8  Neurofeedback and Cognitive-Enhancement Training

4.1.9  Psychoeducation

4.2  Mechanisms of Action

4.3  Efficacy and Prognosis

4.4  Variations and Combinations of Methods

4.5  Problems in Carrying Out the Treatments

4.6  Multicultural Issues

5  Case Vignettes

6  Further Reading

7  References

8  Appendix: Tools and Resources

Appendix 1: Support Groups, Organizations, and Resources

|1|1Description

1.1  Terminology

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder marked by persistent patterns of inattention and/or hyperactivity-impulsivity symptoms that emerge during childhood and are functionally impairing across settings. This book recognizes that the disorder can persist over the life span and well into adulthood. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) assigns the following codes for this disorder:

314.01 Attention-Deficit/Hyperactivity Disorder, Combined Presentation

314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation

314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive/Impulsive Presentation

314.01 Other Specified Attention-Deficit/Hyperactivity Disorder

314.01 Unspecified Attention-Deficit/Hyperactivity Disorder

The International Classification of Diseases (10th rev., clinical modification; ICD-10-CM; World Health Organization, 2021) lists ADHD under the following codes:

F90.0 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type

F90.1 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive Type

F90.2 Attention-Deficit/Hyperactivity Disorder, Combined Type

F90.8 Attention-Deficit/Hyperactivity Disorder, Other Type

F90.9 Attention-Deficit/Hyperactivity Disorder, Unspecified Type

First described within the medical literature in the late 1700s (Barkley & Peters, 2012), ADHD-related symptoms were previously referred to by labels including “minimal brain damage,” “minimal brain dysfunction,” “hyperkinetic impulse disorder,” “hyperactive child syndrome,” “hyperkinetic reaction of childhood,” and “attention deficit disorder,” among others (Taylor, 2011). Changes in terminology generally reflect evolving theoretical conceptions based on etiology, symptoms of the disorder, and its management.

|2|1.2  Definition

1.2.1  Diagnostic Criteria

According to the DSM-5 (American Psychiatric Association, 2022), ADHD represents “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” as defined by the following diagnostic criteria:

Box 1: DSM-5-TR Diagnostic Criteria for ADHD

A. Either 1 and/or 2:

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (ages 17 and older), at least five symptoms are required.

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily distracted or sidetracked).

Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, cell phones).

Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (ages 17 and older), at least five symptoms are required.

|3|Often fidgets with or taps hands or feet or squirms in seat.

Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless).

Often unable to play or engage in leisure activities quietly.

Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

Often talks excessively.

Often blurts out an answer before a question has been completed (e.g., completes people’s sentences, cannot wait for his or her turn in conversations).

Often has difficulty waiting his or her turn (e.g., while waiting in line).

Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing

B.  Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C.  Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

D.  There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E.  The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Specify whether:

314.01(F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.

314.00(F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

314.01(F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.

Specify whether:

314.01(F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.

314.00(F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

314.01(F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.

Specify if:

In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.

|4|Specify current severity:

Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.

Moderate: Symptoms or functional impairment between “mild” and “severe” are present.

Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text. rev.), https://doi.org/10.1176/appi.books.9780890425787 (Copyright © 2022). American Psychiatric Association. All Rights Reserved.

According to ICD-10-CM (World Health Organization, 2019), the diagnostic criteria for ADHD are specified in Box 2.

Box 2: ICD-10-CM Diagnostic Criteria for ADHD

F90. Hyperkinetic Disorders: A group of disorders characterized by an early onset (usually in the first five years of life), lack of persistence in activities that require cognitive involvement, and a tendency to move from one activity to another without completing any one, together with disorganized, ill-regulated, and excessive activity. Several other abnormalities may be associated. Hyperkinetic children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble because of unthinking breaches of rules rather than deliberate defiance. Their relationships with adults are often socially disinhibited, with a lack of normal caution and reserve. They are unpopular with other children and may become isolated. Impairment of cognitive functions is common, and specific delays in motor and language development are disproportionately frequent. Secondary complications include dissocial behavior and low self-esteem.

Excludes:

Anxiety disorders

Mood [affective] disorders

Pervasive developmental disorders

Schizophrenia

F90.0 Disturbance of activity and attention:

Attention deficit:

Disorder with hyperactivity

Hyperactivity disorder

Syndrome with hyperactivity

Excludes:

Hyperkinetic disorder associated with conduct disorder

Reprinted with permission from the ICD-10-CM Classification of Mental and Behavioral Disorders, https://icd.who.int/browse10/2019/en#/F90 (Copyright © 2019). World Health Organization. All Rights Reserved.

|5|1.2.2  Applicability of Criteria for Adults

It is important to note that ADHD criteria in previous editions of the DSM and ICD were initially designed for children, and controversy exists regarding the appropriateness of the nomenclature for adults (Kessler et al., 2010). Most prominently, the diagnostic requirement of childhood onset of symptoms in the DSM-5 (i.e., some symptoms present before the age of 12 years) and ICD-10 (i.e., symptoms usually in the first 5 years of life) can be very difficult for a clinician to assess retrospectively when conducting a diagnostic assessment with an adult (Sharma et al., 2021). In addition, the presentation of ADHD symptoms may differ considerably between adults and children (Vitola et al., 2017). For instance, ADHD among adults appears to be better characterized by deficits in executive functioning and attention relative to hyperactivity or impulsivity that is more frequently present among children and adolescents. Moreover, some research suggests fewer symptoms are needed to reliably identify adults with ADHD (Kessler et al., 2010; Vitola et al., 2017). Considering these concerns, the DSM committee reduced the symptom threshold from six in the Diagnostic and Statistical Manual of Mental Disorders Text Revision (4th ed.; DSM-IV-TR; APA, 2000) to five in the DSM-5 for adults over the age of 17 years (APA, 2013), a change that persists in the Diagnostic and Statistical Manual of Mental Disorders Text Revision (5th ed.; DSM-5-TR; APA, 2022). Despite the importance of executive function among adults with ADHD (Adler et al., 2015; Silverstein et al., 2020), the ADHD symptom list itself was not expanded in DSM-5 or DSM-5-TR to include more features of executive dysfunction.

1.3  Epidemiology

1.3.1  Prevalence and Incidence

Although ADHD was once believed to primarily be a childhood condition, the disorder is now increasingly recognized as one of the most common mental health conditions in adults. Depending on the population, reports indicate prevalence rates between 2% and 5% (Asherson et al., 2016). Notably, there are some data to suggest increasing rates of ADHD diagnosis among adults in the US (Chung et al., 2019). For example, findings from a recent cohort study by Chung and colleagues (2019) indicated the annual adult ADHD prevalence and incidence rates had increased over a 10-year period from 0.43% in 2007 to 0.96% in 2016. Findings from a 2017 global sample that looked at the aggregate prevalence of ADHD in adults in 20 countries revealed a prevalence rate of 2.8% (Fayyad et al., 2017). A consistent finding across studies from the US and global populations was higher prevalence rates among adults living in higher-income countries (Chung et al., 2019; Fayyad et al., 2017).

|6|1.3.2  Sex

ADHD is diagnosed more frequently in adult males than in females (Chung et al., 2019), but these sex differences are less prominent in adults as compared to children (Simon et al., 2009). Several proposed explanations for the narrowing in sex ratio between child- and adult-diagnosed ADHD include higher disease persistence among females (Hinshaw et al., 2012) as compared to males (Biederman et al., 2012), difference in the symptom presentation of males (e.g., more likely to present with combined symptoms and higher rates of hyperactivity and impulsivity) as compared to females (e.g., more likely to present with inattentive symptoms; Li et al., 2019), and different patterns of comorbidity (e.g., males more likely to present with externalizing disorders and females more likely to present with internalizing disorders; Williamson & Johnston, 2015).

1.3.3  Age

ADHD is typically first identified during the preschool or elementary years, when functionally impairing symptoms become evident to parents and teachers (APA, 2013; Kooij et al., 2010). Many adults who were diagnosed with ADHD as children report their symptoms have diminished with age; however, it is estimated that 35–65% of adults diagnosed with ADHD during childhood will continue to meet full criteria for the disorder (Owens et al., 2015). Although ADHD research has historically focused on adults who were first diagnosed as children, a growing number of adults are seeking initial evaluation and treatment for inattention (Huang et al., 2020). Some experts maintain that the disorder remains underrecognized in adults secondary to more subtle symptom presentations, stigma, and the frequency of comorbid psychiatric conditions (Ginsberg et al., 2014).

1.3.4  Ethnicity

ADHD has been reported in adults across cultures and nationalities. For example, the World Health Organization World Mental Health Surveys that screened for ADHD in selected countries in the Americas, Europe, and the Middle East found prevalence rates of 0.6% (Iraq and Romania) to 7.3% (France) (Fayyad et al., 2017). As mentioned previously, higher prevalence rates were identified in higher-income countries such as France and the Netherlands (Fayyad et al., 2017). More recent studies have examined relationships between race, ethnicity, and adult ADHD within the US. Findings from Chung and colleagues (2019) suggested that within the US, ADHD is more prevalent among White populations as compared to non-Hispanic Black or Hispanic/Latino populations with Asian and Native Hawaiian or other Pacific Islander adults having the lowest rates.

|7|1.4  Course and Prognosis

ADHD is considered a chronic disorder in which symptoms present before the age of 12 years (APA, 2022). Approximately 60% of adults diagnosed with ADHD during childhood continue to experience some level of clinically significant symptom impairment through adulthood (Targum & Adler, 2014). Notably, the extant literature suggests that symptom presentation has a distinct course as individuals age. In adulthood, hyperactivity tends to decrease in severity as inattention, restlessness, and impulsivity become more prominent with age (Targum & Adler, 2014). In fact, of those adults diagnosed with ADHD during childhood, the majority (90%) experience inattention, whereas only half (50%) report problems with hyperactivity and/or impulsivity. More persistent symptoms are associated with higher familial rates of ADHD (for a review, see Faraone & Larsson, 2019).

Without appropriate symptom management, ADHD during adulthood can negatively impact academic, social, and work functioning (Holst & Thorell, 2019). For example, adult ADHD each year results in incremental costs that range from $105 to $194 billion (Doshi et al., 2012), and adults with ADHD also report significantly lower academic achievement and educational attainment (Arnold et al., 2020) relative to their typically developing peers. These individuals may present in school and work settings as distractible, disorganized, and sensitive to stress, all factors that can compromise advancement and achievement (Kooij et al., 2010). Another factor closely related to the prognosis of ADHD in adulthood is the prevalence of comorbid mental health disorders with findings suggesting that as many as 50–80% of adults with ADHD have, or will develop, at least one coexisting psychiatric disorder (Katzman et al., 2017). An estimated 57% of adults with ADHD meet criteria for a depressive disorder, 66% meet criteria for an anxiety disorder, and 9% have comorbid alcohol use disorder while 16% have a drug use disorder (Chung et al., 2019). Prognosis may also be impacted by family functioning in childhood, in terms of the environmental impact on development of comorbid conduct issues and other mental health concerns (APA, 2022).

Relatively poor outcomes reported for adults with ADHD must be interpreted considering experts’ suspicions that underrecognition of the disorder has led to underdiagnosis and inadequate treatment (Ginsberg et al., 2014). Indeed, Kessler and colleagues (2006) reported that of 3,199 American adults with ADHD, only 10.9% had received treatment for ADHD within the previous year. However, outcomes in adults with ADHD who receive appropriate treatment (to be discussed in later chapters of this volume) are encouraging. For example, psychosocial and pharmacological interventions for adult ADHD can produce improvements in quality of life and symptom reductions (McGough, 2016). Unfortunately, these interventions are not curative: Effective management of adult ADHD is likely to require long-term psychological and psychopharmacological management (McGough, 2016).

|8|1.5  Differential Diagnosis