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.If impulsive symptoms are more likely to beretained than hyperactive symptoms in young adulthood, then clearly individualsmay fall short of these stringent criteria.Bear in mind also that clients may not havethese problems often or all the time.Adults, unlike children, are likely to havemore control over their impulses not least by being able to exercise choices over theirenvironment.They can select their work environment, for example, long distancelorry driving may be a more attractive employment than a 9 5 office job.Othersmay prefer to be self-employed.Professions in information technology appear tobe favoured most likely because this satisfies a thirst for immediate gratificationas computer work provides individuals the opportunity to multi-task using lots ofdifferent windows, etc.Hence, although such adults may well be symptomatic, theirsymptoms may not impair their functioning.Although not formally part of the diagnostic criteria, there are other difficultiesthat present in adult ADHD such as procrastination, low tolerance of frustration,mood lability, low self-esteem, disorganisation, attitudinal problems, disinhibitionand ceaseless mental activity.The ways these problems commonly present in adultADHD are presented in Table 2.3.Table 2.3 Symptomatic features of ADHD in adulthoodProcrastination Individuals with ADHD do not put things off for hours or days, they putthings off for weeks or months.They have loads of projects half startedbut they do not see things through.They may get into debt because theydon t pay bills on time or miss deadlines.If they do meet deadlines, it isonly because they have crammed in last-minute information or stayedup all night to do so.They are always late and have loads of excuses asto why they have been unable to do a task on time.Low tolerance This is often presented as being irritable or tetchy.Individuals areof frustration often impatient and quick to become cross especially when others donot appear to understand them or follow what they are saying.Mood lability Mood states can change rapidly and possibly without apparent triggers.These symptoms may be misdiagnosed as bipolar disorder, but thedifference is that, for ADHD, lability occurs over a matter of hourswhereas in cases of bipolar disorder it will occur over a period ofweeks.Low self-esteem Individuals have a history of failing (which they may perceive asthe incompletion of projects).They commonly feel that they areunderachieving according to their potential and constantly seekreassurance or approval.They are sensitive to criticism and motivatedto seek social recognition and approval.At the same time they oftenhave a sense of self-efficacy and resilience, which drives them toconstantly seek new opportunities and successes.Their entrepreneurialnature may appear incompatible with a lack of self-esteem.(continued) 28 ADHD IN ADULTSTable 2.3 (continued)Disorganisation This is often presented as poor planning and sequencing.They mayhave difficulty organising and prioritising information in addition toimposing order and structure in their world.This may be for particulartasks, e.g.household chores resulting in mess and chaos in their livingenvironment, or more functionally, e.g.being late for work, taking along time to prepare a meal.This problem may present as a lack ofco-ordination and a tendency to adopt a haphazard, chaotic approachto tasks.Attitudinal Individuals may present as irritable and oppositional, and argue forproblems the sake of the argument.They may seek arousal and stimulus inthis way, thus presenting as difficult individuals who do not takecriticism well.They may be bad employees, who do not acceptline management.Attitudinal problems may result in the fallingout with friends and colleagues.They may have a high turnover ofjobs.Disinhibition This may be expressed as both verbal and physical disinhibitivebehaviours.Individuals may not be able to inhibit the impulseto speak out and say the first thing that comes into their head,resulting in them being hurtful and insensitive towards others.Their impropriety may get them into trouble in their interpersonalrelationships with friends, colleagues and the law.They may be unableto inhibit the impulse to express anger physically by either lashing outat others and/or destroying property.Antisocial behaviour is likely tobe opportunistic and unplanned.If feeling depressed, poor impulsecontrol may be a risk for acting out suicidal ideation.Sensation- A need for high stimulation and immediate gratification will oftenseeking lead to individuals engaging in risk-taking behaviours.This maybehaviour be expressed as an obsessive eagerness to explore new ideas andgain new experiences.Leisure pursuits may contain a sense ofdanger and recklessness, e.g.mountaineering, bungee jumping.Individuals may deliberately heighten the excitement by increasingthe odds or risk.They tend to live life to the excess and push limitsto extremes.This symptom may be expressed in illicit drug takingbehaviour, they may present as accident prone, and/or engage inunsafe sex.Ceaseless Individuals will talk about their brain working too fast and a speedingmental activity up of thoughts that rapidly change.They are unable to keep trackof these thoughts or write them down and they may feel completelyoverwhelmed and exhausted by this experience.Other people presentas being able to relax and appear calm, but still report having racingthoughts.If a client presents with speeded up thoughts/ideas asopposed to a flooding of thoughts/ideas then one might considerhypermania to be the primary problem. ASSESSMENT OF ADHD IN ADULTS 29The Canadian longitudinal follow-up study conducted by Weiss et al [ Pobierz całość w formacie PDF ]
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.If impulsive symptoms are more likely to beretained than hyperactive symptoms in young adulthood, then clearly individualsmay fall short of these stringent criteria.Bear in mind also that clients may not havethese problems often or all the time.Adults, unlike children, are likely to havemore control over their impulses not least by being able to exercise choices over theirenvironment.They can select their work environment, for example, long distancelorry driving may be a more attractive employment than a 9 5 office job.Othersmay prefer to be self-employed.Professions in information technology appear tobe favoured most likely because this satisfies a thirst for immediate gratificationas computer work provides individuals the opportunity to multi-task using lots ofdifferent windows, etc.Hence, although such adults may well be symptomatic, theirsymptoms may not impair their functioning.Although not formally part of the diagnostic criteria, there are other difficultiesthat present in adult ADHD such as procrastination, low tolerance of frustration,mood lability, low self-esteem, disorganisation, attitudinal problems, disinhibitionand ceaseless mental activity.The ways these problems commonly present in adultADHD are presented in Table 2.3.Table 2.3 Symptomatic features of ADHD in adulthoodProcrastination Individuals with ADHD do not put things off for hours or days, they putthings off for weeks or months.They have loads of projects half startedbut they do not see things through.They may get into debt because theydon t pay bills on time or miss deadlines.If they do meet deadlines, it isonly because they have crammed in last-minute information or stayedup all night to do so.They are always late and have loads of excuses asto why they have been unable to do a task on time.Low tolerance This is often presented as being irritable or tetchy.Individuals areof frustration often impatient and quick to become cross especially when others donot appear to understand them or follow what they are saying.Mood lability Mood states can change rapidly and possibly without apparent triggers.These symptoms may be misdiagnosed as bipolar disorder, but thedifference is that, for ADHD, lability occurs over a matter of hourswhereas in cases of bipolar disorder it will occur over a period ofweeks.Low self-esteem Individuals have a history of failing (which they may perceive asthe incompletion of projects).They commonly feel that they areunderachieving according to their potential and constantly seekreassurance or approval.They are sensitive to criticism and motivatedto seek social recognition and approval.At the same time they oftenhave a sense of self-efficacy and resilience, which drives them toconstantly seek new opportunities and successes.Their entrepreneurialnature may appear incompatible with a lack of self-esteem.(continued) 28 ADHD IN ADULTSTable 2.3 (continued)Disorganisation This is often presented as poor planning and sequencing.They mayhave difficulty organising and prioritising information in addition toimposing order and structure in their world.This may be for particulartasks, e.g.household chores resulting in mess and chaos in their livingenvironment, or more functionally, e.g.being late for work, taking along time to prepare a meal.This problem may present as a lack ofco-ordination and a tendency to adopt a haphazard, chaotic approachto tasks.Attitudinal Individuals may present as irritable and oppositional, and argue forproblems the sake of the argument.They may seek arousal and stimulus inthis way, thus presenting as difficult individuals who do not takecriticism well.They may be bad employees, who do not acceptline management.Attitudinal problems may result in the fallingout with friends and colleagues.They may have a high turnover ofjobs.Disinhibition This may be expressed as both verbal and physical disinhibitivebehaviours.Individuals may not be able to inhibit the impulseto speak out and say the first thing that comes into their head,resulting in them being hurtful and insensitive towards others.Their impropriety may get them into trouble in their interpersonalrelationships with friends, colleagues and the law.They may be unableto inhibit the impulse to express anger physically by either lashing outat others and/or destroying property.Antisocial behaviour is likely tobe opportunistic and unplanned.If feeling depressed, poor impulsecontrol may be a risk for acting out suicidal ideation.Sensation- A need for high stimulation and immediate gratification will oftenseeking lead to individuals engaging in risk-taking behaviours.This maybehaviour be expressed as an obsessive eagerness to explore new ideas andgain new experiences.Leisure pursuits may contain a sense ofdanger and recklessness, e.g.mountaineering, bungee jumping.Individuals may deliberately heighten the excitement by increasingthe odds or risk.They tend to live life to the excess and push limitsto extremes.This symptom may be expressed in illicit drug takingbehaviour, they may present as accident prone, and/or engage inunsafe sex.Ceaseless Individuals will talk about their brain working too fast and a speedingmental activity up of thoughts that rapidly change.They are unable to keep trackof these thoughts or write them down and they may feel completelyoverwhelmed and exhausted by this experience.Other people presentas being able to relax and appear calm, but still report having racingthoughts.If a client presents with speeded up thoughts/ideas asopposed to a flooding of thoughts/ideas then one might considerhypermania to be the primary problem. ASSESSMENT OF ADHD IN ADULTS 29The Canadian longitudinal follow-up study conducted by Weiss et al [ Pobierz całość w formacie PDF ]