Unrecognized Attention-Deficit Hyperactivity Disorder in Adults Presenting for Outpatient Psychotherapy

Abstract

Adult patients with significant childhood and current symptoms of attention-deficit hyperactivity disorder (ADHD), but whose ADHD had not been previously recognized, were evaluated by three clinical consultants working with diverse referral populations. These 60 adults shared common characteristics of physical and mental restlessness, impulsivity, disabling distractibility, low self-esteem, self-loathing, and a gnawing sense of underachievement. Specific learning or behavior problems were often present. These patients were chronically disaffected. The diagnosis of ADHD appeared to be missed because these individuals presented with atypical symptoms or had found ways to compensate for their deficits. Descriptive generalizations are offered concerning their coping strategies. These adults had sought previous psychiatric care for non-ADHD symptoms but had numerous unsuccessful treatment attempts. Most patients had been treated for mood or anxiety disorders. Traditional defense analysis had little beneficial effect and aggravated problems of self-esteem; modifications of the psychotherapeutic process are recommended. In open clinical trials without formal measures, the majority of such patients appeared to respond to low doses of antidepressants (i.e., desipramine 10-30 mg daily) and seemed to lose the therapeutic effect at higher antidepressant doses.

Attributions and perceptions of childhood in women with ADHD symptomatology

“…Canonical-correlation analyses revealed that although depression contributes to these group differences, it is no more important a predictor than ADHD symptomatology, suggesting that the perceptions and attributions reported were not simply a reflection of current thinking and mood, factors known to influence attributions and recall. Higher rates of depression and anxiety in people with ADHD identified in adulthood have already been documented by Biederman et al (1994) and Ratey, Greenberg, Bemporad, and Lindem (1992), as well as in this same cohort of women (Rucklidge & Kaplan, 1997). Although a genetic basis must be considered in understanding the higher rates of comorbid disorders in people with ADHD (Comings, 1996), the current study suggests an important way in which nongenetic factors, such as maladaptive attributional styles developed as a way to cope with negative experiences, could contribute to these high rates of comorbidity.…”

The Relation Between Maternal Symptoms of Attention-Deficit/Hyperactivity Disorder and Mother–Infant Interaction

“…In addition to their core symptoms of inattention and impulsivity/hyperactivity, adults with ADHD often report work difficulties, lack of organization, poor planning, forgetfulness, problems with follow-through, difficulty concentrating, and low self-esteem (Barkley 2006;Biederman et al 2006;Ratey et al 1992). Furthermore, women with ADHD are more likely to experience co-occurring mood, anxiety, and substance use disorders than women without ADHD (Biederman et al 1994;Murphy and Barkley 1996;Secnik et al 2005).…”

Adult attention deficit hyperactivity disorder

“…Secondary amines are more selective (noradrenergic) with fewer side effects. Case reports first suggested that the TCA desipramine (DMI) was efficacious for adults with ADHD [8].…”