ADHD IN YOUNG ADULTS Elizabeth Lefler, Ph.D. UNI Psychology Department & Licensed Psychologist, Iowa May 27, 2015 Slides and citations available upon request

NEW RESEARCH AREA 75% of studies on adult ADHD have been published in the last 10 years More research needed now that DSM-5 is out, and has changed the ADHD cutoff for adults From 6 to 5 symptoms Age of onset from 7 to 12 years Some new parenthetical examples Forgetfulness symptom now includes examples of forgetting to return calls or pay bills

ADULT ADHD Myth: kids “grow out of it” Current research: 60-80% of children with ADHD become adults with ADHD or ADHD-related impairment 2.5-5% rate in adulthood 2-8% prevalence rate in college Many adults fall below the threshold, but still have several symptoms and impairment

IMPAIRMENT Lower academic achievement Lower rates of college graduation (and thus lower incomes) Higher rates of conflict with work supervisors More frequent job changes Greater relationship discord Lower rates of exercise Higher levels of pessimism

IMPAIRMENT Higher rates of substance use/abuse Higher teen pregnancy rates/more unsafe sex/more STDs Higher rates of (and more serious) automobile accidents Higher rates of comorbid disorders Lower rates of saving and investing money Higher rates of impulse spending

INATTENTION CRITERIA Fails to give close attention to details Difficulty sustaining attention Does not seem to listen Does not follow through on instructions Difficulty organizing tasks or activities Avoids tasks requiring sustained mental effort Loses things necessary for tasks Easily distracted Forgetful in daily activities

HYPERACTIVITY- IMPULSIVITY CRITERIA Fidgets with hands or feet or squirms in seat Leaves seat inappropriately Runs about or climbs excessively Has difficulty playing/engaging in leisure quietly Is “on the go” or “driven by a motor” Talks excessively Blurts out answers before questions are completed Has difficulty awaiting turn Interrupts or intrudes on others

PROBLEMS W/ DSM SYMPTOMS Symptoms are not developmentally scaled Assessing Intellectual Disability? No requirement for corroboration by others To be in the 93 rd Percentile: Age – 5 of 9 symptoms Age – 4 of 9 symptoms Age of 9 symptoms

CHANGES FROM CHILDHOOD Gender Difference Largely disappears From 4:1-10:1 in children to 2:1-1:1 in adults Impairment comparable across men and women Etiology No reason to suspect any changes here Dopamine in frontal lobe Smaller, less developed brain regions Orbital-Prefrontal Cortex Basal Ganglia Cerebellum Heritability (80%) Pre- or postnatal insults (lead, alcohol, premature birth)

CHANGES FROM CHILDHOOD Assessment Developmental and family history; Clinical Interview Behavior ratings from two parties (from parent &teacher to self & collateral) Cognitive and Achievement Testing Behavioral Observation? Neuropsych measures? Measure of malingering?

CHANGES FROM CHILDHOOD Treatment Medication Parent Training in Child Management Children: 65-75% respond No equivalent for adults Family Therapy for Teens: Problem-Solving, Communication Training Classroom Behavior Modification Special Education (IEP, 504) Residential Treatment For adults specifically? Much more work needed. CBT, Academic and work accommodations?

SPECIAL ISSUES Overlap of Symptoms Inattention is a common symptom to many mental health problems (e.g., anxiety, depression, and even psychosis). Comorbidity concerns Malingering We rely on self-report measures where the items are very face-valid Many young adults are now interested in getting a prescription for stimulant medications College students are motivated to get extra test taking time Weight loss as a motivator

SPECIAL ISSUES Medication Considerations Transition out of parents’ home; stop taking meds Morning classes through late-night study sessions Self-imposed medication holidays Lots of leftover medication Diversion of medication to peers Taking higher doses than prescribed to study all night or “party”

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