Adult Attention Deficit Hyperactivity Disorder (ADHD) Assessment and Treatment

Assessing and treating ADHD in adults involves a comprehensive approach that includes diagnostic evaluations, standardised tests, and evidence-based therapeutic interventions. Below is an overview of the process:

1. Assessment of ADHD in Adults

Initial Consultation and Clinical Interview

The assessment typically begins with an in-depth clinical interview. This involves collecting information about the individual’s:

Current symptoms: Difficulty with attention, focus, impulsivity, or hyperactivity.
Developmental history: ADHD is a neurodevelopmental disorder, so symptoms often originate in childhood, even if they become more noticeable later.
Impact on daily life: The psychologist will explore how symptoms affect work, relationships, daily functioning, and emotional well-being.
Family history: There is a strong genetic component to ADHD, so a family history of ADHD or related disorders may be considered.
Comorbidities: ADHD often co-occurs with other conditions, such as anxiety, depression, or learning disabilities. A thorough assessment involves checking for these conditions.

Standardised Questionnaires and Rating Scales

Several standardised tools are used to assess the severity and nature of ADHD symptoms. Commonly used scales include:

Adult ADHD Self-Report Scale (ASRS): A screening tool to evaluate the frequency of ADHD symptoms in adults.
The Comprehensive Autistic Trait Inventory (CATI): is a detailed self-report assessment tool designed to measure a wide range of traits and behaviours associated with autism in both clinical and non-clinical populations. Unlike traditional diagnostic tools, the CATI captures the broader autism phenotype by evaluating traits across multiple domains, including social communication, cognitive rigidity, sensory sensitivity, and repetitive behaviours. It provides a nuanced understanding of autistic traits on a continuum, making it useful for identifying subclinical characteristics as well as assisting in the diagnostic process for autism spectrum disorder (ASD).
Wender Utah Rating Scale (WURS): Retrospective assessment of childhood ADHD symptoms.
Brown Attention-Deficit Disorder Scales (BADDS): Measures executive functioning difficulties that are common in adults with ADHD.

These scales help quantify symptom severity and identify patterns across different areas of functioning.

Neuropsychological Testing (If Needed)

At times a referral for neuropsychological testing is indicated. These tests assess cognitive functions such as attention, memory, processing speed, and executive functioning. These tests can rule out other conditions that might mimic ADHD (e.g., cognitive impairments due to depression or anxiety).

Ruling Out Other Causes

To ensure that ADHD is the correct diagnosis, it’s essential to rule out other potential causes of the symptoms, such as:

Anxiety disorders
Depression
Substance abuse
Learning disabilities
Sleep disorders The psychologist may also collaborate with a physician to rule out medical conditions such as thyroid disorders or vitamin deficiencies.

2. Treatment of ADHD in Adults

Psychoeducation

Education about ADHD is crucial in helping adults understand how the disorder affects them. Psychoeducation may cover:

Symptom recognition: Understanding how symptoms manifest in daily life.
Coping strategies: Learning practical techniques to manage ADHD in different contexts, such as work, home, and relationships.
Self-advocacy: Encouraging clients to seek accommodations at work or school and manage expectations.

Psychotherapy (Cognitive Behavioural Therapy – CBT).

CBT helps the individual identify and challenge unhelpful behaviours and thoughts, improving their overall functioning.

Cognitive Behavioural Therapy (CBT), especially Mary Solanto’s CBT model for adult ADHD, is used by Miguel to treat the cognitive, emotional, and behavioural challenges of ADHD. CBT for ADHD focuses on:

Time management and organisation: Strategies to improve planning and reduce procrastination.
Emotional regulation: Managing frustration, impulsivity, and negative self-criticism.
Cognitive restructuring: Addressing distorted thinking patterns and reducing feelings of inadequacy or self-doubt.
Problem-solving skills: Developing more effective ways to approach everyday tasks and responsibilities.
Structured training/coaching in:
Creating structured schedules
Setting goals and priorities
Managing time and reducing distractions

Mindfulness-Based Therapies

Mindfulness practices can help individuals with ADHD improve focus and emotional regulation. Mindfulness-Based Cognitive Therapy (MBCT) teaches individuals to stay present, reduce impulsivity, and manage the emotional swings often associated with ADHD.

Monitoring and Follow-Up

Treatment for ADHD in adults is an ongoing process. Regular follow-ups are crucial to assess progress, adjust treatment strategies, and address any emerging challenges, such as changes in life circumstances or comorbid conditions.

Medication

Although not a component of a psychological treatment, medication is often a key part of treatment for ADHD in adults, helping to manage core symptoms like inattention, impulsivity, and hyperactivity.

A psychiatrist or primary care doctor typically prescribes and monitors medication, while the psychologist provides therapy for behavioural management.

Common medications include:

Stimulants: Such as methylphenidate (Ritalin, Concerta) and amphetamines (Adderall, Vyvanse). These increase dopamine and norepinephrine levels, improving focus and reducing impulsivity.
Non-stimulants: Such as atomoxetine (Strattera) or guanfacine (Intuniv). These may be used if stimulants are not effective or cause intolerable side effects.