Adult Attention Deficit Hyperactivity Disorder (ADHD)
Assessing and treating ADHD in adults involves a comprehensive approach that includes diagnostic evaluation, standardised tests and evidence-based therapeutic interventions. The process is set out below.
Assessment
Initial consultation and clinical interview
The assessment begins with an in-depth clinical interview covering:
- 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. How symptoms affect work, relationships, daily functioning and emotional wellbeing.
- 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, and a thorough assessment checks for them.
Standardised questionnaires and rating scales
Several standardised tools are used to assess the severity and nature of ADHD symptoms:
- Adult ADHD Self-Report Scale (ASRS). A screening tool that evaluates the frequency of ADHD symptoms in adults.
- Comprehensive Autistic Trait Inventory (CATI). A detailed self-report tool that measures a wide range of traits and behaviours associated with autism in both clinical and non-clinical populations. Rather than a yes-or-no diagnosis, it captures the broader autism phenotype across social communication, cognitive rigidity, sensory sensitivity and repetitive behaviours, which makes it useful for identifying subclinical characteristics and for assisting in the diagnosis of autism spectrum disorder.
- Wender Utah Rating Scale (WURS). A retrospective assessment of childhood ADHD symptoms.
- Brown Attention-Deficit Disorder Scales (BADDS). Measures the executive functioning difficulties that are common in adults with ADHD.
These scales 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, and can rule out other conditions that mimic ADHD, such as cognitive impairment due to depression or anxiety.
Ruling out other causes
To ensure ADHD is the correct diagnosis, other possible causes of the symptoms are ruled out, including anxiety disorders, depression, substance abuse, learning disabilities and sleep disorders. I may also work with a physician to rule out medical conditions such as thyroid disorders or vitamin deficiencies.
Treatment
Psychoeducation
Education about ADHD is crucial in helping adults understand how the disorder affects them. It may cover symptom recognition (how symptoms show up in daily life), coping strategies for work, home and relationships, and self-advocacy, such as seeking accommodations at work or study and managing expectations.
Cognitive Behavioural Therapy
CBT helps you identify and challenge unhelpful behaviours and thoughts, improving your overall functioning. I use Cognitive Behavioural Therapy, and especially Mary Solanto's CBT model for adult ADHD, 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 and coaching in creating structured schedules, setting goals and priorities, and managing time and reducing distractions.
Mindfulness-based therapies
Mindfulness practices can help people with ADHD improve focus and emotional regulation. Mindfulness-Based Cognitive Therapy (MBCT) teaches you 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 important to assess progress, adjust strategies and address emerging challenges, such as changes in life circumstances or co-occurring conditions.