At the Atlanta Center For Adult ADHD, we are often asked about natural approaches to help manage ADHD. An important study was published this year that analyzed the effect of aerobic exercise on ADHD using rating scales and functional magnetic resonance imaging. Aerobic exercise was found to improve clinical symptoms as well as cognitive function in adolescents with ADHD. Brain activity in areas affected by ADHD such as the right frontal and temporal cortices was increased as well.
The American Psychiatric Association’s Diagnostic and Statistical Manual,Fifth edition(DSM-5), is used
by mental health professionals to help diagnose ADHD. It was released last spring
and replaces the previous version, the text revision of the fourth edition
(DSM-IV-TR), which was difficult to use when making a diagnosis of adult (as opposed to childhood) ADHD.
There were some changes in the DSM-5 for the diagnosis of ADHD: symptoms can
now occur by age 12 rather than by age 6; several symptoms now need to be
present in more than one setting rather than just some impairment in more than
one setting; new descriptions were added to show how symptoms might appear at
older ages; and for adults and adolescents age 17 or older, only 5 symptoms are
needed instead of the 6 needed for younger children.
Below are the new DSM-5 guidelines:
DSM-5 Criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or
- Inattention: Six or more
symptoms of inattention for children up to age 16, or five or more for
adolescents 17 and older and adults; symptoms of inattention have been
present for at least 6 months, and they are inappropriate for
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
avoids, dislikes, or is reluctant to do tasks that require mental
effort over a long period of time (such as schoolwork or homework).
loses things necessary for tasks and activities (e.g. school materials,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile
- Is often easily distracted
- Is often forgetful in daily activities.
and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for
children up to age 16, or five or more for adolescents 17 and older and
adults; symptoms of hyperactivity-impulsivity have been present for at
least 6 months to an extent that is disruptive and inappropriate for the
person’s developmental level:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
symptoms are present in two or more setting, (e.g., at home, school or
work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
symptoms do not happen only during the course of schizophrenia or
another psychotic disorder. The symptoms are not better explained by
another mental disorder (e.g. Mood Disorder, Anxiety Disorder,
Dissociative Disorder, or a Personality Disorder).
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
At the Atlanta Center for Adult ADHD, the DSM-5 guidelines serve as an important tool to assure making an accurate diagnosis in accordance to current APA concensus.
At the Atlanta Center for Adult ADHD, significant importance is placed on identifying other psychiatric conditions that influence affect diagnosis and treatment of ADHD. The 2007 National Co-Morbidity Replication Study (NCRS) found that adults 18 to 44 years of age with ADHD experienced higher rates of major depression (18.6% vs 7.8% in non-ADHD adults), bipolar disorder (19.4% vs 3.1% in non-ADHD adults), and dysthymia (12.8% vs 1.9% in non-ADHD adults). Depression may result in part from untreated ADHD due to situational/adjustment factors and mild mood depression (dysthymia) often improves considerably when ADHD is treated with a stimulant medication alone. For major depression in adult ADHD patients, bupoprion is often a good option since it can treat both conditions simultaneously. Since bupoprion is typically not as “robust” as stimulants in treating ADHD, stimulant medications often can used as well (with periodic monitoring of blood pressure/pulse). Medications used to treat ADHD may cause worsening of manic symptoms in bipolar patients and must be used cautiously. In adult adhd, anxiety often improves considerably when stimulant medications are used as patients are able to better cope with anxiety-provoking thoughts and situations. Selective Serotonin Reuptake Inhibitors (SSRI’s) for generalized anxiety disorder may be used along with stimulant medications. Counseling, especially cognitive behavioral therapy (CBT) is usually very helpful in treating all of the above conditions. For more information on the Atlanta Center for Adult ADHD, please visit www.Atlanta-ADHD.com.