Attention-Deficit/Hyperactivity Disorder (ADHD), Inattentive Type in Adults

What is attention-deficit/hyperactivity disorder (ADHD), inattentive type, in adults?

Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric condition that makes it difficult to pay attention, control impulsivity (taking action before fully thinking things through) or manage excitable behavior (the person is squirming/fidgeting or “hyperactive”). The disorder interferes with the quality of life by intruding on day-to-day functioning.

The American Psychiatric Association has identified three different types of ADHD. These are:

• Predominantly inattentive presentation.
• Predominantly hyperactive-impulsive presentation.
• Combined presentation (inattentive and hyperactive-impulsive symptoms are present).

Adults with significant problems with inattention — but who exhibit few or no symptoms of hyperactivity — are said to have the predominantly inattentive presentation of ADHD. People with this type of ADHD have trouble paying attention to details, are easily distracted, often have trouble organizing or finishing tasks and often forget routine chores (such as paying bills on time or returning phone calls).

What causes attention-deficit/hyperactivity disorder (ADHD) in adults?

The causes of attention-deficit/hyperactivity disorder (ADHD) are unclear, but the condition often runs in families. There appears to be a genetic and neurobiological basis for ADHD. Usually, adults with the predominantly inattentive form of ADHD first developed it during childhood and adolescence. They were likely reprimanded in elementary or middle school, were consistently distracted and turned in incomplete work. However, because children with this form of ADHD usually aren't usually hyperactive, the disorder may have gone unrecognized until they reached adolescence or adulthood. This is especially true for girls and women with inattentive ADHD. Girls may be more quiet and passive than those who don't have the disorder, and thus don't stand out in the classroom. At times, adult women can go undiagnosed until one of their children is diagnosed with ADHD. At this point they might recognize similarities in their own behavior patterns and seek professional help.

Researchers are studying environmental trauma (the personal and social interpretation of trauma and responses to the trauma) and other issues related to pregnancy or early life exposure (environmental toxins, alcohol and tobacco use during pregnancy, premature birth, low birth weight) as other possible factors that may play a role in ADHD.

What are the symptoms of attention-deficit/hyperactivity disorder (ADHD), inattentive type, in adults?

According to the American Psychiatric Association’s diagnostic criteria, there are nine symptoms associated with inattention. Although nearly everyone experiences inattention problems at times, people with the predominantly inattentive presentation of ADHD frequently experience the following symptoms. These symptoms may intrude and interfere in their daily functioning at work, with family members or in social situations. The nine symptoms associated with the predominantly inattentive presentation of ADHD are:

• Often has trouble staying focused on tasks at work, home or play.
• Frequently does not pay close attention to details or makes careless mistakes at work or while doing other tasks.
• Often has trouble organizing tasks or activities (misses deadlines, disorganized work).
• Is easily distracted.
• Frequently does not follow through on instructions or fails to complete work assignments, chores or other activities.
• Often forgets doing routine chores (like paying bills, returning phone calls, keeping appointments).
• Avoids tasks that require long periods of mental focus (preparing reports, filling out forms).
• Often loses items needed to complete tasks or activities.
• Does not appear to be listening even when spoken to directly.

Adults may have predominantly inattentive presentation of ADHD if they:

• Experience serious or chronic problems due to five or more of these symptoms.
• Have no other mental health disorder that could be the cause of these symptoms.

How is attention-deficit/hyperactivity disorder (ADHD), inattentive type, diagnosed?

There is no single medical or genetic test for the predominantly inattentive type of ADHD. Diagnosis of ADHD requires a careful review of symptoms. A qualified mental health professional, often a physician (psychiatrist or neurologist) or clinical psychologist, evaluates you. The evaluation consists of these three steps:

1. Confirm the presence of symptoms.
2. Confirm that the symptoms aren't due to another mental health or environmental condition (such as increased work demand or significantly heightened stress in a person’s life).
3. Determine the presence of co-existing mental health disorders, such as depression, anxiety or bipolar disorder.

Your healthcare provider:

• Will ask you for a detailed history about your past and current behavior patterns. The interview will include questions about how you function at work, home and in social settings. Family members or close friends may also be interviewed to verify and provide additional information. The presence of symptoms is not enough. Symptoms must be present since 12 years of age, must be present in more than one setting, and must interfere with your daily life.
• Will ask you about your family’s medical history and you may be required to undergo a physical examination to rule out medical conditions that can cause symptoms resembling those of ADHD (such as sleep disorders, learning disability, alcohol/drug use problems).
• Will ask you to complete a rating scale checklist of symptoms. The psychologist or doctor might use other standardized behavior rating scales.
• May ask you to take other types of psychological or medical tests to determine the presence of co-existing conditions, such as anxiety or depression.

Technically, to be diagnosed with ADHD inattentive type, adults (age 17 and older) must have:

• Five or more symptoms of inattention (see symptoms); symptoms can change over time.
• Symptoms must be present for at least 6 months.
• Symptoms must interfere with or reduce the quality of social, home or work life.
• Several symptoms were present before the age of 12.
• Several symptoms are present in at least two major areas of your life, for example, work, home or social life. Some examples might be job loss due to inattention symptoms or financial problems caused by organizational skills or failing to pay bills on time.
• Symptoms are not due to another mental condition.

How is attention-deficit/hyperactivity disorder (ADHD), inattentive type, in adults treated?

Although there is no cure for the disorder, it can be successfully treated. There are several different approaches for treating adults, but generally some combination of medication and behavioral therapy yields the best results.

Medications

Prescription drugs that are used to treat ADHD in children usually are effective for most adults with the predominantly inattentive form of ADHD. However, the dosage and frequency of medications may have to be adjusted early during the course of treatment. It is important to match the needs of the person with ADHD with the characteristics of the drug.

The major classes of prescription medications that are prescribed for ADHD are psychostimulants, antidepressants, and nonstimulant drugs. These treatments affect the neurotransmitters that send signals to brain cells.

• Psychostimulants are the medications of choice in treating ADHD. The two types that are most commonly used are amphetamine and methylphenidate. Mixed amphetamine salts are marketed under the brand name Adderall®. Methylphenidate is sold under the brand names Ritalin®, Concerta®, Metadate® and others. Immediate release, sustained released and extended release forms of amphetamine and methylphenidate are available. The dosage and frequency of these medications may have to be adjusted to maximize their effectiveness. Extended-release formulations are recommended over immediate-release formulations.
  In certain cases, if psychostimulants are not effective or the person has a co-existing psychological disorder that may be affected by stimulant treatment, other medications might be prescribed.
• Antidepressants: Drugs such as tricyclic antidepressants, monoamine oxidase inhibitors, bupuprion (Wellbutrin®) and venlafaxine (Effexor®) increase norepinephrine levels in the brain and have a positive effect on the symptoms of ADHD. These drugs are not approved by the FDA for this indication, although they are used off-label.
• Nonstimulants: These medications may be required in cases where a patient does not respond to stimulants or has an adverse reaction to them. They may also be used for people with co-existing psychiatric conditions. Atomoxetine (Strattera®) was the first nonstimulant drug approved by the U.S. Food and Drug Administration to treat ADHD in adults. Guanfacine (Intuniv®, Tenex®) is another example of a nonstimulant medication.

Behavior modification

Various approaches may be used to treat adults with inattention problems. Cognitive-behavioral therapy (CBT) helps patients identify problem behaviors and create and implement strategies to self-regulate (control your behavior, emotions and thoughts), change behavior and achieve goals. With CBT, patients identify automatic or irrational thoughts that may result in negative behavior and replace them with positive thoughts and behaviors. Acceptance Commitment Therapy is another form of therapy designed especially to empower individuals to pursue personal values and engage in behavior consistent with their values as opposed to trying to change the individual. Other programs have been developed to enhance self-management, but these are not yet widely available. Group therapy may be effective for adults with ADHD, especially for women.

Coaching

Coaching is a relatively new approach that has become more popular over the past few years. Coaches help people with ADHD handle the challenges of daily life by providing feedback, recommendations and encouragement, and directing the individual to attend to their own solutions to problems. They also offer practical solutions to address certain issues — such as time management and organization — and help their clients achieve goals.

What quick tips can be offered to help adults with ADHD, inattentive type, manage the day-to-day activities of life?

To help manage distractions:

• Request a quiet or private work area; move to an unused conference space or other area where there are few distractions or noise.
• Wear headphones with soft music to cover up office noise.
• Redirect phone calls to voicemail and return phone calls at set times throughout the day.

To help stay organized:

• Set aside the first 10 to 20 minutes of your day to organize your tasks for the day.
• Work on and complete one task at a time before moving on to the next one.
• Keep a to-do list in a notebook or on your phone.
• Put appointments in your phone and set up alarm reminders before the event.
• Mark deadlines on calendars as a visible reminder tool.
• Use daily planners or online task organizers to help keep track of tasks and events.
• Use sticky pads to write important notes and place them in appropriate areas where they will be seen.
• If a filing system is needed, use labels or color-coded folders or tabs.
• Set up online automatic payment of bills so you don’t forget to pay them.

To prevent losing or misplacing important items:

• Identify specific areas to place specific items and get into the routine of only placing items in these designated spots.

To help stay focused:

• Take handwritten notes during meetings or record them as a backup and fill in details.
• Break up larger tasks into smaller ones. Reward yourself when each task is completed.
• Take short breaks to prevent boredom — take a short walk, do some stretches or drink some water.