Wednesday, December 11, 2013

Hyperactive/Impulsive ADH

Hyperactivity and Impulsivity are often the earliest discernible symptoms of ADHD. The little girl who can’t sit still like the other children in her class; squirming, chatting, and constantly adjusting her dress. The boy on the playground who steals toys, budges in line, hits first and ask questions later... “Why are you crying?”

Adult ADHD?
These symptoms, which are often the first to appear, are also the first to taper off as the person reaches adulthood. Of course there are varying degrees of “tapering”, but generally, hyperactivity becomes less discernible as we age. This partly explains why ADHD was considered a childhood disorder until the last couple of decades. Many still consider it so.

The key word in all of this discussion is “discernible”. Many adults with ADHD explain that their Hyperactive/Impulsive symptoms merely internalize: racing thoughts, restlessness, channel surfing or surfing the net. Additionally, instead of poking, pulling hair, or budging in line ups like they used to in the grade 3 lunchroom, ADHD adults can just step out of line and claim, “I didn’t really want to see that movie anyway.” Few would notice that it was their inability to wait patiently in line that led to their choice to bail.

Adults are more in charge of their environment, so it can appear that their Hyperactive actions and Impulsive decisions were the results of a well thought out choice rather than a hasty action/reaction. They even convince themselves that their choice was autonomous. I knew a man who spoke quite confidently that in his first year of marriage he had 9 different jobs; he quit the first 8 because each boss had been "quite impossible to work for". That was back in the day when he could walk down the street and get another job.

Whether ADHD does or does not disappear in adulthood is not a straight cut discussion. However, since ADHD is defined by medical criteria, the discussion ought to start there. To be diagnosable as Hyperactive/Impulsive ADHD (or combined with Inattentive ADHD) the adult MUST have been impaired by some of the Hyperactive/Impulsive symptoms (listed in the DSM V) prior to age 12, AND for the last 6 months has been impaired often in two or more settings by at least 5 of the 9 symptoms, AND these symptoms cannot be better accounted for by some other mental health diagnosis.

To say that ADHD does not exist in adults, is to say that the conditions highlighted in the previous paragraph are not fulfilled by any adult. I am confident that the friends, family, and co-workers of ADHD individuals would line up en masse on the other side that discussion.

Following the trail of discussion opposing the existence of adult ADHD usually teases out a different underlying objection: “it shouldn’t be called a disorder because ADHD symptoms are advantageous in many situations”, “ADHD is over diagnosed”, etc. Those are legitimate discussions to have; however, to deal with the question of its existence, we must go to the defining criteria for adult ADHD and then determine whether any adults satisfy those criteria. I suggest there are many who do.

Adult Manifestations
Apart from the brief distinctions already made between childhood and adult ADHD, it can be said that adult Hyperactive/Impulsive symptoms often manifest themselves in risk taking behaviour. Whereas Inattentive symptoms manifest themselves in both extremes of the attention spectrum (zoning out and hyper-focus), Hyperactive/Impulsive symptoms are often revealed at only the high end of the risk spectrum.

The results of Hyperactive/Impulsive symptoms affect rates of teen pregnancy, vehicular accidents, criminal activity, emergency room visits, infidelity, school drop out rates, class failures, career changes, and employment terminations; all of which are measurably higher among ADHD individuals than average demographic statistics.

Besides the risk taking actions of these symptoms, Impulsivity also manifests itself in more tame circumstances. Impulsive symptoms are implicated in the frequency and degree of social, educational, or employment faux pas: interrupting discussions, blurting out inappropriate (albeit humorous) comments, making decisions before all the data was collected and analyzed, or boisterously greeting a friend named Jack while boarding a plane, “HiJack!” (give it a moment).

These Impulsive “act before you think” symptoms happen to everyone; with ADHD, they happen often enough to "interferewith or reduce the quality of the individual’s social, academic, or occupational functioning", which is part of the diagnostic criteria.

Written by: Dan Duncan

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