Adult ADHD vs. Narcissism

Face It: ADHD Is Real, Even in Adults (who suffer needlessly, if not treated)

Oh, boy, is ADHD real. Whether it’s over-diagnosed in children or not, it’s definitely not over-diagnosed in adults! On the contrary, adult ADHD is under-diagnosed!!! I’ve diagnosed many adult clients with ADHD, although they were previously diagnosed with depression or anxiety, as their only diagnosis.

Many adults with ADHD are misdiagnosed as having only a mood (depression) or anxiety disorder, while (for plenty of them) the reason they’re depressed or anxious is because they’re disappointed in and worry about their daily performance/functioning. Their disappointment stems from awareness of falling short of their own and other’s daily performance goals and expectations. Whether others know it or not, they know they’re struggling (more or less) with the following seven activities, called executive function behaviors: self-awareness, self-restraint, short-term memory, emotion regulation, motivation, planning and problem solving (including prioritizing).

According to world renowned expert on ADHD, Russell Barkley, PhD. “Essentially, ADHD is an executive function deficit disorder EFDD). The umbrella term “ADHD” is simply another way of referring to these issues. These seven executive functions develop over time, in generally chronological order. Self-awareness starts to develop around age 2, and by age 30, planning and problem solving should be fully developed in a neuro-typical person. Those with ADHD are generally about 30 to 40 percent behind their peers in transitioning from one executive function to the next.”

By the way, before you insist that will power would fix it, I can tell you that will power only works when the person with ADHD recognizes specific “performance’ problems and develops compensatory strategies, (often quite time consuming) to achieve a better outcome. In other words, depending on the level of difficulty with executive functioning, “crutches” are usually necessary. Studies have shown that a combination of medication and individualized counseling, focused on the specific features of ADHD, achieve the best results.

So, if you think ADHD doesn’t really exist, you are so wrong. The facts are clear and there’s plenty of evidence. More than a few studies have shown that the executive function difficulties of ADHD are associated with structural, functional and neurotransmitter alterations in various regions of the brain in children, adolescents and adults with ADHD.…

1. Overall brain size is smaller in adults with ADHD compared to those without ADHD. “A significant association between the number of self-reported ADHD symptoms and total brain volume was found, such that healthy adults who reported ≥6 symptoms had a lower brain volume than those who reported ≤3 symptoms of ADHD. This study suggests that self-reported ADHD symptoms in healthy adults may have neurobiological underpinnings.

  • Hoogman M, Rijpkema M, Janss L, et al. Current self-reported symptoms of attention deficit/hyperactivity disorder are associated with total brain volume in healthy adults. PLoS One 2012; 7: e31273.

2. Neural network connections are different in the brains of adults with ADHD compared to those who do not have ADHD.

  • Makris N, Biederman J, Valera EM, et al. Cortical thinning of the attention and executive function networks in adults with attention-deficit/hyperactivity disorder. Cereb Cortex 2007; 17: 1364-1375.
  • Cortese S, Kelly C, Chabernaud C, et al. Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. Am J Psychiatry 2012; 169: 1038-1055.

3 (a) The neurochemistry of the brain of adults with ADHD is different compared to those who do not have ADHD. Alterations in activity and communication between different regions and networks of the ADHD brain have been found,….

  • Cocchi L, Bramati IE, Zalesky A, et al. Altered functional brain connectivity in a non-clinical sample of young adults with attention-deficit/hyperactivity disorder. J Neurosci 2012; 32: 17753-17761.
  • Hoekzema E, Carmona S, Ramos-Quiroga JA, et al. An independent components and functional connectivity analysis of resting state fMRI data points to neural network dysregulation in adult ADHD. Hum Brain Mapp 2014; 35: 1261-1272.
  • Mattfeld AT, Gabrieli JD, Biederman J, et al. Brain differences between persistent and remitted attention deficit hyperactivity disorder. Brain 2014; 137: 2423- 2428.
  • McCarthy H, Skokauskas N, Mulligan A, et al. Attention network hypoconnectivity with default and affective network hyperconnectivity in adults diagnosed with attention-deficit/hyperactivity disorder in childhood. JAMA Psychiatry 2013; 70: 1329-1337.

and there is evidence to suggest that disruptions in the relay of messages between neurons by the chemicals dopamine and noradrenaline (in animal studies) also contribute to the neurobiology of ADHD.

  • Economidou D, Theobald DE, Robbins TW, et al. Norepinephrine and dopamine modulate impulsivity on the five-choice serial reaction time task through opponent actions in the shell and core sub-regions of the nucleus accumbens. Neuropsychopharmacology 2012; 37: 2057-2066.
  • Volkow ND, Wang GJ, Newcorn J, et al. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2007;64: 932-940.
  • del Campo N, Fryer TD, Hong YT, et al. A positron emission tomography study of nigro-striatal dopaminergic mechanisms underlying attention: implications for ADHD and its treatment. Brain 2013; 136: 3252-3270.

3 (b) Maturation of certain dopaminergic neural pathways appears to be delayed in children and adolescents with ADHD.

  • Tomasi D, Volkow ND. Functional connectivity of substantia nigra and ventral tegmental area: maturation during adolescence and effects of ADHD. Cereb Cortex 2014; 24: 935-944.

3 (c) Levels of available dopamine receptor and transporter molecules are typically lower in some parts of the brain in adults with ADHD than in those who do not have ADHD.

  • Volkow ND, Wang GJ, Newcorn J, et al. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention deficit/hyperactivity disorder. Arch Gen Psychiatry 2007; 64:932-940.
  • Tomasi D, Volkow ND. Functional connectivity of substantia nigra and ventral tegmental area: maturation during adolescence and effects of ADHD. Cereb Cortex 2014; 24: 935-944.
  • Volkow ND, Wang GJ, Newcorn J, et al. Brain dopamine transporter levels in treatment and drug naive adults with ADHD. Neuroimage 2007; 34: 1182-1190.

3 (d) Established and effective ADHD medications are known to interact with the dopamine and noradrenaline systems.

  • Del Campo N, Chamberlain SR, Sahakian BJ, et al. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biol Psychiatry 2011; 69: e145-157

3 (e) In adults with ADHD, there is emerging evidence that deficiencies in glutamate signaling may play a role in modulating neurotransmitter release in some brain regions.

  • Maltezos S, Horder J, Coghlan S, et al. Glutamate/glutamine and neuronal integrity in adults with ADHD: a proton MRS study. Transl Psychiatry 2014; 4: e373.
  • Perlov E, Philipsen A, Hesslinger B, et al. Reduced cingulate glutamate/glutamine-to-creatine ratios in adult patients with attention deficit/hyperactivity disorder — a magnet resonance spectroscopy study. J Psychiatr Res 2007; 41:934-941.

If this information is new to you, ADHD might seem catastrophic. But, it needn’t be! Once an adult gets an accurate diagnosis of ADHD and accepts the diagnosis, there are many strategies and medications that promote optimal functioning. By the way, when you learn more about ADHD, you’ll recognize the same sorts of executive function difficulties in your family of origin. You see, ADHD is largely genetic.

Anyhow, after you or a loved one discovers that there’s a name and treatment for the problems you’ve been having, you can finally do something to help yourself! I’ve seen “depression” and “anxiety” melt away when adults with ADHD were finally diagnosed and treated for the source of the problem.

Contrary to popular belief, diagnosing ADHD in adults is not particularly complicated. It can be done in one or two visits, and does not require expensive testing, when co-existing conditions aren’t in the picture. Diagnosing Adult ADHD is not the same process as diagnosing it in children.

If you or someone you care about suspects ADHD may be the cause of recurring, frustrating behavior, I hope you’ll find out for sure. Untreated ADHD can make life more difficult than it has to be. Eliminate the self-disparagement and criticism that often accompany Adult ADHD. Get tested and treated!

I describe how I diagnose Adult ADHD in one of my other blog posts. Check it out!