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Diseases & Conditions

Attention Deficit Disorder Without Hyperactivity in Adults

What is attention deficit disorder without hyperactivity in adults?

Attention deficit hyperactivity disorder (AD/HD) is a common psychological disorder that is characterized by problems with attention, impulsivity and/or hyperactivity. Adults who have significant problems with inattention, but exhibit few or no symptoms of hyperactivity, are said to have the predominantly inattentive subtype of AD/HD.

Executive functions of the brain--such as verbal and nonverbal working memory, self-regulation and motivation, and planning--are thought to be impaired in adults with AD/HD. Adults who have AD/HD without hyperactivity can experience difficulties with maintaining attention and focus, using working memory and recall, and regulating emotions. Organizing and prioritizing tasks can be challenging.

According to the American Psychiatric Association's diagnostic manual, there are nine symptoms associated with inattention problems. Although nearly everyone experiences some of these problems at times, people with the predominantly inattentive form of AD/HD show at least 6 of the 9 symptoms and experience significant difficulties in their daily lives because of them. These symptoms may cause disruptions in their school, work, family or social activities.

Here is a list of the 9 symptoms associated with the predominantly inattentive form of AD/HD:

  • Often has difficulty sustaining attention at work or play
  • Frequently does not pay close attention to details or makes careless mistakes at work, school or other tasks
  • Often has problems organizing chores or activities
  • Is easily distracted by outside stimuli
  • Frequently does not follow through when given instructions or fails to complete work or school assignments, chores or other activities, even though the person understands what is expected
  • Often becomes forgetful when performing routine chores
  • Frequently puts off or avoids tasks that require sustained attention
  • Often loses materials needed to complete tasks or activities
  • Appears not to be listening even when spoken to directly

Adults who experience serious or chronic problems due to 6 or more of these symptoms and do not have symptoms of hyperactivity or impulsivity may have AD/HD without hyperactivity. Other psychological conditions, such as depression or anxiety, can also accompany the predominantly inattentive form of AD/HD.

What causes AD/HD without hyperactivity in adults?

No one is sure exactly what causes AD/HD without hyperactivity, but the condition often runs in families. There appears to be a genetic and neurobiological basis for attention deficit disorder. Usually, adults with the predominantly inattentive form of AD/HD first developed it during childhood. However, because children with this form of AD/HD usually are not hyperactive, the disorder might go unrecognized until they reach adolescence or adulthood. This is especially true for girls and women with AD/HD without hyperactivity. Girls may be more quiet and passive than those who do not have the disorder. Women often go undiagnosed until one of their children is diagnosed with AD/HD. Then they might recognize similarities in their behavior patterns and seek professional help.

Researchers are studying nutritional, environmental and other factors that may play a role in AD/HD.

How is AD/HD without hyperactivity in adults diagnosed?

There is no single medical or genetic test for the predominantly inattentive form of AD/HD. A qualified mental health professional, such as a physician or clinical psychologist, must evaluate the person in order to provide a diagnosis.

  • The doctor or other mental health professional will conduct a diagnostic interview to obtain a detailed history about your past and current behavior patterns. The interview will include questions about how you function at home, school and work. Your family members or close friends may also be interviewed to verify and provide additional information.
  • You will be asked about your family’s medical history and may be required to undergo a physical examination to rule out medical conditions that can cause symptoms resembling those of ADHD.
  • You may be asked to fill out a checklist with symptoms. The psychologist or doctor might use other behavior rating scales.
  • Other types of psychological tests may be administered to rule out the presence of co-existing conditions, such as anxiety or depression.

To be diagnosed with AD/HD, you must be experiencing significant impairment in at least two major areas of your life (for example, work, school, or home). Major problems such as job loss due to inattention symptoms, excessive conflict in relationships or divorce, financial problems caused by poor organization or failing to pay bills on time, or being placed on academic probation are some examples.

Some medical disorders, such as seizure disorders or thyroid problems, might cause symptoms resembling those of AD/HD. That is why a medical exam is necessary to rule out medical causes.

How is AD/HD without hyperactivity 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 AD/HD in children usually are effective for most adults with the predominantly inattentive form of AD/HD. However, the dosage and frequency of the medications may have to be adjusted. It is important to match the needs of the person with AD/HD with the characteristics of the drug.

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

    Psychostimulants are the medications of choice in treating AD/HD. The two types that are most commonly used are amphetamines and methylphenidate. Mixed amphetamine salts are marketed under the brand name Adderall®. Methylphenidate is sold under the brand names Ritalin®, Concerta®, or Metadate®. Immediate release, sustained released and extended release forms of Adderall and Ritalin are available. The dosage and frequency of these medications may have to be adjusted to maximize their effectiveness.

    In certain cases, if psychostimulants are not effective or the person has a co-existing psychological disorder, other medications might be prescribed.

    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. Atomoxitine (Strattera®) was the first nonstimulant drug approved by the U.S. Food and Drug Administration to treat AD/HD in adults.

    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.
  • Behavior modification or other forms of therapy—Various approaches may be used to treat adults with inattention problems. Therapy helps patients to identify problem behaviors and create and implement strategies for changing their behavior and achieving goals.

    Behavior modification is a traditional approach aimed at changing behavior patterns by reinforcing desired behaviors through rewards or incentives.

    Cognitive behavior therapy focuses on the patient’s current behavior patterns, unlike traditional psychoanalytic therapy. It is aimed at identifying automatic or irrational thoughts that may result in negative behavior and replacing them with positive thoughts and behaviors. Programs have been developed to enhance self-management, but these are not yet widely available.

    Group therapy may be effective for adults with AD/HD, especially for women.
  • Coaching—Coaching is a relatively new approach that has become more popular over the past few years. Coaches help people with AD/HD handle the challenges of daily life by providing feedback, recommendations, and encouragement. They also offer practical solutions to address certain issues--such as time management and organization--and help their clients achieve goals.
References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/27/2013…#15253