With the recognition that the evidence base continues to evolve and that there is a lack of quality evidence to guide the management of complex patient presentations, this article answers some common clinical questions based on available evidence as well as our collective experience in the management of adult ADHD and comorbidities. Clinical trials, guidelines, meta-analyses, and systematic reviews were selected by the authors for inclusion in this review.
In total, unique articles were identified; 8 were excluded at the title filtering stage, 7 at the abstract filtering stage, and another 7 after a full-text review. Overall, 22 articles were excluded and 91 were included. Manual searches of the reference lists of identified articles and other interesting published works including authoritative texts were also selected, bringing the total number of articles included in this review to Taken together, such observations suggest the existence of two separate syndromes that have distinct developmental trajectories [ 11 ].
The general population prevalence of ADHD in adults has been estimated to be 2. Nonetheless, despite the relatively high prevalence of ADHD in adults, it is often unrecognized in patients who present to the clinic reviewed by Ginsberg et al. This is particularly true for females, who are a largely unrecognized population for several reasons. Notably, childhood ADHD is usually diagnosed after a referral from parents or teachers, with boys being more likely to be referred for treatment since they present primarily with external symptoms such as hyperactivity, which are inevitably more noticeable to others [ 19 ].
Conversely, females with ADHD are more likely to have internalizing symptoms, resulting in a later diagnosis, and greater time for developing strategies to mask core symptoms [ 20 ]. Despite this, one meta-analysis reported that females with ADHD often have greater intellectual impairments than males with the disorder [ 19 ], highlighting the importance of recognizing and appropriately managing this under-represented population. Adult ADHD is associated with profound functional and psychosocial disability, leading to serious personal and societal costs.
Its most prominent feature is attentional dysfunction, associated especially with impairment in focused and sustained attention [ 21 ]. Individuals with ADHD also experience neuropsychological difficulties associated with deficient inhibition [ 22 ], memory [ 22 ], executive functioning [ 23 , 24 ], decision making [ 25 ], and emotional dysregulation [ 26 ]. ADHD is associated with educational difficulties, requiring extra help, attending special classes, repeating grades [ 30 ], as well as higher rates of academic suspension and drop outs [ 31 ].
Later in life, adults with ADHD experience challenges with time management, organization, and self-regulation, which can result in employment and financial problem [ 27 , 33 ]. The detrimental effects of ADHD on overall health and safety provide additional imperative to appropriately recognize and manage this debilitating disorder. Adult ADHD has been associated with poorer driving and a higher incidence of traffic citations and motor vehicle accidents [ 35 ]. A recent study found that Japanese adults with ADHD visited physicians 10 times more often than a non-ADHD control group, and had rates of emergency room visits and hospitalization three times greater than controls [ 28 ].
This was mostly attributed to accidental death and characteristics associated with ADHD such as risk-taking behaviour. In addition to its substantial burden at the individual level, adult ADHD is often associated with considerable societal costs. Notably, there have been consistent associations between adult ADHD and unemployment [ 34 , 37 ]. Along with these functional and psychosocial impairments, ADHD is associated with a higher risk of developing mood and anxiety disorders. In many studies, ADHD has been associated with comorbid depression, anxiety disorders, bipolar disorder, and substance use disorder [ 27 , 30 , 40 , 41 , 42 ].
The National Comorbidity Survey reported that adults with ADHD are three times more likely to develop major depressive disorder MDD , six times more likely to develop dysthymia, and more than four times more likely to have any mood disorder [ 37 ]. Most notably, individuals with ADHD are twice as likely to experience substance abuse or dependence [ 43 ]. These comorbidities present important clinical challenges since their co-occurrence results in greater disease burden and more severe illness courses than ADHD or mood and anxiety disorders alone [ 44 ].
There are strong familial links between ADHD and psychiatric comorbidities such as bipolar disorder, suggesting a genetic contribution [ 17 ]. One possible explanation is that ADHD and mood disorders stem from similar neurobiology. Recent studies have demonstrated that similar regions of the brain are involved in ADHD and psychiatric disorders [ 17 ].
Neuroimaging studies have implicated differences in volume and activity in the frontal lobe, which is responsible for attention, behaviour selection, and emotion [ 16 ]. Studies of neurotransmitters have also pointed to abnormalities in dopamine DA and norepinephrine NE signaling [ 16 , 45 ], thus corroborating Volkow et al. Interestingly, the main neural pathway that modulates emotional affect comprises the limbic-cortical-striatal-pallidal-thalamic LCSPT circuits, consisting of connections between the orbital and medial prefrontal cortex OMPFC , ventromedial striatum, ventral pallidum, hippocampal subiculum, mediodorsal and midline thalamic nuclei, and amygdala [ 47 ].
These circuits integrate higher cognitive functions with visceral information and external environmental conditions to affect mood and emotional states, through reciprocal connections with regions of the cortex that are involved with control of higher cognitive functions as well as regions associated with regulation of autonomic functions, including the periaqueductal gray and the hypothalamus [ 48 ].
While the neuronal activity within LCSPT circuits is predominantly glutamatergic and is locally modulated through the gamma-aminobutyric acid GABA system [ 49 ], the activity of the LCSPT circuit with its related organs can be modulated by a variety of other neuromodulators, including the endocannabinoids [ 50 ] and the various monoamines. In part, this may be related to deficits in reward processing with altered monoamine signalling having been implicated as the underlying mechanism of this effect.
This deficit in reward processing characterized as low hedonic tone [ 51 , 52 ], is hypothesized to be at least in part related to deficits in modulation of this circuitry [ 53 ]. These deficits, which result in altered sensitivity to reinforcement, have been shown in children with ADHD who have been reported to preferentially respond to immediate rewards, but not when the rewards are delayed and therefore only exhibit conditioning to immediate rewards [ 54 ], which parallels some of the anomalous changes in the neural pathways that regulate reward and motivation [ 55 ], matching those in depression.
As such, one can imagine this low hedonic tone as a key feature shared by MDD and resulting from a shared dysfunction in monoamine signaling, particularly in the ventral striatum [ 52 ]. In support, abnormalities in DA and NE signalling have been reported in both MDD and ADHD, suggesting a potentially shared underlying pathophysiology, at least in some individuals [ 56 , 57 , 58 , 59 ]. Interestingly, treatment with methylphenidate normalizes the hypoperfusion of prefrontal areas and is associated with corresponding improvement in ADHD symptoms [ 60 , 61 , 62 , 63 , 64 , 65 ].
Perhaps this explains the findings of Sternat et al. Studies have concluded that emotional dysregulation is a distinctive attribute of adult ADHD psychopathology, however these symptoms may be misdiagnosed as a mood disorder [ 66 , 67 , 68 ]. Similarly, ADHD symptoms may be masked by substance use [ 43 ]. Physicians are often more familiar with mood and anxiety disorders, which may contribute to misdiagnosis and delays in treating ADHD in adults [ 69 ].
It has been suggested that stress, depression, and anxiety could manifest as a consequence of undiagnosed and untreated ADHD [ 70 ]. Overall, these challenges have contributed to an under-diagnosis and under-treatment of adult ADHD [ 18 ]. In part, these situations are exacerbated by the development of mistaken beliefs regarding the over-diagnosis and over-treatment of ADHD [ 73 ], which further lower the likelihood of patients receiving the diagnosis and targeted treatment to change their life trajectory.
The most common psychiatric comorbidities that co-occur with ADHD in adults are depression, anxiety disorders, bipolar disorder, SUDs and personality disorders. The overlapping and distinctive features of these disorders are summarized in Fig. Given the considerable overlap between these disorders, the conceptualization of ADHD as a spectrum using a dimensional rather than a categorical approach to diagnosis and treatment has been proposed [ 3 ].
Overlapping and distinctive features of ADHD and common psychiatric comorbidities compiled from: Searight et al. ADHD has a high prevalence of comorbidity with bipolar disorder. Rates of ADHD comorbidity in bipolar disorder have been estimated between 9. Characteristics of the manic or elevated phase of bipolar disorder that overlap with ADHD include restlessness, talkativeness, distractibility, and fidgeting [ 17 ]. The distinctive features of bipolar disorder, largely characterized by the depressive phase, as well as the episodic course of symptoms, can help to elucidate a differential diagnosis [ 17 ].
Several studies have suggested that comorbid ADHD hastens an earlier age of onset of bipolar disorder. Questions regarding the role of stimulants in bipolar depression remain unresolved [ 79 , 80 ]. This might be related to raised hedonic tone in bipolar depression [ 51 ]. Furthermore, the use of long-acting stimulants in individuals with ADHD and bipolar disorder has been advocated by some once mood has been stabilized with an appropriate mood stabilizer [ 17 ]. Individuals with comorbid ADHD and depression have a high disease burden including lower self-reported quality of life than those with MDD alone [ 44 ].
One important consideration is the possibility of depressive symptoms manifesting as a result of coping with lower hedonic tone in ADHD [ 51 ] rather than being representative of a depressive disorder separate from ADHD [ 69 ]. This is not surprising, since serotonergic agents alone would not be expected to improve ADHD symptoms, which typically respond to catecholaminergic agents such as noradrenalin-dopamine reuptake inhibitors or psychostimulants.
Purely serotonergic activity lowers dopamine and norepinephrine levels via effects on 5-HT 2C and 5-HT 2A interneurons, respectively [ 83 ]. As well, this presentation may represent demoralization as a result of ADHD and subsequent emergence of symptoms such as anhedonia, sleep issues, and irritability.
Therefore, the key to successfully diagnosing concurrent MDD is facilitated by recognizing the presence of a static depressed affect, appetite changes, or suicidal ideation [ 69 , 84 ]. Comorbid ADHD is more common in individuals with a primary diagnosis of social phobia than panic disorder [ 85 ]. Individuals with anxiety disorders who have comorbid ADHD tend to have more severe anxiety symptoms, earlier age of onset of anxiety, and more frequent additional comorbid psychiatric diagnoses and substance use than those who do not have ADHD [ 85 ].
ADHD is often diagnosed later in individuals who have comorbid anxiety than in those without anxiety, possibly because the presence of anxiety may inhibit impulsivity [ 87 ]. Nonetheless, one might also understand the comorbidity between the anxiety disorders and ADHD as being related to common neurobiological deficits associated with poor prefrontal activity and deficits in top-down regulation. Support for this model is derived from anatomical findings in children with ADHD showing delayed maturation in terms of the thickness of the entire cortex, with the greatest delays in prefrontal cortex PFC and ACC [ 94 ].
Substance abuse or dependency is approximately twice as common in individuals with ADHD as it is in the general population [ 43 ]. There is a particularly strong association between ADHD and cigarette use, with these populations demonstrating stronger physical dependence to nicotine when compared to individuals without ADHD [ 96 ].
The association between ADHD and SUD is bidirectional, and stems from various sources including neurobiological factors, other comorbid psychiatric disorders, behavioural characteristics such as novelty-seeking or impulsivity, and attempts to self-medicate ADHD symptoms [ 43 ]. In support of the latter, individuals with ADHD more frequently report the use of substances in order to manage their mood or as sleep aids [ 97 ]. Studies have found that ADHD in individuals with SUD is associated with earlier onset of substance use, increased likelihood of suicide attempts, more hospitalizations, higher rates of poly-substance abuse, less likelihood of achieving abstinence, and lower rates of treatment adherence [ 43 , 98 , 99 ].
Overall, the co-occurrence of ADHD and SUD can result in a more severe course of both substance use and psychiatric symptoms and outcomes. Although a link between treatment of ADHD with psychostimulants and later development of SUD has been proposed, this is not supported by the literature [ 95 ].
The literature on comorbid ADHD and personality disorders is sparse compared to other psychiatric comorbidities. Importantly, individuals with ADHD and personality disorders have more severe impairment [ ], exhibit lower response rates to methylphenidate treatment compared to adults with ADHD alone [ ], and have poorer persistence on ADHD therapy [ ]. ADHD and personality disorders often co-occur with other axis I disorders. The substantial burden of comorbid ADHD and personality disorders is underscored by the high co-occurrence of these conditions in incarcerated individuals.
There is a paucity of clinical trials evaluating management strategies for personality disorders in general [ ], let alone with comorbid ADHD. It is plausible that in some individuals, adult ADHD may manifest as a personality disorder and that targeting treatment to ameliorate symptoms of ADHD might also improve features of antisocial behaviour.
It is important to determine if a patient presenting with one of the above-listed psychiatric disorders also has comorbid ADHD. This may be difficult, in part because of the difficulties associated with establishing a correct diagnosis. Nonetheless, some individuals will be able to overcome their deficits such that diagnosis will be delayed. Compensating skills may delay or prevent diagnosis if one follows the strict DSM definition.
In fact, as noted by Moffitt et al. Thus, those with delayed onset of symptoms may in fact be able to compensate thereby delaying diagnosis, but they may eventually require treatment nonetheless. This compensation and delayed diagnosis may contribute to unrecognized ADHD, which has been associated with poor treatment response or noncompliance due to forgetfulness, or perceived lack of improvement of symptoms [ 66 ], or mismanagement where the medication will only address the problems it is designed to target e.
SSRIs will not address the primary premorbid ADHD contributing to the trajectory of depression, bipolarity, anxiety and substance abuse problems. In fact, treating ADHD has been shown to prevent worsening comorbidities with depression, bipolarity, anxiety and substance use disorders [ 7 , 8 ]. Thus, we propose three key questions that clinicians can ask in order to help identify red flags suggestive of an ADHD diagnosis in complicated patients:. Several published articles have presented reviews and recommendations concerning treatment options and algorithms [ 16 , ].
Treatment selection must be informed first and foremost by efficacy in terms of functional outcomes. Functional outcomes include symptom reduction, but also extend to improved daily functioning and increased quality of life [ ]. Indicators of improved functioning include more efficient at working or studying, more stable relationships, success in containing aggressive impulses, and improved parenting [ 72 ].
Long-term efficacy as well as adherence to treatment is also crucial to success. Pharmacologic treatments for ADHD are usually divided into stimulants and non-stimulants. Stimulant medications include methylphenidate, mixed amphetamine salts, and lisdexamfetamine dimesylate. Non-stimulants used in ADHD treatment include atomoxetine and alphaadrenergic agonists. Antidepressants such as venlafaxine and bupropion have also been evaluated as treatment options for ADHD, with some evidence of benefit in addressing ADHD symptoms [ 16 , ].
One systematic review and meta-analysis of treatments for ADHD concluded that immediate-release methylphenidate was superior to other treatments in terms of benefits and harms [ ]. It also supported the efficacy of atomoxetine, long-acting bupropion, and extended-release stimulants, but found that short-acting stimulants had similar risk-profiles to these other options, with greater efficacy in terms of symptom reduction.
Another important treatment consideration is the potential for the effective treatment of ADHD to improve functional outcomes of patients with comorbid conditions. Many studies have reported improvements in comorbid psychiatric symptoms when ADHD is effectively treated. For instance, atomoxetine has been associated with improvements in both ADHD and comorbid anxiety [ ] and depressive [ ] symptoms. Other studies have demonstrated the efficacy of co-administration of SSRIs or serotonin-norepinephrine reuptake inhibitors SNRIs with stimulants on functional outcomes in ADHD with comorbid anxiety or depressive symptoms [ , ].
Perhaps more exciting is the concept that early and optimal treatment of ADHD could potentially prevent the later development of psychiatric comorbidities. Taken together, these observations suggest that pharmacologic therapy for ADHD in young adults could change the trajectory of psychiatric morbidity in adulthood. Such findings provide powerful support for the early and aggressive treatment of ADHD.
A final important treatment consideration is safety and tolerability. Both stimulant and non-stimulant medications have possible side effects, which must be taken into account. Common side effects of stimulants include headache, appetite suppression, nausea, dry mouth, mood fluctuations, difficulty sleeping, jitteriness, increased heart rate, and increased blood pressure [ ]. Generally the severity and risk of these side effects is considered minimal. However, due to the possibility of serious cardiac adverse events, it is recommended that patients be screened for both family and personal histories of cardiac conditions prior to prescription of stimulant medications [ ].
Side effects vary depending on the type of non-stimulant employed, but common side effects of atomoxetine include appetite suppression, dry mouth, insomnia, constipation, vomiting, dizziness, fatigue, nausea, dyspepsia and mood swings [ ]. However, most experts agree that minimal lab investigations are needed prior to the initiation of ADHD medications in adults, particularly the psychostimulants. For instance, routine bloodwork is not necessary in most individuals, and only at-risk individuals may require monitoring of blood pressure, heart rate, and electrocardiogram prior to starting psychostimulants.
Non-pharmacological interventions play a central role in the management of ADHD. Similarly, the addition of psychotherapeutic approaches to pharmacotherapy in adults with ADHD whose symptoms persist despite medication has been shown to improve symptoms and functioning [ ]. Notably, recent research suggests that cognitive behavioural therapy CBT has bidirectional efficacy for both ADHD and depressive disorders [ ].
Psychotherapeutic modalities are also central to the management of the most common psychiatric comorbidities in adults with ADHD, namely SUD, depression, anxiety, and bipolar disorder. However, prospective studies of psychosocial strategies in comorbid ADHD populations are scarce. The available evidence suggests benefit of a multimodal approach in individuals with ADHD and comorbid psychiatric disorders, but large prospective studies are needed to definitively address the magnitude of benefit for ADHD and mood symptoms. What are the risks of prescribing psychostimulants to a patient with ADHD plus bipolar disorder or anxiety?
Will it precipitate a switch to mania or an exacerbation of anxiety? A review of previous studies supports stimulants as a first-line therapy for the treatment of ADHD symptoms in individuals with concurrent ADHD and bipolar disorder, given a lack of strong evidence that stimulants are linked to mania [ 17 ]. However, there is a theoretical risk of stimulant therapy resulting in mood destabilization in individuals with bipolar disorder [ 16 ]. In individuals with anxiety, mixed amphetamine salts were found to be well tolerated as an adjunctive treatment to SSRIs, SNRIs, or other antidepressants [ ].
The consensus in the literature is that the most severe, functionally impairing or destabilizing illness should be treated first, and comorbidities should be addressed in a stepwise fashion once the patient has responded to treatment [ 17 , 69 , ]. Generally, in patients with comorbid ADHD and mood disorders, the affective disorder should be given higher priority, and residual ADHD symptoms can then be assessed once the mood disorder has been addressed pharmacologically [ 84 ].
In bipolar disorder, mood stabilization is a prerequisite for effective ADHD treatment [ 76 ]. Similarly, in SUD it is generally recommended that substance abuse should be stabilized first [ ]. What should I do if my patient is smoking marijuana, or has a history of cocaine use? Marijuana use may have long-term negative consequences on attention, and therefore the CADDRA guidelines do not support the treatment of ADHD symptoms while a patient is taking marijuana for self-medication or recreationally [ ].
Although there have been some concerns that stimulant use in the treatment of ADHD may cause increased cocaine cravings or use, this was not supported in a study of methylphenidate [ ]. Retrieved 13 July The Cochrane Database of Systematic Reviews.
- Topic Overview!
- Adult ADHD and comorbid disorders: clinical implications of a dimensional approach.
- Musical Form?
Retrieved 1 January Why were the MTA medication treatments more effective than community treatments that also usually included medication? Answer: There were substantial differences in quality and intensity between the study-provided medication treatments and those provided in the community care group. CNS Drugs. Bibcode : PLoSO..
Psychology Research and Behavior Management. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. Only one paper examining outcomes beyond 36 months met the review criteria.
Attention Deficit and Hyperactivity Disorders. Encyclopedia of Social Problems. Retrieved 2 May Harvard Review of Psychiatry. Australian Family Physician. Archived PDF from the original on 24 September Current Opinion in Pediatrics. Amsterdam: Elsevier Academic Press. Archived from the original on 20 April Centers for Disease Control and Prevention Archived from the original on 1 March Retrieved 10 October Cognitive behavioral therapy for adult ADHD. National Institutes of Health. Archived from the original on 19 January Journal of Attention Disorders.
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Archived from the original on 7 February A Systematic Review of the Literature". Journal of Attention Disorders Review : It is possible that in untreated patients with CD, neurologic symptoms such as chronic fatigue, inattention, pain, and headache could predispose patients to ADHD-like behavior mainly symptoms of inattentive type , which may be alleviated after GFD treatment. Frontiers in Psychology. Psychological Assessment.
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Getting a diagnosis through Psychiatry-UK
Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities Encyclopedia of Food Safety. Very few studies enable proper evaluation of the likelihood of response in children with ADHD who are not already preselected based on prior diet response.
Disorders of Childhood: Development and Psychopathology. Cengage Learning. Retrieved 6 July Year Book of Pediatrics E-Book. Elsevier Health Sciences. Archived from the original PDF on 24 October Retrieved 13 October Child and Adolescent Psychiatry and Mental Health. Pharmacracy: medicine and politics in America.
Westport, CT: Praeger. Mental diseases are invented and then given a name, for example attention deficit hyperactivity disorder ADHD. Frontiers in Neural Circuits. Early results with structural MRI show thinning of the cerebral cortex in ADHD subjects compared with age-matched controls in prefrontal cortex and posterior parietal cortex, areas involved in working memory and attention. DA has multiple actions in the prefrontal cortex. It promotes the "cognitive control" of behavior: the selection and successful monitoring of behavior to facilitate attainment of chosen goals.
Aspects of cognitive control in which DA plays a role include working memory, the ability to hold information "on line" in order to guide actions, suppression of prepotent behaviors that compete with goal-directed actions, and control of attention and thus the ability to overcome distractions. Cognitive control is impaired in several disorders, including attention deficit hyperactivity disorder. Noradrenergic projections from the LC thus interact with dopaminergic projections from the VTA to regulate cognitive control.
Attention Deficit Hyperactivity Disorder (ADHD)
Trends in Cognitive Sciences. Recent conceptualizations of ADHD have taken seriously the distributed nature of neuronal processing [10,11,35,36]. Most of the candidate networks have focused on prefrontal-striatal-cerebellar circuits, although other posterior regions are also being proposed . Clinical Psychology Review.
April The Lancet. A meta-analysis". Pharmacology, Biochemistry, and Behavior. European Journal of Paediatric Neurology. European Neuropsychopharmacology. Annual Review of Psychology. EFs and prefrontal cortex are the first to suffer, and suffer disproportionately, if something is not right in your life. They suffer first, and most, if you are stressed Arnsten , Liston et al.
A review of the literature". Behavioral studies show altered processing of reinforcement and incentives in children with ADHD. These children respond more impulsively to rewards and choose small, immediate rewards over larger, delayed incentives. Interestingly, a high intensity of reinforcement is effective in improving task performance in children with ADHD. Pharmacotherapy may also improve task persistence in these children. Previous studies suggest that a clinical approach using interventions to improve motivational processes in patients with ADHD may improve outcomes as children with ADHD transition into adolescence and adulthood.
August Archived from the original on 1 May Textbook Of Child and Adolescent Psychiatry illustrated ed. Archived from the original on 6 May Retrieved 2 November Tidsskrift for den Norske Laegeforening in Norwegian. Clinical EEG and Neuroscience. Medication and behavioral treatments are both widely used to treat ADHD. Patients who receive behavioral treatments—typically therapy, parent training, or neurofeedback —often ultimately need less medication, but several influential studies have concluded that the two treatment approaches may work best in tandem.
Whatever medication is used, it's important to receive the correct dosage, since ADHD medications, and stimulants in particular, can worsen other conditions that may co-occur with ADHD, including bipolar disorder , obsessive-compulsive disorder , and anxiety. Psychiatry , Psychopharmacology.
Society pays heavy price for failure to diagnose and treat conduct disorder
Boys, who tend to show more hyperactive or impulsive symptoms, have historically been more likely to be diagnosed with ADHD than girls. But increased awareness of inattentive symptoms has led to an increase in diagnoses among girls in recent years. Overall, 5 to 11 percent of children and adolescents have been diagnosed with ADHD. Children and teens with ADHD may benefit from accommodations at school to help adapt curricula, classroom environments, and testing procedures to their learning styles and to compensate for developmental delays.
Adolescence , Education , Gender. There is an ongoing debate over whether multitasking, an increasing societal dependence on technology, or the competing demands of the modern world create ADD symptoms in otherwise attentive people. Aside from the merits of the clinical debate, however, a plugged-in world of noisy, visually cluttered phones, screens, and other devices can be frustrating to many and is likely to be especially challenging for individuals with ADHD. Attention , Media , Productivity.
ADHD Emotions: Why You Feel Rejection Sensitive Dysphoria
Maintaining fulfilling relationships can be a challenge for people with attentional problems. Because they are easily distracted, they may not appear to be listening closely to loved ones, and time- management challenges may lead them to be frequently late—or to forget social plans and important errands altogether. Because close relationships are so crucial to happiness and well-being, it's critical for those with ADHD to be aware of the effects of their condition on others and to develop skills for building stronger social ties.
Even among those who agree ADHD exists, there are competing theories about what, if anything, triggers its symptoms. Until recently, it was considered a childhood disorder that individuals eventually grew out of. Environment , Productivity. By Justin J Lehmiller Ph. People with ADHD are more open to the idea of being in a consensually non-monogamous relationship. However, open relationships can be a double-edged sword for persons with ADHD.
Take a closer look at how removing modern foods improves the nutrition and metabolism of your brain. By Benjamin Cheyette, M. Need to find just the right medication for ADHD? Learn how different medications work to create focus. They are not all the same! By Susan McQuillan M.