More threads by David Baxter PhD

David Baxter PhD

Late Founder
Adult ADHD: Effects on Relationships and Self-Esteem
by Simone Hoermann, Ph.D.
Nov 19th 2009

About 5 percent of adults in the United Stated can be diagnosed with Attention Deficit/Hyperactivity Disorder. Dr. David Gutman, Director of Psychopharmacology at the Columbia East 60th Street Day Treatment Program, recently sat down with me to talk about Adult ADHD.

?Adult ADHD is basically a collection of symptoms of attention and hyperactivity issues that start in childhood. Adults with ADHD have difficulty with paying attention and with getting things done. They get fidgety, and have a hard time sitting through meetings. Often, people describe that they get distracted by their own thoughts ? one thought leads to another, leads to another, and so on. People with ADHD often start working on one thing, get distracted by something else, and then forget what they were working on to begin with. They tend to put off tasks they have to focus on.? explains Dr. Gutman. ?Typically, people come to see me, because they realize they have been struggling for a while. Sometimes, parents realize that they have an issue after their child has been diagnosed with ADHD. Most frequently, though, it is a family member who urges them to seek help. ?

Having AH/DH can have quite a toll on interpersonal relationships and a person?s self-esteem. ?A person with ADHD has a hard time paying attention.? says Dr. Gutman, ?They often have difficulty structuring their time and prioritizing tasks. That?s why they tend to show up late to appointments or dates. They can be quite forgetful, and they tend to not pay attention or to interrupt frequently when others are talking. You can see how this can get quite frustrating for the people in the environment, particularly romantic partners and spouses. People get disappointed and fed up, and they feel mistreated. It?s hard to understand that someone with AD/HD is not behaving this way on purpose. In addition, ADHD can also really affect the way people feel about themselves. Many people with ADHD have been told in their childhood that they?re not living up to their potential. They commonly internalize this message, which can have negative consequences later in life. They often feel like they are flawed or not good enough, and that they are underperforming. This can really affect a person?s self-confidence. It is often a real struggle for people to figure out what their true potential is, and to develop a healthy sense of self-esteem.?

Dr. Gutman emphasizes that it is important to get a thorough evaluation. It is important to rule out other difficulties that could cause problems with attention, for instance, anxiety or mood disorders. Often, people also have issues with substances and it needs to be sorted out what causes the attention problems. Sometimes, people can have more than one problem, so that several co-occurring conditions may have to be addressed, or the may be a condition that can make the symptoms worse.

The prognosis, according to Dr. Gutman, is quite good. ?The symptoms of ADHD respond very well to medication,? says Dr. Gutman, ?Of all the treatments we can offer in psychiatry, the treatment of ADHD is the one of the most effective ones. Sometimes, people learn tricks and skills to help with attention and memory. Very often, though, people who come to see me have a lifetime of experience with trying different tricks, such as schedules, lists, or systems that help them to not lose things. The first-line medications for ADHD are what we call stimulants: Medications such as Ritalin or Adderall, as well as the non-stimulant Strattera. They work very well for controlling the symptoms. Sometimes, if side effects are too bothersome, we may prescribe Wellbutrin or other medications, the Tricyclics. In all, medication is a very effective treatment for ADHD."

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.


Overall, I find this an accurate and helpful summation.

With regards to medication, however, it's important to understand that contrary to misinformed public opinion, medication isn't "taking the easy way out."

It often takes a knowledgeable physician AND a strong degree of patient advocacy to find the right type/dosage of medication (and sometimes medications).

Ritalin and Adderall are older-generation medications and, for many, often create as many problems as they solve due to their rapid-start-rapid-stop nature. It's also important to know that the dopamine-targeting stimulants can back-suppress serotonin in parts of the brain. Hence there is sometimes a need for a serotonin-targeting medication.

While some physicians see Wellbutrin as a sort of one-stop shopping medication for ADHD, it has a fairly high side effect profile and can vastly increase the anxiety of some patients.

In my ten years of advocacy in this area, I've learned that physicians rarely follow an established protocol in prescribing medications for ADHD patients. They also uniformly fail to use rating scales, which help to provide objective evidence of efficacy. And they often start at far too high a starting dosage, completely ignoring the maxim to "start low, titrate slow."

In summary, therapists and adults seeking ADHD treatment do well to educate themselves on these protocols before even selecting a physician.

These medications can truly be life-changing but only if they are approached systematically.
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