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Holding down a job. Caring for a family. Paying bills. Staying on top of chores. Having a social life. The business of life is tough enough, but for the estimated 10 million American adults with attention-deficit/hyperactivity disorder (ADHD), even mundane tasks are overwhelming.  “These people find it increasingly difficult to handle the mounting responsibilities of adulthood,” says David W. Goodman, M.D., director of the Adult Attention Deficit Disorder Center of Maryland in Lutherville. Many people with ADHD have struggled for years. Whether the disorder has been apparent since childhood or has recently been diagnosed, adult ADHD can indeed be the challenge of a lifetime. What Causes ADHD?

eople with ADHD often have other psychiatric conditions such as depression, bipolar disorder, anxiety, or substance abuse. And they may have trouble getting diagnosed because their symptoms are attributed to their psychiatric condition or a problem such as a thyroid disorder, sleep apnea, or hypoglycemia. “We know it’s a brain disorder,” says Dr. Goodman, assistant professor in the department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine in Baltimore, Maryland. In people with ADHD, he says, the frontal lobes, which are involved in thinking, planning, and decision-making, mature two to three years later than they do in people who do not suffer from the disorder. Low levels of dopamine, a brain chemical that regulates movement, emotional response, and sensitivity to rewards, may also be involved.

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While there have been many theories about causes, including mercury exposure, vaccinations, and food additives, they have not been proven, most likely due to the difficulty of testing. Most toxicology research centers around the effects of high levels of substances, not low-level exposure, which some experts say could be the culprit. However, researchers have identified some associations. If a person has ADHD, chances are someone else in the family tree does, too. Exposure to lead or other toxins may play a role. Women who smoke or drink during pregnancy are more likely to have a child with ADHD. And low birth-weight babies and preemies are also at greater risk.

How Is Adult ADHD Treated?

reating ADHD is a delicate balancing act because if someone has another psychiatric disorder, such as anxiety, depression, or substance abuse, that also has to

be addressed. And a clinician has to make sure that the treatment for one condition doesn’t worsen the symptoms of another, or he may find that treating ADHD first in people with mild anxiety actually increases the anxiety. Two classes of drugs have been approved for treating ADHD. Stimulants, including methylphenidates and amphetamines, are considered the front-line treatment for ADHD, but non-stimulants are also prescribed. The medications can be short- or long-lasting. Depending upon the drug, side effects may include headache, decreased appetite, insomnia, dry mouth, agitation, anxiety, nausea, and sexual problems. Stimulants may also slightly increase blood pressure and heart rate, or in rare cases, trigger a serious cardiovascular event, such as heart disease or heart failure. So some people may need an electrocardiogram before starting them. Despite possible side effects, for many people medication is a game changer. “There can be a rather substantial improvement in cognitive ability,” says Dr. Goodman. “And you can tell if it is going to help within a day.” He typically prescribes a low dosage to start, gradually increasing it until the patient experiences relief. If a patient is skittish about taking medication, Dr. Goodman recommends giving it a try to see if it helps. “The disorder won’t go away,” he adds. “The goal of treatment is to obtain the best quality of life and performance.”

Can Therapy Make a Difference?

ome people with ADHD may have difficulty planning, organizing, managing time, prioritizing, and executing tasks,” says Dr. Goodman. Cognitive behavioral therapy (CBT), a form of talk therapy, can teach people techniques that address those problems. Therapy serves another purpose: Adults with ADHD may be resentful they weren’t diagnosed

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