ADHD by Paul H. Wender & David A. Tomb

Author:Paul H. Wender & David A. Tomb
Language: rus
Format: mobi
ISBN: 9780190240264
Publisher: Oup Us
Published: 2016-10-03T21:00:00+00:00

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6

ATTENTION- DEFICIT

HYPERACTIVITY DISORDER

IN ADULTS

THIS CHAPTER IS BUILT AROUND a long- standing

research effort developed in the Department of Psychiatry

at the University of Utah School of Medicine. The research

was initiated in the mid- 1970s by Paul H. Wender, MD, and

included as key contributors Drs. Fredrick Reimherr and

David Wood. With the publication of our first scientific

study in 1976 about the use of medication in adult ADHD,

we became one of the first centers to recognize that ADHD

continued into adulthood and to begin to study such indi-

viduals. We undertook controlled experiments on the effects

of various drug treatments on approximately 200 patients

whom we diagnosed as ADHD children “grown up”— that

is, adults with continuing problems with ADHD. In addi-

tion, we conducted experiments on metabolism and drug

responsivity in a large number of patients with ADHD in an

effort to understand the underlying chemical abnormalities,

and we treated scores of patients clinically. Our experience is

therefore based on the treatment of several hundred ADHD

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adults. (It has been a tremendous scientific advantage to

be able to work with adults. They can provide information

about the inner experience of being ADHD— something

children cannot do— and we have been able to learn about

the feelings, reactions, and lives of ADHD adults in a way we

never could from our studies of children. We can ask them

to give informed consent to allow us to conduct nonthera-

peutic experiments— something one cannot do with chil-

dren who cannot give truly informed consent.) Reports on

our work have been judged by editorial boards consisting

of experts in the field, were published in scientific journals,

and most all clinicians now agree that ADHD may indeed

persist in adults in their thirties, forties, and fifties, and that

in many instances adults with ADHD respond to stimulant

medication in a way similar to children with ADHD. Many

other investigators have become interested in this area.

At the time we began, most child psychiatrists believed

that ADHD diminished in adolescence and disappeared in

adulthood. Since then other investigators have explored the

development of ADHD children into adolescence and adult-

hood. As we discussed in Chapter 4, probably one- third to

two- thirds of ADHD children continue to have problems in

adult life, and as many as one- half of them continue to have

ADHD symptoms marked enough to interfere with their

functioning as students, workers, partners, or parents.

As we have said, a view that was held in the past was that

the reaction of ADHD children to stimulant medication was

“paradoxical.” Whereas stimulants usually produce eupho-

ria or excitement in adults, they seemed to result in quietness

and settling down in ADHD children. It is not clear whether

this same effect is produced in normal children because no

one has given stimulant drugs to non- ADHD children over

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A DH D I N A DU LTS | 161

a period of weeks or months. However, when non- ADHD

children with learning disorders are given stimulant drugs,

such as Ritalin, they do not calm down but instead often

become anxious, irritable, and driven. Thirty years ago the

common belief was that, as ADHD children outgrew the

problems during adolescence, their paradoxical response

went away, and then, as older adolescents and adults, they

responded to stimulant medication in the normal way by

becoming excited, stimulated, and euphoric.

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