Young adult male suffering social and occupational difficulties identified as having Attention Deficit Disorder*

keywords: inattentive, adhd, social difficulties, depression, anxiety

Occupation:
unemployed

Question:
Mr X, 21 years old, was referred for organisational, attentional and social difficulties and suspect Attention Deficit Disorder.

Problem:
Mr X had been suffering from a lack of motivation and focus and inappropriate social behaviour.

Complications:
Mr X was a high functioning individual with average to superior intellectual abilities. He is measured to have a severe level of depression and extremely severe level of stress and anxiety. However, various high psychometric scores and his neurophysiological profile suggests that his neurophysiological and neuropsychological deficits can not be attributed solely to a mood disorder (anxiety or depression) or chronic fatigue. Mr X?s results indicated a pattern of inattentiveness, difficulty adjusting to complex stimuli, and vulnerability to interference affects are consistent with the arousal abnormalities that have been identified in his neurophysiological measurements; abnormally high delta activity and cortical coherence suggesting lack of cortical differentiation and abnormally low signal to noise.

Outcome:
Mr X?s brain function results indicated a pattern of inattentiveness, difficulty adjusting to complex stimuli, and vulnerability to interference affects that were consistent with the arousal abnormalities. His neurophysiological measurements revealed abnormally high delta activity and cortical coherence suggesting lack of cortical differentiation and abnormally low signal to noise.

In summary, the neuropsychological and neurophysiological pattern is consistent with a subgroup of ADD subjects of the inattentive type who display low cortical arousal and associated psychometric deficits (Rowe & Hermens, 2006).

Mr X recieved appropriate treatment for his condition and his cognitive and social functioning improved considerably.

Conclusion:
Mr X displays neurophysiological and neuropsychological markers for attention deficit disorder and the presence of related early childhood difficulties. Therefore, Mr X was recommended to trial a stimulant medication. His Neurophysiological and neuropsychological profile indicated methylphenidate (Ritalin or Concerta) to be the first choice (Hermens et al., 2006).

Given the presence of extremely severe anxiety, Mr X was recommended to monitor his anxiety levels as stimulants may exacerbate this. However, sometimes anxiety can occur due to abnormal processing of irrelevant stimuli due to an ADD condition, as was indicated in Mr X?s profile. However, if anxiety becomes a problem, prescription of atomoxetine (Strattera), a nonstimulant, was recommended, as this has also been found to be effective for alleviating symptoms in adult ADHD (Adler et al., 2006; Faraone et al., 2005; Reimherr et al., 2005; Spencer et al., 2006).

Given the presence of anxiety and depression in Mr X?s symptoms, he was advised to eek further intervention from a psychologist experienced in cognitive behavioural therapy (CBT) programs. CBT would provide Mr X with further strategies to combat anxious and depressive symptoms as well as developing better organisational habits and providing further psychoeducation regarding social interaction, ADD, depression and anxiety. This together with successful treatment of his ADD was expected to significantly improve his overall level of functioning and lead to an eventual reduction in any prescription of medication (Levy, 2001).

References

Adler, L, Dietrich, A, Reimherr, F, Taylor, L, Sutton, V, Bakken, R, Allen, A, and Kelsey, D (2006). Safety and Tolerability of Once Versus Twice Daily Atomoxetine in Adults with ADHD. Ann Clin Psychiatry , 18 , 107-113.

Faraone, SV, Biederman, J, Spencer, T, Michelson, D, Adler, L, Reimherr, F, and Glatt, SJ (2005). Efficacy of atomoxetine in adult attention-deficit/hyperactivity disorder: a drug-placebo response curve analysis. Behavioral & Brain Functions [Electronic Resource]: BBF , 1 , 16.

Hermens, DF, Rowe, DL, Gordon, E, and Williams, LM (2006). Integrative neuroscience approach to predict ADHD stimulant response. Expert Review of Neurotherapeutics , 6 , 753-763.

Levy, F (2001). Implications for Australia of the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder. Australian and New Zealand Journal of Psychiatry , 35 , 45-48.

Reimherr, FW, Marchant, BK, Strong, RE, Hedges, DW, Adler, L, Spencer, TJ, West, SA, and Soni, P (2005). Emotional Dysregulation in Adult ADHD and Response to Atomoxetine. Biol Psychiatry , 58 , 125-131.

Rowe, DL and Hermens, DF (2006). Attention-deficit/hyperactivity disorder: neurophysiology, information processing, arousal and drug development. Expert Review of Neurotherapeutics , 6 , in press.

Spencer, TJ, Faraone, SV, Michelson, D, Adler, LA, Reimherr, FW, Glatt, SJ, and Biederman, J (2006). Atomoxetine and adult attention-deficit/hyperactivity disorder: the effects of comorbidity. J Clin Psychiatry , 67 , 415-420.

*The case examples are based on clinical experience but are dissimilar from real cases. The examples provided are for illustrative purposes only and any resemblance to a real life case is of coincidence.