Attention-deficit/hyperactivity disorder (ADHD) in adults: a multilayered approach to a serious disorder of inattention to the future

Abstract

Attention-deficit/hyperactivity disorder (ADHD) affects people of all ages, yet its presentation varies as the person matures and social demands increase from childhood into adulthood. Interestingly, when analyzing the disorder in adults, it is not immediately clear what the ‘attention deficit’ in the ADHD denomination exactly means. Adults with ADHD have a broad range of difficulties, far beyond an attentional deficit, that impact negatively their social functioning and often lead to failures in all walks of life. Therefore, in this review, I attempt to reconcile the notion of attention deficit with the protean manifestations of ADHD in adults through a proposal that ADHD symptoms have as a common denominator an inattention to the future. I build this construct through a multilayered approach, progressing from the epidemiological and clinical considerations for Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, to a deeper understanding of the disorder, discussing how these patients fail to anchor the present into the future (i.e., to be attentive to future consequences), thus failing to approximate future goals from present action. Integrating cognitive observations with imaging abnormalities, it is possible to propose that ADHD in adults is perhaps the most prevalent frontal lobe disorder in humans, ultimately impacting upon psychosocial management and treatment strategies.

Resumo

O transtorno de déficit de atenção/hiperatividade (TDAH) afeta pessoas de todas as idades, embora a apresentação varie de acordo com a maturação cerebral e as demandas sociais, da infância para a idade adulta. Interessantemente, quando se analisa o TDAH em adultos, não fica imediatamente claro o que quer dizer o ‘déficit de atenção’. Adultos com TDAH apresentam um conjunto amplo de dificuldades, que vão muito além de um déficit atencional, impactando negativamente seu funcionamento social e levando a fracassos recorrentes em vários aspectos da vida. Nessa revisão eu tento conciliar a noção de deficit de atenção com as complexas manifestações do TDAH em adultos, através da proposição de que os sintomas têm como denominador comum uma desatenção ao futuro. Eu construo esse argumento através de uma abordagem que se inicia com uma revisão dos aspectos clínicos e epidemiológicos até uma compreensão mais profunda do distúrbio, discutindo como esses pacientes têm dificuldade em ancorar o presente no futuro (ou seja, estar atentos às consequências futuras), assim falhando em aproximar objetivos futuros de ações no presente. A partir da integração do contexto cognitivo com alterações de neuroimagem é possível propor que o TDAH em adultos é talvez a forma mais prevalente de doença de lobo frontal em humanos, com impacto no manejo psicossocial e na busca de estratégias terapêuticas.

Keywords

Attention Deficit Disorder with Hyperactivity - Adult - Frontal Lobe - Executive Function - Reward

Palavras-chave

Transtorno do Déficit de Atenção com Hiperatividade - Adulto - Lobo Frontal - Função Executiva - Recompensa

Publication History

Received: 23 July 2024

Accepted: 27 July 2024

Article published online:
02 October 2024

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