Über die Autorin bzw. den Autor

Dr Susan Young is a Senior Lecturer at the Institute of Psychiatry, King's College, London. She is a Chartered Clinical and Forensic Psychologist, and a Clinical Neuropsychologist. Dr Young has a Doctorate in Clinical Psychology from University College London and a PhD from King's College London, University of London. She has many years experience working at the renowned Maudsley Hospital in the UK where she developed and set up the neuropsychology service for the UK's first National Adult ADHD service. Dr Young has extensive experience in the assessment and psychological treatment of young people and adults with ADHD, both males and females. She has published widely on the subject, in particular on epidemiology, neuropsychological functioning, psychosocial functioning, comorbidity and psychological treatment.

Dr Jessica Bramham is a Clinical Lecturer at the Institute of Psychiatry, King's College London. She has a Doctorate in Clinical Psychology from the Institute of Psychiatry and an MA from Cambridge University. She is a Chartered Clinical Psychologist and Clinical Neuropsychologist. Dr Bramham was Dr Young's Successor at the Adult ADHD Service at the Maudsley Hospital and is currently lead Clinical Psychologist for the service. She has been involved in expanding service in order to meet the growing needs of the adult ADHD population in the UK. Neuropsychological assessment is a particular interest of Dr Bramham. She is involved in researching cognitive functioning in adulthood ADHD, the implementation and evaluation of group and individual psychological interventions.

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"This volume is a ground-breaking first step in standardizing the psychosocial treatment of adults with ADHD." - Dr. Sam Goldstein, University of Utah

"I think it is a uniquely valuable guide to how psychological thinking and treatment can be helpful to adults with ADHD- I recommend it to all professionals taking on this work." - Professor Eric Taylor, Head of Department of Child and Adolescent Psychiatry, King's College London Institute of Psychiatry

"What emerges from this perspective is clinical wisdom. I could see and fell both the patient and the therapy." - Margaret Weiss, Director of Research, ADHD Clinic, Children's and Women's Health Centre, Canada

There is increasing recognition of the prevalence of ADHD in adulthood, which is estimated to be around one percent in the general population.  These people have often experienced lifelong underachievement; they feel misunderstood and have not received the help they need.  Reflecting the growing awareness of this problem, ADHD in Adults provides a comprehensive account of the presentation of adulthood ADHD, its assessment and treatment.

Written by experienced practitioners in the field, the book introduces a cognitive behavioural model of ADHD from which the authors developed the Young-Bramham Programme.  This is a unique, modular framework for assessing and treating people with adulthood ADHD and associated problems using practical intervention techniques.  The book is accompanied by the Young-Bramham Programme Companion Website, www.wiley.com/go/adhdadults that provides downloadable materials for use by clients and therapists.

ADHD in Adults is invaluable reading for clinicians working with adult ADHD clients in many different settings including primary care, adult mental health, learning disability, forensic, neuropsychiatry and neuropsychology.  It will also be a useful self-help resource for ADHD clients, friends, family and supporters.

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ADHD in Adults

John Wiley & Sons

Chapter One

This book aims to provide clinicians with a comprehensive psychological guide to practice when working with adults with ADHD; from the assessment and diagnosis stage, through to treatment of both core symptoms and associated problems. As ADHD is a heterogeneous disorder, each individual is likely to present with a different constellation of symptoms covering a range of psychological strengths and weaknesses. For this reason, this book contains several stand-alone modules that have been devised and collated to form the Young-Bramham Programme. The Young-Bramham Programme provides an innovative and intensive practical approach to the presentation of adulthood ADHD using cognitive behavioural and motivational interviewing techniques, which are described in detail using case examples. Each module is presented in a separate chapter of this book and can be used independently or in conjunction with other modules.

Clinicians often report feeling under-equipped to treat this client group and that there is relatively limited literature regarding psychological treatment. This is despite ADHD adults seeking help for assessment and/or treatment of their presenting complaints in increasing numbers. Approximately one-third of children with ADHD continue to be fully symptomatic into adult life and the remainder often retain some residual problems that warrant treatment. In addition, although the diagnosis of the disorder of ADHD relies on a categorical perspective, many of the core attentional and impulsivity difficulties are continuously distributed within the normal population. Therefore, there are many individuals with attention, impulsivity and hyperactivity problems that fall below the threshold for formal diagnosis, but who nevertheless may also benefit from treatment of their functional impairments. Thus, the Young-Bramham Programme is appropriate for individuals who have a formal ADHD diagnosis; individuals who previously had a diagnosis and continue to have residual symptoms or problems; and individuals who present with an undiagnosed constellation of attention and/or hyperactive impulsive symptoms, and related problems.

Literature regarding pharmacological treatment of the disorder has been evolving in conjunction with increased recognition of its longstanding nature (e.g. Horrigan, 2001). However, stimulant medication is not effective for up to 20-50% of adults with ADHD as they may not experience symptom reduction or they are unable to tolerate the medication (Spencer et al., 1995; Wender, 1998; Wilens, Spencer & Biederman, 2002). Moreover adults who have benefited from pharmacological intervention may not experience a considerable reduction in their core symptoms (Weiss, Hechtman & Weiss, 1999) and they may continue to experience a number of symptoms and/or associated problems more suitable for treatment with psychological interventions. Cognitive remediation techniques that target problems associated with adult ADHD, such as attentional difficulties, poor motivation, poor organisational skills, impulsivity and anger management problems, have been shown to be effective in improving daily functioning skills (Stevenson, Whitmont, Bornholt, Livesey & Stevenson, 2002).

People with ADHD have often developed secondary conditions following lifelong ADHD-related frustration and failure (Murphy, 1995; Young, 2002). Indeed, a number of outcome studies have demonstrated a wide range of comorbid conditions associated with ADHD including anxiety disorder, depression, substance misuse and dysfunctional anger (for reviews, see Brassett-Grundy & Butler, 2004a; Murphy & Barkley, 1996; Shekim, Asarnow, Hess, Zaucha & Wheller 1990). Whilst these conditions are effectively treated by psychological interventions for individuals without ADHD, clinicians sometimes feel discouraged from intervening in the same way with clients with ADHD as they fear there may be complicating factors. We therefore decided to write this book to share our knowledge and provide guidance for clinicians who are working with adults with ADHD.

A second reason for writing the book was that we have talked to our clients and listened to their life histories. This led us to conduct an investigation into their thoughts and feelings about receiving a diagnosis of ADHD and their experience of treatment with medication (Young, Bramham, Gray & Rose, in submission). The results of the study formed the theoretical basis of the Young-Bramham Programme (see Chapter 3).

THE COMPANION WEBSITE

The Young-Bramham Programme book is supplemented by a Companion Website, which provides practical and pragmatic exercises that allow the client to identify personal specific problems and methods to address them. Strategies that involve writing ideas down or making lists of potential consequences target difficulties in organisational skills and memory problems which are inherent in adulthood ADHD. The therapist therefore needs to maximise the opportunity to create lists and structure plans during sessions. Examples, charts, diaries, figures, diagrams and illustrations are presented in both the book and on the Companion Website (the latter in a format suitable for use in sessions) to clarify information, and/or to improve accessibility and understanding of the concepts and issues presented. The Companion Website provides psychoeducational handouts and blank copies of relevant materials introduced in the programme. The materials can be downloaded, copied and used in treatment sessions to determine, evaluate and treat specific symptoms, problems and strategies. The materials will help the therapist and the client to collaboratively tailor the Young-Bramham Programme interventions according the client's specific needs.

ATTENTION DEFICIT HYPERACTIVITY DISORDER IN ADULTHOOD

Attention Deficit Hyperactivity Disorder was originally regarded as a childhood disorder in which the core symptoms of hyperactivity, impulsivity and attentional difficulties were thought to dissipate during adolescence. However, prospective studies examining the long-term outcome of childhood ADHD indicate that the condition can persist into adulthood (Brassett-Grundy & Butler, 2004a; Mannuzza, Klein, Bessler, Malloy & LaPadula, 1993; Taylor, Chadwick, Heptinstall & Danckaerts, 1996; Weiss, Hechtman, Milroy & Perlman, 1985). Estimates of prevalence vary widely and range between 3 and 9% of young people and 2% of adults are likely to meet DSM IV diagnostic criteria (Shaffer, 1994). A high proportion of young people may retain lesser residual symptoms as young adults. A Canadian longitudinal follow-up study suggested that up to two-thirds of young adults retain at least one disabling symptom of ADHD (Weiss, Hechtman, Milroy & Perlman, 1985). Symptom expression in adulthood seems to change as the disorder progresses (Bramham, Young, Morris, Asherson & Toone, 2005a, 2005b; Weiss & Hechtman, 1993). In our investigation of clinical referrals to the Maudsley Hospital, London, we have found that impulsivity and hyperactivity seem to diminish with age, but attentional problems persist into the middle adulthood years and beyond (Bramham et al., 2005a, 2005b).

It has been established that ADHD has a strong genetic component, with heritability estimates of 60-90%; that is, identical twins demonstrate greater concordance for symptoms of inattention...