Published on 03/03/2015 by admin
Filed under Neurology
Last modified 03/03/2015
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21 Attention-Deficit/Hyperactivity Disorder
Kenneth Lakritz
A 26-year-old draftsman consulted a psychiatrist for help with anxiety. He had begun a job 3 months earlier and had just been placed on probation for slowness and inattention to detail. This was his third job in three years since completing vocational education.
This patient acknowledged falling behind at work, but could not offer an explanation for this behavior. Although he had experienced an initial enthusiasm for his work, that feeling quickly faded. Subsequently, he found he was having substantial difficulty maintaining focus when he found his work to be “boring.” He agreed that he had a tendency to procrastinate, noting that despite having adequate funds he was behind on his taxes and mortgage. His wife reported that he sporadically abused alcohol and cocaine.
At age 8, he was diagnosed with hyperactive-type attention deficit disorder. Treatment with methylphenidate was successful. Subsequently he maintained adequate academic progress. The methylphenidate prescription was discontinued at age 18 after his high school graduation; his hyperactivity had not reappeared.
This vignette exemplifies an individual whose hyperactivity was successfully treated during childhood and later tolerated discontinuation of stimulant treatment without the recurrence of hyperactivity, but whose other associated cognitive impairments persisted. In adults, attentional disorders can present as apparent laziness, lack of focus, and procrastination. This patient needs a retrial of his ADHD medication.
Attention-deficit/hyperactivity disorder (ADHD) is a common, well-characterized, and very treatable neuropsychiatric disorder surrounded by social and political controversy.
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