Professionally successful adults with attention-deficit/hyperactivity disorder (ADHD): Compensation strategies and subjective effects of pharmacological treatment

Adultos bem sucedidos profissionalmente com transtorno de déficit de atenção/hiperatividade (TDAH): Estratégias de compensação e efeitos subjetivos do tratamento com metilfenidato.

Abstract

Although as a group, adult patients with ADHD have difficulties in social functioning due to inattention and executive dysfunction, some strive and succeed in living a productive, independent life. Purpose: To report on professionally successful adults with ADHD and analyze their main symptoms, compensation strategies and the subjective effect of methylphenidate on their functioning. Methods: The main symptoms of five patients with ADHD who are University educated and financially independent are reported. These patients were selected from a personally followed cohort of adults with ADHD. All were diagnosed according to DSM-IV adapted criteria (K-SADS E, version 6.0) and completed the Portuguese translated version of the ADHD adult self-reporting scale (ASRS). Results: Main reported symptoms included difficulties with attention, tendency to procrastinate and to 'shuffle' priorities, excessive daytime somnolence, memory difficulties and impulsiveness. Compensation strategies revolve around conscious, 'energy demanding' and time consuming efforts to control and circumvent symptomatic behavioral tendencies. They feel methylphenidate helps by alleviating the need to constantly apply compensation strategies for socially disabling symptoms. In sum, they achieve the same results in a more natural, less effortful fashion. Conclusions: Adults with ADHD may succeed professionally despite significant symptoms of inattention and executive dysfunction. They do so by appropriately using effortful strategies of compensation, the need for which is alleviated by the use of methylphenidate. These subjective reports require confirmation in prospective studies on larger series of patients.

Key words:
Neuropsychological tests; attention-deficit/hyperactivity; executive dysfunction; treatment

Resumo

Embora a maior parte dos pacientes adultos com TDAH apresentem dificuldades no seu funcionamento profissional, alguns conseguem ser bem sucedidos e levam uma vida produtiva e independente. Objetivo: Relatar adultos com TDAH profissionalmente bem sucedidos e analisar seus principais sintomas, suas estratégias para compensar estes sintomas e os efeitos subjetivos do metilfenidato no seu funcionamento. Métodos: São relatadas as histórias clínicas de cinco pacientes com TDAH que completaram um curso superior e são financeiramente independentes, selecionados ao acaso a partir de uma coorte de adultos com TDAH. Todos foram diagnosticados segundo critérios do DSM-IV adaptados para adultos (K-SADS E, versão 6.0) e completaram a versão adaptada para o português do adult self-report scale (ASRS) para sintomas de TDAH. Resultados: Os principais sintomas relatados incluíram dificuldades com atenção, tendência a procrastinar e 'embaralhar' as prioridades, sonolência diurna excessiva, dificuldades de memória e impulsividade. As estratégias de compensação utilizadas giram em torno de esforços conscientes, que demandam um alto nível de 'energia' e tempo, para controlar e 'driblar' tendências comportamentais inadequadas. A impressão subjetiva relatada é de que o metilfenidato reduz a necessidade de aplicar as estratégias de compensação e os mesmos resultados são obtidos de uma forma mais natural, com menos esforço. Conclusões: Adultos com TDAH podem ser bem sucedidos socialmente, apesar de sintomas importantes de dificuldades atencionais e disfunção executiva. Eles conseguem ser bem sucedidos por utilizarem estratégias de compensação que demandam vigilância constante. Este pacientes relataram que a necessidade destas estratégias é algo aliviada pelo uso de metilfenidato, embora este possível mecanismo deva ser confirmado em estudos prospectivos de séries maiores de pacientes.

Palavras-chave:
Testes neuropsicológicos; déficit de atenção/hiperatividade; disfunção executiva; tratamento

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Publication Dates

• Publication in this collection
  Jan-Mar 2008

History

• Received
  04 Feb 2008
• Reviewed
  20 Feb 2008
• Accepted
  27 Feb 2008