ebook_ADHD2019

50 Rohde, Buitelaar, Gerlach & Faraone nically relevant symptoms as they enter into adulthood. Reduction of hyperactive/ impulsive symptoms is more significant than that of inattentive symptoms (remis- sion in 70 vs. 40% of individuals, respectively). 4 Thus, the most frequent presenta- tion found in adults is ADHD with predominantly inattentive symptoms. Among the challenges in characterizing ADHD in older individuals, there is the failure of the symptom descriptions (especially the hyperactivity/ impulsivity symptoms) to capture developmental specific adult focused clinical manifestations. There are also difficulties associated with assessing retrospectively the presence of symptoms in childhood. 15 In addition, the clinical picture in adults might be also characteri- zed by symptoms related to executive dysfunctions and emotional impulsivity. Sin- ce adults might present substantial impairment even with lower number of symp- toms in any of the two dimensions (inattention and/or hyperactivity/impulsivity), a lower symptom threshold for the diagnosis in adults was proposed by the DSM-5. Considering the lack of reliability for assessing ADHD childhood symptoms re- trospectively in adults and recent findings suggesting a considerable prevalence of late-onset cases among adult individuals with ADHD in population samples, 7 clinicians should put most emphasis when assessing adults for ADHD in a care- ful characterization of the symptom profile, sustained chronic course and level of impairment associated with ADHD symptoms, and in ruling out other conditions that better explain current inattentive, executive deficit and impulsivity symptoms. It is also important to recognize that core ADHD symptoms might have a dif- ferent “dressing” in adulthood. Thus, hyperactivity in adults often manifests itself as inner restlessness or agitation, a sense of continuous restlessness, not being able to relax properly or needing alcohol or drugs to relax or to sleep. Hyperactivity can in the short term be constantly compensated by frequent sporting activities, or constantly finding something to do. Hyperactivity sometimes also manifests itself in excessive talking, an inability to stop talking or carrying out activities, or rattling on and on. ADHD is also described as ‘the brake is off ’, which is recognized by a lot of patients with hyperactivity. 16 It is not uncommon in adulthood for attention problems and impulsivity to be more prominent than hyperactivity. A very prominent symptom is feeling quickly impatient or irritable when waiting in queues or traffic jams. Impulsive behavior might manifest as acting without thinking or in blurting things out, spending too much money or spending it too quickly, carrying out plans immediately, resigning from jobs in a flurry, starting relationships quickly, and not being able to postpo- ne the gratification of needs. These behaviors often have consequences for rela- tionships with other people and with employers, as well as for a person’s financial situation. Impulsive binges also frequently occur, often to combat restlessness or because of an inability to postpone the gratification of needs. Binge eating may explain why adults with ADHD often suffer from excess weight. 16 Closely related to impulsivity is the phenomenon of ‘sensation- seeking’, ‘no- velty-seeking’ or seeking out excitement. This phenomenon manifests itself in the