There has been a recent surge in recognizing, diagnosing and treating adults who have adhd. The traditional belief is that one grows out of adhd and stimulant medications (e.g., Ritalin® (methylphenidate), Cylert® (pemoline). These cause harm that outstrips the benefit when used in adults. As well, adults are presumed to have learned appropriate behaviours and can cope with adhd more effectively. But that view is under some reconsideration, particularly with problem gamblers, as some studies have shown a possible association between problem gambling and adhd (Goldstein et al., 1985, Carleton et al., 1987; Carlton and Manowitz, 1992; Rugle and Melamed, 1993).

Studies show around 20% of (a sample of 40) pathological gamblers had adhd and another 18% had some symptoms while not qualifying for a full diagnosis (Specker et al., 1995). There has been some observation that men with adhd tend to be hyperactive and impulsive, and women tend to be more inattentive. However, these differentiations remain controversial, as a recent report found no such differences (personal communication, APA Conference, 2000).

Clinically, it may be understandable that people with ADHD would find the fast-paced, highly stimulating, consistently structured nature and environment of gambling attractive and conducive to their short attention spans and easily distracted tendencies. It can be hypothesized that those clients with ADHD are particularly easily drawn to fast-paced, quickly rewarded forms of gambling (e.g., video gambling). Careful inquiry of the nature of their gambling may help to clarify this diagnosis.

Psychiatric experts are still divided in their opinions on whether pharmacological ADHD treatment’s benefits outweigh the potential harm. The decision will remain largely a personal one, as there are many strong believers on this issue. Some see it as a drug to be abused; others as a cure.

Stimulant medications such as Ritalin® and Dexedrin® have been proven to be most effective. However, they may have some side-effects such as cardiac arrhythmia, sleep disturbance, anorexia and abuse potential.

The current treatment trend is to use medication that has fewer side effects (e.g., SSRI has the potential of becoming a first-line treatment).

Note that a client’s subjective positive response to the use of stimulant medications is not a reliable indicator of adhd, as it is common for those without adhd to experience some improvement in energy, alertness and concentration after taking stimulant medications.

When to Refer for a Psychiatric Assessment

• when the diagnosis is unclear, needing more sophisticated diagnostic process and instruments
• when the medication is ineffective or needs re-evaluation or adjustment
• when the client would like to know about more recent developments in treatment for ADHD
• when the family needs psychoeducation about the disorder and advice on how to cope with a hyperactive family member who gambles.

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