Attention-deficit/hyperactivity disorder (ADHD) was first described 100 years ago by Still and has been known as hyperactivity, hyperkinesis disorder of childhood, or minimal brain dysfunction (Seidman, Valera, & Bush, 2004). Still (1902) suggested that the symptoms were a result of a lack of moral control and the failure of the individual to conform to the environmental expectations for behavior. At that time, the factors that contributed to this form of moral failure were unidentifiable, but Still speculated, "That there are cortical changes . . . seems almost certain from our knowledge of these conditions" (p. 1012). In the 1920s, physicians noted that there was a relationship between neurological impairment, such as that caused by cerebral trauma, and behavior disorders (Strother, 1973). This relationship set the stage for symptoms of ADHD to be considered as a reflection of a neurobiologicalbased disorder (Doyle, 2004). Researchers began to examine hyperactivity and impulsivity in children and adults as a neurological disorder of the frontal lobe (Quinn, 1995).
Recent advances in the methods of identifying and treating ADHD among adults have been the result of advances in research focused on the role of cognitive impairment in the constellation of symptoms that define ADHD (Doyle, 2004). The focus on the neurobiological features of adult ADHD has advanced understanding of the functional implications of this disorder and aided in the development of effective assessment and counseling treatment strategies for adults with ADHD. The purpose of this article is to review for counselors the recent advances in pathophysiology research, evaluation strategies, and counseling treatment of ADHD among adults. This article highlights research from the literature of neuropsychology and counseling in order to describe the neurological impairments that are a central feature of ADHD among adults and to describe the impact of these impairments on psychosocial functioning. The clinical application of this research to the assessment and treatment of ADHD is described in order to promote evaluation and intervention strategies that counselors may use to address both the neurological dysfunction and psychosocial deficits characteristic of ADHD.