Attention deficit hyperactivity disorder is often associated with children, but some adults also deal with it.
Adults with the disorder may feel impulsive or have a hard time sitting still and completing tasks. It may go undiagnosed because people think it is the person’s fault, not a disorder.
Dr. Elias K. Shaya, regional medical director and senior associate executive director for behavioral health services at MedStar Health, talks about the disorder in adults.
What is adult ADHD?
Attention deficit hyperactivity disorder is a developmental disorder or condition that starts in childhood and may persist into adulthood in approximately half the individuals who experience it as children. It causes difficulties characterized by emotional, intellectual, behavioral and physical symptoms.
Those symptoms cause a child or an adult to have significant difficulty with:
- Maintaining their attention on a given task such as listening without being distracted;
- Being able to be organized at an age-appropriate level, such as excessively losing their things;
- Being impulsive and impatient, such as intruding into other people’s activities, interrupting others and having difficulties in waiting for their turn.
- Being physically hyperactive such as running around, moving excessively, fidgeting in place and being restless.
Do most adults who get it also have it as children?
The standard of making the diagnosis of ADHD is based on a textbook that is published by the American Psychiatric Association. With a few exceptions, making the diagnosis of ADHD requires that the individual had exhibited some manifestations of this condition in childhood, before the age of 12.
How is adult ADHD different than pediatric ADHD?
There are a few differences in the way ADHD manifests itself in children as opposed to adults; those include differences in some of the symptoms as well as the way those symptoms affect a person at the different stages of life. While ADHD may cause academic challenges for a child, in an adult, it would impact their work performance, career progress or interpersonal relationships. Another example would be impulsivity. A child may dart into the street without looking, whereas an adult may impulsively take a new job without adequate information.
What are the symptoms?
The two broad categories that ADHD symptoms manifest themselves are inattention and hyperactivity.
Some of the inattention symptoms include making careless mistakes and difficulty remaining focused on a given task, concentrating and following what other people are saying to them, even when they are speaking to them directly. Symptoms also include putting off getting started on a project or being able to finish and wrap up final details once the challenging parts are already completed. Other inattentive symptoms include misplacing things at work or home, being easily distracted by noises and frequently forgetting appointments and important obligations.
Some of the hyperactivity symptoms include frequently feeling restless, fidgety, frequently squirming or moving their hands and feet while sitting, or leaving their seats in meetings when they would be expected to remain seated. Other symptoms include feeling hyper and unable to wind down or relax, feeling like one is “driven by a motor,” being impatient and unable to wait their turn, talking excessively in social settings, interrupting others and finishing their sentences for them, or blurting out answers before the question is even completed.
Patients who struggle with ADHD also have difficulty with low frustration tolerance, easy irritability and moodiness, and have a tendency to seek immediate gratification, which leads them to make impulsive decisions and engage in risky behavior.
What tasks do adults with ADHD have trouble performing?
Adults with ADHD may struggle with getting started on projects that require them to plan and get organized, while they may impulsively get started on other projects but quickly lose interest and leave them unfinished. They frequently find themselves with many started but unfinished projects. Adults with ADHD frequently find themselves causing tension in relationships with others in social or work settings as they may frequently cut other people off and reach impulsive conclusions without enough patience for adequate deliberations. Another challenge includes daydreaming that leads to distractibility and forgetfulness and making careless mistakes, especially on detailed-oriented tasks that are past the main challenge.
How is it treated?
Depending on severity and the other particulars of each individual, adult ADHD may be treated with medications, a particular type of psychotherapy, or a combination of both.
The category of medication that has the most research evidence to support its efficacy in adult ADHD is called stimulants. These include various preparations and formulations of amphetamine and methylphenidate. A non-stimulant medication that is approved by the FDA for treatment of ADHD is called atomoxetine.
Additionally there are other medication options that are not approved by the FDA for the treatment of adult ADHD but that have been proven in some research studies to be effective; this is what we call “off-label prescribing.” Those include medications that are known antidepressants such as bupropion and desipramine. Other medications that have been found effective for ADHD in children include clonidine and guafacine. However, according to some of the research studies, those were not found to be effective in adults.
The specific type of psychotherapy associated with the most research evidence for efficacy in adult ADHD is cognitive behavioral therapy, with particular attention to executive function difficulties. This can help the patient develop skills to deal with the disorder such as:
- Consistent use of planners and timers;
- Creating and maintaining a filing system – digital or paper;
- Keeping track of tasks and task completion;
- Improving awareness of time and deadlines;
- Awareness of short term and long term goals;
- Breaking down big projects or tasks into smaller steps to help avoid procrastination.
Why does it often go undiagnosed?
Unfortunately, like all psychiatric disorders and in addition to physical symptoms, ADHD causes symptoms and dysfunction in our emotions, thoughts or behavior. It is then frequently misperceived as an individual’s fault or personal attribute rather than a manifestation of an illness. So a person is frequently accused of being “lazy” or “uninterested.” A person with ADHD whose most severe symptoms may be controlling their hyperactivity, restlessness, impatience or impulsivity may then be criticized by others for those challenges, which are then used as attributes of that person rather than symptoms of their illness. Frequently the person may have the same perception of themselves and that frequently leads to discouragement and isolation without being aware that this is a diagnosable and treatable condition. Furthermore, the stigma associated with the “so-called” mental illnesses discourages people from seeking the help they need.