Adult ADHD

Adult attention-deficit/hyperactivity disorder (ADHD) is a mental health condition exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior. Adult ADHD symptoms can lead to a number of problems, including unstable relationships, poor work or school performance, and low self-esteem.

ADHD always starts in early childhood, but in some cases it’s not diagnosed until later in life. It was once thought that ADHD was limited to childhood. But symptoms frequently persist into adulthood. For some people, adult ADHD causes significant problems that improve with treatment.

Treatment for adult ADHD is similar to treatment for childhood ADHD, and includes stimulant drugs or other medications, psychological counseling (psychotherapy), and treatment for any mental health conditions that occur along with adult ADHD.

Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) and hyperactivity. But ADHD is the preferred term because it includes the two main aspects of the condition: inattention and hyperactive-impulsive behavior.

Adult ADHD symptoms may include:

• Trouble focusing or concentrating
• Restlessness
• Impulsivity
• Difficulty completing tasks
• Disorganization
• Low frustration tolerance
• Frequent mood swings
• Hot temper
• Trouble coping with stress
• Unstable relationships

Many adults with ADHD aren’t aware they have it — they just know that everyday tasks can be a challenge. Adults with ADHD may find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.

All adults with ADHD had ADHD as children, even if it was never diagnosed. Some people with ADHD have fewer symptoms as they age, while others continue to have significant symptoms as adults.

What’s normal and what’s ADHD?

Almost everyone has some symptoms similar to ADHD at some point in their lives. If your difficulties are recent or occurred only occasionally in the past, you probably don’t have ADHD. ADHD is diagnosed only when symptoms are severe enough to cause ongoing problems in more than one area of your life. These persistent and disruptive symptoms can be traced back to early childhood.

Diagnosis of ADHD in adults can be difficult because certain ADHD symptoms are similar to those caused by other conditions, such as anxiety or mood disorders. And many adults with ADHD also have at least one other mental health condition, such as depression or anxiety.

When to see a doctor

If inattention, hyperactivity or impulsive behavior continually disrupts your life, talk to your doctor about whether you might have ADHD. Because signs of ADHD are similar to those of a number of other mental health conditions, you may not have ADHD — but you may have another condition that needs treatment.

While the exact cause of ADHD is not clear, research efforts continue.

Multiple factors have been implicated in the development of ADHD. It can run in families, and studies indicate that genes may play a role. Certain environmental factors also may increase risk, as can problems with the central nervous system at key moments in development.

You’re potentially at increased risk of ADHD if:

• You have blood relatives (such as a parent or sibling) with ADHD or another mental health disorder
• Your mother smoked, drank alcohol or used drugs during pregnancy
• Your mother was exposed to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy
• As a child, you were exposed to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• You were born prematurely

ADHD has been linked to:

• Poor school performance
• Trouble with the law
• Problems at work
• Alcohol or drug abuse
• Frequent car accidents or other accidents
• Unstable relationships
• Financial stress
• Poor physical and mental health

Although ADHD doesn’t cause other psychological or developmental conditions, a number of other disorders often occur along with ADHD. These include:

• Mood disorders. Many adults with ADHD also have depression, bipolar disorder or another mood disorder. While mood problems aren’t necessarily due directly to ADHD, a repeated pattern of failures and frustrations due to ADHD can worsen depression.
• Anxiety disorders. Anxiety disorders occur fairly often in adults with ADHD. Anxiety disorder may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.
• Personality disorders. Adults with ADHD are at increased risk of personality disorders, such as borderline personality disorder or antisocial personality disorder.
• Learning disabilities. Adults with ADHD may score lower on academic testing than would be expected for their age, intelligence and education.

You’re likely to start by first talking to your family doctor. Depending on the results of the initial evaluation, your doctor may refer you to a specialist, such as a psychologist or psychiatrist.

What you can do

To get ready for your appointment:

• Make a list of any symptoms you’ve had and problems they’ve caused, such as trouble at work, at school or in relationships.
• Make a list of key personal information, including any major stresses or recent life changes you’ve had.
• Make a list of all medications you take, including any vitamins or supplements. Also include the amount of caffeine and alcohol you use, and whether you use street drugs.
• Prepare questions to ask your doctor.

Basic questions to ask your doctor include:

• What are the possible causes of my symptoms?
• What kinds of tests do I need?
• What’s the best treatment?
• What are the alternatives to the primary approach that you’re suggesting?
• I have these other health conditions. How can I best manage them together?
• Should I see a specialist such as a psychiatrist or psychologist?
• Is there a generic alternative to the medicine you’re prescribing?
• Are there any brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask questions anytime you don’t understand something.

What to expect from your doctor

Be ready to answer questions your doctor may ask, such as:

• When do you first remember having problems focusing, paying attention or sitting still?
• Have your symptoms of hyperactivity, inattention or impulsiveness been continuous or occasional?
• Which symptoms bother you most, and what problems do they seem to cause?
• How severe are your symptoms?
• In what settings have you noticed the symptoms: at home, at work or in other situations?
• What was your childhood like? Did you have social problems or trouble in school?
• How is your current and past academic and work performance?
• What are your sleep hours and patterns?
• What, if anything, appears to worsen your symptoms?
• What, if anything, seems to improve your symptoms?
• What medications do you take?
• Do you consume caffeine?
• Do you drink alcohol or use street drugs?

Different types of doctors may diagnose and supervise treatment for ADHD. Seek a provider who has training and experience in caring for adults with ADHD. Psychiatrists, psychologists, family doctors and neurologists may diagnose ADHD, but only psychiatrists and psychologists are likely to provide counseling. Psychologists do not prescribe medication.

Diagnosing ADHD in adults

It can be more challenging to identify ADHD in adults than in children. Signs and symptoms in adults can be hard to spot. No single test can confirm the diagnosis. Your doctor will likely start by doing a physical exam and asking you questions.

Ruling out other conditions

Your doctor or mental health provider will consider whether your symptoms may be caused by something other than ADHD. Conditions that can cause symptoms similar to those caused by ADHD include:

• Mental health disorders. Several mental health conditions can mimic ADHD both in children and in adults, including anxiety disorders, mood disorders, adjustment disorders, learning and language deficits, and psychotic disorders.
• Other health problems. Your doctor may consider a different diagnosis or refer you to a specialist if you have a history of other conditions, such as a developmental disorder, seizures, a thyroid disorder, lead poisoning or low blood sugar (hypoglycemia).
• Drugs and medications. Alcohol or drug abuse and certain medications can cause ADHD-like symptoms.

Evaluating signs and symptoms from childhood

A persistent pattern of signs and symptoms as a child is essential for a diagnosis of adult ADHD. You may have a hard time remembering whether your problems date back to childhood. For that reason, your doctor may ask for your old school records and for information from teachers, parents and anyone else who knew you when you were young. Your doctor may also ask to hear from your spouse, a parent, close friend or someone else who knows you well.

Diagnostic criteria for ADHD

To be diagnosed with ADHD, you must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. You must have six or more signs and symptoms from one or both of the two categories below.

Inattention

• Often fails to give close attention to details or makes careless mistakes in work or other activities
• Often has difficulty sustaining attention in tasks
• Often doesn’t seem to listen when spoken to directly
• Often doesn’t follow through on instructions and fails to finish tasks
• Often has difficulty organizing tasks and activities
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
• Often loses items necessary for tasks or activities
• Is often easily distracted
• Is often forgetful in daily activities

Hyperactivity and impulsivity

• Often fidgets with hands or feet or squirms in seat
• Often leaves the room when remaining seated is expected
• Often is physically active or restless in situations when it’s inappropriate
• Often has difficulty quietly engaging in leisure activities
• Is often “on the go” or often acts as if “driven by a motor”
• Often talks too much
• Often blurts out answers before questions are completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others’ conversations

In addition to having at least six symptoms from these categories, someone with adult ADHD:

• Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present as a child
• Had behaviors that weren’t normal for children the same age who didn’t have ADHD
• Has symptoms for at least six months
• Has symptoms in more than one setting that significantly impair performance at school or work or negatively impact home life or relationships

Other criteria

Because symptoms of ADHD may differ in adults from those in the DSM criteria — especially those listed for symptoms of hyperactive behavior — other criteria more specific to adults are generally used to help confirm a diagnosis.

Your doctor may give you a questionnaire and expanded list of signs and symptoms to help determine whether you have ADHD. In addition, your doctor will carefully examine the impact of your symptoms on your current life — your performance at work or in school and your relationships with friends and family.

Current treatments typically involve medication, psychological counseling or both. A combination of therapy and medication is often the most effective treatment.

Medications

Stimulants (psychostimulants) are the most commonly prescribed medications for ADHD, but other drugs may be prescribed.

• Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. Examples include methylphenidate (Concerta, Metadate, Ritalin, others), dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR), and lisdexamfetamine (Vyvanse). These ADHD medications help treat the signs and symptoms of inattention and hyperactivity — sometimes dramatically. Stimulant drugs are available in short-acting and long-acting forms. One long-acting form is available as a patch that can be worn on the hip.
• Other medications used to treat ADHD include atomoxetine (Strattera) and antidepressants such as bupropion (Wellbutrin). Atomoxetine and antidepressants work slower than stimulants and may take several weeks before they take full effect. These may be good options if you can’t take stimulants because of health problems, because of a history of substance abuse or because of a tic disorder or if stimulants cause severe side effects.

The right medication and the right dose vary between individuals, so it may take some time in the beginning to find what’s right for you. Talk with your doctor about the benefits and risks of medications. And keep your doctor informed of any side effects you may have when taking your medication.

Psychological counseling

Counseling for adult ADHD can be beneficial and generally includes psychological counseling (psychotherapy) and education about the disorder. Psychotherapy may help you:

• Improve your time management and organizational skills
• Learn how to reduce your impulsive behavior
• Develop better problem-solving skills
• Cope with past academic and social failures
• Improve your self-esteem
• Learn ways to improve relationships with your family, co-workers and friends
• Develop strategies for controlling your temper

Common types of psychotherapy for ADHD include:

• Cognitive behavioral therapy. This structured type of counseling teaches specific skills to manage your behavior and change negative thinking patterns into positive ones. It can help you deal with life challenges, such as school, work or relationship problems, and help address other mental health conditions, such as depression or substance abuse. This therapy can be done one-on-one or in a group.
• Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Such counseling can improve communication and problem-solving skills.

Because ADHD is a complex disorder and each person is unique, it’s hard to make recommendations for all adults who have ADHD. But some of these suggestions may help:

• Make a list of tasks to be accomplished each day. Make sure you’re not trying to do too much.
• Break down tasks into smaller, more manageable steps.
• Use sticky pads to write notes to yourself. Put them on the fridge, on the bathroom mirror, in the car or in other places where you’ll benefit from having a reminder.
• Keep an appointment book or electronic calendar to track appointments and deadlines.
• Carry a notebook or electronic device with you so that you can note ideas or things you’ll need to remember.
• Take time to set up systems to file and organize information, both on your electronic devices and for paper documents. Get in the habit of using these systems consistently.
• Follow a routine that’s consistent from day to day and keep items, like keys and your wallet, in the same place.
• Ask for help from family members or loved ones.

Relationships

If you’re like many adults with ADHD, you may be unpredictable and forget appointments, miss deadlines, and make impulsive or irrational decisions. These behaviors can strain the patience of the most forgiving co-worker, friend or partner.

Therapy that focuses on these issues and helps you better monitor your behavior can be very helpful. So can classes to improve communication, conflict resolution and problem-solving skills. Couples therapy and classes in which family members learn more about ADHD may significantly improve your relationships.

There’s little research that indicates that alternative medicine treatments can reduce ADHD symptoms. Before using any alternative interventions, talk with your doctor to determine risks and possible benefits. Some alternative treatments that have been tried but are not yet fully proved scientifically include:

• Yoga or meditation. Doing regular yoga routines or meditation and relaxation techniques may help you relax and learn discipline, which may help you manage your symptoms of ADHD.
• Special diets. Most diets that have been promoted for ADHD involve eliminating foods thought to increase hyperactivity, such as sugar and caffeine, and common allergens such as wheat, milk and eggs. Although studies have not proved a consistent link, some diets recommend eliminating artificial food colorings and additives. If you notice that a certain food causes a change in your symptoms, you may want to try eliminating it from your diet to see if it makes a difference. However, consult with your doctor or dietitian before starting a limited diet. A diet that eliminates too many foods can be unhealthy because it may lack necessary vitamins and nutrients.
• Vitamin or mineral supplements. While certain vitamins and minerals are necessary for good health, there’s no evidence that supplemental vitamins or minerals can reduce symptoms of ADHD. “Megadoses” of vitamins — doses that far exceed the Recommended Dietary Allowance (RDA) — can be harmful.
• Herbal supplements. Talk with your doctor before taking supplements. Scientific evidence on effectiveness is lacking, and some products may damage your health.
• Essential fatty acids. These fats, which include omega-3 oils, are necessary for the brain to function properly. More research is needed to say whether they may improve ADHD symptoms.
• Neurofeedback training. Also called electroencephalographic (EEG) biofeedback, this treatment involves regular sessions in which you focus on certain tasks while using a machine that shows brain wave patterns. Theoretically, you can learn to keep brain wave patterns active in the front of your brain — improving symptoms of ADHD. More research is needed to determine whether this treatment works.

While medication can make a big difference with ADHD, taking other steps can help you understand ADHD and learn to manage it. Some resources that may help you include:

• Support groups. Support groups allow you to meet other people with ADHD so you can share experiences, information and coping strategies. These groups are available in person in many communities and also online.
• Social support. Involve your spouse, close relatives and friends in your ADHD treatment. You may feel reluctant to let people know you have ADHD, but letting others know what’s going on can help them understand you better and improve your relationships.
• Colleagues, supervisors and teachers. ADHD can make work and school a challenge. You may feel embarrassed telling your boss or your professor that you have ADHD, but most likely they’ll be willing to make small accommodations to help you succeed. Ask for what you need to improve your performance at work or school, such as more in-depth explanations or more time on certain tasks.
• ADHD coaches. Coaching is not therapy. An ADHD coach is a paid guide who will give you individual advice and support in facing the challenges of living with this disorder. Your coach may help you by suggesting practical skills and concrete steps you can take to achieve your goals. There is no scientific evidence on ADHD coaching effectiveness, so it’s important that you work with someone who is willing to collaborate with your health care team. If you choose this option, ask your health care team for advice on how to interview potential coaches and what training and expertise they should have.

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