What is it?
- Adult attention-deficit/hyperactivity disorder (adult ADHD) is a mental health condition that causes inattention, 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 can persist into adulthood.
ADHD has been called attention-deficit disorder (ADD) and hyperactivity. But attention-deficit/hyperactivity disorder is the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.
Adult ADHD symptoms can include:
- Trouble focusing or concentrating
- Difficulty completing tasks
- Frequent mood swings
- Hot temper
- Trouble coping with stress
- Unstable relationships
Many adults with ADHD aren't aware they have the disorder — they just know that everyday tasks can be a real challenge. Many adults with ADHD find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social engagements. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings, outbursts of anger and troubled relationships. Many adults with ADHD have a history of problems at school and at work.
All adults with ADHD had ADHD as children, even if it was never diagnosed. About 1 in 3 people with ADHD grows out of symptoms; about 1 in 3 continues to have symptoms that are less severe as adults; and about 1 in 3 continues to have significant symptoms as adults.
What's normal, and what's ADHD?
At some point in life, virtually everyone has some or all of the symptoms for ADHD. Some people simply have personalities with certain characteristics common with ADHD. But ADHD is diagnosed only when symptoms are severe enough to cause ongoing problems in multiple areas of your life. In adults with ADHD, these persistent and disruptive symptoms can be traced back to early childhood. If your difficulties are recent or occurred only occasionally in the past, you're not considered to have ADHD.
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. To make it even more challenging, half of adults who have ADHD also have at least one other diagnosable mental health condition, such as depression or anxiety.
While the exact cause of ADHD remains a mystery, it increasingly appears that structural changes in the brain are linked to the disorder. Here are several factors that may play a role in developing ADHD:
- Altered brain function and anatomy. Brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, people with ADHD appear to have less activity in the area of the brain that controls attention than people who don't have ADHD.
- Inherited traits. ADHD can run in families.
- Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke, drink alcohol or use drugs are at increased risk of having children with ADHD. Likewise, women exposed to environmental poisons during pregnancy — such as polychlorinated biphenyls (PCBs) — may be more likely to have children with symptoms of ADHD.
- Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span.
How is Adult ADHD Diagnosed?
It can be more challenging to identify ADHD in adults than in children. The 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 a number of questions.
For a diagnosis of ADHD, you must have six or more signs and symptoms from one or both of the two categories below:
- 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 does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish work or other duties (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
- Often loses things 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 sea
- Often leaves the room in situations in which remaining seated is expected
- Often physically active in situations in which it is inappropriate
- Often has difficulty engaging in leisure activities quietly
- Is often "on the go" or often acts as if "driven by a motor"
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (for example, butts into conversations or games)
In addition to having at least six symptoms from one of the two categories, someone with adult ADHD:
- Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present before age 7
- 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 that hurt school, work, home life or relationships in more than one setting
The best treatment for ADHD is still a matter of debate. Current treatments typically involve medication, psychological counseling or both. A combination of therapy and medication is often the most effective treatment.
Stimulants (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters.
These ADHD medications help treat the core signs and symptoms of inattention and hyperactivity — sometimes dramatically. However, effects of the drugs can wear off quickly, especially if you take a short-acting type rather than a long-acting type of stimulant. The right dose varies between individuals, so it may take some time in the beginning to find the dose that's right for you. Stimulants used to treat ADHD include:
- Methylphenidate (Ritalin)
Stimulant drugs are available in short-acting and long-acting forms.
- The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours.
- Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean you won't need to take medication as often, it can take up to three hours to start working.
Side effects of stimulants can include insomnia, anorexia, nausea, decreased appetite, weight loss, headache, increased blood pressure, faster pulse, abdominal pain and shifting moods. In some people, stimulants may cause involuntary muscle movements of the face or body (tics). Rarely, they cause seizures, high blood pressure (hypertension), delusions (psychosis) or liver problems. For most people, these medications are considered a safe long-term treatment for adult ADHD. If you have certain conditions, including high blood pressure, heart disease, or problems with alcohol or drug use, your doctor may start your treatment with a nonstimulant medication.
Other medications sometimes used to treat ADHD include:
- Antidepressants such as bupropion and venlafaxine (Effexor)
Atomoxetine and antidepressants work more slowly than stimulants and may take several weeks before they take full effect. These medications may be a good option if you can't take stimulants because of health problems, have a history of substance abuse or have a tic disorder or if stimulants cause severe side effects. Bupropion or venlafaxine may be a good choice if you have a mood disorder along with ADHD.
- Side effects of atomoxetine can include nausea, decreased appetite, insomnia, slightly increased blood pressure and heart rate, decreased sex drive (libido), sweating, and painful urination.
- Side effects of bupropion can include headache, nausea, dry mouth, insomnia, sweating, anxiety and constipation. These side effects may improve as your body adjusts to the medication. In rare cases, bupropion can cause seizures. Bupropion causes fewer sexual side effects than atomoxetine and most other antidepressants. Higher doses of bupropion have been associated with seizures.
- Side effects of venlafaxine and other commonly prescribed antidepressants can include nausea, loose bowel movements, headache and insomnia. These will likely improve as your body adjusts to the medication. For many people the most bothersome side effect is a decrease in sexual desire or ability, which may not improve. High doses of venlafaxine can increase blood pressure.
Adults with ADHD often benefit from counseling. Counseling for adult ADHD also generally includes psychological counseling (psychotherapy) and education about the disorder (psychoeducation). Counseling can help you and your family members understand why ADHD occurs, how it affects your life and relationships, and how treatment works.
Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that are right for every adult. But some of the following suggestions may help:
- Make a list of tasks to be accomplished each day. Make sure you're not trying to do too much.
- 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 will benefit from having a reminder or information.
- Keep an appointment book or planning calendar to track appointments and deadlines. You may want to use an electronic personal digital assistant (PDA).
- Carry a notebook with you so you can write down ideas or things you'll need to remember.
- Take time to set up systems to file and organize information, both on the computer and for paper documents. Get in the habit of using these systems consistently.
- Break down tasks into smaller, more manageable steps.
- Ask for help from family members or loved ones.
- Follow a routine that's consistent from day to day.
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. Support 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 teacher you have ADHD, but most likely they'll be happy to make small accommodations to help you succeed. Ask for what you need to improve your performance at work or at school (such as more in-depth explanations or more time on certain tasks).