ADHD in Adults

 

Adult attention-deficit/hyperactivity disorder (ADHD) is a mental health disorder that includes a combination of persistent problems, such as difficulty paying attention, hyperactivity and impulsive behavior. Adult ADHD can lead to unstable relationships, poor work or school performance, low self-esteem, and other problems.

Though it's called adult ADHD, symptoms start in early childhood and continue into adulthood. In some cases, ADHD is not recognized or diagnosed until the person is an adult. Adult ADHD symptoms may not be as clear as ADHD symptoms in children. In adults, hyperactivity may decrease, but struggles with impulsiveness, restlessness and difficulty paying attention may continue.

Treatment for adult ADHD is similar to treatment for childhood ADHD, though some ADHD medications approved for children are not approved for adult use. Adult ADHD treatment includes medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with ADHD.

Symptoms

 

Some people with ADHD have fewer symptoms as they age, but some adults continue to have major symptoms that interfere with daily functioning. In adults, the main features of ADHD may include difficulty paying attention, impulsiveness and restlessness. Symptoms can range from mild to severe.

 

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.

Adult ADHD symptoms may include:

  • Impulsiveness

  • Disorganization and problems prioritizing

  • Poor time management skills

  • Problems focusing on a task

  • Trouble multitasking

  • Excessive activity or restlessness

  • Poor planning

  • Low frustration tolerance

  • Frequent mood swings

  • Problems following through and completing tasks

  • Hot temper

  • Trouble coping with stress

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.

Causes

 

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:

  • Genetics. ADHD can run in families, and studies indicate that genes may play a role.

  • Environment. Certain environmental factors also may increase risk, such as lead exposure as a child.

  • Problems during development. Problems with the central nervous system at key moments in development may play a role.

 
Risk factors

 

Risk of ADHD may increase 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

  • 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

Complications

 

ADHD can make life difficult for you. ADHD has been linked to:

  • Poor school or work performance

  • Unemployment

  • Trouble with the law

  • Alcohol or other substance abuse

  • Frequent car accidents or other accidents

  • Unstable relationships

  • Poor physical and mental health

  • Poor self-image

  • Suicide attempts

Coexisting conditions

 

Although ADHD doesn't cause other psychological or developmental problems, other disorders often occur along with ADHD and make treatment more challenging. 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 disorders may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.

  • Other psychiatric disorders. Adults with ADHD are at increased risk of other psychiatric disorders, such as personality disorders, intermittent explosive disorder and substance abuse.

  • Learning disabilities. Adults with ADHD may score lower on academic testing than would be expected for their age, intelligence and education.

  • Learning disabilities can include problems with understanding and communicating.

Signs and symptoms of ADHD in adults can be hard to spot. However, core symptoms start early in life — before age 12 — and continue into adulthood, creating major problems.

No single test can confirm the diagnosis. Making the diagnosis will likely include:

  • Physical exam, to help rule out other possible causes for your symptoms

  • Information gathering, such as asking you questions about any current medical issues, personal and family medical history, and the history of your symptoms

  • ADHD rating scales or psychological tests to help collect and evaluate information about your symptoms

 
Other conditions that resemble ADHD

 

Some medical conditions or treatments may cause signs and symptoms similar to those of ADHD. Examples include:

  • Mental health disorders, including mood disorders such as depression or anxiety, conduct disorders, learning and language deficits, or other psychiatric disorders

  • Medical problems that can affect thinking or behavior, such as a developmental disorder, seizure disorder, thyroid problems, sleep disorders, lead poisoning, brain injury or low blood sugar (hypoglycemia)

  • Drugs and medications, such as alcohol or other substance abuse and certain medications

Standard treatments for ADHD in adults typically involve medication, education, training and psychological counseling. A combination of these is often the most effective treatment. These treatments can relieve many symptoms of ADHD, but they don't cure it. It may take some time to determine what works best for you.

Medications

 

Talk with your doctor about the benefits and risks of any medications.

  • Stimulants, such as products that include methylphenidate or amphetamine, are typically 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.

  • Other medications used to treat ADHD include the nonstimulant atomoxetine (Strattera) and certain antidepressants such as bupropion (Wellbutrin, others). Atomoxetine and antidepressants work slower than stimulants do, but these may be good options if you can't take stimulants because of health problems or a history of substance abuse or if stimulants cause severe side effects.

 

The right medication and the right dose vary among individuals, so it may take time to find out what's right for you. Tell your doctor about any side effects.

 
Psychological counseling

 

Counseling for adult ADHD generally includes psychological counseling (psychotherapy), education about the disorder and learning skills to help you be successful.

 

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, work or 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.

  • 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.

 
Working on 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 ways to better monitor your behavior can be very helpful. So can classes to improve communication and develop conflict resolution and problem-solving skills. Couples therapy and classes in which family members learn more about ADHD may significantly improve your relationships.

 
Alternative medicine

 

There's little research to indicate that alternative medicine treatments can reduce ADHD symptoms. However, one recent study indicates that mindfulness meditation may help improve mood and attention in adults who have ADHD, as well as those who don't have ADHD.

Before using alternative interventions for ADHD, talk with your doctor about risks and possible benefits.

 
When to see a doctor

 

If any of the symptoms listed above continually disrupt your life, talk to your doctor about whether you might have ADHD.

Different types of health care professionals may diagnose and supervise treatment for ADHD. Seek a provider who has training and experience in caring for adults with ADHD.

Dean

Freedlander MD

San Francisco   415.399.0642
            San Jose    408.882.3988
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