ADHD in Adults
It is estimated that 60% of children diagnosed with ADHD continue to experience symptoms as adults.
As professionals, we have the potential to make a huge difference to ADHD adults’ life chances. We have a responsibility to develop our knowledge and skills in order to give those we care for the best possible outcomes.
Why it Matters
Adults with ADHD experience higher rates of relationship problems, social isolation, accidents, addictive behaviour, financial difficulties and under-achievement. They are also at greater risk of committing crime and of developing mental health problems such as anxiety, depression, and alcohol and drug addiction.
What Help do ADHD Adults Need?
Adults will fall into three groups.
The first group are those who were diagnosed as children, and accept and understand their condition. Their need is likely to be for continuing treatment and support to maintain their levels of functioning and help them cope with different stages in their lives.
The second group are those who were diagnosed as children but have been in denial, abandoning treatment as they grew up and only now returning to seek help. Their immediate need is for information and guidance as they begin to accept the condition and start treatment for its symptoms.
The third group are people who present for the first time with symptoms as adults struggling to function effectively. They will need an accurate diagnosis, followed by information, treatment and ongoing support.
NICE recommends that mental health trusts set up separate adult support services, run by specialist teams experienced in the diagnosis and management of ADHD.
Symptoms of ADHD in Adults
Adults with ADHD don’t all experience the same symptoms in the same way, but there is a lot of common ground. Typically, they feel restless, and struggle to sit still even in situations that others find relaxing. Their minds are always on the go, but they can’t focus their ideas, which tend to come as a constant flow of short-lived, random and unconnected thoughts.
Mood swings are common, and can happen from minute-to-minute, with frustration, impatience and anger cutting in without warning – and then vanishing as quickly. Despite high levels of activity, people with ADHD find it hard to complete tasks, even small ones such as household chores. Instead, they flit between tasks, moving on to another before the first is finished. They can easily forget what they were meant to be doing. They find it hard to judge and manage time, leaving tasks till the last minute and frequently being late.
Regardless of their IQ level, ADHD adults have often underachieved at school because of their difficulties in handling classroom situations, fitting into school routines, and focusing on work.
Difficulties in coping and feelings of inadequacy from childhood often contribute to feelings of low self-esteem. ADHD adults tend to report that they feel different from others, and that they feel misunderstood. This can lead to social isolation.
It’s easy to dismiss the symptoms, because none are unique to ADHD sufferers. Most of us forget things, run late, get bored, lose motivation, get distracted or act on impulse sometimes. For those with ADHD however, these experiences are constant and define how they live their chaotic lives. ADHD adults have been ADHD children – they don’t know of any other life.
The Positive Side
ADHD adults can often be seen as the life and soul of the party, talkative and full of energy. Many are able to ‘hyperfocus’, concentrating for hours on something they are really engrossed in. Enjoying risk, they can thrive in situations where others might flounder.
ADHD Adults at Work
People with severe ADHD often struggle to settle into jobs, flitting from one to another. They can find it hard to meet deadlines, remember responsibilities, and complete work. Impulsive behaviour and mood swings make for awkward social interactions; and work relationships can be strained. Team working is difficult. Where ADHD is not so severe, however, high energy and the ability to hyperfocus can be a great advantage. There are very many highly successful people who demonstrate these traits – but need someone else to do the filing!
ADHD Adults in Relationships
Relationships are likely to pose challenges for people with both mild and severe ADHD.
A hyperfocus on the present task with a constant search for the next high-energy project may lead to success at work, but isn’t so useful at home where partners tend to value stability and an equal contribution to mundane household tasks. When ADHD people fail to spot and understand social cues, or can’t focus on giving attention to another person, they can often be seen as rude or uncaring.
Seeking stimulation, some ADHD adults actively seek out partners who are ‘bad’ for them. Where they do find calmer partners, it’s not unusual for them to provoke arguments and fights, just for interest.
Relationships are put under pressure by daily frustrations over constant lateness and broken promises, and by more serious issues such as debt caused by impulsive overspending and the inability to manage money. Grand projects are frequently announced and then forgotten, whilst the partner finds themselves adopting a parent role as they try to get the ADHD person organised.
Diagnosis of Adult ADHD
Diagnosing ADHD in adults is difficult because so many of the symptoms can arise as a result of a wide range of psychological and physiological conditions. Diagnosis therefore can’t be made by GPs, who should refer people to mental health services for a specialist assessment. Interviews and questionnaires are used to assess the person’s current and past behaviour, and information is also sought from family or close friends.
An ADHD diagnosis can be a great relief. It gives people a reason for how they are, a starting point for understanding how to cope with the symptoms, and the potential for medication and support that can make a huge difference.
When ADHD is Missed
There are likely to be a number of people in the mental health and criminal justice systems suffering from undiagnosed ADHD. The main reasons for this are as follows:
- The symptoms are easily confused with those of a wide range of mental health conditions.
- Living with ADHD can lead people to suffer mental health problems including anxiety and depression.
- Problems arising from drug and alcohol abuse can hide the fact that someone may be suffering from ADHD.
- The ADHD traits of impulsive behaviour, need for excitement and sudden outbursts of temper can lead people into a downward spiral of criminal behaviour.
Unless the possibility of ADHD is thoroughly investigated, people risk receiving inappropriate and unsuccessful treatments throughout their lives, or of their symptoms being dismissed as untreatable personality problems. For people in all these groups, a diagnosis of ADHD and subsequent therapy can be the starting point of a journey back to normal life.
It is therefore vitally important that professionals working in these sectors understand the symptoms and implications of ADHD, and suggest referrals for assessment whenever behaviour and symptoms suggest that ADHD could be involved.
We do still have a major problem in the UK in that many doctors and psychiatrists have not been fully trained in how to recognise ADHD. NICE guidance however clearly states that health trusts should ensure that they are providing sufficient appropriately-trained specialists,
Treatment for Adult ADHD
Medication
Around 65% of adults report significant improvements as a result of taking medication for their symptoms. Typically, people say they feeling calmer and more focused, with fewer mood swings and less anxiety. This allows them to finish tasks that require sustained effort, make decisions about how to manage their time, and relax. They find it easier to make friends, and to sustain jobs and relationships.
The most effective and widely used treatments are the stimulants methylphenidate (Ritalin, Eqasym, Concerta) and dexamphetamine (Dexedrine). A non-stimulant drug called atomoxetine (Stratera) is also used.
Talking Therapies
Psychological treatments are increasingly being used to treat ADHD symptoms. A number of health trusts are now providing group cognitive behavioural therapy sessions, following NICE guidance that the small amount of evidence available indicates these are likely to be beneficial.
Many ADHD adults benefit greatly from mutual support groups, where they can share experiences knowing they will be understood, learn how others have coped with similar issues, and discover how to make the best of their strengths. Taking part in these groups can make a huge difference to an individual’s quality of life. A trained and knowledgeable facilitator can increase the effectiveness of a group.
A further development is the growth of the idea of ADHD coaching, giving individuals one-to-one or group support as they work on particular issues and challenges.
Talking therapies can be sufficient on their own for people with mild symptoms, and can be used in combination with medication in more severe cases.
New! Making Sense of Adult ADHD
The Supporting Adults with ADHD Programme
Following the success of our Making Sense of Adult ADHD programme with the ADDing to Life adult support group, we are ready to share this programme with practitioners supporting adults with ADHD.
For more information on Making Sense of Adult ADHD, please e-mail us at
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