A Brief Overview:

ADHD in Adults

Attention Deficit Hyperactivity Disorder

J.Patrick Bertroche DO

B Lehmann MS-III

What is ADHD?

ADHD in adults is a real and treatable medical condition. Common characteristics of ADHD include inattentive, impulsive, and hyperactive behaviors. Adults with ADHD can experience one of these symptoms, while others may experience all of them. The symptoms of ADHD can impact everyday life—at home, at work, and socially.

Over the years, the term "Attention Deficit Disorder" or "ADD" has been used to describe the condition. While some still refer to it as ADD, this term is no longer in widespread use. ADHD is the clinical term most medical experts use today as it most accurately describes all aspects of the condition.

One of the common misconceptions about ADHD is that it occurs only in children. But the truth is, ADHD can affect people of all ages—children, adolescents, and adults. It's estimated that in the United States alone, nearly 8 million adults have ADHD. The condition affects both men and women, including adults from all races and cultural backgrounds.

ADHD is thought to be a biological condition that affects certain types of brain functioning. The exact cause of ADHD is still unknown, but scientists have focused their research on the brain's chemical messengers dopamine and norepinephrine. These messengers are believed to play a role in behaviors like attention and movement.

Much like height or eye color, ADHD can be inherited. Studies suggest that 76% of ADHD is linked to family genetics. So the condition is more common among people who have a close relative with ADHD. Interestingly, many adults don't even realize they have ADHD until their own child is diagnosed with ADHD.

ADHD can be successfully managed. In fact, many successful adults have ADHD, including CEOs and Olympic athletes. The symptoms of ADHD can be effectively managed with treatments like Concerta, Adderall, Ritalin and Methylphenidate as part of a total treatment program. If you've been diagnosed with ADHD, ask your healthcare professional about managing the everyday challenges of ADHD.

ADHD signs and symptoms

You get distracted at work—your child has trouble paying attention at school. You forget to pay your bills—your child forgets to do chores. They symptoms of ADHD may affect you differently, but the cause may be the same. Like your child, it's possible that you could have ADHD.

The core ADHD symptoms of inattention, hyperactivity, and impulsivity behavior are the same for adults as for children. But these symptoms are often more subtle in adults. Hyperactivity, in particular, is generally less common in adults. While children with ADHD may be in constant motion, adults are more likely to have trouble relaxing.

Some people think that ADHD only affects children. But the truth is, while ADHD always begins in childhood, the symptoms frequently continue into adult life. Approximately 60% of children with ADHD continue to have ADHD symptoms as adults. It is estimated that only 25% of ADHD cases are diagnosed in childhood or adolescence. And even fewer are treated.

All people display ADHD symptoms from time to time. So the guidelines for diagnosing a child or adult with ADHD are very specific. For children, the symptoms must occur more frequently than in other children the same age. And for adults, the symptoms must persist from childhood and create everyday challenges. ADHD symptoms must cause significant difficulty in at least 2 areas of life, such as school, home, work, or social settings.

Not everyone with ADHD has every symptom, or experiences the symptoms of ADHD to the same degree. The symptoms of ADHD can create difficulties in everyday life.

Every day contains its share of challenging moments. Like being forgetful. Or dealing with distractions at work. For an adult with ADHD, moments like these happen more often. ADHD symptoms can make everyday responsibilities feel like a challenge.

Approximately 60% of people who had ADHD symptoms as a child continue to have symptoms as adults. And only 1 in 4 of adults with ADHD were diagnosed in childhood—and even fewer are treated. Over the years, some adults may have developed strategies to work around their daily challenges in different areas of life.

Problems generally associated with ADHD include inattention, hyperactivity and impulsive behavior. Adults with ADHD can struggle with difficulties in one or more areas of daily life.

Common signs and symptoms of ADHD in adults include:

• Poor concentration
• Short attention span
• Disorganized
• Forgetful
• Difficulty starting and/or finishing projects
• Jumps from one task to another
• Time-management issues
• Makes impulsive decisions
• Difficulty interacting with others

Not every person with ADHD has every symptom, or experiences the severity of ADHD symptoms to the same degree. The symptoms of ADHD can make it difficult to focus on day-to-day responsibilities. ADHD can even make interacting with others more challenging.

ADHD and Adults, what you should know:

In adults, ADHD symptoms can create challenges at work, at home, with family, and with other relationships. ADHD is a real, and treatable, medical condition that affects about 8 million—that’s 1 in 20—adults in the United States.

Diagnosing ADHD in adults can be difficult. Many adults aren’t aware that they have ADHD—they just feel challenged by everyday tasks. Some adults discover ADHD symptoms in themselves when their child is diagnosed with the disorder. Others may have struggled with symptoms in childhood, but without proper diagnosis. Studies suggest that between 30% and 70% of children with ADHD continue to have symptoms as adults.

It’s important to note: To be clinically diagnosed with ADHD, adults must not only have persistent and current symptoms, they must also have exhibited symptoms of ADHD in childhood.

Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder³

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development.

Either (1), (2), or Combined Type:

(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: 

Inattention

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. often has difficulty sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
8. is often easily distracted by extraneous stimuli
9. is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

1. often fidgets with hands or feet or squirms in seat
2. often leaves seat in classroom or in other situations in which remaining seated is expected
3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. often has difficulty playing or engaging in leisure activities quietly
5. is often “on the go” or often acts as if "driven by a motor"
6. often talks excessively

Impulsivity

1. often blurts out answers before questions have been completed
2. often has difficulty awaiting turn
3. often interrupts or intrudes on others (eg, butts into conversations or games)

·             Some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years

·              Some impairment from the symptoms must be present in at least 2 settings (eg, at home and at school)

·              There must be clear evidence of interference with developmentally appropriate social, academic, or occupational functioning

·             The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and is not better accounted for by another mental disorder

·             ADHD, Combined Type should be used if 6 (or more) symptoms of inattention and 6 (or more) symptoms of hyperactivity-impulsivity have persisted for at least 6 months

How is ADHD diagnosed?

Most adults experience inattentive, impulsive, and hyperactive behaviors from time to time. You misplace your keys. Get distracted at work. Every once in a while you may even blurt out something you didn't mean to say. But, for adults with ADHD, these symptoms appear more often, which can create difficulties managing day-to-day responsibilities.

The reality is, many adults don't even know they have ADHD. Only 25% of adults with ADHD were diagnosed as children. Some seek professional help for depression or anxiety and find out they have ADHD. Adults with ADHD may have other conditions in addition to ADHD.

Often, adults first recognize the signs and symptoms of ADHD in themselves when their child is diagnosed. ADHD has been linked to family genetics. Studies have shown that 17% to 44% of fathers of children with ADHD also have ADHD. And 11% to 38% of mothers of children with ADHD also have the condition.

There's no single laboratory test used to determine an ADHD diagnosis. Rather, your healthcare professional will likely follow a standardized ADHD checklist. You may be asked questions about your family's medical history, as well as your past and present experiences at school, work, and in social settings.

For some adults, being diagnosed with ADHD can bring a sense of relief. They can begin to see the connection between their behavior and the symptoms of the condition. And understand that their symptoms can be significantly improved with the right diagnosis and treatment.

The sooner you get an evaluation and an ADHD diagnosis, the faster you can start effectively managing your symptoms.

Treatment options

The most commonly prescribed treatments for ADHD today are from a class of drugs called stimulants. Healthcare professionals have been prescribing stimulants to treat ADHD since 1960. They are proven to improve ADHD symptoms, including inattention and hyperactivity.

Stimulants work to enhance the availability of the brain's chemical messengers dopamine and norepinephrine by mimicking the brain's natural production of them. These messengers are believed to play a role in behaviors like attention and movement.

When used under medical supervision, stimulants are generally well tolerated. The most common side effects include decreased appetite, insomnia, increased anxiety, and/or irritability. Mild increases in heart rate and blood pressure can occur in some people taking stimulants.

ADHD medications are available in short and long-acting formulations. The short-acting forms can last up to 4 hours. And, long-acting forms like CONCERTA^® are time-released to deliver medication throughout the day.

Adults can successfully manage their ADHD symptoms with the right treatment. To do so takes a comprehensive approach. This includes prescription medicine and behavioral therapy. Behavioral therapy can include support groups, counseling, and changes you make in how you go about your daily life.

If you're diagnosed with ADHD, your healthcare professional may prescribe a medication to meet your needs. There is no cure for ADHD, and no one treatment is right for everyone. So your healthcare professional will tailor a treatment plan, weighing the benefits and risks of each treatment with your personal medical history.

To date, the most commonly prescribed medications used to treat ADHD are from a class of drugs called stimulants. Stimulants can dramatically improve ADHD symptoms like inattention and hyperactivity. These include methylphenidate and amphetamines. Doctors have been prescribing stimulants to treat ADHD since 1960.

Stimulants are believed to enhance the availability of the brain's chemical messengers dopamine and norepinephrine. These messengers play a role in behaviors like attention and movement.

ADHD medications are typically available in short and long-acting formulations. The short-acting forms can last up to 4 hours. Long-acting forms, like CONCERTA^®, are time-released to deliver medication throughout the day. Many experts believe that ADHD medication is most effective when used everyday to encourage healthy habits like planning and discipline.

ADHD symptoms can appear at work, at home, and in social situations. If you've been diagnosed with ADHD, ask about getting on the path to success in managing ADHD.

(Information obtained with help from Ortho-McNeil-Janssen Pharmaceuticals)