Filed under: Boomer's Health
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. 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.
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:
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.
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 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:
You're at increased risk of ADHD if:
ADHD has been linked to:
Although ADHD doesn't cause other psychological or developmental conditions, a number of other disorders frequently occur along with ADHD. These include:
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.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with the doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For a possible diagnosis of adult ADHD, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
The following chart from the National Institute of Mental Health lists the types of doctors who are qualified to diagnose and supervise treatment for ADHD, although not all may have specific training in the disorder.
|Specialist||Can diagnose ADHD?||Can prescribe medications, if needed?||Provides counseling or training?|
|Family doctor||Yes||Yes||Usually no|
Diagnosing ADHD in adults
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.
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:
Evaluating signs and symptoms that you had ADHD as a child
A persistent pattern of signs and symptoms, beginning no later than age 7, 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 gather information from teachers, parents and anyone else who knew you when you were young. Your doctor will also want 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 spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association.
The DSM assessment was developed primarily for children, but uses the same criteria to diagnose adults. When considering your symptoms, your doctor or mental health provider will consider what symptoms you had as a child, as well as which symptoms you still have as an adult.
For a diagnosis of ADHD, you must have six or more signs and symptoms from one or both of the two categories below:
Hyperactivity and impulsivity
In addition to having at least six symptoms from one of the two categories, someone with adult ADHD:
Other criteria for diagnosing ADHD in adults
Because symptoms of ADHD will 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.
A number of questionnaires and expanded lists of signs and symptoms have been developed to check for signs of adult ADHD. Your doctor may have you answer the questions on one of these to help determine whether you have ADHD.
In addition, your doctor will carefully examine the impact of your core symptoms on your current life — your performance at work or in school and your relationships with friends and family.
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:
Stimulant drugs are available in short-acting and long-acting forms.
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:
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.
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.
Psychotherapy for adults with ADHD is often focused on helping develop skills to resolve specific issues. It can help you:
Common types of psychotherapy for ADHD include:
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:
If you're like many adults with ADHD, you may be unpredictable and difficult to get along with. Forgotten appointments, missed deadlines, impulsive or irrational decisions, and angry outbursts 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 skills, conflict resolution and problem solving. Couples therapy and classes in which family members learn more about ADHD may significantly improve your relationships.
While more research is needed, there's some evidence that alternative medicine treatments can reduce ADHD symptoms. Some alternative treatments for ADHD include:
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:
Once you have your ADHD under control, you can take steps to prevent it from getting worse.