Misunderstanding Adult ADHD—It’s Not Just for Kids Anymore
Some of what I write about concerning adult ADHD comes from an article in Psychiatric Times. “Adult ADHD: A Review of the Clinical Presentation, Challenges, and Treatment Option” by Jennifer Reinhold, PharmD, BCPS, BCPP.
We typically think of attention deficit hyperactivity disorder (ADHD) as a childhood problem, and roughly half the children and teens outgrow it. However, up to 50% persist into adulthood, where ADHD can be more challenging to recognize than when they are younger.
It can be difficult to recognize because no two people with ADHD are exactly alike. And if you know an adult with ADHD and he has certain symptoms, another person with ADHD may look quite differently but still have ADHD. He may be able to concentrate if he’s interested in what he’s doing, while some with ADHD have trouble focusing under any circumstances. Some look for stimulation, while others avoid it. Some can be withdrawn and antisocial, while others can be very social and go from one relationship to the next. Because the presentation can be so variable, it may not occur to anyone that this is ADHD. Below are some of many areas adults with ADHD may have difficulty with.
Someone with ADHD may have trouble with:
Chronic lateness and forgetfulness
Problems at work
Low tolerance for frustration
Adult ADHD Relationships and Work Problems
Adults with ADHD are more likely to:
Have marital problems
Get separated and divorced more often
Have multiple marriages
Problems at Work
Adults with ADHD are more likely to:
Change jobs frequently and perform poorly
Be less happy with their jobs and have fewer successes at work
They may also have:
More speeding tickets, suspended licenses, or get in more crashes
Use alcohol or drugs more often
Have less money
Have psychological trouble like being depressed or have anxiety
Often lose things like tools, wallets, keys, paperwork, eyeglasses, and mobile phones
Forgetfulness in daily activities, such as running errands and keeping appointments
It is easy to interpret this behavior as not caring enough to make a task a priority; or even more personally, not caring enough about me to make it a priority. This is interpreting a cognitive problem as an emotional one. So, It is very helpful to remember that if you know someone with ADHD, do not take it personally. ADHD can present in ways that you don’t necessarily associate with this disorder such as anger, speeding tickets and marital problems. It may not be a sign of disrespect or not caring or even being incompetent in life. More simply it can be a presentation of ADHD.
Adults can complete and measure themselves at home. Anyone just wondering if they might have ADHD can use this tool, Also, it can help direct someone toward seeking help or be reassured.
There are two other points about diagnosing adult ADHD ithat are worth mentioning. First, to be formally diagnosed with ADHD an adult must have had the symptoms before they were 12 years old. Patients do not have to be diagnosed with ADHD before 12, but their symptoms should have been present in childhood. Secondly, the symptoms must be present in two settings—for example, at home and at work/school or with both family/friends and colleagues/classmates. Secondly, addition to their cognitive obstacles, many adults simultaneously have depression, anxiety, and/or substance abuse problems. In fact, in the adult ADHD problem these occur at twice the rate of the general population. One study that found that 87% of adults with ADHD had one other psychiatric diagnosis, and 56% had two.
Sometimes it may appear that the symptoms of ADHD in adults suddenly appear out of nowhere. In fact it may be the loss or failure of their coping mechanism to continue to control their symptoms is why the patient is coming for help now. For example, does a recent move, promotion, divorce, or other life change explain why their ADHD symptoms are now unmanageable? If we do not account for how well coping mechanisms are functioning, it may make our patient’s symptoms appear too acute to meet the criteria for ADHD. There are many instances where the patient was unaware of the extent of their reliance on coping mechanisms or the duration of their dependence on others. However, when the patient’s coping mechanisms are taken into account, it can be easier to see the chronic nature of their symptoms.
ADHD is not black and white. It is not either you have it or you don’t. I think it’s more accurate to look at ADHD as on a spectrum like we now do with autism spectrum disorder. Someone may not meet the formal criteria for ADHD but, to coin a phrase, be ADHDish. The ADHDish adult will have fewer symptoms and they will be milder. Also, their symptoms won’t cause as much difficulty in that adult’s life.
In the Dubin Clinic we treat a lot of ADHD in both children and adults using Direct Neurofeedback. We get good results in the majority of those patients, certainly more than 85%. Initial improvements are usually noticed in the first session. A total of about 30 sessions are needed for ADHD improvements to improve and remain stable.