Adult ADHD (attention-deficit/hyperactivity disorder)

Definition

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.


Symptoms

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:

  • Trouble focusing or concentrating
  • Restlessness
  • Impulsivity
  • Difficulty completing tasks
  • Disorganization
  • Frequent mood swings
  • Hot temper
  • Trouble coping with stress
  • Unstable relationships

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.


Causes

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:

  • Altered brain function and anatomy.Brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, people with ADHD appear to have less activity in the area of the brain that controls attention than people who don’t have ADHD.
  • Inherited traits.ADHD can run in families.
  • Maternal smoking, drug use and exposure to toxins.Pregnant women who smoke, drink alcohol or use drugs are at increased risk of having children with ADHD. Likewise, women exposed to environmental poisons during pregnancy — such as polychlorinated biphenyls (PCBs) — may be more likely to have children with symptoms of ADHD.
  • Childhood exposure to environmental toxins.Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span.

Risk factors

You’re at increased risk of ADHD if:

  • Your mother was exposed to toxins during pregnancy
  • Your mother smoked, drank alcohol or used drugs during pregnancy
  • You have blood relatives (such as a parent or sibling) with ADHD or another mental health disorder
  • You were born prematurely
  • You were exposed to environmental toxins as a child

Complications

ADHD has been linked to:

  • Poor school performance
  • Trouble with the law
  • Problems at work
  • Alcohol or drug abuse
  • Frequent car accidents or other accidents
  • Unstable relationships

Although ADHD doesn’t cause other psychological or developmental conditions, a number of other disorders frequently occur along with ADHD. These include:

  • Mood disorders.Many adults with ADHD also have depression, bipolar disorder or another other 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 disorder may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.
  • Personality disorders.Adults with ADHD are at increased risk of personality disorders, such as borderline personality disorder or antisocial personality disorder.

Preparing for your appointment

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

  • Write down any symptoms you’ve had and problems they’ve caused,such as trouble at work, at school or in relationships. Write down any symptoms you’ve been having that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information,including any major stresses or recent life changes you’ve had.
  • Make a list of all medications you take,including any vitamins or supplements.
  • Write down questions to askyour doctor.

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:

  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What kinds of tests do I need?
  • What’s the best treatment?
  • What are the alternatives to the primary approach that you’re suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Should I see a specialist such as a psychiatrist or psychologist?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

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:

  • When do you first remember having problems focusing, paying attention or sitting still?
  • Have your symptoms of hyperactivity, inattention or impulsiveness been continuous or occasional?
  • Which symptoms bother you most, and what problems do they seem to cause?
  • How severe are your symptoms?
  • In what settings have you noticed the symptoms: at home, at work or in other situations?
  • What was your childhood like? Did you have social problems or trouble in school?
  • How is your current and past academic and work performance?
  • What are your sleep hours and patterns?
  • What, if anything, appears to worsen your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What medications to you take?
  • Do you consume caffeine?
  • Do you drink alcohol or use street drugs?

Tests and diagnosis

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?
Psychiatrist Yes Yes Yes
Psychologist Yes No Yes
Family doctor Yes Yes Usually no
Neurologist Yes Yes 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:

  • Mental health disorders.A number of other mental health conditions can mimic ADHD both in children and in adults, including anxiety disorders, mood disorders, adjustment disorders, learning and language deficits, and psychotic disorders.
  • Other health problems.Your doctor may consider a different diagnosis or refer you to a specialist if you have a history of a developmental disorder, seizures, sleep apnea, hearing or vision problems, a thyroid disorder, lead poisoning or low blood sugar (hypoglycemia).
  • Drugs and medications.Alcohol or drug abuse and certain medications can cause ADHD-like symptoms.

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:


Inattention

  • Often fails to give close attention to details or makes careless mistakes in work or other activities
  • Often has difficulty sustaining attention in tasks
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish work or other duties (not due to oppositional behavior or failure to understand instructions)
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
  • Often loses things necessary for tasks or activities
  • Is often easily distracted
  • Is often forgetful in daily activities

Hyperactivity and impulsivity

  • Often fidgets with hands or feet or squirms in seat
  • Often leaves the room in situations in which remaining seated is expected
  • Often physically active in situations in which it is inappropriate
  • Often has difficulty engaging in leisure activities quietly
  • Is often “on the go” or often acts as if “driven by a motor”
  • Often talks excessively
  • Often blurts out answers before questions have been completed
  • Often has difficulty awaiting turn
  • Often interrupts or intrudes on others (for example, butts into conversations or games)

In addition to having at least six symptoms from one of the two categories, someone with adult ADHD:

  • Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present before age 7
  • Had behaviors that weren’t normal for children the same age who didn’t have ADHD
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