In the past, it was generally accepted that attention deficit hyperactivity disorder (ADHD) was a childhood disorder. Now we know that ADHD persists into adulthood for many.
ADHD in adults has been highly publicized over the last decade. Some studies indicate that approximately 7-8 percent of children and adolescents in the United States struggle with ADHD, with symptoms continuing into adulthood in as many as 60 percent of cases, affecting approximately 4-5 percent of adults. However, symptoms seen in adult ADHD are often quite different from those seen in children.
Clinical guidelines for childhood ADHD, provided by the American Psychiatric Association, differentiate among the hyperactive/impulsive, inattentive and combined hyperactive inattentive subtypes of attention deficit disorder.
To make the diagnosis, some hyperactive/impulsive or inattentive symptoms must have been present before age seven, and they must have persisted for at least six months and caused significant impairment in at least two major settings of the person’s life.
The symptoms of inattention, hyperactivity and impulsivity in adults look different than they do in children and adolescents; however, there are some parallels.
In children, ADHD can cause problems in school or home life. In adults, ADHD may cause problems that affect job performance, duties at home and even relationships.
Symptoms of inattention in adults include difficulty sustaining attention, a high level of distractibility, forgetfulness, poor concentration and struggling to complete tasks they don’t find interesting. This may result in misplacing items and poor ability to manage day-to-day responsibilities such as completing household chores or maintenance tasks. Adults with inattentive ADHD may also have difficulty paying bills on time, poor organizational skills, difficulty planning and trouble with time management. They may have a history of academic and career underachievement.
Hyperactivity symptoms in adults include internal restlessness, difficulty sitting through meetings, excessive talking, fidgeting and an inability to relax while doing quiet activities such as reading.
Symptoms of impulsivity in adults include impulsive job changes, driving too fast, interrupting others, getting easily frustrated and having a hard time controlling immediate reactions such as verbal outbursts.
ADHD symptoms in adults may affect:
• Job performance. Work performance may be inconsistent for adults with ADHD because of problems organizing work, managing time and concentrating on one task at a time. They may quit their jobs out of boredom.
• Personal relationships. Relationships may suffer for adults who have problems focusing their attention on conversations, “reading” the behavior and moods of others and expressing their own feelings.
• Temper. Adults with ADHD may become easily frustrated because they have difficulty tolerating stress. These adults may overreact and exhibit a quick temper.
• Problem-solving ability. Adults who have difficulty waiting for things they want may not be able to accurately foresee the consequences of their actions. As a result, they may engage in risky behaviors, such as unprotected sex, unsafe driving, alcohol and drug use or unwise financial ventures.
While childhood symptoms are a prerequisite for an adult ADHD diagnosis, the symptoms manifested in adults often look very different than in children and adolescents. Most adults, including those with and without a childhood history of ADHD, will display some of the symptoms above. However, most adults who seek formal evaluation for ADHD experience significant problems in one or more areas of their daily living, including difficulties at work or in the home. In other situations, symptoms mimicking ADHD, such as inattention and lack of focus, may be due to other conditions, including depression, anxiety and substance-abuse disorders.
An accurate diagnosis is the first step in learning to manage the symptoms of ADHD effectively. If you believe you exhibit symptoms described in this column, and these symptoms are affecting your daily life, you may benefit from evaluation by a psychologist or psychiatrist.
Many adults with ADHD have learned behavioral techniques and made lifestyle changes to adapt and perform at an effective level. For this reason, treatments often don’t require medication.
Adult ADHD does not have to stop you from leading a successful life. When properly diagnosed and treated, ADHD can be well managed, leading to increased satisfaction in life and significant improvements in daily functioning.
For more information, visit www.help4adhd.org, www.chadd.org, www.cdc.gov or www.nimh.nih.gov.
Dr. Shahna Rogosin is division chairwoman of the Department of Psychiatry and Behavioral Health for the Fremont Clinic of the Palo Alto Medical Foundation. She practices in the Fremont and Los Altos offices.
