When I was a trainee in psychiatry (middle of the 1990s), classical teaching held that
ADHD was a disorder of childhood, with symptoms settling during adolescence. We
did not consider the possibility of the illness persisting into adulthood. DSM and ICD,
the two diagnostic / classificatory systems used by psychiatrists, have been slow to
acknowledge ADHD in adults as a standalone diagnostic entity. For a practicing
psychiatrist, however, adults with ADHD seeking professional help – for the first time
- in their 20s and 30s is not an uncommon experience.
Symptoms of ADHD in adult life are often associated with difficulties in everyday life
at home, at work and with friends and family. There are increased rates of relationship
problems, divorce and accidents. However, the most common concern which drives
them to look for a clinical evaluation is underachievement at work. Low self-esteem
and clinical depression are frequently encountered.
Recognizing the illness…
Adult ADHD is essentially a name for the developmental impairment of a set of brain functions called “executive functions”. What are these functions? These are the skills involved in planning, selective attention, motivation and impulse control. Adults with ADHD have problems in six major areas of executive functioning:
Activation– Problems with organization, prioritizing and starting tasks.
Focus– Problems with sustaining focus and resisting distraction, especially with reading.
Effort– Problems with motivation, sustained effort and persistence.
Emotion– Difficulty regulating emotions and managing stress.
Memory– Problems with short-term memory and memory retrieval.
Action– Problems with self-control and self-regulation.
Signs and Symptoms of Adult ADHD
Activation
Focus
Effort
Procrastination; difficulty getting started on projects
Inability to screen out distractions
Difficulty sustaining effort over long periods of time
Excessive disorganization and messiness
"Are you listening?"
Starting multiple tasks, but never completing any of them
Inability to prioritize tasks
Randomly skipping from topic to topic in conversation
Missing deadlines
"Lazy"
"Physically present, mentally
absent"
Poor at following up
Underestimating the time needed to finish a task
Reading words over and over in order to grasp the meaning
Trouble going to sleep at night and staying alert during the day.
Emotion
Memory
Action
Easily bored
Trouble remembering things, even for a short time
Inability to delay gratification
Poor frustration tolerance
Doesn’t recall conversations, things others said
Thinking after speaking
"Mood swings"
"Forgetful"
Regret after hasty acts
Constant worrying
Diffiiculty with multi-tasking
No / litte regard for cosequences
Quick temper
Constantly losing or misplacing things
Jumping to conclusions
Adult ADHD: Myths Vs. Facts
MYTH:
ADHD is just a lack of willpower. Persons with ADHD focus well on things that interest them; they could focus on any other tasks if they really wanted to. FACT:
ADHD looks very much like a willpower problem, but it isn’t. It is essentially a chemical problem in the management systems of the brain. It’s a neurobiological
inability to – among other things – sustain and shift attention without much conscious
effort.
MYTH:
Everybody has the symptoms of ADHD, and anyone with adequate intelligence can overcome these difficulties. FACT:
ADHD affects persons of all levels of intelligence. And although everyone has symptoms suggestive of ADHD at some time or the other, only those with chronic and
persistent real-world impairments from these symptoms warrant a diagnosis of
ADHD.
MYTH:
ADHD can’t really cause much damage to a person’s life. FACT:
Untreated or inadequately treated ADHD syndrome often severely impairs learning, education, work life, family life, social interactions and the ability to drive safely. Poor self esteem is a major issue in adulthood.
MYTH:
Unless you have been diagnosed with ADHD as a child, you can’t have it as an adult. FACT:
Many adults have struggled all their lives with unrecognized ADHD impairments. They haven’t received help because they assumed that their chronic difficulties, like depression or anxiety, were caused by other impairments that did not respond to the usual treatments.
Treating the illness…
Methylphenidate is the gold standard of medical management – whether in children,
adolescence or adults.
Behavior management strategies for adults with ADHD
Adults with ADHD can also benefit from some basic organizational concepts and behavior management strategies to help manage the condition. Here are ways to train yourself to make the problems more manageable:
Take medications as prescribed. Take your ADHD medications exactly as prescribed. Missing a dose or taking two doses at once to catch up on missed doses can have negative consequences for you and others. If you are noticing side effects or other problems, speak to your psychiatrist.
Organize yourself. Train yourself to become more organized. Make lists of daily tasks (be reasonable!) and strive to complete them. Use a daily planner, leave notes for yourself and set your alarm clock when you need to remember an appointment or other activity. There are dozens of free apps in your phone that can help you with this
– try them.
Minimize distractions. Find ways to reduce the distractions throughout the day. If you find yourself being distracted by loud music or the television, turn it off or use earplugs. Move yourself to a quieter location or ask others to help reduce distractions. Many adults find stochastic resonance (“white / pink noise”) helpful.
Find constructive outlets for excess energy. People with ADHD sometimes seem to have more nervous energy than others, and this hyperactivity needs to have an outlet of some sort. Regular, vigorous physical activity is a simple option.