Understanding the prevalence of ADHD in adults
ADHD symptoms and diagnosis in adulthood
Treatment options for adults with ADHD
Comorbid Conditions and Risk Factors for Adults with ADHD
In this module, you will learn:
The prevalence of ADHD in adults
ADHD symptoms and diagnosis in adulthood
Treatment options for adults with ADHD
Comorbid Conditions and Risk Factors for Adults with ADHD
Moving into Adulthood with ADHD – 5m53s
6.1 Understanding the Prevalence of ADHD in Adults
It is now widely accepted that ADHD is not simply a childhood condition and that many
people continue to experience symptoms in adulthood.
Previously it was believed that ADHD was a condition that children grew out of, but that theory has
been thoroughly disproved. It is now understood that as many as 60% of children that have ADHD
will still have the condition as adults.
The fact that it has been accepted that adults can suffer from ADHD is a huge leap forward in our
thinking and understanding of the condition.
As a result, adults are now able to seek an ADHD diagnosis and treatment. This is significant, as in
the past adults with ADHD would likely have been misdiagnosed with a mental health or personality
disorder, and in that case, would not receive the correct treatment required to treat their symptoms.
Many other adults simply wouldn’t bother to seek a doctor’s opinion in the first place, not realising
there was potentially a diagnosis that could explain their problems.
It is believed that somewhere in the region of 3% of adults worldwide have ADHD. However, it is
also estimated that 80% of adults with ADHD are either unaware of it or are still undiagnosed. There
is still work to be done to raise awareness of ADHD in adulthood.
It’s interesting to note that the gender divide between diagnoses of males and females persists in
adulthood – there are more men diagnosed with the condition than women. It’s unclear if this has
the same root cause as in childhood diagnoses – i.e. that females tend to have the easily-missed
inattentiveness type of ADHD.
Another significant feature of adult ADHD is that it often occurs with other comorbid conditions such
as depression, anxiety disorders, personality disorders and substance abuse disorders. We will look
at some of these later in this module.
Despite the possible underdiagnosis of ADHD in adults, it is clear that there are millions of adults
with the condition, and that they face significant challenges because of their complex health needs.
At this point, we will look in more detail at the way in which it can directly impact the life of an adult
with ADHD.
6.2 ADHD Symptoms and Diagnosis in Adulthood
In this course so far, we’ve gained a good understanding of ADHD symptoms in childhood
and adolescence, but how does the condition present in adulthood?
Symptoms of ADHD in adults are similar to those of children and adolescents. However, as
previously mentioned, adults may also present with other challenging issues such as a personality
disorder or a substance abuse problem. In some cases, it’s only when they seek help for the
comorbid condition that ADHD is discovered.
Adult symptoms of ADHD will generally include the following:
Poor time management and organisation skills
Forgetfulness
Difficulty focusing
Poor attention to detail
Difficulty with starting and finishing a task
Emotional dysregulation
Low tolerance to frustration
Restlessness and fidgeting
Talking excessively, and often interrupting others
It is important to remember that the way in which ADHD affects one adult can be completely
different to the way it affects another.
For example:
One individual may be able to concentrate when at work and yet have a great deal of difficulty in
their social life and with conversations. Another individual could have the exact reverse - and yet
they both still suffer from the same condition.
It is believed that when people with hyperactivity-impulsivity type ADHD reach adulthood, their level
of hyperactivity naturally decreases. However, other symptoms such as impulsivity, risk-taking and
poor concentration levels do not generally get any better without intervention and treatment.
FACT
Approximately one in 10 adults display classic ADHD symptoms including excessive procrastination,
impulsive behaviour, and the inability to complete everyday tasks.
Source: The Independent
It can be quite difficult for people who were not diagnosed with ADHD in childhood to get a
diagnosis in adulthood, even if they present with all of the symptoms. This is because they must be
able to show that their symptoms began in childhood and have been experienced consistently since
then, and obviously, this can be quite hard to do after years or decades have passed.
In order for an adult to get diagnosed with ADHD, they must meet these conditions:
Display at least 5 of the 9 ADHD symptoms described in the 5th edition of the DSM (Diagnostic
and Statistical Manual of Mental Disorders)
Symptoms must have started before the age of 12
Symptoms must not be attributable to any other mental health disorder
Symptoms must significantly affect their daily life
It should also be noted that these symptoms must be shown to have negatively affected the life of the
individual in more than one context.
For example:
The symptoms must affect their social life, their home life and/or their working life.
Any adult seeking an ADHD diagnosis for the first time would need to be referred to a specialist such
as a psychiatrist. It may be necessary to get old school reports, or testimony from family members or
friends who knew the adult as a child, in order to show that the symptoms have been experienced
throughout life. ADHD is not thought to develop in adulthood, so there is a very real need to prove
this link to childhood issues.
There would also need to be some general discussion of the current impact of symptoms, and
potentially some further tests to rule out any other underlying condition that could be contributing
to the symptoms.
6.3 Treatment Options for Adults with ADHD
There are various treatment options for adults with ADHD, and they are along similar lines
as those available for children.
Generally speaking, after a diagnosis from a relevant expert, a treatment plan will be worked out.
This will normally be a multi-faceted approach, as a number of different treatments will often be
required to help an individual successfully overcome their various issues and challenges.
For example:
Adults are usually recommended to take medication, in combination with other strategies such as
therapy and lifestyle changes. The approach should be tailored to the individual – what works for
one person may not work for another.
Remember that it’s common for adult ADHD to also be linked to other issues such as mood disorders
or problems with alcohol or drugs. These issues also have to be tackled in order for the individual to
successfully overcome their difficulties, and so the consideration of any comorbid conditions will be
part of their treatment plan.
Medication
Like the other age groups, when adults take ADHD medication for the first time it can take several
months to find the correct medication and dosage. However, in the majority of cases, medication is
effective at controlling the symptoms of ADHD, so it is worth persevering.
Medication works best when used in conjunction with other approaches.
Cognitive Behavioural Therapy (CBT)
CBT involves working with a therapist to identify problem behaviours and find ways to change them.
Essentially this means changing negative patterns of thinking and replacing them with new
approaches. CBT can be very effective in helping adults with ADHD modify problem behaviours - and
feel better about themselves in the process.
Behaviour Therapy
Subtly different to CBT, behaviour therapy also seeks to change negative habits, but in this
approach, the adult is encouraged to structure their time more effectively and establish achievable
routines. It also uses conditioning – for example, finding ways to reward desirable behaviour so that
the positive actions are repeated until they become habit.
Coaching
Coaching is another strategy aimed at establishing good habits and adding structure to the life of an
adult with ADHD. ADHD coaches can help with practical skills such as time management and
organisation.
Diet and Exercise
Eating the right foods and getting sufficient exercise is good for everyone - and especially those with
ADHD. Adults with ADHD could consider taking supplements of key minerals such as magnesium
and zinc, or try increasing their intake of protein and complex carbohydrates. Furthermore, there is
a great benefit to be gained from regular exercise – even a daily walk is helpful.
Diet and exercise can have a profound impact on brain function, and are well worth trying, but it’s
always advisable to make any changes in these areas under the guidance of a GP.
Meditation and Yoga
Meditation and mindfulness can be useful ways to slow down and develop more awareness of self.
Yoga has a similar focus and is great exercise. These kinds of spiritual approaches can help to
reduce feelings of anxiety and increase feelings of wellbeing.
A combination of any or all of the above strategies is usually effective at controlling ADHD
symptoms. However, it may take some time, and a period of trial-and-error, before the optimum
combination is found.
Another thing to consider, alongside managing the symptoms of ADHD, is the prevalence of
comorbid conditions such as depression, anxiety and personality disorders in adults with the
condition. We examine these in more detail in the next and final section of this module.
6.4 Comorbid Conditions and Risk Factors for Adults with
ADHD
While ADHD is widely recognised nowadays, this wasn’t always the case, and there are
thought to be many undiagnosed adults, or adults who have been diagnosed late in life.
This comes at a hefty price, as prolonged delay in diagnosis and treatment often result in negative
outcomes. Untreated adult ADHD is intimately associated with depression, anxiety, personality
disorders, drug and alcohol abuse, and even criminality.
FACT
Statistics indicate that around 25% of UK prisoners have ADHD, and it is now considered one of the
most common behavioural disorders in the UK.
Source: The Guardian
Like children and teenagers with the condition, adults can face challenges in most areas of their life
because of their symptoms, especially if they’re undiagnosed and untreated. Work, home and social
life can all suffer, as can the person’s health.
Work and Education
Although there is no reason why people with ADHD can’t have successful careers, the symptoms of
the condition can make working and/or academic life difficult. Issues with interpersonal skills,
distractibility, forgetfulness and poor time management are just some of the problem areas.
There are many strategies that can be employed to mitigate these issues. For example, noise-
cancelling/white noise headphones could be used in an office to prevent distractions. Adults with
ADHD will find it useful to work with a coach or therapist to come up with tailored strategies for
their specific problems.
Legal Issues and Criminality
Many studies have found that people with ADHD are more likely to get into legal trouble than
neurotypical people, particularly if it’s left untreated. The reasons for this are not clear, and it would
be simplistic to state that symptoms such as impulsivity and lack of emotional regulation are entirely
to blame. Just because someone has ADHD, it doesn’t follow that they’re definitely going to commit a
crime! There are other wider, socio-economic factors related to living with ADHD at play too.
Getting an effective treatment plan in place can mitigate the risk of offending. When ADHD is
successfully controlled it has less impact, and the result is that those living with the condition are
much less likely to commit crime.
Social Connections and Relationships
Social life and relationships can be challenging for people with ADHD. They sometimes have poor
social skills, for example, talking too much or interrupting others, and not listening properly when
others speak. These habits can be problematic in friendships and romantic relationships.
Coaching and CBT are good strategies for learning social skills. Regular medication is also helpful in
controlling symptoms.
Drug and Alcohol Abuse
Adults with ADHD are more likely to abuse drugs and alcohol than neurotypical adults, and many of
them are simply self-medicating or trying to control their symptoms. This is especially true of
individuals who are not receiving treatment for the condition.
Timely diagnosis and treatment are key to preventing substance abuse – if the symptoms are
controlled by ADHD, there is less need to self-medicate.
Mental Health Disorders
Depression is common in those with ADHD because of the difficulties they face in daily life, and the
level of frustration and distress caused by their symptoms. Again, this is more likely if the ADHD is
undiagnosed for a long time, or not treated.
Anxiety is also a widespread comorbidity in adults because their lives are stressful and dogged with
uncertainty. They often feel unsure of what is expected, or unable to carry out the tasks expected of
them, and this causes continual anxiety.
Mental health disorders such as anxiety and depression can be treated with medication and therapy.
Personality Disorders
Less commonly, a person with ADHD can have one of a number of different personality disorders,
such as narcissistic personality disorder (NPD) or borderline personality disorder (BPD). The link
between BPD and ADHD in particular is quite strong, as both are characterised by impulsive
behaviour and emotional dysregulation, amongst other things. Some research indicates that having
childhood ADHD increases the risk of developing BPD later in life, although more research is needed
to confirm this.
Treating ADHD with a comorbid personality disorder can be difficult because the medication which
works for ADHD might exacerbate symptoms of the personality disorder.
In summary, the effect of ADHD on the life of an adult is considerable, but in most cases, its impact
can be reduced by following a comprehensive treatment plan. In an ideal world, diagnosis and
treatment would begin in childhood, because early intervention can potentially make a real
difference to the long-term outcome for the individual.
SUMMARY
In this module, we have focused on ADHD in adulthood and described how the symptoms of the
condition are similar to those faced in childhood.
We also looked at the range of treatment options available for adults with ADHD, which usually
involve medication in combination with other strategies such as therapy and lifestyle changes.
Finally, we touched upon the prevalence of serious comorbid conditions experienced by adults with
ADHD, such as anxiety, personality disorders, and substance dependence.
In the next module, we will look in greater depth at some of the treatments available for ADHD.
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