What is attention deficit hyperactivity disorder (ADHD)?
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most well-recognized childhood developmental problems. This condition is characterized by inattention, hyperactivity and impulsiveness. It is now known that these symptoms continue into adulthood for about 60% of children with ADHD. That translates into 4% of the US adult population, or 8 million adults. However, few adults are identified or treated for adult ADHD.
ADHD in adults
Adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks or completing work within time limits. If these difficulties are not managed appropriately, they can cause associated behavioral, emotional, social, vocational and academic problems.
Adult ADHD stats
ADHD afflicts approximately 3% to 5% of school-age children and an estimated 60% of those will maintain the disorder into adulthood.
Prevalence rates for ADHD in adults are not as well determined as rates for children, but fall in the 1% to 5% range.
ADHD affects males at higher rate than females in childhood, but this ratio seems to even out by adulthood.
Common behaviors and problems of adult ADHD
The following behaviors and problems may stem directly from ADHD or may be the result of related adjustment difficulties:
Chronic lateness and forgetfulness.
Difficulty controlling anger.
Substance abuse or addiction.
Poor organization skills.
Low frustration tolerance.
Difficulty concentrating when reading.
These behaviors may be mild to severe and can vary with the situation or be present all of the time. Some adults with ADHD may be able to concentrate if they are interested in or excited about what they are doing. Others may have difficulty focusing under any circumstances. Some adults look for stimulation, but others avoid it. In addition, adults with ADHD can be withdrawn and antisocial, or they can be overly social and unable to be alone.
School-related impairments linked to adult ADHD
Adults with ADHD may have:
Had a history of poorer educational performance and were underachievers
Had more frequent school disciplinary actions
Had to repeat a grade
Dropped out of school more often
Work-related impairments linked to adult ADHD
Change employers frequently and perform poorly
Have had fewer occupational achievements, independent of psychiatric status
Social-related impairments linked to adult ADHD
Adults with ADHD are more likely to:
Have a lower socioeconomic status.
Have driving violations such as: be cited for speeding; have their licenses suspended; be involved in more crashes; rate themselves and others as using poorer driving habits.
Use illegal substances more frequently.
Self-report psychological maladjustment more often.
Relationship-related impairments linked to adult ADHD
Adults with ADHD are more likely to:
Have more marital problems and multiple marriages.
Have higher incidence of separation and divorce.
Much of this functional impairment diminishes with remission of the disorder and can be mitigated by appropriate treatment.
How is adult ADHD diagnosed?
While researchers may disagree about age of childhood onset in diagnosing adult ADHD, all agree that ADHD is not an adult-onset disorder and must be verified from childhood. An assessment of ADHD symptoms and behavior from childhood may include any or all of the following:
A questionnaire to determine if the adult had ADHD in childhood.
School report cards, if available, to look for comments about behavior problems, poor focus, lack of effort or underachievement relative to the student’s potential.
Discussion with the parents to determine any symptoms during childhood.
A complete history from the adult with the symptoms. He or she may self report symptoms in childhood.
The developmental history would be consistent with ADHD, including evidence of problems with peers, other delays such as bed wetting, school failure, suspensions, or special interventions such as sitting in front of the class, etc.
A strong family history of ADHD may also be informative, given the strong genetic component of the disorder.
Other examinations may also be performed, including:
A physical exam to rule out medical or neurological illness.
An EEG, CT, or MRI.
Psychoeducational testing (for example: IQ test, achievement testing) if a learning disability is suspected.
Medications to treat adult ADHD
The same drug treatments proven to be efficacious in children appear to benefit adults with ADHD.
In the past, the first treatment offered to adults with ADHD has been stimulant drugs. Studies show that approximately two thirds of adults with ADHD who are given these medications show significant improvement in ADHD symptoms.
However, there are some difficulties in using stimulants to treat ADHD in adults. Stimulants are controlled substances and it is not uncommon for adults with ADHD to have or to have had problems with substance abuse. Short acting stimulants may wear off quickly and since adult patients administer the medication themselves, and usually have problems with forgetfulness, compliance can be problematic with multiple day dosing. Adults may experience significant difficulty in the evening when they do housework, pay bills, help children with homework or drive, or are tempted to use substances “to relax.” Learn more about Stimulant therapy for ADHD.
Strattera is the only nonstimulant medication approved by the Food and Drug Administration (FDA) for the treatment of ADHD, not just for children and adolescents, but for adults as well. This is the first medication to receive an FDA indication for treatment of ADHD in adults.
Strattera does not have abuse potential and does not require a special prescription.
Behavioral treatments for adult ADHD
Adult ADHD may be treated with one or more of the following:
Individual cognitive and behavioral therapy to enhance self-esteem.
Relaxation training and stress management to reduce anxiety and stress.
Behavioral coaching to teach the person strategies for organizing home and work activities.
Job coaching or mentoring to support better working relationships and improve on-the-job performance.
Family education and therapy.
In-depth assessment, treatment planning, medication management, individual therapy, education and family support are all necessary to help the adult with ADHD function in new ways and build his or her self-esteem. Because ADHD is often associated with other conditions (such as specific learning disabilities, anxiety and mood disorders, obsessive compulsive disorder and chemical dependency), in-depth assessment is the first step in developing a comprehensive, customized treatment plan.
Psychosocial behavior management strategies
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 overcome these problems or make them more manageable:
Take medications as directed. If you are taking any medications for ADHD or any other condition, be sure and take them 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 health care provider as soon as possible.
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.
Control impulsive behavior. If you have a tendency to do things you later regret, such as interrupting or getting angry at others, manage the impulse by counting to 10 while breathing slowly instead of acting out. Usually the impulse will pass as quickly as it appeared.
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.
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. A hobby or other pastime can be helpful.
Ask for help. We all need help from time to time and it is important to not be afraid to ask for it when you need it. If you are having disruptive thoughts or behaviors, ask a counselor if they have any techniques that might help control them.
Living with adult ADHD
Although most people don’t outgrow ADHD, they do learn to adapt. If the difficulties associated with ADHD are managed appropriately throughout their lives, adults with ADHD can learn to develop personal strengths and become productive and successful.
Reviewed by the doctors at The Cleveland Clinic Children’s Hospital.
WebMD Medical Reference provided in collaboration with the Cleveland Clinic.
Reviewed by Brunilda Nazario, MD on September 15, 2008
Portions of this page © The Cleveland Clinic 2000-2004.