Let's Talk About ADHD in Adults
Most adults with ADHD have had it since childhood but were never diagnosed. Think that could be you? We're here to help.by Gail O’Connor Health Writer
Imagine walking around with a condition that affects every aspect of your life, and not knowing it. If you’re reading this, maybe you know what that’s like. For years you’ve struggled with procrastination, disorganization, and time management. Worse, you’ve probably come down hard on yourself for these things. But the problems aren’t because of some character defect—ADHD is a real condition and surprisingly common in adults. If you’re wondering whether that could be you (or you’ve recently been diagnosed), here’s what you need to know about this totally manageable disorder.
Our Pro Panel
We went to some of the top experts in ADHD to bring you the most up-to-date information possible.
Lindsay Elton, M.D.
Child Neurology Consultants
Mary Beth Lardizabal, D.O.
St. Paul, MN
Patricia Gerbarg, M.D.
Assistant Clinical Professor, Psychiatry
New York Medical College
It’s hard to say exactly because ADHD looks very different from person to person. But generally, if you experience symptoms—like impulsiveness, poor planning, or mood swings—that are severe, happen frequently, and are disruptive to your life, you should consider being evaluated for adult ADHD.
Some folks with ADHD have had to deal with frustrations from romantic partners about attentiveness and mood swings. Other hurdles that men and women with ADHD encounter involve relationship hopping, feeling distant, or cheating. It’s not easy, we know. But, with a little hard work and extra help (from therapists, etc.) healthy and happy relationships are doable.
Some small studies suggest getting less processed food, and more fatty acids into your diet have a modest benefit on improving ADHD symptoms, so eating foods like salmon and nuts can’t hurt.
While many people use medications to help in managing symptoms of ADHD, this is a personal decision and should be made with the help of your doctor and therapist. Understanding the different medications available and what they can do for you can help you make the right decision.
First, What Is ADHD Again?
Simply put, ADHD, or attention-deficit hyperactivity disorder, is one of the most prevalent childhood disorders that can continue through adolescence and into adulthood. According to the Centers for Disease Control and Prevention, roughly 5% of the adult population has ADHD. Prevalence is higher for men (5.4%) versus women (3.2%), according to the National Institute of Mental Health (NIMH), though women may be underdiagnosed.
What does the disorder look like in adults? There are three main behaviors associated with ADHD, according to the NIMH:
Adults with ADHD may have one of the above signs or symptoms, or a combination. They can frustrate the person experiencing them, and try the patience of friends, bosses, and partners. And because ADHD is perceived to be a kid’s disorder, for years adults with ADHD will blame themselves for their “spaciness” or “forgetfulness,” when in reality, they have a common condition—one that can be managed.
Do I Have Symptoms of ADHD?
Of course, everyone is inattentive or restless at least sometimes, and no one’s above an occasional late bill or a forgotten RSVP. But ADHD is different: It’s not being inattentive sometimes, or restless now and then. In people with ADHD, these behaviors are:
Disruptive to quality of life
Let’s take a closer look at how these symptoms may appear in your everyday life. Check and see if any of these sound familiar to you.
Inattention: Having trouble sticking with someone in conversation, wandering off-task, giving up persistence to finish things, losing stuff, and feeling unable to stay focused are part of ADHD's inattention symptom. All of which can add up to feeling generally disorganized. This may also include:
Having a hard time remembering conversations or directions
Feeling flustered or stressed out
Overlooking or missing details and making careless mistakes
Avoiding things that take sustained mental effort, like paying bills
Having trouble keeping work materials organized, managing time, and meeting deadlines
Losing stuff: your wallet, your keys, your phone
Hyperactivity: Being in perpetual motion—moving, tapping, being squirmy—is the most common sign of ADHD that you see in preschoolers. Adults may also have trouble sitting still, but often hyperactivity is more about internal feelings of an inner restlessness, having a million racing thoughts, and getting bored easily. This can include:
Having trouble waiting in line, waiting for an answer…waiting in general
Inability to sit still at work
Low frustration tolerance
Getting bored easily
Impulsivity: At its most basic definition, impulsivity is doing something without forethought. In kids, that could mean darting into the street without looking. In adults? Saying something you instantly regret, sending an impatient text that you wish you hadn’t, excessively interrupting others, or major emotions coming on in a flash are all signs of impulsivity. Impulsivity could apply to risky behaviors like taking drugs or having sex without thinking about the long-term consequences. It can include:
Interrupting or intruding on others’ conversations
Emotional reactions that stem from a hypersensitivity to criticism
Remember, it’s not whether you feel restless now and again, or if you misplace your keys from time to time. (That’s just called life.) ADHD means these behaviors are serious enough and happening often enough that they are impacting your ability to get through your day-to-day, possibly jeopardizing your job or relationships as well.
How Do Doctors Diagnose Adult ADHD?
A primary-care doc might identify signs of ADHD and offer a preliminary diagnosis, but if your physician doesn’t have extensive ADHD-specific experience, you should be referred to a licensed clinician, like a psychiatrist or psychologist, who does.
There isn’t a single medical, physical, or genetic test for ADHD, but a diagnostic evaluation can be provided by a qualified mental health care professional or physician. They should gather info from multiple sources, including:
ADHD symptom checklists
A detailed history of past and current functioning
Information obtained from family members or significant others
Standardized behavior rating scales
What shouldn’t happen: a diagnosis of ADHD after a few brief office observations or phone calls. ADHD symptoms don’t necessarily reveal themselves that way, especially in adults, and a good diagnostician will take a thorough history of your life, plus include the possible presence of co-occurring conditions, like anxiety.
During a thorough evaluation, the clinician will try to determine the extent to which these symptoms are affecting your life, and if they have been present since you were a kid. In making the diagnosis of ADHD in an adult, at least five of the above symptoms should be present.
These symptoms can change over time, though. The stuff you might remember as a kid, like a teacher who said you didn’t listen, could look totally different in your adult life, like struggling at work to stay on task.
Most children with ADHD receive a diagnosis while they’re still in elementary school. (ADHD symptoms can appear as early as between 3 and 6 years old.) For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12. It’s not a condition that comes on suddenly in adulthood, in other words.
What Is the Best Treatment for Adult ADHD?
Pharmacologic treatments for this disorder can be very effective, though they should always be used in combination with psychotherapy and psychosocial interventions as well. While these treatments for adults may be similar to what’s used to treat children with ADHD, the medications may be different for adults, whose bodies have changed over time. Adults may require a different skillset than kids to help stay organized, and in particular may also need treatment for other issues like depression and anxiety.
Finding the right balance with medication can take some trial and error. Your healthcare provider may try different meds and dosages before hitting on the right one. Some people are amazed by the difference in how they feel, thanks to medication. It’s important not to miss doses or symptoms may return. These are some of the most common meds your doctor may prescribe:
Prescribing a stimulant for a condition that’s a lot about feeling overstimulated may sound counterintuitive, but stimulants are the most popular medication to treat ADHD. They work by giving a boost of the brain chemicals dopamine and norepinephrine, which help your brain focus and shoo away distractions.
They’re a popular choice to help manage moderate to severe cases of ADHD—mainly because evidence shows they work, improving symptoms in about 70% of adults shortly after starting treatment, according to the Cleveland Clinic. There’s no evidence that using them leads to drug abuse, but there’s always the possibility of addiction with any stimulant, so ask your doc questions before deciding whether or not to try them.
There are just two first-line molecules used to treat ADHD: methylphenidate and amphetamine. They’re both central nervous system stimulants, which help many people improve focus and attention. Half of patients will find that using either type of stimulant works equally well. The other half, however, will discover that one is more effective for them than the other.
Methylphenidate-based stimulants include:
Adhansia XR (methylphenidate hydrochloride)
Concerta (methylphenidate HCI ER)
Jornay PM (methylphenidate hydrochloride)
Quillichew ER ((methylphenidate hydrochloride)
Qullivant XR (methylphenidate hydrochloride)
Ritalin (methylphenidate hydrochloride)
Amphetamine-based stimulants include:
Evekeo (amphetamine sulfate)
Vyvanse (lisdexamfetamine dimesylate)
With stimulants having a strong track record for efficacy, why would someone consider a non-stimulant? There are certain instances where a doctor will prescribe a non-stimulant: if stimulants aren’t helping, if you’re suffering from unpleasant side effects, or if you might benefit from one in combination with a stimulant.
Non-stimulants don’t work as quickly as stimulants do, but they may also help mitigate symptoms of ADHD by improving focus, attention, and impulsivity, by increasing brain activity of norepinephrine.
Norepinephrine is a neurotransmitter linked to attention. Unlike stimulants, nonstimulants may take four to six weeks to show results. Strattera (atomoxetine), long known as the first non-stimulant medication for ADHD, works in about half of patients. Non-stimulants include:
People with ADHD often have other conditions too, like depression, anxiety, and bipolar disorder. While not approved by the Food and Drug Administration for the treatment of ADHD, antidepressants may be used alone or in combination with stimulants to treat ADHD.
Beyond meds, simple lifestyle changes may also help treat ADHD symptoms. Some small studies suggest getting less-processed food and more fatty acids into your diet can have a modest benefit on improving ADHD symptoms. (Think salmon, olive oil, and nuts.)
Avoiding highly processed foods and sugars is also a good idea, since these are known to quickly spike—then drop—your energy levels, which are likely already on a roller coaster thanks to the ADHD. And regular exercise like walking, cycling or yoga, while not a cure-all, can be a positive outlet when you’re feeling wound up or restless.
Does ADHD Treatment Have Side Effects?
Both stimulants and non-stimulants can have side effects. These are a few things to look out for.
Stimulant side effects can include:
An upset stomach
Higher blood pressure
Moodiness and irritability
“Rebound” (a flare-up of ADHD symptoms when the medication wears off)
Since stimulants can also increase blood pressure, heart rate, and anxiety levels, if you have other health problems or an anxiety disorder, talk to your doctor before starting meds.
Nonstimulant side effects can include:
What’s Life Like for Adults With ADHD?
For adults with ADHD who were never diagnosed or diagnosed late in life, there might be a history of poor grades, trouble at work, and prickly relationships with friends and romantic partners. Maybe you switched majors or schools a lot. You’ve probably fielded frustrations from romantic partners about your attentiveness (or lack thereof).
Even if your partner’s pretty forgiving of you forgetting important dates or appointments, a bigger hurdle if you have ADHD might be boredom when that dopamine rush of a new relationship fades over time, which can result in relationship hopping, feeling distant, or cheating. Therapy or couples counseling can help.
It’s not easy having ADHD, but there is hope: ADHD is a condition that responds to being managed. You may have ADHD, but with the right interventions, it doesn’t need to keep you from a healthy and satisfying work and personal life. (ADHD didn’t stop Michael Jordan, Will Smith, Simone Biles, or Walt Disney.) Your ADHD will be unique from someone else’s, and with the right care and support you can learn the skills to manage it.
- ADHD Statistics: Centers for Disease Control and Prevention. (2016). “Data and Statistics About ADHD.” cdc.gov/ncbddd/adhd/data.html
- ADHD Statistics in Adults: National Institute of Mental Health. (2017). “Prevalence of ADHD Among Adults.” nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd.shtml
- Definition of ADHD: American Psychiatric Association. (2017). “What Is ADHD?” psychiatry.org/patients-families/adhd/what-is-adhd
- Signs and Symptoms: National Institute of Mental Health. (2019). “Attention-Deficit/Hyperactivity Disorder, Signs and Symptoms.” nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
- Underdiagnosis in Adults: The Primary Care Companion for CNS Disorders. (2014). “Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature.” ncbi.nlm.nih.gov/pmc/articles/PMC4195639/
- ADHD in Girls and Women: ADDitude. (2019). “ADHD Symptoms in Women.” additudemag.com/what-are-the-symptoms-of-adhd/
- Diagnosing in Adults: CHADD. (n.d.). “Diagnosis of ADHD in Adults.” chadd.org/for-adults/diagnosis-of-adhd-in-adults/
- Treatment: Centers for Disease Control and Prevention. (2019). “Treatment of ADHD.” cdc.gov/ncbddd/adhd/treatment.html