When you think about ADHD, you probably think about high-energy kids who need extra help in school. But what happens when those kids become adults?
In the past, it was thought that most kids outgrew attention-deficit/hyperactivity disorder (ADHD). Today, experts believe only 1 out of 8 children truly outgrows the condition.
Robert P. Wilfahrt, M.D., a family medicine physician at Mayo Clinic, is an expert on ADHD. In an episode of Mayo Clinic Radio, he says, “For a long time, parents were told, ‘Oh, Johnny’s having trouble in fourth grade, but he’ll be a great adult.’ He probably is. But he’s probably a great adult with ADHD.”
He continues, “ADHD is a neurodevelopmental disorder. A person who suffers from that distractibility and impulsivity was born that way. It’s not a behavioral choice. It’s not a result of their upbringing. It’s not a result of any habits that they might have grown up with. They came out of the womb with ADHD, and it’s been with them 24/7.”
About 5% of U.S. adults — 8 million people — have adult ADHD, but less than 20% get diagnosed or treated for it. Unfortunately, untreated ADHD may adversely affect daily life, work opportunities, relationships and life expectancy.
Symptoms of ADHD in adults
Symptoms of ADHD are similar in adults and children, but many adults have learned to make their ADHD less obvious.
Typical symptoms include:
- Disorganization and problems prioritizing.
- Poor time management skills.
- Problems focusing on a task.
- Trouble multitasking.
- Excessive activity or restlessness.
- Poor planning.
- Low frustration tolerance/hot temper.
- Problems following through and completing tasks.
- Trouble managing stress.
According to Dr. Wilfahrt, “The hyperactivity that those kindergarten teachers are dealing with tends to fade away with time. It takes a lot of energy to be hyperactive, and as a guy in his 40s, I can’t maintain that, right? But impulsivity and the ups and downs of emotional dysregulation can persist. So, I might not fidget as an adult, but I might not finish the bathroom remodeling project that I started six months ago.”
Dr. Wilfahrt says two symptoms he sees often in adults are:
- Emotional dysregulation. People with ADHD have emotions that bounce with unhelpful intensity and speed. For example, a minor slight from a co-worker could cause a strong emotional reaction for a person with ADHD. But then 15 minutes later, the person with ADHD is fine again.
- Trouble sleeping. At bedtime, people with ADHD can feel physically tired, but their minds are bouncing with disjointed thoughts. After hours of exhaustion, they fall asleep. But with little time spent actually sleeping, the next morning they’re tired and may have trouble getting to work on time.
ADHD and lower life expectancy
Getting treatment for adult ADHD is critical. One study showed that ADHD reduced life expectancy by 6.5 years for those who experienced ADHD only as children, and more than 11 years if it continued into adulthood.
“ADHD has a snowballing effect. If you’ve been ineffective your whole life, you tend to feel bad about it, developing anxiety about your performance and depressive symptoms as well,” he explains. “Because they’re stressed from being unsuccessful, they might adopt coping mechanisms — like alcohol or smoking, or make other bad choices.”
These coping mechanisms and choices can negatively affect health and lifespan, he says.
Untreated ADHD also is associated with more accidents and accidental death. And ADHD can make it harder for people to manage chronic health conditions.
Dr. Wilfahrt says, “Maybe they get diabetes later in life. And diabetes is picky. It’s a burden. You may have to test yourself and adjust doses of insulin four times a day. And if you have ADHD, you’re not good at that kind of complexity. So, caring for yourself later in life is difficult.”
Tests for ADHD in adults
According to Dr. Wilfahrt, unless your doctor is looking for it, adult ADHD is pretty easy to miss. There’s no definitive screening test for adult ADHD. To get an adult ADHD diagnosis, you’ll likely be evaluated in several ways, including:
- A physical exam to help rule out other possible medical causes for your symptoms.
- A medical history interview to learn about your current and past symptoms, health history and family medical history.
- Rating scales and checklist to help collect and evaluate information about your symptoms.
Rating scales and checklists are an especially important part of diagnosing ADHD in adults. Your doctor will ask you to rate yourself on a variety of factors. In addition, your doctor may also ask others — such as family members, friends, employers and colleagues — to complete similar surveys. If you’re diagnosed with ADHD, these tools are often used during your treatment to monitor symptoms and track your progress.
ADHD treatment for adults
The good news is there are several effective treatments for people with adult ADHD. While there’s no cure for ADHD, treatments can manage your symptoms and help you live a more rewarding life.
“[ADHD] is probably the easiest neuropsychiatric condition to successfully treat with medication. We all need this vitamin-like substance called dopamine in a certain part of our brains, and there’s some very inexpensive, easy-to-use medicines that put dopamine there,” says Dr. Wilfahrt. “There are stimulant and nonstimulant medicines that will address these symptoms.”
The most effective treatment for ADHD is a combination of medicine, psychological counseling, education and skills training. However, everyone is different. Be sure to talk to a doctor before taking any medications or supplements for ADHD.
Adult ADHD medication
If you have adult ADHD, you’ll work with your doctor to choose what medications to use. Medication choices depend on factors such as how long a medication lasts, the risk of side effects and the potential for drug misuse.
There are two big categories of medications for adult ADHD — stimulants and nonstimulants:
- Stimulants work quickly and effectively to help people control their ADHD symptoms. Long-term studies have shown that they’re safe, but there are risks of side effects and they don’t tend to last all day.
- Nonstimulants are another effective way to treat ADHD, with about three-fourths the power of the stimulant medicines. They don’t work immediately, taking between 3 days and a month or more to kick in (depending on which agent is chosen). But, once working, they are effective all day. They are helpful for people who also have anxiety, depression or issues with the side effects of stimulants, and can be particularly effective in helping shut off ADHD brain at bedtime, improving sleep. They don’t carry any risk for misuse.
Sometimes, doctors prescribe both stimulants and nonstimulants together. It often takes a few adjustments before you find the right medication plan for you.
Best ADHD medication for adults with anxiety
Having ADHD is stressful. So, it’s no surprise that ADHD and anxiety disorders often go hand-in-hand. Studies show that more than half of people with ADHD also have an anxiety disorder.
Many medications that are effective in treating ADHD can also be used for people with anxiety. Nonstimulants, antidepressants and even some blood pressure medications have been shown to alleviate symptoms of people with ADHD and anxiety. Stimulant medications help some people with anxiety, but they can increase anxiety symptoms in other people.
Home remedies for ADHD
Although people have used supplements — like vitamins or minerals — to improve their health for decades, using natural supplements to manage ADHD is a relatively new idea. Some promising research studies indicate that iron supplements likely help people manage ADHD if they have deficiencies in iron. Evidence from children also suggests that taking lots of fish oil — 2 grams twice per day — probably has a tiny effect on ADHD, small enough that it won’t likely replace their prescription meds. The best home remedy for ADHD is exercise: Both ‘big’ efforts, like going for a jog or bike ride, and ‘little’ movements, like pacing while talking on the phone, can nicely improve a person’s focus and smooth their moods.
ADHD counseling for adults
Counseling can be helpful for people with adult ADHD and their loved ones.
- People with adult ADHD can learn to improve organizational skills, reduce impulsive behavior, understand past failures, develop problem-solving skills and improve relationships.
- People who are impacted by an adult with ADHD can also benefit from counseling — helping them manage the stress of living with a person with ADHD, improving communication and learning problem-solving skills.
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