ADHD in Adults

Attention-deficit/hyperactivity disorder can - and does - affect adults as well as children

Illustration by Kristina Rowell

In this age of information overload, our ability to maintain focused attention seems destined to fade away into the technosphere along with the latest Twitter, Instagram and Facebook post. How fast-paced living and splintered screen time affect our attention span is not fully understood, but experts say Americans with attention-deficit/hyperactivity disorder (ADHD) have had to contend with attention difficulties since long before gigabytes and blogs became household terms.

Most likely you’ve heard of ADHD, but you might not realize that the condition can affect adults as well as kids. In fact, many adults have ADHD but do not know it. In the United States, ADHD affects 4.1 percent of adults, with 41.3 percent of those cases classified as “severe,” according to the National Institute of Mental Health.

ADHD is a mental health condition that affects the brain’s ability to select what we need to concentrate on, maintain focus so that we can efficiently begin and finish what we have to do and put the job to rest and shift to other tasks. Attending to tasks is a brain function “with many layers to it, [and] each one of those aspects can be disrupted,” leading to ADHD symptoms, says Hisham Hafez, MD, a psychiatrist and president of Healthy Perspectives in Nashua.

ADHD might seem like a problem that has only recently surfaced; middle-aged and older adults will likely be unable to recall hearing of classmates who were diagnosed with ADHD when they were kids. But ADHD symptoms are not new. “ADHD just wasn’t recognized as a disorder” as it is now, says Shawne Diaz, MA, LCMHC, a licensed clinical mental health counselor at Elliot Behavioral Health Services. Years ago, kids with attention problems were often simply considered daydreamers, for example.

Today, not only is the disorder more widely recognized and treated, its long-term effects are better understood. Until the early 1980s, many people believed that ADHD symptoms resolved with growing up. But “we now know ADHD is a condition that starts in childhood and can continue into adulthood,” Hafez says. More than 50 percent of people who have ADHD as children still experience ADHD symptoms as adults, Hafez says.

People with ADHD typically fall into one of three categories — they suffer from being inattentive, hyperactive or impulsive — or they have a combination of symptoms. The inattentive form of ADHD is more prevalent in females, while hyperactivity or a mix of symptoms is more commonly found in males, Diaz says. Aside from cases in which factors such as disease or head trauma interfere with the functioning of the brain, causes of ADHD remain a bit of a mystery — although a family history of the condition is considered a significant risk factor.

ADHD symptoms can include mood swings, the inability to focus, anxiety and low self-esteem. Sometimes people who have ADHD get frustrated “because things aren’t happening as fast as they want them to be happening,” Diaz says. People with ADHD might find that they frequently lose things, are generally forgetful or struggle with time management. Some adults who have ADHD also lack social skills. “They might interrupt a lot or kind of blurt out an answer” or interjection, Diaz says.

Many adults who have ADHD have never been diagnosed as having the condition, Diaz says, and not everyone needs treatment, but faced with the challenges the disorder presents, people with ADHD often at least try to find ways of their own to deal with the condition. “They develop different techniques and behaviors to get around not being able to pay attention or not being able to organize things or sit still,” Diaz says. Symptoms can still linger, however. Adults who were hyperactive as children can learn to rein in their energy, for example, but might still be fidgety during a work meeting, Diaz says. Some adults with ADHD try to select a work environment that suits their attentional disposition, but run into trouble if faced with a mismatch of attention-related ability and the task at hand.

But more than anything else, adults with ADHD often find that the condition harms their relationships, Hafez says. They might miss their spouse’s birthday, or frequently run late for appointments and events. They might be disorganized and fail to follow through on what they promise because they’ve forgotten what they said. As the fall-out and frustration build, matters can worsen. “If you have a condition like this and it goes undiagnosed, you’re trying very hard but you’re not succeeding,” Hafez says, which can affect your self-esteem and influence your relationships with other people. “In that sense, it might affect your mood or your ability to function,” Hafez adds. Social anxiety can develop, interfering with the person’s ability to relate to people and approach people, he says.

Although treatment will not cure ADHD, it can be highly effective, Hafez explains, for managing symptoms. Many patients are prescribed a blend of medication and therapy that helps address behavior patterns and the social and psychological components of ADHD. “Treatment in my opinion has to be very individualized,” Hafez says, and should take into account the patient’s life, work, and relationships.

ADHD treatment can be profound “for people who all their life have worked extremely hard” but were unable to get good grades in school and have struggled in their career and home life, Hafez says. Some adult ADHD patients describe treatment as “transformative,” he adds, and say that at last they know what they need to focus on to finally achieve success at work and in their personal relationships.