2024 Adult ADHD: a Guide on Symptoms, Causes, and Treatment

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that leads to issues with attention, impulsivity, and hyperactivity. People with ADHD are neurodivergent.

It means that their brain is developed differently than a typical brain. Their neural connections are lesser and specific regions of their brain are smaller and less denser. It is commonly diagnosed in school-going children.

ADHD is marked by consistent and ongoing difficulties with maintaining focus and attention, and impulsivity.

Some of the signs of people with ADHD are:

Inattention: Inattention is observed as

Overlooking details, making careless mistakes at work or school
Having difficulty maintaining attention during tasks or play; attending lectures or long readings.
Misplacing their belongings
Being easily distracted
Being forgetful

Hyperactivity, Impulsivity: It is observed as

Fidgeting when seated
Being constantly in motion
Children are reported to constantly climbing on things
Having difficulty staying seated in situations where they are expected to be seated, such as in classrooms.
Talk excessively
Having difficulty taking turns, or waiting for their turn.

These symptoms tend to affect the typical development of an individual and also disrupt daily functionality.

Causes of ADHD

The exact causes of ADHD are not known. However genetic and environmental causes are known to play a role in ADHD. Some specific causes include:

Genetics: ADHD tends to run in families, suggesting the role of genetic predisposition.
Brain Structure and Function: Differences in brain structure and functioning, particularly in areas related to attention, impulse control, and executive function, have been observed in individuals with ADHD.
Neurotransmitter Imbalance: Imbalances in neurotransmitters (chemical messengers in the brain) like dopamine and norepinephrine can affect communication within the brain circuits that control attention and behavior.
Prenatal Factors: Factors during pregnancy such as maternal smoking, alcohol use, exposure to toxins, premature birth, and low birth weight may increase the risk of ADHD.
Environmental Factors: Early exposure to environmental toxins (e.g., lead), high levels of stress in early childhood, and inconsistent parenting styles may contribute to the development of ADHD symptoms.
Brain Injury: Injury to the frontal lobe of the brain due to trauma or illness can sometimes lead to symptoms resembling ADHD

What is Adult ADHD

For many years, the diagnosis of ADHD was only reserved for children. However, studies have found that the condition also prevails in adolescents and adults.

Over 2-3% of the adult population is known to be affected by adult ADHD (Katzman, 2017). Adults with ADHD often report their experiences as-

“I constantly struggle to manage my time effectively. I always find it difficult to complete my tasks in the stipulated time. It is as if I can’t make sense of how much time has passed."

"I find myself constantly jumping from one thing to the next, which can be frustrating for myself and the people around me. It's like, I start tasks but struggle to finish them because new ideas pop into my head."

“I often end up jumping into saying something in the office meetings, its as if I have to just say something, I end up later feeling that I should have thought before speaking up or mostly, it wasn't required for me to speak at all.”

People with ADHD, usually report having difficulty maintaining focus, organizing their tasks, managing their time, and hastily taking action without giving it a thought. ADHD is a long-term, debilitating disorder that impacts many areas of an individual’s life. It affects one’s professional and personal life, interpersonal relationships, and self-esteem.

Adult ADHD vs. ADHD

ADHD has three main symptoms, Inattention, Impulsivity, and Hyperactivity. These three symptoms are seen in both adults and children. However, they differ in how they manifest in adults and children. With children, these signs and symptoms may be more obvious and easier to spot as compared to adults.

Usually, the way ADHD symptoms present changes over the course of time of an individual.

In children, inattention is observed around school tasks and other chores. They end up misplacing their stuff, have difficulty completing tasks, and have difficulty attending and listening when they are spoken to.

Hyperactivity in children is observed as they are constantly on a run, climbing on things, fidgeting with their hands, and having difficulty sitting through lectures in the classroom. Impulsiveness is observed as skipping queues, blurting out answers when not their turn, and acting without thinking.

However, in the cases of adults, since they had lived with the symptoms for so long, they have either found a way to cover it up or have excuses for them. For adults, hyperactivity becomes more internalized with feelings of restlessness but their inattention and lack of focus areas are more prominent and persistent.

In adults, Inattention is the most persistent symptom of ADHD. It is observed in their work life, with difficulty completing their task due to lack of focus, forgetting things, not paying attention to details, and careless mistakes.

Hyperactivity, on the other hand, is more like a general feeling of unrest, getting bored easily from routine tasks and wanting continuous change, talking excessively. Impulsiveness can be seen as getting involved in more risky behavior, blurting out answers in meetings, monopolizing a conversation, and spending impulsively.

The instances and examples mentioned above are situations, habits, and things that most people indulge in at some or other time. So when diagnosing a person with ADHD, a holistic understanding of the person, their context, duration, and disruption in their daily lives needs to be considered.

Also, a lot of these symptoms, such as that of impulsivity could be seen in other conditions like Borderline Personality Disorder in adults or Oppositional Defiant Disorder. So, the mere presence of these examples in your or someone’s behaviors does not warrant a diagnosis of ADHD.

A thorough investigation and analysis by a clinical psychologist is essential. To simply understand, for any of the manifestations to be a symptom of ADHD it has to be frequent, persistent, and uncontrollable; impacts functionality or disrupt two or more areas of life (eg, school, work, relationships) and worsens during times of stress.

Types of Adult ADHD

Several recent researches emphasize the significance of various characteristics of adult ADHD. Primarily, three kinds of ADHD are hyperactive-impulsive type, inattentive type, and combination presentation.

Predominantly Inattentive Type:

The prevailing traits of the predominantly inattentive presentation include inability to maintain focus, frequent casual errors, difficulty organizing work, easy distractibility, forgetfulness, avoidance of intellectually taxing tasks, and frequent misplacing of belongings.

Hyperactive-Impulsive Type:

Symptoms including fidgeting, restlessness, difficulty sitting still, excessive talking, answering questions quickly, difficulty waiting one's turn, and interrupting others are all part of the hyperactive-impulsive presentation.

Combined Presentation:

A considerable amount of symptoms from both the inattentive and hyperactive-impulsive groups are present in the mixed presentation, which significantly impairs day-to-day functioning. Such as the inability to sit, restlessness, excessive talking, making hasty decisions, procrastination, and forgetfulness all the symptoms are present simultaneously.

Hence, It is critical to recognize that adult ADHD symptoms can change and progress with time, necessitating a thorough assessment and individualized intervention plan from medical professionals to effectively manage the illness.

Can you develop ADHD as an adult?

Decades of research indicate that ADHD is a condition that develops in childhood and continues in adulthood. Many times it has been reported that people who were first diagnosed with ADHD in adulthood, missed getting an official diagnosis in childhood, probably because their symptoms did not cause much dysfunctionality. Often, the increasing demands and challenges of adulthood make ADHD symptoms more prominent and pronounced.

However, growing evidence has reported many instances where ADHD symptoms first appeared only in adulthood and are distinct from childhood ADHD (Reimherr, F, W., et al, 2015)). Studies have also reported that the causes of ADHD for childhood ADHD are distinct from adult ADHD.

Recent scientific studies have mentioned that there are more and more people who are diagnosed with late-onset ADHD who had no earlier history of those symptoms as a child. Another interesting finding reported that more females were diagnosed with Adult ADHD with apparent no signs of ADHD in childhood as compared to men. This is opposite to the gender ratio of ADHD diagnosis in childhood where more boys are diagnosed with ADHD as compared to girls.

ADHD in Adult Women: A Brief Overview

While inattention, impulsivity, and hyperactivity are the hallmark symptoms of ADHD, how they manifest in women may vary. Symptoms of inattention are more common in women with ADHD than hyperactive ones. They could have trouble staying focused, organized, or finishing things. They are frequently thought of as forgetful or daydreamers.

Physical hyperactivity and impulsivity may be less obvious among women however, they could be restless and impulsive on the inside which can show out as too much chatting or trouble waiting for their turn. Emotional Dysregulation is another indicator wherein emotional symptoms such as mood swings, anxiety, and depression are often reported (Weir, K., 2024). A few of the following instances of everyday emotional dysregulation in women might be observed as:

Emotional responses that don't seem to be in sync with the cause.
Low ability to tolerate irritation or frustration.
Difficulty in calming down or prone to sudden emotional outbursts.
Overwhelming feelings.
Unable to shift focus away from the feeling.

ADHD symptoms in women may be influenced by hormonal fluctuations during the menstrual cycle, pregnancy, and menopause. These variations may make symptoms worse and make treatment plans more difficult to implement. Moreover, women with ADHD may have additional stress and difficulties due to cultural expectations demanding them to be orderly, nurturing, and attentive.

It is observed throughout various studies that ADHD is time and again overlooked, misdiagnosed, or concealed among women causing them severe distress and to struggle in silence. In addition, early research on ADHD primarily focused on men/ assigned male at birth resulting in ADHD studies on adult women years behind.

Certain specialists claim that the present criteria's writing is less accurate or useful when it comes to diagnosing women. Furthermore, appropriate diagnosis and interventions to pay close attention to these indicators are crucial to lessen the difficulties in social, professional, and emotional spheres for adult women.

Treatment options for Adult ADHD

A combined approach is used for the treatment of Adult ADHD. A combination of medications, psychological counseling, and skills training is the most effective treatment. It holistically takes care of all the aspects of ADHD.

Medications:

The medications that are used for treating adult ADHD help to focus better on the tasks. The medications help people with ADHD to ignore the distractions, increase attention span, reduce hyperactivity, and control their impulsivity. The medications don’t cure ADHD. They help ease out the symptoms of ADHD and manage the distress around it.

It is also important to note that every medication works differently for every individual. It might take a while to figure out with your doctor the medication that suits you best.

The most common type of medication used is stimulants. Stimulants help increase the level of dopamine and norepinephrine in your brain. These chemicals help in your ability to pay attention and motivation. Stimulants work faster on your brain and are used with caution as they may have the potential to be addictive and other side effects.

Other kinds of medications used are non-stimulants. These medications are slower to show response. They increase norepinephrine in your brain. Non-stimulants help you improve your attention, focus, and impulsivity. It is considered more safe for use as its potential to create dependency is lower.

Psychological Counseling

Adults with ADHD face significant psychological stress, studies report that around 50-60% of adults with ADHD also have other psychiatric conditions. Thus, to manage the symptoms of ADHD and cope with associated stressors, psychotherapy is considered to be an effective option.

In psychological counseling, the clients are educated about their symptoms, and taught skills to manage their executive functioning better. For example, how to cope with past academic or professional failures and improve self-esteem.

Psychological Counseling also helps to navigate relational struggles, as adults with ADHD due to their impulsivity, forgetfulness, missing deadlines, and careless mistakes tend to experience issues with their coworkers, boss, friends, and family. Psychotherapy tends to address these aspects and help them cope better.

Summary

ADHD is a brain disorder that can be chronic and disrupts daily functionality to various degrees.

ADHD manifests differently across age groups, with adults often facing unique challenges in diagnosis and management. Understanding its varied symptoms and types—hyperactive-impulsive, inattentive, or combined—requires comprehensive assessment by a clinical psychologist. The exact causes of ADHD and especially Adult ADHD need to be ascertained.

While genetic and environmental factors contribute to its onset, effective treatment involves a tailored approach combining medication, therapy, and skills training to manage the symptoms better. Accurate diagnosis by qualified professionals is crucial for developing personalized strategies that enhance daily functioning and quality of life for individuals navigating the complexities of ADHD throughout adulthood.

References

Katzman MA, Bilkey TS, Chokka PR, et al.. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 2017;17:302

Waite, R. (2010). Women with ADHD: It is an explanation, not the excuse du jour. Perspectives in Psychiatric Care, 46(3), 182-196.

Pérez-Álvarez, M. (2017). The four causes of ADHD: Aristotle in the classroom. Frontiers in psychology, 8, 259649.

Reimherr, F. W., Marchant, B. K., Gift, T. E., Steans, T. A., & Wender, P. H. (2015). Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate. ADHD Attention Deficit and Hyperactivity Disorders, 7, 115-128.

Weir, K. (2024, April 1). Emotional dysregulation is part of ADHD. See how psychologists are helping. Monitor on Psychology, 55(3).