Adults with Attention Deficit Hyperactivity Disorder
Twenty years ago, medical professionals did not believe that adults struggled with Attention Deficit Hyperactivity Disorder (ADHD). We believed that this was a childhood condition that disappeared in adulthood. But about ten years ago, long-term studies demonstrated that many symptoms of ADHD persisted into and through adulthood. More recent evidence suggests that almost two-thirds of children who are diagnosed with ADHD as children have significant problems during adult life. Our understanding of this condition has changed.
ADHD is characterized by symptoms such as hyperactivity, inattention, problems with planning and organizations, impulsivity, and distractibility. In order for an individual to be diagnosed, they must have significant impairment in at least two spheres of life (e.g. school, work, relationships, or home life).
Most children who are diagnosed with ADHD are hyperactive, which results in disruption at school and at home. It is far easier for teachers to identify these children, than the less busy, inattentive kids that may also have ADHD, but without the hyperactivity.
As children with ADHD, of the hyperactive type, grow up, their hyperactivity may diminish, but they still can have big problems with planning, organization, impulsivity, and distractibility. Fortunately, adults have more choice over work options, and can pick a vocation that isn’t so impacted by their ADHD. But they can still struggle at work, in school and with relationships.
Unfortunately, adults with ADHD have higher rates of poor school performance, lower incomes, higher rates of job loss or turnover, higher rates of auto accidents, and increased rates of divorce. The often have a higher proportion of drug abuse, depression, and anxiety than the population at large.
In our behavioral health department at The Everett Clinic, we see scores of adults who wonder if they have Attention Deficit Hyperactivity Disorder. Some of these individuals were diagnosed as children, took medication in elementary school, but stopped when they were teens. Now as young adults returning to college, they are struggling. These individuals are relatively easy to diagnose because they were already identified as children. Generally, we have to assess if they are having major challenges in at least two areas of adult life to re-diagnose them.
But some individuals with attention problems were not diagnosed as children because 1) they were bright and able to compensate in the lower grades for their inattention (they weren’t disruptive and they got decent grades) or 2) they had the inattentive type of ADHD which is more difficult to identify. These children were more often “spacy” but not disruptive. They tend to get lost in the back of the classroom. The proper diagnosis of these adults is more difficult.
Frequently these individuals may have other problems that may make their diagnosis more complex. They may also struggle with anxiety and depression which can impact many areas of life. Sometimes men and women can have medical issues that muddy the water.
It is important to remember that ADHD does not develop in adult life! According to the Diagnostic manual it must have been present prior to age of 7.
So how do we diagnose adults with ADHD? Unfortunately there are no blood tests or diagnostic imaging that verifies this diagnosis. If they were diagnosed as children, it is far simpler. But, if not, we must reconstruct their early childhood and carefully determine how they functioned as children, retrospectively. In other words, would we have diagnosed them with ADHD when they were children?
It is very helpful if adults bring in elementary school report cards, where we can look at teacher’s comments (e.g. daydreamer, difficulty staying on task, looks half asleep, trouble completing assignments, forgets to bring in homework, etc.). Sometimes it is helpful if we can talk to parents, siblings, or significant others. They can provide independent observations which help us make a diagnosis. The use of popular ADHD scales can be helpful, but only in conjunction with a detailed history.
When we do make a diagnosis of ADHD, medications can be extremely helpful (more about medical treatment in a future post). It is always gratifying when we make an accurate diagnosis, provide treatment, and the adult feels that he or she is able to function more effectively at work, school, or at home.