ADHD in adults
Attention deficit hyperactivity disorder (ADHD) develops in childhood. The symptoms often improve with age, but they can sometimes carry on into adulthood. Some people are first diagnosed with ADHD as adults.
Experts have agreed on specific criteria that need to be met for ADHD to be diagnosed. These criteria describe how pronounced inattentive, hyperactive and impulsive behaviors are. It is estimated that 15% of children and teenagers with ADHD still fulfill the criteria when they are adults. The symptoms of ADHD are different in adults, though. Hyperactivity is often less of a problem and inattentiveness becomes the most noticeable symptom.
Some people are first diagnosed with ADHD as adults. It can be difficult for adults with ADHD to find support. Because it is generally considered to be a childhood condition, information and treatment specifically for adults is less widespread.
What are the signs of ADHD in adults?
ADHD is less apparent in adulthood than it is in hyperactive and “fidgety” children and teenagers. Adults with ADHD mainly have problems organizing their everyday life or work, focusing on tasks for longer periods of time, and keeping appointments or paying bills.
They are also very impulsive, though. Adults who have ADHD may talk a lot and constantly interrupt others. Some get into trouble quite easily, end relationships suddenly, switch jobs at the drop of a hat, or quit before they have found a new position. They may also cause problems on the roads, for instance due to reckless driving.
Many adults with ADHD have trouble keeping their emotions under control. They are irritable, tend to lose their temper and have a low tolerance for frustration. When stressed, they find it hard to attend to their responsibilities. In general, adults with ADHD also have difficulty setting and reaching goals.
There is some disagreement among specialists as to whether ADHD actually exists in adulthood. But many of the professional associations in Germany now recognize ADHD in adults as a diagnosis. Medication has also been approved for the treatment of ADHD in adults.
It comes down to this: If someone has psychological problems that significantly affect his or her quality of life for a longer period of time, then it is a good idea to seek professional advice. It is also important to be cautious when diagnosing ADHD to avoid unnecessary or incorrect treatment.
How is ADHD diagnosed in adults?
The criteria for diagnosing ADHD in adults are essentially the same as those for diagnosing ADHD in children. If the following criteria are met, the person is considered to have ADHD:
- The abnormal behavior started in childhood
- There are at least six signs of inattentiveness, hyperactivity or impulsiveness
- There are problems in more than one area of the person’s life
- There are major problems in social or professional settings
Some people who have ADHD were never diagnosed with it as children. There is a special questionnaire for those adults, designed to help the doctor to diagnose it by looking back. This has to be done before any medication can be prescribed.
It is important to rule out any other mental disorders that may be causing the symptoms. Sometimes ADHD is mistaken for another condition, such as borderline personality disorder or bipolar disorder.
Many people with ADHD also have other disorders or problems, such as social behavior disorders, depression, tic disorders and alcohol or drug dependency. These kinds of problems may be complications of ADHD. Adults with ADHD often report low levels of self-esteem, which can sometimes lead to depression. Alcohol and drug use may be an attempt to cope with ADHD or relieve the symptoms.
How do adults with ADHD cope with the disorder?
Most of the problems that adults with ADHD have are related to their short attention span or impulsiveness. Some of them develop good coping strategies, though, including the following:
- Plan your day in detail and make a list to help you remember what you need to do. It is important not to take on too much at a time.
- Divide tasks into smaller steps to make it easier to slowly work your way through them.
- Put reminders in places where they can help you, like on your front door or refrigerator, or in the car.
- Make a note of important appointments and chores in a notebook or in an app.
- Introduce routines and always keep important things – like the keys to the house or your wallet – in the same place.
Because ADHD causes different problems in different people, it’s hard to give general advice. But many people find out over time what can help them cope better in everyday life. Support from family and friends is helpful here.
Where can adults with ADHD turn to for help?
ADHD in adults is usually treated by psychiatrists, specialists for psychosomatic medicine, neurologists or psychotherapists. Before young people with ADHD turn 18, it's a good idea to get a head start with finding a new practice because you may have to wait a long time to get an appointment. In some cases young adults can continue treatment with their child psychiatrist or therapist until they turn 21.
Who should I tell about my diagnosis?
People who have mental disorders often ask themselves whether they should tell other people about their diagnosis. Close friends or family members may already know, but it's a different matter at the workplace. Whether or not to tell your coworkers or boss is a very difficult and personal decision. Many people decide to keep the diagnosis to themselves for one or more of the following reasons:
- They are afraid of losing their job or of not being hired.
- Discrimination in the workplace may be a concern.
- They're not sure what sort of rights they have as an employee.
- They consider their disorder to be a private matter that is no one else’s business.
But there are also good reasons for not keeping the diagnosis a secret:
- Over time, it can be mentally exhausting to hide the disorder from others.
- It may be stressful to keep worrying about whether someone could find out.
- Dealing with your problems honestly and openly can make things easier.
- If no one knows about your condition, it will not be possible to apply for help from your employer.
- If your coworkers and boss know about the disorder, they're more likely to offer support and understanding.
Because the advantages and disadvantages of being open about having ADHD can vary so much from person to person, there is no general advice concerning who to tell about the diagnosis. It may help to discuss the issue with your doctor or psychotherapist. In larger companies, it may be possible to talk to someone from the works council or the company’s medical services first.
Asherson P, Adamou M, Bolea B, Muller U, Morua SD, Pitts M et al. Is ADHD a valid diagnosis in adults? Yes. BMJ 2010; 340: c549.
Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP), Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (DGSPJ). Langfassung der interdisziplinären evidenz- und konsensbasierten (S3) Leitlinie "Aufmerksamkeitsdefizit- / Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter". AWMF-Registernr.: 028-045. May 2017.
Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36(2): 159-165.
Moncrieff J, Timimi S. Is ADHD a valid diagnosis in adults? No. BMJ 2010; 340: c547.
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