ADHD, or attention deficit hyperactivity disorder, poses unique impact and management challenges characterized by inattentiveness and hyperactivity/impulsiveness. These symptoms impact individuals of all ages, influencing daily lives, relationships, and overall well-being. Beyond the core symptoms, adults with attention deficit hyperactivity disorder may face burnout, emotional dysregulation, and ADHD brain fog. Understanding these aspects is crucial for effective management and treatment.
Types of ADHD
ADHD is a common neurodevelopmental disorder that is often diagnosed in childhood and can persist into adulthood. Children with ADHD may struggle with attention, impulse control, and hyperactivity.
There are three different types of ADHD based on the predominant symptoms [5]:
Predominantly Inattentive Presentation
- Difficulty organizing or completing tasks.
- Trouble paying attention to details and following instructions or conversations.
- Easily distracted or forgetful of daily routines.
Predominantly Hyperactive-Impulsive Presentation:
- Excessive fidgeting, talking, or inability to sit still for extended periods.
- Restlessness and impulsive behavior include interrupting others, grabbing things, or speaking at inappropriate times.
- Difficulty waiting for turns or following directions.
Combined Presentation:
- There is an equal presence of symptoms from both the inattentive and hyperactive-impulsive types.
It’s important to note that symptoms can change over time, leading to variations in the presentation of ADHD.
Common ADHD symptoms
The term ADHD refers to a condition marked by two main types of behavioral challenges: inattentiveness and hyperactivity/impulsiveness [13]. These symptoms typically become noticeable in children and teenagers before age 6, affecting various aspects of their lives [13].
In adults, ADHD symptoms are more subtle, including poor organizational skills, mood swings, impulsivity, and difficulty handling stress [13]. Related conditions may co-exist, such as depression and bipolar disorder [13].
Core symptoms of ADHD [13]:
Inattentiveness:
- Short attention span
- Forgetfulness
- Organizational challenges
- Difficulty following instructions
Hyperactivity and Impulsiveness:
- Constant fidgeting
- Excessive talking
- Acting without thinking
- Lack of a sense of danger
Beyond Core Symptoms
In addition to these symptoms, adults with ADHD may experience burnout and brain fog, which can impact all aspects of their lives, including relationships, job stability, self-esteem, and daily task management [9].
ADHD “Brain Fog”
Brain fog isn’t a diagnosis or medical term but refers to confusion and unclear thinking that makes it hard to concentrate, recall information, and make decisions. Some ADHD symptoms, like trouble paying attention, impulsivity, or poor working memory, can contribute to ADHD and brain fog. Still, brain fog can also be linked to cognitive impairments, brain inflammation, and neuroinflammation associated with ADHD.
Brain fog is a common term for experiencing sluggish cognitive tempo and difficulty with clear thinking. It can occur due to factors like inadequate sleep, poor nutrition, or the use of certain medications or drugs [11]. However, it is often associated with a subjective feeling of mental haziness caused by chronic low-level inflammation in the body, brain, or nervous system [11].
This inflammation can negatively affect mental and physical well-being [11]. While there is a lack of conclusive evidence for specific treatments targeting the mechanisms of this inflammation, various interventions, including medications and nonpharmacological approaches, may help reduce inflammation and improve cognitive and executive function. [11].
It is believed that early exposure to inflammatory triggers like cigarette smoke can raise the risk of ADHD in young children. People with ADHD also have a higher likelihood of having other inflammatory health conditions, such as asthma and eczema [7].
People with ADHD might have higher levels of cytokines, which are linked to the body’s immune response and inflammation [4]. Cytokines are small proteins released by cells that specifically impact how cells interact and communicate with each other [19].
Elevated cytokine counts have been linked to several symptoms, including[4].:
- Reduced attention span
- Higher likelihood of errors in cognitive tasks
- Delayed reaction times
- Disruptions in working memory [4].
Some people, especially children, may find some of the medications used to treat ADHD make them feel brain fog, especially medicines that may cause daytime drowsiness. Fatigue stemming from poor sleep can also lead to or worsen feelings of brain fog.
If you or a loved one experiences ADHD brain fog symptoms, it is essential to talk to your doctor about your symptoms, and they can help work to treat it.
ADHD Burnout
ADHD Burnout is a distinctive state characterized by physical, mental, and emotional exhaustion, resulting in overwhelming mental fatigue, reduced productivity, and feelings of hopelessness [14]. Recovering from this state can be challenging, but practical steps, such as identifying triggers and taking proactive measures, are crucial [14].
Triggers for ADHD burnout include transitions, changes in routine, sensory overload, sustained attention demands, and ADHD masking [14]. Recognizing these triggers allows individuals to address and manage them effectively, involving strategies like establishing a consistent routine, prioritizing sensory needs, and breaking down tasks into more manageable components [14].
ADHD Shutdown:
People with ADHD might go into shutdown mode when they’re dealing with intense emotions or challenging situations, making it tough for them to stay productive [3]. Changes in routines can be particularly challenging, leading to more exhaustion, frustration, and anger for those with ADHD [3]. When faced with overwhelming emotions, challenging tasks, or tough situations, individuals with ADHD might enter shutdown mode instead of reacting emotionally or trying to handle their feelings [3]. This state is sometimes called ADHD shutdown, ADHD paralysis, or ADHD freeze.
If stress hangs around for too long, the body’s sympathetic nervous system can kick into overdrive, causing increased anxiety and eventually leading to a state of hyperarousal or shutdown. Hyperarousal is a constant feeling of being on edge or alert, which can be draining.
On the other hand, shutdown is when the body and mind shut down in response to overwhelming stress. This makes it hard to stay productive and brings about numbness, disconnection, and an inability to act [3].
Emotional dysregulation:
Dealing with emotions when you have Attention-Deficit/Hyperactivity Disorder (ADHD) is a common challenge. It’s not just about feeling emotions differently; there’s a unique process in the brain for individuals with ADHD [18].
The amygdala, responsible for handling emotions like fear and delayed rewards, tends to be more active in people with ADHD [18]. Beyond the amygdala, there are structural and functional issues in critical areas responsible for emotional processing, like the amygdala, orbitofrontal cortex, and ventral striatum [18].
These regions experience changes in connectivity, making it challenging to regulate emotions effectively [18]. Additionally, the cortex, dealing with cognitive and emotional tasks, shows unusual activation patterns when faced with positive and negative stimuli [18].
The disrupted brain circuitry in ADHD impacts how attention is directed towards emotional cues and adds to the challenges in regulating and responding to emotions [18]. The roots of emotional dysregulation in ADHD can be traced back to a mix of genetic factors and environmental influences, including the impact of critical parenting [18].
The Importance of Treating ADHD
Recognizing the importance of treating ADHD is crucial. Less than 20% of adults with ADHD receive adequate care, underscoring the need for awareness about the consequences of leaving ADHD untreated [2]. When ADHD isn’t treated, it can create challenges with far-reaching effects, such as a lower quality of life, strained relationships, job difficulties, and increased risks of addiction, depression, anxiety, accidents, and even suicide [8].
Adults with ADHD often face additional health challenges, like an increased risk of obesity, sleep disorders, and asthma [8]. Acknowledging and addressing adult ADHD becomes essential to tackle these potential health issues and improve overall well-being [8].
Recent research highlights the common occurrence of adult ADHD, which is frequently overlooked and co-exists with other concerns. This underscores the importance of dealing with ADHD to prevent widespread consequences for individuals and society at large [8]. Overcoming doubts and stigma associated with ADHD provides an opportunity to identify and treat this prevalent comorbidity, potentially assisting a group of patients who may have struggled with recommended treatments [8].
Treatment Options
Treatment typically involves a combination of behavior therapy and medication, with behavior therapy, especially for parents, recommended as the first line for preschool-aged children [5]. A healthy lifestyle, including proper nutrition, regular physical activity, limited screen time, and adequate sleep, can also contribute to managing ADHD symptoms [5].
Medications
Psychiatric medications stand as one important element of ADHD treatment. There are two main types of ADHD medications: stimulants and non-stimulants.
Stimulants
Stimulants, such as amphetamines and methylphenidate, are commonly used to treat ADHD in both kids and adults. They work by boosting certain brain chemicals. While effective, they can lead to side effects like reduced appetite, trouble sleeping, and increased blood pressure. There are concerns about safety and misuse, especially in kids, where it might affect growth [16].
Non-Stimulants
While research continues to assess the effectiveness and safety of a variety of non-stimulant medications used for ADHD, several are effective and include [16]:
- Atomoxetine: Atomoxetine is a non-stimulant recommended for ADHD individuals with additional conditions like tics or suicidal thoughts. It’s effective, but its impact on mood and suicidal thoughts is unclear. Atomoxetine is safer than stimulants, but it has its own set of side effects, like nausea and drowsiness.
- Bupropion: Bupropion, a drug not initially meant for ADHD, has been used for about 20 years. It helps moderately but might be better tolerated than some other medications. However, solid studies are needed to support its use.
- Viloxazine: Viloxazine, still in testing, seems promising, with potentially fewer side effects than similar drugs. Trials are underway to determine its effectiveness and safety for kids and adults.
- Tipepidine: Tipepidine, a new player, shows promise as an add-on to the standard treatment. It’s suitable for addressing remaining symptoms, especially in hyperactivity.
- Agomelatine: Agomelatine is a drug combining two functions, and it looks safe and effective for ADHD core symptoms. Both add-on and standalone options are being explored. Although studies have small samples, they show better results than not taking anything.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS) is emerging as a potential treatment for Attention Deficit/Hyperactivity Disorder (ADHD) [12], offering an alternative to conventional medications like stimulants [12]. This non-invasive medical procedure employs magnetic fields to stimulate nerve cells in targeted brain regions.
Conventional medications, such as stimulants, are often used. However, a significant percentage of patients do not respond well to these medications, leading to adverse effects and limitations in their use [12].
Studies, including a randomized controlled trial, suggest that TMS might help improve ADHD symptoms in adolescents who don’t respond well to traditional medications, which often have side effects and limitations [12]. However, there’s a need for more research to confirm how effective, safe, and practical TMS is for treating ADHD in adolescents. The existing literature highlights the importance of informing healthcare providers about TMS as a potential alternative for adolescents dealing with ADHD [12].
Psychotherapy
Cognitive behavioral therapy (CBT)
Cognitive-behavioral therapy (CBT) is a type of mental health treatment that focuses on how our thoughts and actions happen in the present moment. Unlike traditional therapies, it doesn’t delve into childhood experiences but looks at the here and now.
CBT originated by combining cognitive therapy, which explores our immediate thoughts, with behavior therapy, which looks at our actions [6]. For adults with ADHD, CBT is applied through programs addressing daily challenges like time management and organization, as well as targeting co-existing anxiety and depression [6].
When comparing CBT to ADHD medication, both are effective, with medication controlling core symptoms, while CBT builds habits and skills for effective self-management [6]. In essence, medication handles core ADHD symptoms, and CBT equips individuals with practical tools for daily life [6].
Dialectical behavior therapy (DBT)
DBT combines cognitive behavioral strategies with validating techniques to validate emotions and inspire change. At its core is “radical acceptance,” teaching individuals to accept themselves and their situations [10].
The therapy encourages balanced thinking, helping people find a middle ground between self-acceptance and the potential for change. This flexible mindset is crucial, especially for those with impulsive emotional reactions, laying the foundation for positive behavioral changes [10].
DBT focuses on four key areas to improve behavior [10]:
- Mindfulness: Embracing nonjudgmental views and accepting one’s past and present.
- Distress tolerance: Developing ways to cope with overwhelming emotions, avoid crises, and build stress management skills.
- Emotion regulation: Understanding, labeling, predicting emotions, reducing vulnerability, and increasing positive feelings.
- Interpersonal effectiveness: Learning to maintain relationships and handle conflicts.
Holistic Treatment Options
Exercise
Exercise proves to be a powerful tool in addressing ADHD symptoms, offering a valuable complement to conventional treatments like medication and therapy [17]. Activities such as physical exercise, running, and engaging in complex motor skills stimulate the growth of neurotransmitters like dopamine and norepinephrine, which are essential for cognitive function.
This physiological response extends to the brain stem’s arousal center, fostering a sense of calm and reducing irritability. Additionally, exercise positively influences the prefrontal cortex, a critical component for executive functions and cognitive performance, with studies indicating increased volume with regular physical activity [17].
A Balanced and Healthy Diet
Maintaining a balanced and nutritious diet is essential for everyone but even more critical for people with ADHD. Research indicates that an increased intake of fruits and vegetables may alleviate symptoms of inattention related to ADHD, with the CDC recommending adults consume 1.5 to 2 cups (or more) of fruits and 2 to 3 cups of vegetables daily [1].
Incorporating complex carbohydrates like whole grains, legumes, and fruits with lower sugar content can stabilize blood sugar levels, promoting improved focus and attention. Protein-rich foods, including eggs, lean meat, milk, nuts, and soy, help maintain a feeling of fullness and prevent spikes in blood sugar levels [1].
Additionally, omega-3 and omega-6 fatty acids found in fatty fish, soybean, walnuts, flaxseeds, tofu, chia seeds, and avocados are associated with supporting heart health, memory, and immune function, and some studies suggest they may help improve hyperactivity, impulsivity, and attention symptoms in ADHD [1].
Many people who have ADHD suffer from iron deficiency, making it extremely important to consume foods containing iron. It is also helpful to limit sugary foods, simple carbohydrates such as soda, candy, sweets, unhealthy fats, and too much caffeine [1].
Good Sleep Hygiene
Establishing consistent sleep hygiene routines and ensuring adequate rest is crucial for everyone, but it becomes particularly vital for individuals with ADHD. The connection between ADHD and sleep involves neurotransmitters like GABA, which is responsible for inhibition [15]. In individuals with ADHD, GABA tends to be less available, making the process of falling asleep more challenging.
Therefore, prioritizing good sleep is a practical approach to managing ADHD symptoms and enhancing overall daily cognitive functioning [15]. Disrupted sleep patterns can be attributed to factors such as poor time management, persistent thoughts, and heightened anxiety [3].
Managing ADHD
While ADHD can be a complex condition, there are various treatment options available that can be tailored to suit each individual. It is crucial to seek treatment as early as possible, as this can help unlock a path to improved well-being and a more fulfilling life. Remember, you are not alone, and help is readily available.
Attention Deficit Hyperactivity Disorder (ADHD) can be challenging. If you or someone in your life is struggling with ADHD, contact Neuro Wellness Spa to learn more about our in-person and online psychiatry services. Our dedicated and compassionate team of health providers will work closely with you to identify a treatment plan tailored to your health needs.
References
- ADD.org. Health & Nutrition. https://add.org/adhd-diet/
- ADD.org. Understanding ADHD. https://add.org/untreated-adhd-in-adults/
- ADDitude. When Stress and Anxiety Endure Too Long: ADHD Brains Seizing Up, Toppling Down. (2022, July 9). https://www.additudemag.com/signs-of-anxiety-enduring-adhd-pandemic/
- Anand, D., Colpo, G. D., Zeni, G., Zeni, C. P., & Teixeira, A. L. (2017). Attention-Deficit/Hyperactivity Disorder And Inflammation: What Does Current Knowledge Tell Us? A Systematic Review. Frontiers in psychiatry, 8, 228. https://doi.org/10.3389/fpsyt.2017.00228
- Centers for Disease Control and Prevention. What is ADHD? https://www.cdc.gov/ncbddd/adhd/facts.html
- Cognitive-Behavioral Therapy. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). https://chadd.org/for-adults/cognitive-behavioral-therapy/
- Dunn, G. A., Nigg, J. T., & Sullivan, E. L. (2019). Neuroinflammation as a risk factor for attention deficit hyperactivity disorder. Pharmacology, biochemistry, and behavior, 182, 22–34. https://doi.org/10.1016/j.pbb.2019.05.005
- Geffen, J., & Forster, K. (2017, October 25). Treatment of adult ADHD: A clinical perspective. Journal Title. https://doi.org/10.1177/2045125317734977
- Harvard Health Publishing. Is that brain fog really adult ADHD? (November 1, 2018). https://www.health.harvard.edu/diseases-and-conditions/is-that-brain-fog-really-adult-adhd
- Katz, M. Dialectical Behavior Therapy Gets Our Attention. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). https://chadd.org/wp-content/uploads/2018/06/ATTN_02_15_DialectcalBehavior.pdf
- Kverno K. (2021). Brain Fog: A Bit of Clarity Regarding Etiology, Prognosis, and Treatment. Journal of psychosocial nursing and mental health services, 59(11), 9–13. https://doi.org/10.3928/02793695-20211013-01
- Memon A. M. (2021). Transcranial Magnetic Stimulation in Treatment of Adolescent Attention Deficit/Hyperactivity Disorder: A Narrative Review of Literature. Innovations in clinical neuroscience, 18(1-3), 43–46.
- NHS. Symptoms Attention Deficit Hyperactivity Disorder (ADHD). December 24, 2021. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/
- Neff, M.A. DHD Burnout Recovery. Neurodivergent Insights.com. https://neurodivergentinsights.com/adhd-infographics/adhd-burnout-recovery
- Olivardia, R. How to Fall Asleep with a Rowdy, Racing ADHD Brain. ADDitude. June 28, 2023. https://www.additudemag.com/how-to-fall-asleep-adhd/
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