What is ADHD?

As an adult with ADHD, it can be overwhelming and frustrating, often leaving you feeling misunderstood. Co-workers, friends, and family might not understand how ADHD affects you, making you feel inadequate or as if you’re making excuses for things you can’t control. These misunderstandings can hurt your self-esteem and make it hard to know how to improve your symptoms and quality of life. Additionally, ADHD can cause problems with work, school, relationships, family, and everyday life.

ADHD in adults is more common than you might think, impacting millions worldwide [2]. This guide covers the symptoms, diagnosis, and treatment options for adult ADHD, helping you understand its effects on daily life and when to seek help. Learn about the different types of ADHD and the symptoms associated with each. Discover practical strategies for managing ADHD and enhancing your well-being.

Understanding ADHD

ADHD, or Attention Deficit Hyperactivity Disorder, is a common psychiatric condition recognized primarily in childhood but often persists into adulthood. It impacts individuals globally, affecting approximately 2.8% of adults worldwide, with varying rates in different regions, such as the United States, where prevalence ranges from 2.5% to 4.4% [2]. Despite increased awareness, a significant number of adults with ADHD remain undiagnosed or untreated [2].

Types of ADHD

ADHD is characterized by patterns of inattention and/or hyperactivity-impulsivity that can significantly affect daily functioning and development. There are three main types of ADHD, each presenting with distinct symptoms [12]:

1. Predominantly Inattentive Presentation: Individuals with this type often struggle with maintaining focus, following through on tasks, and organizing activities. Common symptoms include trouble paying attention, overlooking details, being easily distracted, and seeming not to listen when spoken to directly.
2. Predominantly Hyperactive-Impulsive Presentation: People with this type are often restless, fidgety, and find it difficult to stay seated or engage in activities quietly. Symptoms include excessive talking, interrupting others, and acting without thinking.
3. Combined Presentation: This is the most common presentation, where individuals exhibit symptoms of both inattention and hyperactivity-impulsivity. They may struggle with sustaining attention, controlling impulses, and modulating their activity levels in various settings.

Common Symptoms

People with hyperactive, inattentive, or combined subtypes of ADHD often display a range of common symptoms. These include [3]:

• Short attention span, especially for non-preferred tasks.
• Various forms of hyperactivity: physical, verbal, or emotional.
• Impulsivity leading to reckless behavior.
• Persistent fidgeting or restlessness.
• Challenges with organization and prioritizing tasks.
• Poor time management and “time blindness.”
• Mood swings and emotional dysregulation.
• Forgetfulness and poor working memory.
• Difficulty multitasking and executive function.
• Trouble controlling anger or frustration.
• Procrastination and difficulty in task completion.
• High distractibility and difficulty waiting for one’s turn [3].

Related: Understanding ADHD Brain Fog, Other Symptoms, Challenges, and Hope

Causes of ADHD

ADHD is a complex disorder believed to stem from a combination of genetic, neurological, and environmental risk factors [15]:

1. Genetics: ADHD often runs in families, indicating a strong genetic component [9, 15]. Specific genes are thought to predispose individuals to developing ADHD. Additionally, environmental factors such as smoking during pregnancy or early exposure to toxins can also contribute to its development [9]. Brain studies have highlighted differences in areas controlling attention and behavior, including the frontal lobe [9].
2. Brain Differences: Research indicates that individuals with ADHD may have structural and functional differences in specific brain regions involved in attention, behavior, and impulse control. Variations in the size and activity of the prefrontal cortex, basal ganglia, and neurotransmitter systems (e.g., dopamine and norepinephrine) play a role in the manifestation of ADHD symptoms [15].
3. Environmental Influences: Prenatal exposure to substances like alcohol and tobacco, premature birth, low birth weight, and complications during birth increase the risk of developing ADHD. Early childhood adversity, such as trauma or chronic stress, can also contribute to the onset or exacerbation of ADHD symptoms [15].

How does ADHD affect daily life?

ADHD can significantly impact daily life, especially without proper treatment and support. Adults with ADHD may struggle with managing attention, completing lengthy tasks, staying organized, and controlling their impulsive behaviors. These difficulties can interfere with daily tasks, social relationships, and healthy behaviors like regular exercise, good nutrition, and sufficient sleep. Additionally, ADHD can increase the risk of engaging in health-compromising behaviors, such as substance use and experiencing accidents or injuries [16].

What Are the Behaviors of ADHD in Adults?

ADHD is a lifelong neurodevelopmental disorder, with many adults having experienced symptoms since childhood, even if they weren’t diagnosed until later in life. Adults with ADHD often face challenges in several areas: [7].

• Attention Management: Difficulty focusing on tasks that are not immediately interesting.
• Task Completion: Struggling to finish long tasks unless they are particularly engaging.
• Organization: Challenges in staying organized and managing daily responsibilities.
• Behavior Control: Trouble controlling impulsive actions and behavior.
• Hyperactivity: Experiencing internal restlessness and physical fidgeting.

How is ADHD Diagnosed?

Diagnosing ADHD in adults involves several steps, as there is no single test for the condition. Many other issues, like sleep disorders, anxiety, and depression, can have similar symptoms, so it’s important to start by talking to a healthcare provider, such as a psychologist, psychiatrist, or primary care doctor [9, 17].

ADHD symptoms might look different in adults than in children. For example, hyperactivity might appear as extreme restlessness or constantly feeling on the go.

According to the DSM-5, to have an ADHD diagnosis, symptoms must have been present before age 12 and be noticeable in two or more settings, such as at work and home or school and home if diagnosing a child [9, 17]. They should also interfere with or reduce the quality of social, work, or other important areas of functioning and not be better explained by another mental disorder [17].

Adults need to show five or more symptoms of inattention or hyperactivity-impulsivity, which must have been present for at least six months and be inappropriate for their developmental level [17].

Symptoms of inattention in adults can include [17].:

• Making careless mistakes at work or in other activities.
• Having trouble staying focused on tasks or conversations.
• Not listening when spoken to directly.
• Failing to follow through on tasks and duties.
• Having difficulty organizing tasks and activities.
• Avoiding tasks that require sustained mental effort.
• Losing things necessary for tasks and activities.
• Being easily distracted.
• Being forgetful in daily activities.

Symptoms of hyperactivity-impulsivity in adults can include [17]:

• Fidgeting or tapping hands or feet.
• Leaving seats when staying seated is expected.
• Feeling restless.
• Being unable to engage in leisure activities quietly.
• Talking excessively.
• Interrupting or intruding on others.
• Having trouble waiting for their turn.

If you suspect you have ADHD, the first step is to consult a healthcare provider who can evaluate your symptoms and recommend appropriate steps.

How serious is ADHD in adults?

ADHD in adults can be quite serious, mainly if left untreated [16]. It can lead to significant difficulties in various aspects of life, including daily functioning, social interactions, and maintaining a healthy lifestyle [16]. The symptoms can become more pronounced during periods of high stress and demands, potentially leading to health issues and risky behaviors [16].

What happens if ADHD is left untreated?

Untreated or undiagnosed ADHD can cause substantial disruptions in everyday life [16]. Individuals may struggle with daily tasks, social relationships, and maintaining consistent healthy habits. This lack of management can lead to increased health risks, such as substance misuse, infections, and injuries [2, 16]. Additionally, untreated ADHD increases the likelihood of experiencing anxiety, mood disorders, and substance abuse issues [2]. There’s also a higher risk of engaging in unsafe driving behaviors, which can lead to accidents and potential harm [2]. Overall, untreated ADHD can negatively affect an individual’s health, well-being, and functional abilities in various aspects of life, potentially hindering them from reaching their full potential.

When to Seek Help

If you or a loved one find that attention difficulties, completing tasks, staying organized, controlling behavior, or managing hyperactivity significantly impacts daily life, it’s important to seek help. These challenges can make it difficult to carry out daily tasks and maintain healthy relationships. Getting assistance from a mental health professional early on can significantly improve how ADHD is managed and enhance overall well-being.

Treatment and Management of ADHD in Adults

Managing ADHD in adults involves a comprehensive approach to reduce symptoms and improve daily functioning.

Treatment typically includes psychotherapy and medications, primarily stimulants, which help increase attention and reduce hyperactivity and impulsiveness [9]. Non-stimulant medications and behavioral therapies are also used, especially when stimulants aren’t suitable [9].

Effective ADHD management requires a team approach involving healthcare providers, teachers, and families [9]. This collaboration helps create consistent support and strategies for managing symptoms and improving outcomes [9].

ADHD Medications

Medications play a crucial role in managing ADHD symptoms. They include:

Stimulant Medications

These are often the first-line treatment due to their effectiveness in improving focus and reducing impulsivity by increasing dopamine and norepinephrine levels in the brain [1, 8].

• Amphetamines: Examples include Adderall, Vyvanse, and Dexedrine.
• Methylphenidate: Examples include Ritalin, Concerta, and Focalin.

While stimulants can be highly effective, they may not be suitable for everyone due to potential side effects such as increased blood pressure and heart rate [8]. Individuals with certain medical conditions like cardiovascular issues or psychiatric disorders should exercise caution [8].

Non-Stimulant Medications

Non-stimulant medications are used as alternatives for adults with ADHD who either do not respond well to stimulants or experience intolerable side effects.Unlike stimulants that work quickly, non-stimulant medications may take several weeks to achieve full effect and require careful dosage adjustments [14].

• Atomoxetine (Strattera): Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that increases norepinephrine levels in the brain, targeting symptoms like hyperactivity and inattention.
• Intuniv (guanfacine): Intuniv acts as an alpha2A-adrenergic receptor agonist, improving emotional sensitivity and hyperarousal associated with ADHD in adults. It can be used alone or with stimulant medications.
• Kapvay (clonidine): Kapvay, an extended-release alpha-agonist, relaxes blood vessels and increases norepinephrine release in the brain to alleviate ADHD symptoms in adults. It is often used alongside stimulants.

Antidepressants

While more commonly used to treat other mental disorders including mood disorders and anxiety disorders, certain antidepressant medications can be effective options for ADHD treatment and managing symptoms.2

• Wellbutrin (bupropion): Wellbutrin, primarily an antidepressant, is sometimes used off-label for ADHD in adults due to its action as a norepinephrine dopamine reuptake inhibitor (NDRI).
• Effexor XR (venlafaxine): Effexor XR, an SNRI used for depression and anxiety, has limited evidence but may improve ADHD symptoms in adults by increasing norepinephrine and serotonin levels.

Psychotherapy

Psychotherapy can play an important role in the treatment of ADHD and offers a structured approach to managing symptoms and enhancing overall well-being.Psychotherapy can help individuals address past failures in academics, work, or social settings. It can also boost self-esteem and foster resiliency, equipping individuals with problem-solving techniques to navigate challenges more effectively [10]. Therapy sessions can improve interpersonal relationships by providing tools to enhance communication and manage conflicts [10].

Many forms of psychotherapy may be used to help manage ADHD.

Cognitive Behavioral Therapy (CBT) [9]

Cognitive behavioral therapy (CBT) is one of the primary forms of psychotherapy used to treat ADHD. This therapeutic method teaches practical skills to modify behavior and reframe negative thought patterns into constructive ones. Through CBT, individuals with ADHD can learn effective strategies for time management, organization, and impulse control. Cognitive-behavioral therapy (CBT) is a widely recognized and effective form of psychotherapy for treating ADHD in adults, but it is not the only type of psychotherapy used. Other therapeutic approaches are also employed to address the various symptoms and challenges associated with ADHD.

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT combines cognitive therapy with mindfulness to increase awareness of thoughts and feelings. It has been found effective in managing ADHD symptoms, reducing stress, and improving attention [4]. Studies suggest that MBCT may improve executive functioning and relieve symptoms of hyperactivity and impulsivity in adults with ADHD [4]. It complements traditional psychopharmacological treatments as a promising non-pharmacological intervention [4].

Dialectical Behavior Therapy (DBT)

DBT, initially developed for borderline personality disorder, has been adapted for adults with ADHD to address emotional dysregulation [13]. It integrates cognitive and behavioral strategies with mindfulness and acceptance principles [13]. DBT helps individuals improve emotional control by teaching skills such as mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation, making it a beneficial option for managing ADHD-related emotional challenges [13].

Acceptance and Commitment Therapy (ACT)

ACT (Acceptance and Commitment Therapy) is a therapeutic approach used for adults with ADHD. It focuses on accepting thoughts and emotions rather than fighting them [11]. This therapy helps individuals identify personal values and commit to actions that align with those values, aiming to improve focus and manage impulsivity [11]. By developing mindfulness skills, individuals can observe their thoughts without judgment, which may help them cope better with ADHD symptoms [11]. ACT aims to improve psychological flexibility, allowing individuals to lead fuller lives by effectively managing their symptoms rather than eliminating them [11].

For many adults with ADHD, therapy not only targets symptom management but also promotes personal growth and adaptation [10]. By focusing on skill-building and emotional regulation, psychotherapy empowers individuals to lead more fulfilling lives while managing the complexities of ADHD effectively [10].

Related: Practical Benefits of Therapy: How Therapy Can Transform Your Life

Other Treatment Options

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS therapy) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in specific regions of the brain, specifically those responsible for mood and cognitive functions.

Some research has shown that TMS can help the brain become more flexible (synaptic plasticity) and release more dopamine, which helps create new connections between brain cells (neural connections) [6]. This targeted approach has shown promise in improving attention and other cognitive abilities in adults with ADHD [6]. A review of studies with 149 participants found that TMS improved sustained attention by an average of 0.54 points. Targeting the right prefrontal cortex (rPFC) showed even better results, with an improvement of 0.58 points in three studies with 109 participants [6].

A study with 15 sessions of deep TMS targeting the right prefrontal cortex (rPFC) showed significant improvements in attention and memory compared to a fake treatment (sham) [5]. Participants receiving active TMS had faster reaction times on cognitive tests, like the N-back task, indicating better performance [5].

Brain scans after treatment showed increased activity in areas crucial for attention and decision-making, such as the right DLPFC, IPS, and IFG/anterior insula (p < 0.005) [5]. These brain changes were linked to clinical improvements, suggesting that enhanced brain activity directly relates to symptom relief (r = 0.43, p < 0.05) [5]. Further analysis showed better connectivity between key brain regions, indicating improved network function (p < 0.005) [5]. While TMS shows potential for changing neural networks involved in ADHD symptoms, more research is needed to confirm its long-term effectiveness and broader impact on treatment [5].

Neuro Wellness Spa has performed over 130,000 TMS sessions (and counting) for various mental health conditions with a 72% TMS response rate. If you are interested in exploring whether TMS is a treatment option for you or a loved one, reach out, and our team would be happy to discuss how TMS could potentially help manage your ADHD symptoms.

Related: TMS for ADHD

Holistic Wellness and Lifestyle Approaches

Adults with ADHD can manage their condition through a variety of holistic methods. Here are some practical strategies [18].

• Mindfulness and Self-Compassion: Practicing mindfulness can help with inattentive and hyperactive symptoms by increasing awareness and emotional regulation. Self-compassion involves recognizing personal struggles and responding with kindness, which can reduce stress and improve self-esteem.
• Regular Exercise: Physical activities, especially aerobic exercise, have multiple benefits. They can enhance cognitive functions, improve attention, and reduce behavioral symptoms. Other forms of movement, like yoga or tai chi, can also be helpful.
• Sleep Hygiene: Maintaining a consistent sleep schedule, creating a restful environment, and avoiding stimulants before bedtime can improve sleep quality, which can help manage ADHD symptoms.
• Nutrition: A balanced diet that includes whole grains, fruits, vegetables, lean proteins, and omega-3 fatty acids can support brain function and overall mental health. Avoiding processed foods and excessive sugar is also beneficial.
• Stress Management: Techniques such as cognitive-behavioral therapy (CBT) can help manage stress by teaching problem-solving and organizational skills. Mindfulness and breathwork exercises, like belly and square breathing, can also reduce stress and anxiety.
• Acupuncture: This traditional Chinese medicine technique may help regulate symptoms by stimulating specific points in the body. While research is limited, it has shown potential benefits for stress and anxiety.
• Supplements and Herbs: Certain supplements, such as omega-3 fatty acids, micronutrients like zinc and magnesium, and adaptogens like rhodiola and ashwagandha, may help manage ADHD symptoms. However, it’s important to consult with a healthcare provider before starting any supplement regimen.
• Gut-Brain Health: Eating prebiotic and probiotic foods, such as kimchi and sauerkraut, can support a healthy gut microbiome, which is linked to improved mental health and reduced anxiety [18].

These holistic approaches can complement conventional treatments, such as medication and psychotherapy, providing a comprehensive strategy to manage ADHD.

Related: How to Treat ADHD Without Meds

Help and Support for ADHD in Adults

ADHD is a prevalent and often underdiagnosed condition that can significantly impact daily life and overall well-being. Understanding its symptoms, causes, and available treatments is crucial for effective management. With advances in treatment options such as medication, psychotherapy, and innovative approaches like Transcranial Magnetic Stimulation (TMS), individuals with ADHD can find effective strategies to manage their symptoms and improve their quality of life. Ongoing research and clinical practice will continue to enhance our understanding and treatment of ADHD, offering hope and support to those affected.

If you suspect you or a loved one has ADHD, seeking professional help is an important first step towards managing this condition. Neuro Wellness Spa provides comprehensive treatment options, including in-person and online psychiatry, medication management, psychotherapy, and Transcranial Magnetic Stimulation (TMS therapy). Contact us today to discover how our experienced team can help you navigate ADHD and improve your quality of life. Reach out now to schedule a consultation and take the first step towards effective ADHD management.

References:

1. American Academy of Family Medicine. (n.d.). Treatment and management of ADHD in adults. Retrieved from https://www.aafp.org/family-physician/patient-care/prevention-wellness/emotional-wellbeing/adhd-toolkit/treatment-and-management.html
2. ADDITUDE. (2020, April 6). ADHD statistics: New ADD facts and research. Retrieved from https://www.additudemag.com/statistics-of-adhd/
3. ADDITUDE. (2019, September 16). ADHD Symptoms & Signs of Hyperactive, Inattentive, Combined Subtypes. https://www.additudemag.com/adhd-symptoms-checklist/
4. Bachmann, K., Lam, A. P., & Philipsen, A. (2016). Mindfulness-based cognitive therapy and the adult ADHD brain: A neuropsychotherapeutic perspective. Frontiers in Psychiatry, 7, 117. https://doi.org/10.3389/fpsyt.2016.00117
5. Bleich-Cohen, M., Gurevitch, G., Carmi, N., Medvedovsky, M., Bregman, N., Nevler, N., Elman, K., Ginou, A., Zangen, A., & Ash, E. L. (2021). A functional magnetic resonance imaging investigation of prefrontal cortex deep transcranial magnetic stimulation efficacy in adults with attention deficit/hyperactive disorder: A double blind, randomized clinical trial. NeuroImage: Clinical, 30, 102670. https://doi.org/10.1016/j.nicl.2021.102670
6. Chen, Y. H., Liang, S. C., Sun, C. K., Cheng, Y. S., Tzang, R. F., Chiu, H. J., Wang, M. Y., Cheng, Y. C., & Hung, K. C. (2023). A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders. BMC Psychiatry, 23(1), 756. https://doi.org/10.1186/s12888-023-05261-2
7. Cleveland Clinic. (2016, August 15). Are adult and childhood ADHD different conditions? Retrieved from https://consultqd.clevelandclinic.org/adult-childhood-adhd-different-conditions
8. Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit activity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4
9. Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2023). Attention Deficit Hyperactivity Disorder. In StatPearls. StatPearls Publishing.
10. Mayo Clinic. Adult attention-deficit/hyperactivity disorder (ADHD). Retrieved from https://www.mayoclinic.org/diseases-conditions/adult-adhd/diagnosis-treatment/drc-20350883
11. Munawar, K., Choudhry, F. R., Lee, S. H., Siau, C. S., Kadri, N. B. M., & Binti Sulong, R. M. (2021). Acceptance and commitment therapy for individuals having attention deficit hyperactivity disorder (ADHD): A scoping review. Heliyon, 7(8), e07842. https://doi.org/10.1016/j.heliyon.2021.e07842
12. National Institute of Mental Health. Attention-Deficit Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
13. Ramsay, J. Russell. (2021, April 30). DBT: The emotional control therapy you need now. ADDITUDE. Retrieved from https://www.additudemag.com/dbt-for-adhd-dialectical-behavioral-therapy/
14. Rodden, J. (2023, September 5). Non-stimulant ADHD medication overview. ADDITUDE. Retrieved from https://www.additudemag.com/adhd-symptoms-checklist/
15. Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). What have we learned about the causes of ADHD? Journal of Child Psychology and Psychiatry, and Allied Disciplines, 54(1), 3–16. https://doi.org/10.1111/j.1469-7610.2012.02611.x
16. U.S. Centers for Disease Control. Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved from https://www.cdc.gov/adhd/articles/adhd-across-the-lifetime.html
17. U.S. Centers for Disease Control. Diagnosing ADHD. Retrieved from https://www.cdc.gov/adhd/diagnosis/index.html
18. Zylowski, L. (2024, June 11). What is integrative medicine for ADHD? A holistic health & wellness guide. ADDITUDE. Retrieved from https://www.additudemag.com/integrative-medicine-adhd-holistic-health-wellness-guide/