#1 What is ADHD?
I’ve heard the statements below and more in my conversations with ADHD adults.
- “My therapist says I’m too successful to have ADHD.”
- “I got by for a long time and then all of sudden I start struggling. I had no idea I had ADHD!”
- “I was never impulsive or hyperactive. So, it never occurred to me that I might have ADHD.”
There is a lot of confusion and misinformation about ADHD…
In simplest terms ADHD is a neurological condition that is usually genetically transmitted, characterized by distractibility, impulsivity and restlessness or hyperactivity. However, the symptoms (more on this below) will look different among adults with ADHD and can present themselves differently throughout your life time.
#2 What are the symptoms of ADHD in Adults?*
Dr. Ned Hallowell, a psychiatrist who specializes in ADHD, identified the symptoms below as ones that could be attributed to ADHD.
- A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).
- Difficulty getting organized.
- Chronic procrastination or trouble getting started.
- Many projects going simultaneously; trouble with follow through.
- A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
- A frequent search for high stimulation.
- An intolerance of boredom.
- Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
- Often creative, intuitive, highly intelligent
- Trouble in going through established channels and following “proper” procedure.
- Impatient; low tolerance of frustration.
- Impulsive, either verbally or in action, as an impulsive spending of money.
- Changing plans, enacting new schemes or career plans and the like; hot-tempered.
- A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
- A sense of insecurity.
- Mood swings, especially when disengaged from a person or a project.
- Physical or cognitive restlessness.
- A tendency toward addictive behavior.
- Chronic problems with self-esteem.
- Inaccurate self-observation.
- Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.
Dr Hallowell further suggests that: “If you have exhibited at least twelve of the following behaviors since childhood and if these symptoms are not associated with any other medical or psychiatric condition, consider an evaluation by a team of ADHD professionals.
In a standard evaluation the clinical definition (click below to view this definition) will be used for diagnostic purposes.
Click here to view the clinical definition of ADHD listed in the Diagnostic and Statistical Manual of Mental Disorders
Below is the clinical definition of ADHD listed in the Diagnostic and Statistical Manual of Mental Disorders for ADHD, which is the standard reference among mental health professionals. It is the most commonly accepted definition.
DSM-5 Criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
- Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
- Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor.”
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games) In addition, the following conditions must be met:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
- Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Based on the types of symptoms, three kinds (presentations) of ADHD can occur: Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
Reference: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
#3 What Causes ADHD?
You may have heard that poor diet, food dyes, too much sugar, environmental chemicals, poor schooling, too much TV, poor pre-natal care or poor parenting are causes of ADHD. While it is possible that drug or alcohol use during pregnancy could alter the brain and may be a possible cause of ADHD, there is no credible research that has validated the others as causes of ADHD. Though they definitely can exacerbate ADHD symptoms.
Current research shows that ADHD is a brain based biological disorder, caused by a number of factors that affect how the brain develops and functions. And the one factor that stands out is a neurotransmitter imbalance.
As you know, each region in the brain is responsible for a particular function; of course there are overlapping functions. But for the various regions to do their jobs, they must be linked to one another through neural circuits that carry information from one brain region to another.
For this to happen neurotransmitters must be available to transmit the messages. But, in the ADHD brain, because there is an imbalance of dopamine and norepinephrine, the messages are not transmitted efficiently.
As a result, the various regions of the brain cannot perform their functions well, resulting in the ADHD symptoms you experience, such as difficulty:
- paying attention
- regulating emotions
- and more…
So, there you have it. I’m sure continuing research will uncover more in the coming years.
#4 How is ADHD diagnosed?
While there is no single test that can be used to diagnose ADHD, in a standard evaluation you must have all of the following:
- Have at least 6 inattentive and/or 6 hyperactive/impulsive symptoms for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities (for people ages 17 and older, only 5 symptoms must be present)
- Had several symptoms present before age 12
- Have several symptoms in at least 2 settings (such as home, school, or work)
- Have symptoms that clearly interfere with or reduce the quality of social, academic, or occupational functioning
- Have symptoms that are not be better explained by another cause
Even with a standard evaluation, it is still important that you seek out a professional who has expertise in mental health issues (see below).
#5 If I think I have ADHD, Who Should I see for an evaluation?
Getting an accurate diagnosis is one of the most critical pieces in managing your ADHD.
It is best that you consult with a psychologist, psychiatrist or psychiatric nurse practitioner for an evaluation, preferably someone who specializes in ADHD (if possible), as they are trained in the field and are the most qualified to make a diagnosis.
You may be tempted, though, to consult with your family doctor, as the process can seem easier and quicker. And some family doctors may be willing to diagnose and prescribe medication for mental health issues. But I caution against going this route.
Diagnosing mental health issues correctly requires specialized and up-to-date knowledge, which your family doctor likely does not have. This lack of expertise can result in delays in receiving the correct diagnosis and treatment plan. And, without a correct diagnosis, your ability to move effectively and efficiently toward your goals may be severely compromised.
However, your family doctor can be a good first step, as they can rule out possible physical causes for your symptoms. And they may be able to help you by making an appropriate referral.
#6 How do I know I have ADHD and not something else?
This is a really important question. The key is to make sure you receive an evaluation from a psychologist, psychiatrist or psychiatric nurse practitioner who can answer this question.
It is important to note that for adults diagnosed with ADHD:
- 20% – 30% also have depression.
- 25% also have anxiety.
So, while it is possible you have something other than ADHD, it is also possible you have ADHD along with another condition.
The bottom line is that only a qualified professional can provide an accurate diagnosis.
#7 Is it possible to first be diagnosed with ADHD as an Adult?
The simple answer is, “Yes.” It is not uncommon for adults to grow up with undiagnosed ADHD.
Many, who are first diagnosed as an adult, reached some degree of success because they are so bright, and over the years developed coping mechanisms and compensating strategies to get by. And, while some may look successful to others, they might not feel successful.
But because they visualized hyperactive little boys when they thought of ADHD, they did not consider that they may have ADHD, like the person who sent me the note below.
I’ve really been identifying with everything you and your testimonials have been saying on your website, but I’ve never been diagnosed myself.
For years as a university student I have constantly struggled with mastering my procrastination on assignments and study, and I’ve realised recently it seems to stem from this impulsivity, this tendency to immediately act on every thought I have. All the issues you are talking about that adults with ADHD have to deal with, I feel that I have been dealing with.
I have been hesitant to diagnose myself as having ADHD, wondering if it being this hard to concentrate is just normal, or that I couldn’t have ADHD because I was never one of “those” kids, the hyperactive kids in school on medication and so on. Do you get clients like this? I suppose I am just hoping you might be able to shed some light on my situation, whether indeed it is normal to feel this way or if it’s worth seeing a doctor with my concerns.
So, like the writer of the note above, adults diagnosed later in life might struggle for a long time, figuring they just needed to try harder, before they decide to seek out help.
But at some point, like you, perhaps, they get tired of struggling and just getting by. Maybe life got more complicated — kids, new job / promotion, grad school, other life event — and their coping mechanisms stopped working.
So, they sought out help and were diagnosed with ADHD. It’s not that adults diagnosed later in life all of sudden got ADHD!
They just finally found out the reason for all their struggles…
# 8 How Is ADHD Treated In Adults?
When you first thought of treating your ADHD, you probably thought of medication. And, though medication can be the cornerstone of a treatment plan for ADHD, an effective holistic treatment plan for ADHD should entail much more than just medication.
I’ve written a 43 Page Interactive PDF Workbook, Treatment Options for ADHD Workbook: A Guide to Exploring and Making Decisions About Treating Your ADHD to give you an overview and process for sorting through your possible treatment options including:
- psychosocial treatments – therapy, support groups and coaching
- complementary treatments and alternative treatment – using your strengths, forming connections, exercise, sleep, nutrition, meditation, neurofeedback, brain training software
It is important to note that this workbook is not intended to be comprehensive in scope or depth. Nor is it intended to take the place of medical advice from your doctor.
It is a starting point.
Of course, you should consult with your doctor when considering your options and before starting any treatment.
# 9 Who should I go to, if I want medication to treat my ADHD?
Of course, any doctor can prescribe medication.
And you may be tempted to go to your family doctor for medication because, well, it is less of a hassle… I get it. But I caution against this route, if you have a choice, as your family doctor does not have the updated specialized education and expertise to treat mental illnesses.
A psychiatrist or psychiatric nurse practitioner is a much better option (when possible), as they are typically far more knowledgeable about:
- the different types of medications.
- how to use medications in combination.
- how to manage side effects.
- how to use medication to treat multiple issues
And, in the long run, seeing a psychiatrist or psychiatric nurse practitioner for medication might save you time, money and energy, as they will be better able to work with you in finding the right medication(s) and dosage.
#10 Can adults be cured of ADHD?
The short answer is, “No.”
You can’t get rid of your ADHD. It is part of you, including all the positive and challenging aspects that come with it.
But you can choose to:
- get support and learn how to work with / manage the symptoms so they don’t get in your way.
- surround yourself, as much as possible, with supportive people, who will accept you as you are, as well as help you grow.
- put yourself, as much as possible, in environments (including work) that draw on your strengths and minimize use of your weaknesses.
- adapt a holistic treatment to counter your symptoms.
If you can do the above, while your ADHD will not be cured, it will be less problematic for you, really.