ADHD in adults

See also the separate leaflet on ADHD in Children.

What is ADHD in adults?

ADHD is a pattern of behaviours which first appear during childhood, and the symptoms of ADHD include:

• Overactivity.

• Being easily distracted, and unable to stick to anything for any length of time.

• Being impulsive, and doing things on the spur of the moment or without thinking.

• Being unable to concentrate for any length of time.

Many of us might have one or more of these features but they are more severe and cause problems with day-to-day activities for people with ADHD. In ADHD, these difficulties interfere with how you get on with other people, and how you get on at work.

ADHD tends to get better as affected children become adults. The overactivity usually gets less, but the impulsivity, poor concentration and risk-taking can get worse. These can make it hard to work, learn and get on with other people.

Adults with ADHD are more likely to experience other problems and mental health conditions such as depression, anxiety, mood swings, feelings of low self-esteem and substance abuse, and can feel overwhelmed and struggle, especially in less structured environments.

How common is ADHD in adults?

About 5 in every 100 school-aged children have ADHD. The symptoms of childhood ADHD persist into adulthood in up to 65 in 100 children with ADHD. Therefore ADHD affects about 3-4 in 100 adults.

In children, boys are more commonly diagnosed than girls, whereas in adults, there are more equal numbers of men and women who are known to have ADHD.

What are the symptoms of ADHD in adults?

Attention deficit hyperactivity disorder (ADHD) is suspected in adults if there are at least five inattention symptoms and/or at least five hyperactivity-impulsivity symptoms that have:

• Started before 12 years of age.

• Occurred in two or more settings, such as at home and work.

• Been present for at least six months.

• Clearly interfered with, or reduced the quality of social, academic or occupational functioning.

• Not been better explained by another disorder such as oppositional defiant disorder or conduct disorder.

Inattention symptoms include:

• Failing to give close attention to detail or making careless mistakes in work, or other activities.

• Difficulty in maintaining concentration when performing tasks.

• Appearing not to listen to what is being said, as if the mind is elsewhere, without any obvious distraction.

• Failing to follow through on instructions or finish a task (not because of oppositional behaviour or failure to understand).

• Difficulty in organising tasks and activities.

• Reluctance, dislike, or avoidance of tasks that require sustained mental effort.

• Losing items necessary for tasks or activities, such as pencils, mobile phones, or wallets.

• Being easily distracted.

• Forgetfulness with regards to daily activities.

Hyperactivity and impulsiveness symptoms include:

• Fidgeting with or tapping hands or feet, or squirming when seated.

• Leaving the seat, where remaining seated is expected, such as in a work meeting.

• Being or feeling restless where inappropriate.

• An inability to engage in leisure activities quietly.

• Being 'on the go' all the time, restless and others finding it difficult to keep up.

• Talking excessively.

• Blurting out an answer before a question has been completed.

• Difficulty waiting their turn.

• Interrupting or intruding on others.

The classification for ADHD used in the UK is the International Classification of Diseases 11th Revision (ICD-11). In the USA, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is used.

See the separate article What are the signs of ADHD in women? for more details.

How is ADHD diagnosed in adults?

If you have become aware of problems that may indicate ADHD as an adult, your GP should refer you to see a mental health professional with expertise in ADHD in either a local Community Mental Health Team or a Neurodevelopmental Service. This is often a psychiatrist but may also be a specialist nurse or psychologist.

The assessment will focus on the problems you are having, whether they confirm that you do have ADHD or not, and how troublesome they are.

Attention-deficit hyperactivity disorder (ADHD) in adults may be associated with other mental health problems (including mood and anxiety disorders, substance use disorders, and personality disorders) that may make diagnosis and the treatment of adult ADHD more difficult.

What causes ADHD in adults?

ADHD is the extreme of behavioural traits that are common. Genetics play an important role in whether someone has ADHD. There are also lots of other factors involved, including social and environmental factors. Therefore ADHD can occur in different ways:

• Common genetic variants interact with environmental factors, resulting in the features of ADHD.

• Very occasionally, someone will have ADHD because they have rare genetic variants, irrespective of any environmental factors.

Family studies have found that the risk of being diagnosed with ADHD is nine times higher in brothers or sisters (siblings) of someone with ADHD, when compared to siblings of someone without ADHD.

People who have other disorders affecting the development of the nervous system, such as autistic spectrum disorder (autism) are also more likely to have ADHD than people who don’t. Studies have found common genetic risk factors for ADHD and autism.

Environmental factors most strongly associated with ADHD are low birth weight and maternal smoking during pregnancy. Other risk factors include preterm delivery, epilepsy, brain injury, lead exposure, iron deficiency, fetal alcohol exposure during pregnancy, psychological and social problems, and poor maternal mental health.

How to treat ADHD in adults

Medication will usually be offered if ADHD symptoms are causing significant difficulties. Either lisdexamfetamine or methylphenidate are usually offered as first choice, with dexamfetamine or atomoxetine as possible alternatives if lisdexamfetamine and/or methylphenidate can't be used, are not tolerated because of side-effects, or are ineffective.

Treating adults with ADHD by using alternative methods to medications may also be considered:

• These treatments may include a structured supportive psychological intervention focused on ADHD, regular follow-up either in person or by phone, and cognitive behavioural therapy.

• Mindfulness techniques and psycho-educational groups can also help

If you are becoming very distressed or depressed because of your symptoms, your GP can refer you to a community mental health team or counsellor.

Self-help

There are a number of things that often help adults with ADHD to overcome any difficulties and these include:

• Making lists, keeping a diary, using stick-up reminders, and setting aside some time to plan what you need to do.

• Finding ways of letting off steam, such as exercise, dance or sport

• Finding ways of relaxing, such as reading, listening to music or playing a musical instrument, and using relaxation techniques.

• Setting realistic goals.

• Reminding about the things you can do well.

• Avoiding things that make life more difficult, such as arguments with other people, using drugs and alcohol, and finding ways to reduce any pressure at work.

• Asking for help from friends, family and at work to help make life easier. ADHD is considered a disability in the UK and therefore your place of work must make “reasonable adjustments” to support you.

• Joining a self-help group (see 'Further Reading' below) or using some of the web chat rooms for people with ADHD. Seeking help from others who understand the problems may be useful to both you and your partner or family.

Can ADHD get worse in adults?

Adult ADHD symptoms tend to get generally better as you get older. However, although the overactivity usually gets less, the impulsivity, poor concentration and risk taking can get worse. These can make it hard to work, learn and get on with other people. Therefore, the difficulties caused by ADHD may get worse because of the impact on activities with friends, family and at work.