What to Know About ADHD in Adults

Attention deficit hyperactivity disorder, or ADHD, is a neurological condition characterized by inattention, impulsivity, and hyperactivity. While commonly associated with children who are unable to focus at school or sit still, ADHD isn’t something that kids simply outgrow once they get older. Up to 90% of children diagnosed with ADHD continue to exhibit symptoms into adulthood, and an estimated 8.7 million American adults live with ADHD.

“ADHD is categorized as a developmental disorder because symptoms first appear in childhood, but it still affects plenty of adults,” explains Dr. Ryan Sultan, a psychiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center and Integrative Psychiatry where he researches and treats ADHD, anxiety, depression, and substance use disorders.

However, adults with ADHD might continue to struggle with focus, organization, time management, and emotional regulation, says Dr. Sultan. “For adults who struggle with ADHD, there are many ways to treat symptoms, and it’s important to know that certain ADHD traits can be harnessed into strengths,” he says.

Health Matters spoke with Dr. Sultan to learn more about adult ADHD and how to treat it.

What is happening in the brain of people who have ADHD?
The prefrontal cortex is the “personality center” of the brain; it controls our thinking, problem-solving, working memory (which acts as a mental workspace, allowing the brain to store information briefly and use it for complex tasks like reasoning, learning, and comprehension), planning, decision making, and emotion regulation. The prefrontal cortex development of someone with ADHD tends to be three to five years behind someone without ADHD – until about 30 years old, when it tends to catch up and symptoms may start to decrease.

Additionally, ADHD is characterized by a dysregulation of two neurotransmitters, dopamine and norepinephrine. People with ADHD tend to have lower amounts of dopamine (which, among other functions, helps us to feel pleasure) and norepinephrine (which plays an essential role in attention, cognitive function, and stress reactions, including our “fight or flight” response).

What are the symptoms of ADHD in adults?
Adults with ADHD most often experience symptoms related to hyperactivity and inattention.

In the first category, this might include: fidgeting (swinging their legs, tapping their fingers, etc.); constantly moving around; finding it hard to relax or sit still; or having trouble with patience (blurting out answers, interrupting others, or struggling to wait in line).

In the second category, this might include: struggling to complete difficult or uninteresting tasks; frequently forgetting things or misplacing items; unable to focus during conversations, reading materials or jobs; or trouble with staying organized, including time-management. Someone with ADHD might also experience emotions in a very heightened, intense way. They can become easily frustrated, overwhelmed or upset, and have difficulty controlling their emotions.

Research has also shown that people with ADHD have an increased risk for addiction disorders, including substance abuse. People with ADHD often have dysregulated dopamine pathways, particularly in the prefrontal cortex and the striatum. These areas are involved in reward processing, impulse control, and executive function. Lower levels of dopamine activity in these pathways can make individuals with ADHD more prone to seeking out behaviors or stimuli that provide an immediate boost in dopamine levels — essentially, they seek out quick rewards to compensate for the underactivity in their dopamine system.

What are the positive aspects of ADHD?
Although it can certainly pose challenges, living with ADHD has its own unique benefits and strengths for adults.

People with ADHD often show great curiosity and creativity. Their ability to think outside the box often makes them great problem solvers, and they are also known to exhibit spontaneity, resilience, and courage.

Those with ADHD are also typically great in a crisis and perform very well under pressure. They are often able to hyperfocus, or “lock in” on tasks they are  interested in for long periods of time, producing a high-quality end result.

How is ADHD diagnosed?
Only a trained healthcare or mental health professional, such as a psychiatrist, psychologist, or primary care doctor, can diagnose ADHD. Diagnosing someone requires a comprehensive assessment of their medical and mental health history. ADHD runs in families; there is up to a 91% percent likelihood that someone will pass the condition onto their children.

ADHD is more difficult to diagnose in adults than in children. Other conditions that cause similar symptoms, such as depression or anxiety, can complicate the diagnosis process. Also, ADHD symptoms can lessen as a person gets older.

I’ve noticed that a lot of people have started to use ADHD colloquially, to mean they are feeling disorganized or having trouble focusing. It’s important for people to understand, especially as more and more people are self-diagnosing based on what they see on the internet or social media, that relating to certain ADHD symptoms does not mean they have ADHD.

Adults who think they may have ADHD should go in for comprehensive mental health evaluation, not just an evaluation for ADHD, as there may be other conditions contributing to their symptoms.

Are there any other conditions that commonly coincide with ADHD?
People with ADHD are likely to have other psychiatric conditions, such as learning disorders, anxiety, and depression.

There are also secondary effects of ADHD. For example, children and adolescents with ADHD might get in trouble in school more often than other kids because they’re unable to sit still or can’t help themselves from chatting during class. As a result, adults with ADHD often have diminished self-esteem, which can increase their risk of developing anxiety, depression, or a mood disorder.

How is ADHD treated?
There isn’t a cure for ADHD, but symptoms can be managed with an integrative, multifaceted approach to treatment, which usually includes some combination of medication, psychotherapy, and lifestyle change.

ADHD medication can be very effective. Stimulants, such as amphetamines and methylphenidates, are the most common; they help people with ADHD with focus, emotional regulation, and impulse control by increasing levels of dopamine and norepinephrine. Nonstimulants, such as atomoxetine, clonidine, and guanfacine, increase the level of norepinephrine and work less quickly than stimulants. Nonstimulants tend to be better tolerated because their side effects are not as strong.

Behavioral therapy is another useful option for treating ADHD. A therapist can help someone with ADHD navigate ADHD-related challenges, as well as develop self-regulation tools, time management and organizational skills, and self-esteem. For example, I often encourage people with ADHD to write down appointments and make to-do lists because their working memory is not always strong.

People with ADHD can also benefit from adopting certain lifestyle habits. It’s important for everyone, including people with ADHD, to maintain a nutritional diet, especially since ADHD has been linked with obesity. Experimental studies have shown that both acute and long-term exercise may also help mitigate ADHD symptoms. And lastly, it’s important for people with ADHD to prioritize getting enough sleep, as the condition has been linked to sleep disorders.