Adult ADHD is a psychiatric disorder associated with debilitating inattention and hyperactivity/impulsivity. In simper terms, that means you can’t concentrate, can’t sit still, and maybe don’t think things through before acting.
But problems concentrating, sitting still, and thinking things through don’t necessarily mean you have ADHD. Those issues can be seen in other psychiatric conditions, like adjustment to tough situations, anxiety, depression, psychosis, mania, substance use disorders, and cognitive problems. So how do doctors tell the difference?
Here’s a little information about ADHD.
How is ADHD different to normal distraction and restlessness?
Although there are many differences, here are a few pointers to help clarify.
(1) ADHD symptoms don’t come and go. We all have moments of inattention, excessive energy, and poor decision-making, but for people with ADHD, the symptoms are severe and occur almost every day. The problem is always present. It doesn’t change because a person is happy or sad.
(2) Onset before age 12. According to the psychiatric bible of diagnoses, the DSM 5, symptoms of ADHD must start before the age of twelve. Even when diagnosed as a grown-up, the person with ADHD has struggled throughout childhood and adolescence because of the disorder.
(3) Problems with daily functioning. The symptoms of ADHD cause problems in day-to-day life. Unlike most people, where the occasional inattention and impulsivity don’t cause much of a ruckus, adults with ADHD tend to struggle with failing relationships and difficulty at work or school.
What are the types of ADHD?
There are two subtypes, although it’s possible to have both. Here’s a breakdown:
(1) Inattention Subtype is what it sounds like: people can’t concentrate! Specific symptoms include:
–making careless mistakes and doing sloppy work
–frequently losing stuff (like keys and cell phones)
–frequently forgetting stuff (like appointments or returning important calls)
–having difficulty focusing on and following conversations and not seeming to listen when spoken to directly
–struggling to complete tasks that require organization
–not following through on daily responsibilities, like chores around the house
–avoiding or disliking things that require a lot of attention, like reading, balancing a checkbook, taking a college course, or doing complex work projects
–being easily distracted by unrelated thoughts or noises in the environment
(2) Hyperactive-impulsive subtype means someone has problems staying calm and quiet, and they tend to react before thinking. Specific examples include:
–saying things that are rude or inappropriate without thinking
–acting recklessly on the spur of the moment
–fidgeting and squirming a lot, being constantly “on the go,” or feeling restless
–problems staying seated (like in long meetings)
–difficulties engaging in leisure activities that require calm behaviors
–blurting out answers before the question has been completed, or problems taking turns
–Interrupting others or being intrusive in conversations and activities
How is ADHD diagnosed?
Never diagnose yourself with a mental health disorder after reading an article online!
If you think you have ADHD, make an appointment with a psychiatrist. They’ll do a thorough evaluation and ask many questions as they assess for ADHD and other medical and psychiatric conditions that can mimic ADHD. The provider will probably ask your permission to contact someone who knows you well, to get more history about your childhood, functioning, and drug history. They might also refer you for formal neuropsychiatric testing to help clarify the diagnosis.
How can a physician tell the difference between ADHD and all these other conditions?
Differentiating between the different disorders can be challenging. It takes time, as well as lot of information-gathering and educated clinical judgment. It’s important you seek out professional help instead of diagnose yourself.
That said, attention problems related to stress, anxiety, depression, mania, and psychosis tend to disappear when the patient’s mood and thinking return to normal. The same is for substance abuse; when the addict stops using drugs, their brain eventually returns to baseline and, over time, concentration improves (this can take up to six months or longer, depending on the drug). On the other hand, the person with ADHD has symptoms all the time, no matter how stable their mood and thinking. It is possible to have ADHD and another psychiatric disorder at the same time. In this case, most psychiatrists try to stabilize the non-ADHD disorder first. Sometimes both conditions need to be treated individually.
Separating cognitive problems like brain trauma and dementia from ADHD is more challenging. In general, people with cognitive problems can have inattention, but these are always accompanied by other difficulties. Symptoms in brain trauma are always triggered by brain injury (unlike ADHD, where there’s no clear trigger) and frequently include personality changes, memory problems, and emotional irregularities like rage attacks. Dementia includes diseases like Alzheimer’s. These diseases never start in childhood and are usually associated with memory problems and deficits in self-care (not seen in ADHD). People with intellectual deficit disorder (formerly mental retardation) and autism can have ADHD.
What happens to ADHD as a person ages?
The characteristics of ADHD can appear as early as 3-6 years of age. In young children, the hyperactivity-impulsivity subtype is more common. Symptoms tend to change as a person matures. As childhood progresses into adolescence, problems with attention become more prominent, and the hyperactivity is often replaced with a subjective sense of restlessness. Most children grow out of ADHD, but some continue to have symptoms well into adulthood. Grown-ups with the disorder tend to suffer from the inattentive subtype.
What treatments are available?
There is no cure for ADHD, but treatments like medication, individual therapy, group therapy, support groups, self-education, life-style changes, and self-help (like coping skills) can make a world of a difference
What medications are used?
There are two classes of medications used to target the symptoms of ADHD: amphetamines and non-amphetamines. Doctors who prescribe meds for the disorder include pediatricians, family doctors, and psychiatrists.
(1) Amphetamines tend to cause euphoria, hyperactivity, and impulsivity in most people, but for some unclear reason, they have a calming effect on people with ADHD. When prescribed at safe doses, stimulants help with focus and learning, and they decrease over-activity and impulsivity. Amphetamines are addicting in some individuals, but they’ve actually been shown to decrease risk of substance abuse in teenagers with ADHD.
(2) Non-amphetamine medications like Bupropion, Venlafaxine, and Atomoxetine have also been shown to be beneficial for ADHD. Guanfacine and Clonidine are blood pressure medications that are beneficial for kids, but there’s minimal evidence they help adults. These five drugs aren’t addicting but take longer than amphetamines to start working.
What about psychotherapy?
Therapy can help a person better cope with their illness and day-to-day problems. It comes in many flavors, ranging from behavioral therapy, mindfulness skills, and stress management techniques to family therapy and support groups. Here’s an overview of each:
(1) Behavioral therapy aims to help an individual deal with daily tasks, like organizing or completing work projects and thinking before acting.
(2) Mindfulness or meditation improve focus and restlessness by helping a person be aware of the moment and release all other concerns.
(3) Stress management techniques, or coping skills, are key to surviving stress and change in our lives. A therapist might help the patient with difficult transitions, like starting college, tolerating a break-up with a boyfriend, or beginning a new career.
(4) Family or couple therapy help the individual and their family discover better ways to handle the situation. This might include encouraging different behaviors and improving the family or spouse’s relationship with the patient.
(5) Support groups put you in contact with others who have similar problems. Groups meet regularly to share their feelings and what they’re doing to cope with their illness, plus exchange information about resources in the community.
If you’re struggling with ADHD, check out Tips for people with ADHD. If you want more information about the disorder in general, look into this NIMH site on Attention Deficit Hyperactivity Disorder. The link opens in a new page.