Health

Adults Have Attention Disorders Too

Megan Riddle, M.D. Ph.D. MS, is a fellow in consult-liaison psychiatry at the University of Washington and is completing her second year as an APA Leadership Fellow. She is a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program.  Today she responds to a question from the mother of a child with ADHD to help us better understand Attention Deficit Hyperactivity Disorder (ADHD) and its impact on adults.

Dear Dr. Riddle,

I’m a mom in my late 40s and my 11-year-old daughter has just received a diagnosis of ADHD. Although she’s pretty good at home, it can take a lot of reminders for her to get chores done and homework can be incredibly painful. Her teacher was the one who suggested it might be ADHD – I tend to think of ADHD as being little boys bouncing off the walls and unable to sit still. My daughter, instead, is a total daydreamer and her teachers were constantly having to remind her to stay on task. Thankfully, with the diagnosis, she is now on medication and we’ve started doing a variety of behavioral interventions. My husband and I have really noticed a difference – both at home and at school. My question, though, is about me. I was totally the same way as a kid. Now, I find myself struggling to concentrate at work. This has only really become an issue for me in the last year, as I’ve been promoted from a very active job doing sales and interacting with customers to a managerial desk job with tons of little, detailed tasks. What do you think? Could I have ADHD?

Thanks,
Marcia

 

Dear Marcia,

I am glad your daughter has received a diagnosis and treatment that is helping her. You raise an excellent question. Although Attention Deficit Hyperactivity Disorder (ADHD) is most often associated with children, it affects adults as well. Although this is a condition that develops in childhood, it is not uncommon for an individual to go undiagnosed, just like you have, until something changes in the person’s life – like a change in job that requires more attention to detail.

Although some children do seem to “grow out of” their ADHD, about half the kids whose cases have been diagnosed continue to have symptoms into adulthood, with about 4 percent of adults affected. It’s not uncommon for girls to go undiagnosed in childhood as they more often present as inattentive – the daydreaming you describe – rather than hyperactive – the disruptive bouncing off the walls most often associated with ADHD. Diagnostically, we call both of these types “ADHD” but can add the specifier “predominantly inattentive,” “predominantly hyperactive/impulsive” or “combined” depending on the predominance of symptoms. Family, twin and adoption studies show that ADHD is highly heritable, meaning that children tend to inherit it from their parents. Thus, if your daughter has ADHD it is more likely you are affected as well.

ADHD has five main features:

  1. Inattention: Individuals with ADHD have trouble staying on task for extended periods of time. While we can all be pulled away from projects by the Internet or find our mind wandering to our weekend plans, those with ADHD do this to the degree that it impairs their ability to complete tasks on time. They can have trouble organizing and prioritizing activities and may find time management difficult; they may procrastinate and have trouble making decisions.
  2. Impulsivity: While kids with ADHD may tend to blurt out and jump out of their seats, impulsivity in adults can take a variety of forms. They might quit a job without having another lined up or end a relationship abruptly. They may also be more likely to react out of proportion to a frustration – blowing up at something that may be minor. Studies have shown that those with ADHD also are more likely to have traffic tickets as they can have trouble paying attention to their driving and may act more impulsively behind the wheel than they should.
  3. Hyperactivity: Adults with ADHD often feel restless, unable to sit still. They may enjoy more active jobs and have trouble staying at a desk for long periods of time. This can also present with talkativeness and a tendency to finish other people’s sentences.
  4. Trouble with executive function: Executive function is an overarching ability to establish goals and work toward those goals, including such skills as being able to organize, problem-solve, and shift appropriately between tasks.
  5. Emotional dysregulation: People with ADHD may be more irritable, with low frustration tolerance. Although not specific to ADHD, such mood lability can negatively impact their life at work and home.

While sometimes people brush off ADHD as a relatively benign issue, it can cause significant impairment for those affected. Studies have shown higher rates of difficulties at work and unemployment among those affected. They also tend to not go as far in school and may struggle with substance use issues.

Your first step would be getting a diagnosis. Although there are some online diagnostic tools, the best choice is to talk to your primary care doctor or psychiatrist about your concerns. Also, those with ADHD are more likely to suffer from other psychiatric issues as well, like depression or anxiety. Thus, a thorough psychiatric assessment should be conducted.

There are a number of different medication options that you can discuss with your doctor.  Currently, the medications that have been shown to be most effective are stimulants. These include such medications as Concerta, Vyvanse, Ritalin, Adderall, and Dexedrine. While the exact way in which these medications work in ADHD is still not fully understood, stimulants act on the level of the neuron to alter dopamine and norepinephrine signaling, affecting motivation and reward. If stimulants are not appropriate, there are other medications that have been shown to be helpful with ADHD symptoms, like Strattera and the antidepressant Wellbutrin. Both of these medications are not typically considered first-line treatment as they appear somewhat less effective and take a longer time (on the order of weeks) to show a benefit. However, for those who may not do well on stimulants or for whom stimulants may not be appropriate, these other medications are an option.

Psychotherapy can also play an important role in helping with ADHD symptoms. Studies have shown that cognitive behavioral therapy (CBT) focused on developing skills to deal with difficulties, like distractibility, procrastination, and disorganization, which tend to accompany ADHD and can be so debilitating. CBT is typically done over 12 to 15 sessions with homework to complete in between time to solidify what you work on in therapy.

In sum, you have a lot of options for treatment, but your first step is to get an accurate diagnosis.

Best wishes,
Dr. Riddle

 

References
Bukstein, O. (2016). Attention deficit hyperactivity disorder in adults: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis, from UpToDate.com
Bukstein, O. (2016). Pharmacotherapy for adult attention deficit hyperactivity disorder, from UpToDate.com
Soltano, M. V. (2014). Psychotherapy for Adult ADHD, from UpToDate.com

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  • Ruby in Manhattan May 20, 2019 at 9:48 am

    I’d like to read more on the adult ADHD effect on personal relationships. Inability to focus, follow through, remember/honor commitments and think things out can impair trust between people, or make it difficult to adjust to that person’s chronic impulsivity and lack of attention to detail. My almost 70 year old old friend, who suspects she is adult ADHD, is upset that her buddies often become angry or frustrated with her. What could I do to help? Much as I like her, this relationship can be challenging.

    Reply