Adult ADHD: An owner’s manual

What Is ADHD in Adults?

Signs of ADHD in adults don’t necessarily look like signs of ADHD in children and teenagers. The condition doesn’t always have a predictable trajectory from childhood to adulthood. In fact, some researchers think that there are two distinct disorders: ADHD in adults and ADHD in children. 

Adult ADHD tends to be more complex, or heterogeneous, than childhood ADHD. Adulthood brings increasing demands on a brain’s executive functions, and every year adds more life experience and adaptations. In adulthood, it might become harder to separate ADHD symptoms from other personality traits, learned behaviors, emotional responses, and even coexisting conditions.  

Adult ADHD often flies under the radar. The American Psychiatric Association (APA) estimates that 2.5% of adults have it, but the prevalence could be much higher. Some adults are diagnosed with ADHD when they’re children and then learn over the years to manage their condition with behavioral strategies and medication. But far too many adults go decades without compassionate treatment – or they never receive it at all. This can have severe consequences for someone’s relationships, career, and more. Adults with untreated ADHD may be chronic underachievers, or have low self-esteem. They might have been misdiagnosed with depression or anxiety. They might have internalized the early criticisms they received from teachers or caregivers because their brains didn’t operate in a neurotypical way. 

And this is the great tragedy of ADHD – that so many amazing, neurodiverse people grew up identifying as defective because they didn’t have the information to recognize their enormous strengths.

Adult ADHD Symptoms

• Is easily distracted from certain tasks, and able to get hyper-absorbed in other tasks
• Loses track of time (i.e., experiences “time blindness”)
• Often procrastinates
• Overlooks important details
• Has trouble prioritizing tasks
• Gets lost in daydreaming
• Often lacks motivation  
• Has difficulty tolerating stress or frustration
• Is often impatient
• Gets overwhelmed easily
• Shows signs of hyperactivity like fidgeting or leg bouncing
• Neglects making preventative healthcare appointments
• Has difficulty relaxing or can’t enjoy leisure time
• Frequently loses personal items
• Is frequently late 
• Can come across as inattentive and rude to others (doesn’t seem to be paying attention)
• Is hypersensitive to criticism
• Is prone to emotional outbursts
• Has frequent mood swings (emotional lability)
• Often makes impulsive decisions
• Feels internally restless 
• Seems underachieving, not “living up to potential”
• Is a distracted or reckless driver
• Forgets things easily
• Is a night owl, insomniac, or has other sleep issues
• Binge eats
• Has body-focused repetitive behaviors (BFRB) like skin picking, nail biting, or hair pulling
• Has inconsistent work performance/productivity
• Has difficulty following complicated instructions 
• Has difficulty planning and completing tasks

What Are the 3 Main Symptoms of ADHD?

The three main symptoms of ADHD – hyperactivity, inattention, and impulsivity– don’t necessarily apply to adult ADHD. Kids with ADHD tend to get diagnosed due to obvious motor symptoms (hyperactivity). But the most notable feature of adult ADHD tends to be attentional dysfunction. ADHD is a disorder of executive functioning, so it affects working memory, planning, organization, inhibition, motivation, emotional regulation, and similar cognitive domains. These challenges are countered by some major assets of the ADHD mind, like creativity, intelligence, and problem-solving abilities.  

What is the typical behavior of an adult with ADHD? It’s hard to say because no two people with ADHD are alike, but you can review the symptoms listed above. And it’s important to note that the modern world tends to encourage “pseudo attention deficit disorder” behaviors. For example, even neurotypical people might sometimes feel overwhelmed by a day’s bombardment of emails and text messages. Or they might struggle to concentrate on a task at hand because they’re stressed out by what they read in the media. Or they’re hyperfocused on their phones because their social feed is programmed to be engaging — even addictive. Trauma can also cause symptoms similar to those of ADHD. So you need a clinician to give you a full assessment.

What Does Untreated ADHD Feel Like in Adults?

Undiagnosed and untreated ADHD in adults can be incredibly painful. People who lack information about their disorder might have grown up feeling like failures because they couldn’t perform the same tasks as their neurotypical peers. They might have known they were different, but wrongly attributed it to some moral failure or intelligence deficit rather than their neurodiversity. There can be a lot of shame and self-doubt involved in undiagnosed or untreated ADHD. 

What are the risks of untreated adult ADHD? Adults with untreated ADHD might lose jobs or even spouses due to their impairments and symptoms of inattention. They might be more prone to accidents, sexually transmitted infections (STIs), substance abuse, poor decision-making, and a shorter lifespan. One of the most notorious symptoms of untreated adult ADHD is underachievement. Someone is whipsmart and has a lot of potential, so why aren’t they succeeding at everything? Why are they leaving failed marriages and disrupted careers in their wake? 

But the flip side of this is that once someone is diagnosed by a mental health professional, the ADHD lens can help make sense of all those inexplicable problems in one’s life. For example, someone might begin to recognize their maladaptive behaviors as coping strategies for the challenges of ADHD. So they can finally begin to tackle their problems at the source. And even a late ADHD diagnosis might be crucial to preventing other psychological issues down the line, like depression and anxiety. 

Which Conditions Can ADHD Coexist With?

As many as 4 in 5 adults with ADHD have at least one comorbidity, or coexisting disorder. According to the 2006 National Comorbidity Survey Replication (NCS-R), these are the most common:

• Mood disorders: major depressive disorder (MDD), dysthymia, bipolar disorder
• Anxiety disorders: generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, specific phobia, social phobia, obsessive-compulsive disorder (OCD)
• Substance disorders: alcohol abuse, alcohol dependence, drug abuse, drug dependence
• Impulse control disorders: intermittent explosive disorder (IED)

When adults have coexisting disorders, mental health professionals typically begin by treating the condition that causes the most impairments. For example, someone’s depression might be secondary to the untreated ADHD, triggered by a sense of failure because they haven’t been able to meet neurotypical goals.  

What Can Trigger ADHD in Adults?

Let’s break up this question into two related questions: 

1. Can you develop ADHD as an adult? 
2. What can trigger ADHD symptoms in adults?

Can you develop ADHD as an adult? There’s some conflicting theories on this, but the DSM-5 criteria state that someone has to have manifested symptoms before the age of 12 to be diagnosed with ADHD. So can adults suddenly get ADHD? It’s unusual, but not impossible. Some adults may have an inaccurate self-assessment of their childhood symptomatology. Or they may have had enough parental and social supports in place to camouflage their ADHD until they became more independent. Someone with high intelligence might be able to mask their symptoms, or somehow compensate, for a long time. But eventually their environment may become overwhelming, and it becomes harder to function without the right scaffolding. A sudden onset of anxiety symptoms can also resemble ADHD.

What can trigger ADHD symptoms in adults? ADHD symptoms tend to worsen with stress. So someone’s ADHD might suddenly become unmanageable when they’re confronted with significant life transitions or other stressors. For example, a job might become increasingly demanding, or someone becomes a parent, or they become isolated during a global pandemic. In women, there’s evidence that menopause and premenstrual dysphoric disorder (PMDD) can also trigger symptoms. 

How Can ADHD Affect Work?

ADHD can affect work in both positive and negative ways. Let’s start with the positive. The world is full of wildly successful entrepreneurs, entertainers, teachers, doctors, executives, writers, artists, computer programmers, athletes…and on and on…who have ADHD. Adults with ADHD can absolutely thrive in their workplaces, especially when they understand how their mind works and know the strategies that help them function best.

People who haven’t learned how to manage their ADHD on the job run certain risks. They might be chronically late or not meet their deadlines. And they might be less productive or satisfied than their coworkers if a professional environment is a poor fit for them. 

But there are countless ways to help people with ADHD succeed in their chosen careers. For example, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) offers some practical tips for coping at work. And you don’t have to tell your boss that you have ADHD if you don’t want to. Just share what your strengths are, and what helps you work best. Most importantly, find a job that you love, one that will capitalize on your energy and keep you engaged more often than not.

How Can ADHD Affect Relationships?

ADHD certainly affects romantic relationships, but so does every other mental health condition and personality trait and bad habit and physical ailment and weird hobby and career choice and so on. Every human is different, and yet we fall in love and accept each other anyway. People with ADHD and their non-ADHD partners can actually balance each other out quite beautifully. Sure, it might annoy the partner without ADHD when their spouse lets the bills or dishes pile up, but they might also appreciate the energy that same spouse brings to playing with the kids, or solving a tricky problem. ADHD-focused couples therapy can help mixed households learn to take a strength-based approach instead of judging or demeaning each other’s ways of being in the world.

People with ADHD can sometimes suffer from rejection sensitive dysphoria (RSD), a condition that makes them extremely emotionally responsive to perceived rejection from those they care about. This can show up in relationships as people pleasing, resignation or withdrawal, depression, or even angry outbursts. Research shows that RSD can be treated successfully with medication and/or psychotherapy.

How Can ADHD Affect Parenting?

Due to the major genetic component of ADHD, parents with ADHD often have children with ADHD. Up to half of kids with ADHD have a parent with the disorder. That means that you not only have to think about the neurodiversity of your children and yourself, but also the neurodiversity of your mom and dad! Chances are, your parents were never diagnosed with ADHD, but perhaps they should be screened as well. 

Every parent has certain strengths and weaknesses. A parent with ADHD might struggle with behavioral control and discipline, but they might be great at responding emotionally to their child. In two-parent households, one parent can sometimes compensate for certain difficulties another parent has. For example, the non-ADHD parent can make the weekly schedule and plan the meals, while the parent with ADHD might be better at doing Legos with their child for hours. Families can learn to fit together despite their differences. But sometimes it requires work, and a lot of psychoeducation, all of which can be directed by a great family therapist. You can also find some excellent parenting resources at ADDitude Magazine and CHADD. 

Is ADHD Different in Women?

The stereotypical child with ADHD is a little boy who can’t sit still in the classroom. He’s disruptive during lessons. He’s always going 60 miles an hour while the people around him are following a residential speed limit. But then there are the girls with ADHD. Females with ADHD are less likely to have symptoms of hyperactivity. Instead, their minds might be quietly freewheeling. Inattention symptoms aren’t as noticeable as bouncing off the walls, so female ADHD is more likely to go unrecognized in childhood. Girls also tend to be better at masking their symptoms.

Women with ADHD are more likely to be misdiagnosed with depression, anxiety, or even personality disorders. It’s not unusual for a mom with unrecognized ADHD to suffer from depression or feelings of failure as she compares herself to other parents who seem to manage their households effortlessly, never forgetting an appointment, always sticking to the same bedtime routine, budgeting and planning months and years ahead, etc. Women too often carry these impossible expectations for their families, and that stress can be compounded by ADHD. 

How Do You Diagnose Adult ADHD?

Because adult ADHD is so often overlooked, many adults end up diagnosing themselves on the Internet, through sites like this one. Though self-diagnosis is obviously not of the same value as clinical diagnosis, it can be a good place to start. If you have some of the symptoms of adult ADHD and want to find out more, then you need a proper screening. It’s time to consult with a doctor or mental health professional to understand if you have ADHD.

You can ask your current physician to screen you for ADHD, or you can find a new clinician who specializes in the diagnosis and treatment of ADHD. What you don’t want is an old-school doctor who doesn’t understand the disorder, or who thinks that anyone who mentions ADHD is just shopping for controlled substances. Find someone you trust, with whom you can envision having a long-term relationship. Because it can take a while to get ADHD treatment right (more on that below). 

An ADHD screening is basically an in-depth history of your symptoms. A clinician will ask you about your childhood behaviors, your job history, your relationships, your sleep patterns, and much more. They may also want to talk to other important people in your life because ADHD can sometimes warp self-assessments. Adult ADHD might be incredibly complex, so a diagnosis could take anywhere from 45 minutes to multiple sessions. 

Beyond taking a comprehensive history, some doctors or mental health professionals might find ADHD testing useful. Specific tests and scales for adult ADHD include the following:

• Adult ADHD Self-Report Scale (ASRS)
• Wender-Reimherr Adult Attention-Deficit Disorder Scale (WRAADDS)
• Conners Adult ADHD Rating Scales (CAARS)
• FAST MINDS (Forgetful; Achieving below potential; Stuck in a rut; Time challenged; Motivationally challenged; Impulsive; Novelty seeking; Distractible; Scattered) 
• Weiss Functional Impairment Rating Scale (WFIRS) 
• Adult ADHD Quality of Life Scale (AAQoL) 

An ADHD diagnosis can bring with it feelings of relief, but also shame, regret, grief, and anger, so it’s critical to build a relationship with a compassionate and knowledgeable professional who can help you work through these intense emotions. 

How to Treat ADHD in Adults?

It’s never too late to treat ADHD. People can turn their lives around in their 40s, 50s, even 80s after a late diagnosis. So don’t hesitate to seek help even if you’ve somehow managed for decades without proper treatment. 

Treatment for adult ADHD tends to focus on functional outcomes in different areas of your life. So a mental health professional will want to know what your treatment goals are. Would you like to be able to focus more at work? Would you like to increase your tolerance for routine stressors, or be less impatient or irritable at home? What changes would you like to see?

The two main components of ADHD treatment are the same for kids and adults: medication and behavioral therapy, otherwise known as “pills and skills.” For many people with ADHD, both these elements are essential.

Pills

Pills are stimulant or non-stimulant medications. It usually takes some trial and error to get the right molecule and the right dose to help your attentional issues. But the good news is that ADHD drugs are safe, effective, and not long-lasting. So if a specific medication causes side effects, you can stop it right away and it will be out of your system within 24 hours. 

Skills

Non-pharmacological interventions can be life-changing as well. Everyone with ADHD needs to find what works for them. Any of the following therapies might prove successful in managing symptoms:

• Mindfulness-based interventions (MBIs)
• Dietary changes (based on latest research into gut-brain axis and its role in ADHD)
• Aerobic exercise
• Improved sleep routine
• Psychoeducation (learning about the disorder)
• ADHD coaching (someone to help with practical life strategies) 
• Neurofeedback
• Individual therapy, family therapy, or couples therapy
• Cognitive behavioral therapy (CBT)
• Support groups

How Can I Help a Loved One with Adult ADHD?

The best way you can help a loved one with adult ADHD is to educate yourself about the condition. You need to learn what is in the person’s control, and what isn’t. Then talk to your loved one about their obstacles, and how you might be able to assist. Maybe they are overwhelmed by the idea of researching adult ADHD specialists in their area. You can offer to get them a list of names, or make some phone calls. Maybe they need help remembering to take their medication. Maybe they need you to write them notes instead of giving them verbal reminders, because visual aides help them free up working memory. 

Put your heads together and come up with some strategies that will be mutually beneficial. Because you will need support as well! Above all, try to be less like the judgmental, hypercritical adult that your person remembers from childhood (everyone with ADHD seems to have one), and be more like the supportive friend who loves them unconditionally, and sees how much they have to offer.