ADHD in adults

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Overview

What is ADHD?

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder characterised by difficulties with concentration, attention and impulse control which impact on the person’s day-to-day life. Adults with ADHD often have difficulty concentrating for long periods of time, are easily distracted, or might act or speak before thinking things through. Whilst we might all have these difficulties from time to time, people with ADHD have significant and ongoing difficulties in these areas, which can affect their broader lives, particularly their study, work and relationships.1

About 2-3% of adults are diagnosed with ADHD.2 Whilst ADHD begins in childhood and symptoms typically improve as children get older, about 15% continue to have ADHD as adults.2-4

Treatment varies according to the needs of the person. Those with mild ADHD without other developmental or mental health issues generally do well with a range of psychological strategies. Those with more difficult to manage symptoms or other mental health concerns often benefit from a combination of medication and psychological support.5

Signs and symptoms

The key signs and symptoms of ADHD cover two main areas of difficulty; inattention, and hyperactivity/impulsivity, although in adults hyperactivity and impulsivity may be less obvious.

Inattention
  • Difficulty concentrating
  • Difficulty staying focused
  • Forgetfulness
  • Trouble organising tasks and activities
  • Tendency to lose things
Hyperactivity/ Impulsivity
  • Fidgeting and restlessness
  • Difficulty sitting for long periods of time
  • Difficulty engaging in quiet activities
  • Difficulty waiting turn
  • Acting or speaking before thinking things through.

For a person to be diagnosed with ADHD, they must currently have several symptoms, symptoms must have started before the age of 12, and difficulties must be present in two or more settings (such as at home and at work).

Symptoms that arise later in life are unlikely to be ADHD and should be assessed immediately.

There are three types of ADHD, depending on the main difficulties the person is experiencing. These are:

Predominantly inattentive: The person mostly has symptoms of inattention, rather than hyperactivity or impulsivity.

Predominantly hyperactive-impulsive: The person mostly has symptoms of hyperactivity and impulsivity, rather than inattention.

Combined: The person has symptoms of both inattention and hyperactivity-impulsivity.

What causes ADHD?

There is no single cause of ADHD; rather, there are a range of factors relating to people’s genes, neurobiology (the structure and function of the brain) and environment that increase their chances of developing ADHD.6

Genes

ADHD runs in families and having a relative with the disorder is one of the strongest risk factors. There appears to be a strong genetic component to ADHD.6, 7

Neurobiological factors

In adults with ADHD, research has found some differences in areas of the brain and brain activity that relate to short term memory, the ability to focus, and the ability to make choices.8

Differences have also been found in brain activity associated with attention and self-regulation, that is, the ability to focus attention, as well as manage emotions, thinking and behaviour.9-11

Environmental factors

Certain environmental factors might also play a role in the development of symptoms of ADHD. These include:6

  • Pregnancy and birth factors: Maternal smoking, alcohol and substance misuse, and stress during pregnancy, as well as infant low birth weight and prematurity are all factors linked to ADHD.
  • Early life relationships and opportunities to learn: Growing up in a family with high conflict, or without good opportunities to learn skills for self-regulation, attention and concentration can lead to difficulties in these areas.
  • Certain environmental toxins: Toxins such as lead can affect brain development and behaviour.
  • Dietary factors: For some people (even without ADHD) attention and concentration might be affected by nutritional deficiencies (e.g., zinc, magnesium, polyunsaturated fatty acids) and sensitivities to certain foods (e.g., sugar, artificial food colourings). There is no evidence however that these cause ADHD and a medical practitioner should be involved to evaluate these issues if they are considered of possible concern.

How is ADHD assessed?

In adulthood, ADHD is assessed by a team of professionals with training and expertise in ADHD, with their findings put together to make a diagnosis. In the assessment of ADHD in adults, this team of professionals often includes:12

GP or other medical practitioner: to assess and treat any related health issues

Psychologist: a mental health professional with training in the assessment and treatment of developmental, learning, behavioural and mental health difficulties

Psychiatrist: a mental health professional with medical training who assesses and treats a range of mental health disorders, and who can prescribe medications to address mental health symptoms.

This team of professionals assess for the following:

  • Does the person present with ongoing signs of inattention, hyperactivity or impulsivity?
  • Do these symptoms significantly and negatively impact on the person’s day-to-day functioning?
  • Were these symptoms present before age 12?
  • Do they occur in different settings (e.g., work and home)?
  • Could another reason better explain the symptoms?13

Answering these questions involves interviews, taking a detailed history of the person’s development, physical health, and mental health, and careful consideration of other information such as previous records, prior school reports, and family accounts.

The psychologist might test the person’s memory, attention and other skills.5, 12

The assessor might also observe the person across different settings to see how they behave in different environments with different demands on behaviour.14

How is ADHD treated?

There are a range of treatments which show good outcomes for adult ADHD. These include medication, cognitive-behavioural therapy for adult ADHD, and couples counselling for those experiencing relationship difficulties.

Medication

There is significant evidence supporting the use of medication in the treatment of ADHD in adults.15 Using medication in combination with psychological strategies is likely to lead to the best outcomes.15, 16

CBT for adult ADHD

Research suggests that cognitive-behavioural therapy (CBT) for adult ADHD is the most helpful approach to managing problems associated with ADHD in adulthood.17, 18 In CBT for adult ADHD, a psychologist or other qualified health professional helps the person learn a range of skills that can reduce the impact of ADHD.

CBT for adult ADHD includes:

  • Education about adult ADHD, and how it can affect different areas of people’s lives
  • Organisation, planning, and time-management skills training, including strategies such as the use of calendars and task lists, prioritising, and breaking down large tasks into smaller, more manageable goals
  • Problem-solving skills training: Effective problem-solving involves defining the problem, brainstorming solutions, trying out a solution, and evaluating its success
  • Strategies for reducing distractions and increasing attention span, for example, structuring small tasks around the person’s realistic attention span, removing environmental distractions, and setting reminders.

Thinking in more helpful and realistic ways, particularly around situations that cause distress. Overly negative thoughts and assumptions can prevent people from using skills that may help them manage, and may contribute to other problems such as depression and low self-worth. Learning to identify and challenge these thoughts can be particularly helpful.17, 18

Couples counselling

Whilst not a treatment for ADHD, couples therapy might be useful for those experiencing difficulties in their relationships, which is not uncommon for adults with ADHD.19 Couples counselling involves helping both partners understand how their attitudes and behaviours influence the relationship, learn to express caring and accepting emotions, improve communication, identify and change problem behaviours, and focus on the positive aspects of the relationship.19, 20

Seeking help

Ways to access treatment

Psychological treatment is becoming more accessible with a variety of ways available to access psychological advice, support and treatment for anxiety. This can be via:

  • Parenting and self-help books
  • Online treatment programs, sometimes called eTherapy
  • Seeing a mental health professional such as a psychologist, in person.

When using self-help books and eTherapy programs, it is important to choose ones that have a good reputation, have research to support their approach, and which are recommended by experts in the field.

You can speak with your GP or a mental health professional about which approach might best suit you.

When to seek professional help

If you are finding it difficult to concentrate or focus, and this is affecting your day-to-day life, an assessment should be organised as early as possible with a GP to assess whether ADHD or another health issue might explain your symptoms.

You might benefit from a referral to a psychologist for an assessment, and to help you develop strategies to address issues that you are concerned about. Psychologists are highly trained and qualified to diagnose and treat people with ADHD using a range of methods based on best available research. Psychologists understand the factors that can affect attention and concentration, and can help people with ADHD improve these skills and reduce the impact ADHD has on their lives.

To locate a registered psychologist in your area, call the APS Find A Psychologist Service on 1800 333 497 or visit www.findapsychologist.org.au. Your GP can also organise a referral to a registered psychologist experienced in working with ADHD. Check with your GP whether you might be eligible for rebates or reduced rates.

Tips for improving your attention and concentration

Decrease distractions

Set up your work space to be free from distraction - away from the door (where people come and go), away from the window (and distractions outside), and make sure your workspace is free from clutter, electronic media, and other distractions.

Get organised

Use time management and organisational strategies to streamline your day. To help get more organised, you can:

  • set goals
  • write to-do lists, and use these to plan and prioritise tasks for the day
  • use a diary and set reminders for jobs that need doing
  • group similar tasks that can be done together.21
Break tasks down into smaller chunks

Smaller tasks are easier to complete, easier to organise and are less overwhelming. They are also more easily done whilst your mind is fresh and before your concentration wanes.

Include breaks in activities and tasks

Breaks after work is completed can help you to refocus on the next task.

Use problem-solving

Effective problem-solving includes defining a problem you want to work on, brainstorming solutions, selecting a solution and trying it out, and reviewing the outcome.

  • Contributor(s)
    APS Member Publications
  • Publish date
    14 Nov 2016
  • References
    View
  • Reviewer(s)
    Vicki Anderson, PhD
    Head of Psychology
    RCH Mental Health Theme Director
    Clinical Sciences Research
    Psychological Sciences & Paediatrics
    University of Melbourne

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
  2. Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490-499. doi: http://dx.doi.org/10.1007/s13311-012-0135-8
  3. Mick, E., Faraone, S., Biederman, J., & Spencer, T. (2004). The course and outcome of ADHD. Primary Psychiatry, 11, 42-48.
  4. Ramtekkar, U. P., Reiersen, A. M., Todorov, A. A., & Todd, R. D. (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: Implications for DSM-V and ICD-11. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 217-228. doi: https://doi.org/10.1016/j.jaac.2009.11.011
  5. Wilens, T. E., & Spencer, T. J. (2011). Attention-Deficit/Hyperactivity Disorder. In P. Howlin, T. Charman & M. Ghaziuddin (Eds.), The SAGE handbook of developmental disorders. Thousand Oaks, CA: SAGE Publications.
  6. Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). Practitioner review: What have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry, 54(1), 3-16. doi: http://dx.doi.org/10.1111/j.1469-7610.2012.02611.x
  7. Faraone, S. V., & Mick, E. (2010). Molecular genetics of attention deficit hyperactivity disorder. The Psychiatric Clinics of North America, 33(1), 159-180. doi: http://dx.doi.org/10.1016/j.psc.2009.12.004
  8. Seidman, L. J., Valera, E. M., Makris, N., Monuteaux, M. C., Boriel, D. L., Kelkar, K., . . . Aleardi, M. (2006). Dorsolateral prefrontal and anterior cingulate cortex volumetric abnormalities in adults with attention-deficit/hyperactivity disorder identified by magnetic resonance imaging. Biological Psychiatry, 60(10), 1071-1080. doi: http://dx.doi.org/10.1016/j.biopsych.2006.04.031
  9. Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J., Greenstein, D., . . . Rapoport, J. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences, 104(49), 19649-19654. doi: http://dx.doi.org/10.1073/pnas.0707741104
  10. Makris, N., Biederman, J., Valera, E. M., Bush, G., Kaiser, J., Kennedy, D. N., . . . Seidman, L. J. (2007). Cortical thinning of the attention and executive function networks in adults with attention-deficit/hyperactivity disorder. Cerebral Cortex, 17(6), 1364-1375. doi: http://dx.doi.org/10.1093/cercor/bhl047
  11. Epstein, J. N., Casey, B., Tonev, S. T., Davidson, M. C., Reiss, A. L., Garrett, A., . . . Shafritz, K. M. (2007). ADHD‐and medication‐related brain activation effects in concordantly affected parent–child dyads with ADHD. Journal of Child Psychology and Psychiatry, 48(9), 899-913. doi: http://dx.doi.org/10.1111/j.1469-7610.2007.01761.x
  12. National Institute for Health and Care Excellence. (2013). Attention deficit hyperactivity disorder: NICE quality standard 39. Retrieved from https://www.nice.org.uk/guidance/qs39
  13. Sparrow, E. P., & Erhardt, D. (2014). Essentials of ADHD assessment for children and adolescents. Hoboken, NJ: John Wiley & Sons, Inc.
  14. National Institute for Health and Care Excellence (2016). Diagnosis and management of ADHD in children, young people and adults: NICE clinical guideline 72. Retrieved from https://www.nice.org.uk/guidance/cg72 (Original work published 2008).
  15. Prince, J. B., Wilens, T. E., Spencer, T., & Biederman, J. (2014). Pharmacotherapy of ADHD in adults. In R. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment (4th ed., pp. 826-860). New York, NY: The Guilford Press.
  16. Murphy, K. R. (2014). Psychological counseling of adults with ADHD. In R. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment (4th ed., pp. 741-756). New York, NY: The Guilford Press.
  17. American Psychological Association Division 12. (2013). Research-supported psychological treatments: Cognitive Behavioral Therapy for adult ADHD. Retrieved from http://www.div12.org/psychological-treatments/treatments/cognitive-behavioral-therapy-for-adult-adhd/
  18. Knouse, L. E. (2014). Cognitive-behavioral therapies for ADHD. In R. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment (4th ed., pp. 757-773). New York, NY: The Guilford Press.
  19. Pera, G. (2014). Counseling couples affected by adult ADHD. In R. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment (4th ed., pp. 795-825). New York, NY: The Guilford Press.
  20. Benson, L. A., McGinn, M. M., & Christensen, A. (2012). Common principles of couple therapy. Behavior Therapy, 43(1), 25-35. doi: http://dx.doi.org/10.1016/j.beth.2010.12.009
  21. Claessens, B. J. C., van Eerde, W., Rutte, C. G., & Roe, R. A. (2007). A review of the time management literature. Personnel Review, 36(2), 255-276. doi: http://dx.doi.org/10.1108/00483480710726136

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