Esther Schwartz, Ph.D., ABPP
As we navigate the complex landscape of mental health, it’s easy to overlook a condition which, according to the Centers for Disease Control and Prevention, affects an estimated 8.7 million adults in the United States: Attention-Deficit/Hyperactivity Disorder (ADHD). Many people associate ADHD with childhood fidgeting and bothersome behavior, but it doesn’t necessarily disappear when we reach adulthood. In adults, ADHD can manifest in more subtle but equally disruptive ways.
ADHD is one of several neurodevelopmental disorders. Other neurodevelopmental disorders include diagnoses of autism spectrum, language disorders, learning disorders and intellectual disability, to name a few. Neurodevelopmental disorders are present in childhood; they do not spontaneously present in adulthood.
Diagnosing ADHD in adults is challenging. It is important to consider the lifelong trajectory of the disorder, including symptoms present in childhood and the way in which these symptoms interfere with many aspects of life. For children, pediatricians may be the first resource in discussing concerns about ADHD. Parents may be asked to describe their concerns and even complete ADHD symptom inventories to better flesh out potential diagnosable issues.
The gold standard for diagnosing ADHD in adults is a comprehensive, psychological evaluation. This type of evaluation integrates information from several sources, so the professional does not solely have to rely on the self-report of the individual. Evidence-based assessment integrates data from multiple informants and multiple methods to form a reasonable clinical impression. The benefit of using a multisource and multimethod approach is that there is an abundance of data to formulate a plausible hypothesis about what is getting in the way of a person’s success. Typical test batteries for ADHD include tests of cognition, attention, executive function and verbal fluency. For college students, it is also important to explore the possibility of a learning disorder affecting performance.
Despite its prevalence, adult ADHD is often underdiagnosed and undertreated. Many adults with ADHD do not realize they have the disorder, and those who are diagnosed may not receive the support they need. This is due in part to a lack of awareness and understanding adult ADHD.
One reason is that the symptoms of adult ADHD look different from those of childhood ADHD. Adults with ADHD might be less hyperactive and more inattentive. They may have difficulty with organization, time management and planning. Another reason is that ADHD symptoms can be difficult to tease apart from other conditions, such as anxiety and depression, which also negatively impact motivation and concentration. Moreover, many adults with ADHD have co-occurring conditions, which complicates accurate diagnosis and treatment.
The consequences of untreated adult ADHD may be significant. The unevenness of performance of individuals with ADHD can be puzzling and frustrating to themselves, their families and their peers. Adults with ADHD may be incredibly intelligent, creative and resourceful and yet struggle with basic life skills such as time management, task-completion and controlling emotional outbursts. Adults with untreated ADHD are more likely to experience problems at work, school and in their relationships. They also are more likely to have other mental health conditions, such as anxiety and depression.
While there is no cure for ADHD, there are a number of effective treatments which include medications, behavioral therapy, or ideally, a combination of both. Medication can help to improve symptoms such as inattention, hyperactivity and impulsivity. Therapy can help adults with ADHD develop skills and strategies for self-regulation, organization and managing distractibility.
Adult ADHD awareness is not just a matter of health care, but one of empathy and understanding. It's about acknowledging the diverse ways in which mental health challenges manifest and providing a helping hand to those who need it. Together, we can ensure that adults with ADHD receive the support they deserve, ultimately benefiting us all as a more compassionate and inclusive society.
Esther Schwartz, Ph.D., ABPP, is a staff psychologist in the Department of Family
and Community Medicine at Texas Tech University Health Sciences Center School of Medicine.