Out of Focus: ADHD in Adults

Attention-deficit/hyperactivity disorder (ADHD) is a common pediatric mental disorder. Because it is a neurodevelopmental disorder – that affects the development of the brain or spinal cord – it is a chronic condition, making it a common mental disorder among adults too.

Adults who have common symptoms of ADHD – inattentiveness, difficulty concentrating, restlessness – may simply chalk them up to having a busy life. But, when symptoms interfere with work, academics and relationships, it may be time for an ADHD assessment.

Danielle Keyton, DO, a psychiatrist with WakeMed Mental Health & Well-Being, brings ADHD in adults into focus for readers.

What is ADHD?

Attention-deficit/hyperactivity disorder – ADHD – is a neurodevelopmental disorder that impacts the brain’s frontal lobe. This is the area of the brain responsible for executive functioning – the thought processes that help us organize, plan and see projects through to completion, among other things. People are typically born with ADHD, though it can result after a traumatic brain injury.

So, adults do not typically develop ADHD; they likely had it from birth, correct?

Yes, that’s correct. There is a genetic component to it. Other factors, such as medications or other substances a woman consumes when pregnant, exposure to toxins, or illnesses or injuries that occur in early childhood can contribute to ADHD. ADHD can occur in adults who suffer a traumatic brain injury as well, but most people are born with it.

Is ADHD prevalent among adults?

It’s estimated that a little over 4 percent of adults have an ADHD diagnosis, with males impacted more than females. It’s likely that many more have ADHD – they just do not realize they have an issue. They determine their symptoms result from having busy lives or other reasons. It can also be misdiagnosed as anxiety or depression – which often occur with ADHD. As you can imagine, a person who cannot complete a task or is frequently scolded by a spouse for not listening to them can increase anxiety or depression symptoms.

And, unfortunately, there remains a societal stigma surrounding mental health. ADHD is a neurological issue. Just like diabetes or heart disease, if ADHD is not managed, it can lead to relationship problems and even risky behaviors like substance use disorder and inattentive driving.

Are there different types of ADHD?

Yes, there are three types: Inattentive, hyperactive-impulsive and combination. While children typically display hyperactive-impulsive or combination ADHD, the inattentive version is more common in adults.

Common Characteristics of ADHD

Do adults experience different ADHD symptoms than children?

Hyperactivity is more common among children. Parents and teachers may first believe a child is simply behaving badly. When the outbursts and inability to sit still become a chronic issue, ADHD becomes a consideration.

Adults are more likely to present with organization, memory and time management issues. When these issues become chronic and have negative effects, such as increased depression, relationship problems, issues at work or school, or increased alcohol or substance use, ADHD is likely.”

How do you diagnose ADHD? What’s a common complaint from an adult patient that a physician would hear?

The discussion often starts in the primary care physician office. The common complaints are trouble focusing and bad time management skills. Interestingly, it’s often a family member who notices their spouse, parent or child is displaying chronic issues.

What’s the next step after a visit with the primary care physician?

The best course of action is for a primary care physician to complete an evaluation and then refer the patient to a mental health provider, like a psychiatrist or a mental health counselor. The mental health provider will talk to the patient and complete a clinical assessment of their symptoms and the impact the patient’s symptoms has on their daily life. WakeMed Family Practice patients have access to WakeMed Mental Health & Well-Being providers. Additional outpatient mental health providers are available through the WakeMed Behavioral Network’s Network for Advancing Behavioral Health.

What is the treatment for ADHD in adults?

There are several treatment modalities for ADHD. Some people may benefit from a combination of treatment while others may respond to one – it’s different for each patient. The three modalities include:

• Medication
• Skills training through cognitive behavioral therapy
• Psychotherapy, which can help adults improve their time management skills, learn how to control impulsive behaviors or temper, and improve low self-esteem due to past failures related to their ADHD.

What medications are prescribed for ADHD?

Stimulants, such as Concerta, Ritalin, Adderall and Dexedryne, are first-line medications for the management of ADHD. They work by slowing down the absorption of dopamine and neurotransmitters in the brain. Stimulants work quickly, but they are not for everybody. They can be habit-forming or cause unwanted symptoms (difficulty sleeping, agitation, etc.).

When stimulants cause adverse reactions or do not work, there are nonstimulants, such as Strattera, Wellbutrin and Quelbree, that we can try.

Are there some little things adults with ADHD can do to help with focus?

Fidget spinners or stress balls can be helpful to adults who have ADHD. Also taking frequent breaks or taking a walk can help refocus the mind. We recommend that adults who are taking in-person classes sit in the front row, away from windows.

Is there an online quiz a person can take to help them determine if they have ADHD?

There are several online quizzes adults can take, such as this one from PsychCentral. It’s best to work with a qualified mental health professional to obtain a proper diagnosis and determine the best course of action should you need treatment. People who see a WakeMed Primary Care provider have access to WakeMed Behavioral Health providers. There are many providers within the Network for Advancing Behavioral Health who offer services for ADHD in both adults and children. And if you or your spouse is covered by a company medical plan, it’s likely you have access to mental health providers through that too.

Danielle R. Keyton, DO, is a psychiatrist with WakeMed Mental Health & Well-Being.

Additional Resources

• www.add.org
• www.chadd.org