Adult ADHD: Attention Deficit Hyperactivity Disorder (ADHD) Treatment, Symptoms and Diagnosis

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder characterized by ongoing patterns of inattention, hyperactivity, and impulsivity. These symptoms can have a major effect on everyday activities, making it harder to do well at school or work and maintain strong social connections. While ADHD is typically diagnosed in childhood, it can persist into adulthood, often continuing to affect individuals in various ways as they grow older.

There are three types of ADHD: primarily inattentive, primarily hyperactive-impulsive, and combined type, where individuals experience both inattention and hyperactivity/impulsivity. Symptoms can vary in severity, with some people finding it difficult to stay focused, while others struggle with impulsive behavior or excessive movement.

Although ADHD is often recognized in children, many adults also live with the condition, sometimes without realizing it. Effective treatments, such as medications and therapy, are available to help manage symptoms and improve quality of life.

These are the three primary presentations of ADHD:

• Predominantly Inattentive Presentation: This type is characterized by difficulty with attention and focus. Individuals may struggle with organization, following instructions, or completing tasks. They are often easily distracted and may appear forgetful or disengaged.
• Predominantly Hyperactive-Impulsive Presentation: This presentation involves hyperactivity and impulsivity rather than inattention. Individuals may fidget, have trouble staying seated, interrupt conversations, or act without thinking.
• Combined Presentation: This type includes both inattentive and hyperactive-impulsive symptoms. It is the most common form and involves challenges with focus, organization, impulse control, and restlessness.

The exact cause of ADHD isn’t fully understood, but research suggests that genetics contribute to ADHD. Like many other conditions, ADHD likely develops due to a mix of different factors rather than one single cause.

In addition to genetics, researchers are studying differences in brain development and function in people with ADHD compared to those without it. They’re also looking at environmental influences that might increase the risk, such as brain injuries, prenatal exposures, nutrition, and early childhood experiences. While there’s still a lot to learn, it’s clear that ADHD is influenced by both biological and environmental factors working together.

Diagnosing ADHD involves gathering information from multiple sources rather than relying on a single test. Clinicians use symptom checklists, standardized behavior rating scales, and detailed discussions about the individual’s past and current experiences. They may also review input from family or close friends who have observed the person’s behavior over time. In some cases, practitioners will perform cognitive and academic tests to rule out conditions like learning disabilities that might explain the symptoms. This information, combined with a full understanding of the individual’s daily challenges, forms the foundation for making a diagnosis.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is the standard reference clinicians use when diagnosing ADHD. It outlines three presentations of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Adults must have at least five symptoms that have been present since childhood. The clinician also evaluates how these symptoms impact multiple areas of life, such as at home, in the workplace, and in social relationships. This ensures the diagnosis reflects both the symptoms themselves and their impact on daily functioning.

Each presentation of ADHD is defined by its unique set of symptoms. In the predominantly inattentive presentation, individuals may have trouble organizing tasks, following instructions, and remembering details. They might lose track of items frequently or avoid tasks that require sustained focus. Those with the hyperactive-impulsive presentation often display restlessness, excessive talking, difficulty waiting their turn, or a constant sense of motion. The combined presentation includes significant symptoms of both inattention and hyperactivity-impulsivity. Over time, these presentations can shift. For example, a child who was predominantly hyperactive may show more inattentive symptoms as an adult.

Diagnosing ADHD involves more than just observing symptoms during a brief office visit. Since symptoms may not always be obvious in a single appointment, clinicians must take a detailed history that includes past school records, job performance evaluations, and early childhood behaviors. They also consider whether the symptoms are influenced by other conditions such as anxiety or depression. Screening for co-occurring conditions helps ensure the diagnosis is accurate and the treatment plan is well-informed. By examining the individual’s life history, current challenges, and the impact of symptoms across various settings, clinicians can determine whether the person meets the DSM-5 criteria for ADHD.

Symptoms typically fall into two main categories: inattentiveness and hyperactivity-impulsivity. While many people experience challenges in both areas, some individuals primarily struggle with attention and focus without the hyperactive component. This form, often referred to as attention deficit disorder (ADD), can be less noticeable and is sometimes overlooked.

In adults, ADHD symptoms are more subtle and can appear differently than in childhood. Although hyperactive behaviors may decrease, issues with attention, organization, and impulse control often remain. Symptoms may also become more pronounced when the demands of adulthood increase, such as managing work, home responsibilities, and relationships. Hyperactivity may shift from outward behavior to an internal sense of restlessness.

Adults with ADHD often struggle with:

• Managing their attention and staying focused
• Completing lengthy or uninteresting tasks
• Forgetfulness and misplacing items
• Staying organized and prioritizing responsibilities
• Interrupting conversations or speaking without thinking
• Controlling impulses and maintaining consistency in habits
• Hyperactive symptoms, such as feeling internally restless and fidgety
• Difficulty sleeping and maintaining good self-care routines
• Taking risks without considering potential consequences

During stressful periods or when responsibilities increase, ADHD can make it difficult to manage:

• Daily tasks and obligations
• Social relationships
• Healthy lifestyle such as regular exercise, healthy meals, and sleep
• Avoiding health risks, including substance use, infections, and injuries

In children and teens, ADHD symptoms are usually apparent before the age of six and are noticeable across multiple settings—such as at home, school, and during social activities. Some children display a combination of inattentive and hyperactive-impulsive behaviors, while others may show just one of these patterns.

Inattentiveness Symptoms:

• Short attention span and easy distractibility
• Frequent careless mistakes in schoolwork or other tasks
• Forgetfulness and frequent loss of belongings
• Trouble sticking with tasks that are lengthy or repetitive
• Difficulty following instructions or completing tasks
• Frequently changing activities or tasks before finishing them
• Difficulty organizing activities or assignments

Hyperactivity and Impulsiveness Symptoms:

• Inability to sit still, especially in calm or quiet settings
• Constant fidgeting or moving around
• Difficulty maintaining focus on a task
• Excessive physical activity or restlessness
• Excessive talking, even at inappropriate times
• Struggling to wait their turn or becoming impatient
• Acting without considering consequences
• Frequently interrupting others or cutting into conversations
• Little or no awareness of potentially dangerous situations

For children, these behaviors can cause challenges in academic performance, social relationships, and general discipline. Paying close attention to a child’s behavior can help parents, teachers, and caregivers recognize the common side effects and symptoms of ADHD and when additional support may be needed for mental illness.

Adults with ADHD often face challenges beyond the core symptoms of inattentiveness, hyperactivity, and impulsivity. They may also struggle with depression and other mental health disorders, which can complicate both ADHD diagnosis and treatment. Common mental disorders that frequently co-occur with adult ADHD include:

• Anxiety disorders: Many people with ADHD experience chronic anxiety, which can intensify difficulties with focus and organization and other symptoms. Anxiety symptoms may also contribute to feelings of restlessness, making it harder to distinguish from core ADHD symptoms.
• Mood disorders: Depression and bipolar disorder are often seen in adults with ADHD. Changes in brain activity associated with ADHD can influence mood regulation, contributing to mood swings, irritability, and low self-esteem. These challenges may be exacerbated by ADHD’s impact on everyday life, relationships, and work performance.
• Substance use disorders: Some adults turn to alcohol, drugs, or nicotine as a way of coping with ADHD symptoms, such as impulsivity or restlessness. Substance abuse can lead to a cycle of dependency and further complicate their ability to manage their condition.
• Eating disorders: ADHD has been linked to disordered eating behaviors, including binge eating disorder and compulsive overeating. Impulsivity and difficulty with self-regulation may contribute to irregular eating patterns, emotional eating, or struggles with maintaining a balanced diet.
• Sleep disorders: Difficulty falling asleep, staying asleep, or waking feeling refreshed is common among adults with ADHD. Poor sleep can worsen attention problems, emotional regulation, and energy levels throughout the day.
• Tic disorders: Some adults with ADHD experience a tic disorder, which involve sudden, repetitive movements or vocalizations that are difficult to control. These involuntary tics can range from mild to severe and may be exacerbated by stress, anxiety, or fatigue. In some cases, tic disorders co-occur with ADHD and other neurodevelopmental conditions, requiring specialized management strategies.
• Executive function deficits: Many adults with ADHD struggle with planning, organizing, and completing tasks. This can contribute to additional stress, strained relationships, and a reduced quality of life.

Untreated ADHD can increase the risk of developing other mental health disorders and more severe challenges over time. ADHD is a lifelong mental health condition, but with the right ADHD treatments, symptoms can be effectively managed to improve focus, impulse control, and overall daily functioning. Treating ADHD is not one-size-fits-all, and the best approach depends on individual needs, age, and the severity of symptoms. According to the American Psychiatric Association, in many cases, a combination of ADHD medication and talk therapy provides the most effective results.

Research published in European Psychiatry also suggests that patients that combine therapy with stimulant or nonstimulant medications may experience improved focus, fewer symptoms overall and other possible benefits. Healthcare providers often utilize psychological tests, including an ADHD test, to determine the precise nature and severity of symptoms, ensuring treatment plans align with the latest guidelines from European and American psychiatric associations.