Attention deficit hyperactivity disorder (ADHD) affects people at every stage of life, but it can be effectively treated with an approach often summed up this way: pills and skills. Medication can help people manage ADHD, but it doesn’t eradicate it. And it is a tool that works best when people are also developing life skills.
Doctors estimate that 4 percent of American adults are living with ADHD, though most of them don’t know it.
ADHD, which also affects 8 to 12 percent of American children, is classified as a neurodevelopmental disorder, meaning that it is a result of impairments in the growth and development of the brain. The core features of ADHD are inattention, executive dysfunction (difficulty managing day-to-day living), hyperactivity, and impulsivity. However, the signs of ADHD might look different at different ages.
For instance, hyperactivity and impulsivity are particularly noticeable in children. Adults can also be hyperactive and impulsive; it’s just that the signs become more subtle, and the behavior decreases over time. These adults may have trouble relaxing; they might get up and down a lot, and make a lot of trips to various places. They look very busy, often performing frenetic activity that may or may not be required.
As a result, children and adults with ADHD have different pathways to diagnosis. With kids, we usually get referrals for hyperactivity-behaviors like calling out, provoking conflicts, and being disruptive in school.
With adults, it’s usually inattention and organization problems that lead them to consult a doctor. They find they aren’t able to meet deadlines or function efficiently; they tune people out, or seem distracted and unable to listen.
The underlying causes of ADHD are complex. We know that there is a genetic basis and that ADHD is highly heritable; we think more than one set of genes regulates ADHD, but we don’t know exactly which ones.
In addition to the biological underpinnings of the disorder, there are environmental contributions. Poor nutrition in utero, prematurity, low birth weight, and perinatal trauma — a trauma just before or after birth — are all associated with ADHD. Lead exposure is another risk factor, though it’s not involved in the majority of cases.
At this point, the working theory is that ADHD results from an interaction between genetics and environment. Some “association” studies find a correlation between exposure to screens and video games, but they don’t show causality. The quality of parent-child interaction may also play a role.
In childhood, more boys than girls are affected by and diagnosed with ADHD. However, this evens out over time, so that by adulthood, men and women are equally affected. Also, as hyperactivity diminishes with age, the number of people with ADHD declines. This is one reason the prevalence rates are lower in adults than children.
While kids are most often diagnosed with ADHD as a result of problems at school, adults with ADHD are mostly self-referring. They’ve heard or read about ADHD. Often they’re having difficulty at work, or their sibling or child is diagnosed with the disorder.
ADHD can also appear alongside other psychiatric problems, like depression, anxiety, or relationship troubles. Sometimes, when patients are going through a crisis, we recognize their ADHD only after they have gotten through that crisis.
We have a wide range of effective treatment options for ADHD. While many people think that stimulants are always used to treat ADHD, that is not necessarily the case. Along with medication options, both stimulant and non-stimulant, there are treatments like behavior therapy and coaching in organization and social skills. There is also meta-cognitive training-changing the way you think about and confront your challenges.
ADHD often comes with conditions that need to be treated in tandem. For instance, if you have a learning disability, or anxiety or mood problems, those can also decrease your attention span. Treating these other disorders will help manage your ADHD symptoms.
If you want to educate yourself on ADHD, I recommend the advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), which hosts online resources both for parents of children with ADHD and adults (chadd.org).
ADHD is a biologically based condition that carries serious impairments, and can increase your risk for other psychiatric disorders. It’s every bit as important to identify and treat ADHD in adults as it is in children. And very good treatments are available.
If you suspect you may be affected, ask your primary care physician for a referral. Receiving treatment and training to manage ADHD could dramatically improve your quality of life.
Jeffrey Newcorn, MD, is a Professor of Psychiatry and Pediatrics, and Director of the Division of ADHD, Learning Disabilities and Related Disorders at the Icahn School of Medicine at Mount Sinai.
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