Before managing adult ADHD, you need to understand what ADHD is. ADHD stands for attention deficit/hyperactivity disorder. ADHD is a mental health disorder and a neurological condition that affects brain functioning, resulting in people with this condition having persistent problems including difficulty paying attention, being hyperactive and/or engaging in impulsive behavior, which are not appropriate for that person’s age. These patterns of behavior can have a negative impact on how a person functions and how they develop (R). Although ADHD is more commonly diagnosed in children, people with adult ADHD may be undiagnosed until adulthood, or their condition continues from childhood and adolescence into adulthood (R).
The causes of ADHD are not yet clear and researchers are still trying to determine them. Some factors involved in the development of ADHD. Genetics plays a strong role in the development of ADHD. ADHD is known to have strong family links, meaning that it can be passed from one generation to the next (R). Environmental factors can also play a role in the development of ADHD, such as childhood lead exposure. Problems in childhood development that impact a person’s brain structure or pathways can also play a role in the development of ADHD.
ADHD Around the World
ADHD has been found in all countries where it has been studied (R). Approximately 5-9% of children and adolescents are diagnosed with ADHD. Meanwhile, 3-5% of adults are found to have ADHD. More boys are identified with ADHD during childhood and adolescence compared to girls, as it may be easier to detect by teachers and parents during school. However, more women are diagnosed with ADHD during adulthood, which may be due to the fact that women are more likely to seek help for mental health issues compared to men. Researchers are debating over whether ADHD in adults is simply a continuation of ADHD in childhood and adolescence, or whether it can begin in adulthood. People without childhood ADHD have developed adult ADHD following traumatic brain injuries (TBIs).
Three categories of ADHD
- Primarily inattentive (trouble focusing or paying attention)
- Primarily hyperactive and impulsive
- Combined inattentive, hyperactive and impulsive (R)
What are the core symptoms of ADHD?
- Difficulty in focusing and sustaining attention
- Easily distracted
- Difficulty in organizing important tasks, especially with too many projects
- Loses things easily
- Difficulty in following instructions
- Interrupting during conversations or butting in others’ conversations
- Difficulty waiting their turn
- Talking excessively
- Problems with planning and time management
- Problems with setting priorities
- Frequent mood swings
- Easily bored
- Cannot work without deadlines
What is the impact of Adult ADHD?
ADHD can have a strong negative impact on the quality of life, productivity and life expectancy among adults. Adults with ADHD often struggle with decision making, emotional control, and poor memory, which often leads to difficulty in performing at school or at work, and even in performing tasks of daily living. Such adults also report that they have lower self-esteem and have poorer quality interpersonal relationships compared to adults without ADHD. Compared to adults without ADHD, adults with ADHD also report that they are less satisfied with their professional, social and personal lives.
Common problems for adults with poorly managed or unmanaged ADHD include: unemployment, criminal or legal problems, frequent accidents, such as car accidents, substance use, and typically poorer physical and mental health compared to adults without ADHD. In the United States, adults with ADHD are twice as more likely to die from accidents, and see an income reduction of $8,900-$15,400 per year.
What are some red flags that physicians look for in evaluating adult ADHD?
- Erratic academic or work performance
- Time management problems
- Frequent late or unfinished projects
- Family or marital problems
- Anger management or control issues
- Missed appointments
- Difficulty managing finances
- Difficulty in maintaining organized household routines or other self-regulating activities
- Erratic sleep patterns
- Addictions and compulsive behaviors: such as substance use, problem gambling, compulsive eating, exercising, video gaming, and sexual addiction
- Frequent accidents (such as driving accidents) resulting from recklessness or inattention
- Chronic low self-esteem
- Chronic underachievement
- Has a direct relative with ADHD
How can ADHD be evaluated or diagnosed in adults?
You should talk to your mental health professional or primary care provider if you suspect that you have adult ADHD. You may have not necessarily been assessed or diagnosed as a child or adolescent. Your primary care provider will likely ask you detailed questions about your medical, social, or even academic history. They may ask you to complete questionnaires about your symptoms. They may also conduct or order clinical tests, such as blood tests, to rule out other medical conditions or risk factors. Your primary care provider may also refer to you to other healthcare providers, such as psychiatrists or other medical specialists, psychologists, occupational therapists, speech language pathologists for specialized assessments and consultation.
What other mental health conditions occur with adult ADHD?
One of the reasons why ADHD is difficult to diagnose in adulthood is because it often occurs with other mental health conditions. Adults with ADHD often present with substance use disorder (SUD), generalized anxiety disorder (GAD), major depressive disorder (MDD) or depression, bipolar disorder, sleep disorders, and antisocial personality disorder. Autism spectrum disorders (ASD) and learning disorders are also associated with ADHD. In managing adult ADHD, it is important that if you are diagnosed with these other conditions, that you seek treatment for them and manage them, as well as you manage your ADHD.
Ways to manage symptoms
Medications may be an important part of your treatment plan for managing adult ADHD. You need to have a discussion with your primary care provider to see if medication for treating ADHD is right for you.
Stimulants and non-stimulants are two classes of medication that be used to treat adult ADHD. Psychostimulants or stimulants are a type of drug that speeds up messages between the brain and the body. Stimulants may cause you to feel more awake, alert and energetic. Some examples include amphetamines and methylphenidate. Non-stimulant medications include drugs such as atomoxetine.
First-line medications include long acting stimulants. These medications have best track records for safety and effectiveness. These stimulants are better tolerated and they reduce the need to take multiple doses. If these first-line medications cause significant side effects, do not cause the desired response or are not indicated for their patients, prescribers may decide to use second-line medications. These medications include short or intermediate acting stimulants, atomoxetine, and guanfacine XR. For improved effectiveness, second-line medications can also be used in combination with first-line medications.
If medication treatment with first-line and second-line medications is not effective and if patients require more specialized care, prescribers may use third-line medications. These medications include Bupropion, clonidine, imipramine and modafinil. However, these medications may not be as effective and may have greater side effects or risks to patients.
Medication Therapy Process
Before starting medication therapy, your family physician, nurse practitioner, or psychiatrist should first discuss with you treatment goals and objectives. Such goals can include improving your ability to function or lowering of symptoms, such as impulse control. Then, your prescribing healthcare provider should discuss with you the medications they are considering, their potential side effects, and their potential effectiveness. When selecting medications, your prescribing healthcare provider should consider your age, family history, and other physical or mental health conditions you have. They will also consider how the medications work, the duration of their effect, and any potential side effects, potential drug interactions with other medications you are taking, your attitudes toward medications, as well as their affordability for you.
Once your healthcare provider prescribes your medications, they will need to monitor how well you are doing with these medications. At first, you may need more frequent visits with your prescribing healthcare provider as both you and your provider determine the best medications and doses for you. You and your prescribing healthcare provider may decide to change your medications or change the dose of your medications so that your treatment is most effective. Once your medications and their dose are stable, you will need to have ongoing follow-up with your prescribing healthcare provider (CADDRA, 2018). There may be changes in your condition or health status that might warrant changes to your medication therapy.
You and your healthcare providers may decide not to use medication, or may decide to use medication in combination with non-medication treatments for managing adult ADHD. These treatments include cognitive behavior therapy (CBT) and mindfulness training.
Cognitive behavior therapy is a short-term form of psychotherapy. CBT focuses on the interaction between a person’s emotions, behavior, and their thinking. CBT can be targeted to address issues, such as organizational skills and time management. There are numerous online resources and books for cognitive behavior therapy. Cognitive behavior therapy can also be administered by psychiatrists, psychotherapists, psychologists or other mental healthcare providers. Individual or group CBT sessions may be available within the community. Some researchers have found that CBT is effective for people with ADHD. Though, CBT and medication is more effective than CBT alone.
Mindfulness training is a type of cognitive behavior therapy that increases mindful attention to your thoughts and actions. This can also include meditation. Researchers found that mindfulness training helps to improve emotional control and self-regulation, giving you some coping strategies, as well as lowering hyperactive or impulsive behaviors. Children, adolescents and adults who use mindfulness techniques were shown to have improved mood, lower anxiety, and better social behaviors, and these improvements have been maintained over time.
Managing Adult ADHD at Home, School and Work
Adult ADHD can have a great impact on a person’s home and family life. Unstructured environments are not the best environments for people with ADHD to thrive. Adults with ADHD often have increased stress, feel overwhelmed, become more easily frustrated, lose self-esteem, and can become more dysfunctional or have significant family or relationship conflicts in such environments. Therefore, a more structured environment and home life are helpful in allowing adults with ADHD to thrive. Having structure will help adults with ADHD improve their self-esteem, self-control and allow for better relationships and family life.
Strategies at Home For Children and Adults
- Give one or two clear instructions
- Use gentle touch and clear eye contact when giving instructions
- Avoid yelling and arguing, use a positive and calm tone of voice
- Keep choices limited to two or three options
- Encourage de-escalation of conflicts using calming techniques
- Use praise and meaningful rewards to reinforce positive behaviors
- Set clear, attainable goals and limits
- Schedule family and partner time
- Encourage exercise, balanced meals, good sleep hygiene and hobbies
- Help build structure and routines for meals, exercise and good sleep
- Help with prioritization to reduce procrastination
- Use electronic devices, agendas, calendars and/or apps to help remind of deadlines
- Divide large tasks into smaller ones; create milestones and deadlines for those milestones
- Family members and partners should be firm, but fair
Due to the fast pace of their course work, it can be challenging and overwhelming for adults with ADHD in college or university. Students with ADHD may have difficulties with organization, time management and prioritization, as well as completing assignments and projects. Requesting academic accommodations can help improve their academic success.
Strategies for Students
- Provide clear instructions
- Ask to have instructions repeated
- Encourage students to seek clarification
- Provide frequent and immediate feedback, with balanced (both positive and negative) feedback
- Encourage post-secondary students to contact their accessibility or disability office or center for helpful strategies and accommodations
- Allow for extended time for assignments and writing tests/exams
- Encourage apps or technologies in taking notes and organizing ideas
- Use coaching to help identify strengths, weaknesses, to negotiate problems and work on specific goals
Setting up adults with ADHD for success in the workplace is crucial for their well-being. Many jurisdictions have a disability act, where workers can request workplace accommodations. However, most people with ADHD symptoms would prefer not to disclose their condition because of the stigma attached to mental health conditions because they do not want to be judged as incompetent. Also, these situations need to be navigated carefully.
Strategies for the Workplace
- Request regular and frequent meetings with your manager and take a collaborative approach
- Request assistance from a professional career or workplace coach for strategies and tools to improve work performance and organization
- Create a de-cluttered workspace or maintain a clean desk to make it more work friendly and decrease distractions
- Set goals, prioritize, and review progress on a regular basis
- Explore organizational and productivity apps, websites
- Identify and use effective time management and prioritization techniques
- Speak to a healthcare provider to identify and request specific workplace accommodations
CareClinic’s Platform to Managing Adult ADHD
One of the best rated mobile health apps available is CareClinic. CareClinic allows you to track and document how you are managing your ADHD on your electronic devices. It allows you to track and monitor your symptoms, as well the steps you are taking to manage your condition. This app will help you keep organized, support your routines, and monitor your activities. It will give you more structure, which is helpful for people with ADHD.
One of the features of the app allows you to schedule appointments in the app’s calendar. Whether you are seeing your mental health professional, primary care provider, psychiatrist, psychotherapist, psychologist or another health care provider, these reminders can help you keep track of all your appointments.
The app also has features to enter and track exercise, activities and nutrition. You can enter meditation of mindfulness-based stress reduction techniques that you use. You can also document any cognitive behavior therapy sessions. Any exercises you are doing and your nutritional intake can be documented in the app. These approaches have been shown to lower the symptoms of ADHD. They also improve a person’s ability to function. The app can also help you track and monitor your efforts at managing your condition.
One of the best and most well-known features of the app is its medication reminder feature. You can enter each medication you are taking and the time that you normally take your medication. By using this information, you can schedule medication reminders. Whether you are taking one medication or multiple medications to help manage your ADHD symptoms, these reminders can help you ensure you take your medications correctly and on time. You can easily track how well you’re taking your medication through reports that can be generated.
CareClinic can also track your mood and other symptoms. For each symptom, the app will ask you to rate the severity of each symptom from 0-10, with 0 being the least severe and 10 being the most severe. As with other metrics that the app can track, such as medication, you can generate a report to see how well you are managing your ADHD. Additionally, CareClinic has a diary feature that you can use to document your experience in managing your condition, whether you’re having a good day or bad. You can write diary entries as often as you would like.
More importantly, the app allows your mobile device to sync directly with Apple Health or Google Health (depending on your device). CareClinic can also successfully integrate with other platforms, such as electronic medical records (EMRs) from physician’s offices or pharmacies, if permitted. This can allow you to seamlessly share your data with your care providers so that they can obtain better insights into your health and provide better care.
The premium upgrade for CareClinic allows you to gain access to communities of patients with similar conditions, custom care-plans, custom exercise plans, advanced reminders and more. Since mood disorders and anxiety often occur with ADHD, the anti-anxiety and mood management care plan may be helpful. In the new year, there may be more care plans for mental health conditions, such as ADHD. So, stay tuned.