Adult ADHD is a neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity, but not all patients need to have difficulties in each of these areas to be diagnosed with ADHD. The prevalence of ADHD in children and adolescents is 6-9% and between 3-5% in adults. Dr Mohamed Abdelghani is one of the leading adult ADHD specialists in the UK and is currently the lead consultant psychiatrist for the Adult ADHD Service at Camden and Islington NHS Foundation Trust in Central London. Here he explains what defines adult ADHD, how it is diagnosed and how it can be treated.
Adult ADHD is the same disorder that appears in children and it is essentially the continuity of childhood ADHD. In fact, 50-66% of children with ADHD will continue to be symptomatic into their adulthood. Severity of childhood ADHD symptoms, psychological adversities and whether children have other mental health problems are indicators that their ADHD is likely to persist into their adult lives. Where ADHD differs between adults and children is how patients present their symptoms.
How does ADHD differ between children and adults?
Although the symptoms of ADHD are the same for children and adults, how they present can be different. They will also be different depending on the clinical picture their ADHD depicts. These are the different clinical pictures of ADHD:
- The inattentive clinical picture
- The hyperactive / impulsive clinical picture
- If a patient scores high on both of these domains we call it the ADHD combined clinical picture
Some examples of the presentation of symptoms of an inattentive clinical picture:
- Children – difficulties with tasks that require effort, careless mistakes in schoolwork, reluctance to do homework.
- Adults – they present as easily bored, need a lot of variety in their activities, are easily distracted, disorganised, have poor time-keeping skills, poor decision-making and are sensitive to stress.
Some examples of the presentation of symptoms of a hyperactivity and impulsivity clinical picture:
- Children – excessive running and climbing, not remaining seated when expected to in the classroom, difficulty queuing.
- Adults – inner restlessness, an inability to relax, being on the go all the time, acting impulsively and without thinking, spending impulsively, starting a lot of tasks/jobs, poor relationships with peers, frequently engaging in award-seeking behaviour.
How does a diagnosis of adult ADHD normally result?
It is important to note that almost all the symptoms of ADHD lie on a continuum. For example, even people who don’t suffer with ADHD can have a level of inattention and this differs from one person to the other. However, what defines someone with ADHD as opposed to someone without ADHD is the number of positive symptoms they have and the level impairment that these symptoms has on their ability to function.
To diagnose adult ADHD a validated clinical questionnaire should be used, as well as a full medical and mental history assessment. This assessment must be conducted by a specialist in ADHD. During the assessment, a specialist will be checking to see if the patient meets the diagnostic criteria for ADHD. They will also be testing for other mental health disorders that can mimic the symptoms of ADHD. These include bipolar disorder, depression, anxiety disorders and emotionally unstable personality disorder. This is why it is extremely important for patients to have these assessments done with psychiatrists who have expertise in diagnosing and treating other mental disorders, especially mood disorders and anxiety.
Interestingly, many patients who come to see an ADHD specialist will do so after seeing a psychiatrist for other mental health disorders. This is because co-morbidity is the norm for people with ADHD. This means that people with ADHD will score positively for anxiety disorder and mood disorder, however, it is not uncommon that when ADHD is treated effectively symptoms related to anxiety and mood disorder resolve.
Hence, I see patients who either self-present for an ADHD diagnosis, and patients who see me after seeing numerous psychiatrists for other disorders which treatment has failed to improve.
How can adults manage their ADHD?
Management of ADHD can be approached in more than one way:
- Lifestyle adjustments
- Psychoeducation about the disorder and coping mechanisms
- Psychological therapies
According to the National Institute for Health and Care Excellence (NICE), treating adult ADHD with medication is recommended as a treatment before psychological therapies are. This is because the medications we have for adult ADHD are extremely effective and safe to use. When these medications are taken as prescribed, the impairments that ADHD causes patients will improve.
When a patient is offered medication as a treatment, this will follow a full assessment and discussion about the options available to them. High quality care will look to involve the patient in this decision and a top specialist will want to take the preferences and specific needs of the patient into account when prescribing medication to treat ADHD.
When choosing medication, patients should consider whether they would prefer long-acting medication that is taken once a day, or immediate-release medication, which is taken multiple times a day. It is also crucial that patients are educated by their specialist so that they fully understand how their medication will help them, and what to expect from taking medication. If medication is not taken regularly, or as prescribed, then patients are only receiving cognitive-enhancement benefits, which won’t address the longer-term impairments caused by their ADHD.
Adults with untreated ADHD have been shown to have a higher incidence of road traffic accidents, higher rates of divorce, less job stability and more broken relationships, so getting diagnosed and receiving treatment is extremely important for these individuals.
In summary, ADHD is an easy-to-treat disorder with safe and effective medication available, but patients must be seen by an ADHD specialist. In the UK, ADHD is under-diagnosed and under-treated, which is a concern for patients as ADHD has negative impacts on many aspects of everyday life.
If you are concerned about your mental health, or think you might be affected by ADHD, make an appointment with a specialist.