Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition, which presents as persistent patterns of inattention, hyperactivity and impulsivity that interfere with one’s daily functioning.
The DSM-V classifies ADHD into three subtypes:
- Predominantly inattentive (difficulties in focus and organisation)
- Predominantly hyperactive-impulsive (restlessness, impulsivity and difficulty staying still); and
- Combined presentation (features of inattention, hyperactivity and impulsivity)
While ADHD is commonly identified in childhood, symptoms often persist into adulthood.
How does ADHD present in Adults?
ADHD in adults does not always resemble the stereotypical hyperactive child, which is why it can be missed. Symptoms in adults may appear more subtle and internalised. Adults may struggle with chronic procrastination, disorganisation, forgetfulness, poor time management and difficulty prioritising tasks. Restlessness often manifests as an inability to relax or a need to always be doing something, as opposed to the over hyperactivity we see in childhood. Another common feature, which is often missed is poor emotional regulation. This presents as low frustration tolerance, irritability and mood swings.
Why ADHD can be easily missed in Adults
In my experience, the reason that most adults with ADHD were never diagnosed as children is because they were inattentive rather than hyperactive. It’s difficult to miss the hyperactive subtype, as they are disruptive. However, children who are inattentive are not really bothering anyone, so the diagnosis may go unnoticed. Girls are more likely to mask symptoms, often due to societal expectations of how girls should behave. So, I notice that girls are more likely to remain undiagnosed. In adulthood, ADHD can be mistaken for stress anxiety or even depression, due to an overlap in symptoms. Sadly, adults who have ADHD but have not been diagnosed spend many years feeling inadequate, without realising that there is an underlying neurological explanation. Many adults tend to feel great relief upon being diagnosed, due to having regarded the symptoms as character flaws. They may, at the same time, feel disappointed about not being diagnosed earlier in life, because their lives may have been easier and they may have realized more of their potential.
Adult ADHD in Everyday Life
Recognising ADHD in oneself or a loved one may involve noticing patterns such as:
- Chronic procrastination
- Starting many projects but rarely every completing them
- Poor time management -being consistently late or missing deadlines
- Misplacing everyday items such as one’s phone, glasses or keys
- Being easily distracted during conversations or tasks
- Low frustration tolerance
- Impulsivity in decision making, spending or relationships
- Overstimulation
A diagnosis needs to be made by a qualified healthcare professional and entails taking a detailed developmental history, a structured clinical interview and relevant psychometric assessments. It is important that other conditions that mimic or co-occur with ADHD are ruled out.
Treatment for ADHD is multifaceted and may include stimulant or non-stimulant medication and psychotherapy to assist with emotional regulation, organizational skills and problem solving.
Self Management
Lifestyle factors that can help improve daily functioning include:
- Planners, apps and reminders to structure tasks and manage time
- Breaking down large tasks into smaller, manageable steps
- Establishing consistent routines for work, sleep and exercise
- Practicing mindfulness or relaxation techniques to improve focus
The diagnosis and management of adult ADHD can be truly lifechanging. With the right combination of professional intervention and self management skills, adults with ADHD can harness their strengths, reduce daily struggles and live with greater confidence.
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