ADHD in Adults: Recognising the Signs

The signs and symptoms of ADHD (attention deficit hyperactivity disorder) manifest differently in adults than in children and may be harder to recognise and understand. According to the National Institute for Health and Care Excellence (NICE), the number of adults with ADHD is estimated to represent around 3% to 4% of the population, with many yet to be diagnosed.

Introduction to ADHD in adults

Despite symptoms of ADHD usually appearing in childhood, an increasing number of people are being diagnosed with ADHD during their adult life. People who have not had a formal diagnosis often report that their undiagnosed ADHD has been mislabelled as laziness, lack of care or indifference.

Receiving a diagnosis may help adults to understand and make sense of issues that have plagued them since childhood. However, people may have mixed feelings about receiving a diagnosis as they may feel anxious, stigmatised or worried about being ‘labelled’.

Common signs and symptoms

Evidence of these behaviours alone is not enough to indicate the probability of a diagnosis; however, adults with ADHD may present with all or some of the following behaviours:

• Problems with focusing and planning – this may include failing to meet deadlines at college, university or work, not paying bills, losing items, not staying on top of housework, being late for work or lectures.
• Impulsive behaviour – this may manifest as making impulse purchases, dangerous driving, taking part in risky behaviour, drug or alcohol misuse.
• Inappropriate social etiquette – interrupting people while they are talking, difficulty waiting for a turn to speak, struggling to concentrate on conversations or saying inappropriate things at inappropriate times.
• Difficulties prioritising, focusing or dealing with stress – this can lead to problems with making meaningful relationships (including friendships), family breakdowns and isolation.
• Forgetfulness, disorganisation and carelessness – this can have a negative impact on work, education, family, relationships and finances.

People with ADHD may also experience mood swings, irritability, impatience or problems keeping their temper under control as a result of the condition. 

ADHD is able to coexist with other mental health conditions including anxiety, obsessive-compulsive disorder (OCD), autism (ASD) and personality disorders. ADHD is also thought to be linked to an increased risk of substance misuse. A recent study has recently found that adults with ADHD are more likely to suffer from poor mental health than people with autism.

Challenges and impact on daily life

Adults with ADHD will experience symptoms on a spectrum; their impact may be mild, moderate or severe. Your ADHD symptoms can impact on:

• Family and relationships
• Work and education
• Financial problems
• Social life and ability to make and keep friends
• Self-esteem

If you or a sibling have ADHD, you are more likely to have a child who has ADHD. Having ADHD whilst also parenting a child who shares the condition may introduce additional stressors and complications to your life. Take advantage of any parenting support offered, whether that is one-on-one or in a group setting. Reach out to your GP or health visitor for help as soon as you feel that you need it to minimise the chance of any problems with your child escalating.

Diagnosis and seeking help

If you are concerned that you have ADHD and do not have a diagnosis, you may want to make an appointment to discuss the matter with your GP. Although they cannot make a formal diagnosis, they can have an initial consultation with you, listen to your concerns and refer you to a specialist for further diagnosis. 

Questions that you may be asked by your GP:

• What your symptoms are and when they began
• The settings where your symptoms tend to show (for example college, work, etc.)
• How far your symptoms affect your day-to-day life
• Any recent traumatic events or upheaval that has happened in your life (bereavement, divorce, etc.)
• Any family history of ADHD
• Any other health conditions (including mental health) you have been diagnosed with or have symptoms of

You may struggle to remember details of your early life or childhood. It might be helpful to dig out your old school reports or chat with your parents or carers to see if the potential indicators of ADHD you are experiencing have always affected you in some way.

Your GP will listen to your concerns and may refer you for a further assessment if:

• Your symptoms began in your childhood and have continued throughout your life but you were never formally diagnosed with ADHD
• The symptoms you describe are not likely to be caused by another condition (such as anxiety)
• Your day-to-day activities or enjoyment of your life are being significantly impacted by your symptoms

You can also speak to your GP if you were diagnosed with ADHD as a child but your symptoms are getting worse or have started to make more of an impact on your life. They may still refer you to a specialist in this instance.

When you have your initial consultation, try to be as honest as possible. This may include talking about how your symptoms are interfering with your marriage or finances; your doctor is there to listen and provide expertise, not to judge. 

To be diagnosed with ADHD as an adult, a medical professional must also be able to see that your symptoms are having an impact on your life such as interfering with your relationship, causing you to fail at university or underachieve at work, or taking dangerous risks (such as dangerous driving). 

For children to be diagnosed with ADHD they are usually required to demonstrate:

• Six or more symptoms of inattentiveness

or

• Six or more symptoms of hyperactivity and impulsiveness

as per the diagnostic criteria used. 

For an adult diagnosis, you may only need to demonstrate five plus symptoms rather than six. However, there is some disagreement about when to diagnose an adult with ADHD as symptoms manifest quite differently in grown-ups as opposed to youngsters. Your specialist will be able to discuss anything relating to your diagnosis with you in more detail. 

It is currently thought that ADHD cannot suddenly onset in adulthood as it is considered a developmental disorder. This means that if your symptoms were not present to some degree in childhood, you will not get an ADHD diagnosis.

It is extremely important that if you are struggling during your adult life with mental health, you get the correct diagnosis. There can be some overlap between conditions, for example ADHD in adults can result in untenable financial decisions and unusual, impulse purchases; this behaviour can also be a result of bipolar disorder. In order to receive the correct treatment, your doctor needs to be able to diagnose you with the correct disorder. 

If you are unhappy with your treatment, consider asking for a second opinion to help get to the root of the problem.

If you have the funds, you can also consider visiting a private clinic to discuss getting an ADHD diagnosis in adulthood.

Effective strategies for managing adult ADHD

It is common for adults with ADHD to struggle with organisation, planning and timekeeping.

Ultimately what works for one person may not work for the next, so you may have to try out a few different methods to find what makes your life easier.

Some strategies to consider include:

• Make lists, stick Post-it notes up around your house and keep a diary to remind you of events, deadlines and plans.
• Set alerts, alarms and reminders on your phone.
• Try not to leave things until the last minute and give yourself extra time to organise yourself.
• Exercise regularly, eat a healthy, balanced diet and practise self-care.
• Learn some relaxation techniques such as breathing exercises, tapping or practising mindfulness.
• If your ADHD is causing you problems at work make sure you have an open and honest conversation with your employer and let them know how they can support you.
• If you are a driver, you may need to talk to your doctor about your suitability to drive. If your condition is affecting your safety behind the wheel you will need to inform the Driver and Vehicle Licensing Agency (DVLA).
• Students should speak to their tutors or course leaders about any adjustments required to workloads, deadlines, group work, etc.
• Remember to take any prescribed medication as directed and avoid other things (including alcohol, recreational drugs or herbal remedies) that might interfere with their efficacy.

Some people find taking medication for their ADHD effective. Currently, there are only five types of medicine licensed to treat ADHD. These are:

• Methylphenidate
• Lisdexamfetamine
• Dexamphetamine
• Atomoxetine
• Guanfacine

None of these medicines can ‘cure’ ADHD in adults or children; however, they can help patients to focus, feel calmer and behave less impulsively. This can help to improve performance at work or in education and may make general day-to-day life feel less stressful or overwhelming.

Most of the medicines licensed to treat ADHD are called stimulants and are taken in capsule or tablet form. They are called stimulants as they work by stimulating parts of the brain; most importantly for ADHD sufferers, the parts that are responsible for controlling our behaviour and ability to concentrate. 

Methylphenidate is the most commonly used medicine prescribed to treat ADHD, although sometimes adults will be first prescribed lisdexamfetamine instead. 

ADHD medication comes with side effects ranging from nausea and headaches to problems sleeping, drowsiness, suppressed appetite and aggression. It is important to assess the benefits of taking medication against the potential side effects and find out what works for you. All medicine should only be used as prescribed and under the supervision of your GP. 

If you don’t want to take medication or find that the side effects are too much for you, then there are other strategies available to help you manage your ADHD in adulthood. These strategies can also be used in combination with medication.

To help you to lessen the impact of ADHD on your everyday life you could consider:

• Therapy – talking therapies such as Cognitive Behavioural Therapy (CBT) can help you to reframe your thought processes, actions and behaviours. As an adult you will usually speak to a therapist one-on-one and they can help you to talk through your issues and change the way you approach problems and difficulties. CBT is thought to help people who are prone to getting caught in negative thought patterns.
• Counselling – if your life is being impacted by ADHD, speaking to a trained counsellor may help you. Although counselling is not going to cure your ADHD, it can help to speak with a trained professional who can give neutral and informed advice. If ADHD is affecting your relationship, consider speaking to a marriage or relationship counsellor. Your partner may benefit from taking part in these sessions also.
• Diet – there is conflicting evidence relating to diet and ADHD. However, if you notice certain foods are triggers and make your symptoms worse, cut them out altogether and find alternatives. You may benefit from keeping a food diary or speaking to a dietician. Some research shows that supplements, including omega-3 and omega-6 fatty acids, may help with ADHD symptoms.
• Exercise – if you find you are struggling with excess energy, you might benefit from some high impact cardio; if you need to improve your focus, a gentler art such as yoga or tai chi may help. You won’t cure ADHD in adulthood through exercise, but you may find it reduces your symptoms and getting into an exercise routine may help you with organisation and strategy. Find what works for you.
• Support groups – you may benefit from speaking to other adults who understand what it is like to live with ADHD. If you are struggling with parenting, you may also find a parenting support group helpful to learn tips and strategies to make parenting easier.

Empowering recognition and support

By spreading awareness, educating ourselves and improving our understanding and knowledge of ADHD we can hope to:

• Reduce stigma related to ADHD and all mental health or neurological conditions.
• Dispel many of the common misconceptions about ADHD, most notably that the condition only affects children, which is known to be 100% false.
• Develop effective strategies for adults with ADHD to thrive as students, employees and parents.
• Help adults to feel empowered to seek out support for other issues they experience that may be linked to their ADHD (such as support with alcohol or drug use, dealing with depression/anxiety, debt management, marriage counselling, etc.).

It is important that we recognise ADHD as a genuine condition but we do not let it define someone. The symptoms of ADHD and their impact on the lives of adults will vary from person to person. 

If you have ADHD, it may leave you feeling down and lead to low self-esteem and it can make the usual struggles of adulthood seem even more overwhelming. ADHD means that your brain functions differently to others; it does not mean that you are broken in some way. Do not be scared to ask for adjustments from your employer or tutors, take advantage of any treatment or support available to you and be sure to surround yourself with supportive, positive people who understand you.