The Adult ADHD No One Spotted
ADHD isn't only a childhood condition — plenty of adults live with it too, often without ever being diagnosed. Here's what the three types look like in adults, what the research says about its causes…
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ADHD isn't only a childhood condition — plenty of adults live with it too, often without ever being diagnosed. Here's what the three types look like in adults, what the research says about its causes…
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Most people will have heard of Attention Deficit / Hyperactivity Disorder (ADHD). In the popular imagination, someone with ADHD is the restless child who never stops running and jumping about and seems impossibly "naughty". But ADHD isn't confined to children — adults can have it too. Because adults have more developed reasoning and judgement than children, their symptoms differ slightly from childhood ADHD. As people grow older, the hyperactivity in ADHD tends to ease, while the inattention typically persists. In adults, some ADHD symptoms will have begun in childhood (before the age of twelve), yet other factors — for example a high level of intelligence that helped them perform well academically — can mean their symptoms were never noticed or attributed to ADHD.
Adult ADHD is still divided mainly into three categories: predominantly inattentive, predominantly hyperactive, and the combined type that has features of both. According to the DSM-5, adult ADHD presents mainly with the following symptoms:
To receive a formal diagnosis of ADHD, an adult needs to meet more than five of the symptoms above in either the predominantly inattentive or the predominantly hyperactive type, with the symptoms persisting for more than six months, reaching a level that is inconsistent with their developmental stage and has a direct, negative impact on social and academic / occupational functioning. In addition, some symptoms need to have appeared before the age of twelve, and to occur in two or more settings (for example, at home, at work, and with friends, and so on). The symptoms must also have hindered or led to a deterioration in social, academic, or occupational functioning. On top of this, the symptoms cannot occur only during a schizophrenic episode, and they cannot be better explained by another mental illness (for example, anxiety disorder, personality disorder, and so on).
Like some other mental illnesses, the causes of ADHD are linked to genetic inheritance (Thapar et. al, 2007). Family studies have found that, compared with the relatives of unaffected controls, the parents and siblings of affected index cases have a higher rate of ADHD (a two- to eight-fold increase in risk) (Biederman, 2005). Some twin studies have also shown that the concordance rate for ADHD is far higher in monozygotic twins than in dizygotic twins (Thapar et. al, 1999). In addition, adoption studies have found that, compared with the adoptive parents of an index case and the parents of controls without ADHD, the biological parents of an adopted person have a higher rate of ADHD (Sprich, 2000). Beyond genetic inheritance, research has also found that smoking or drinking during pregnancy can increase the rate of ADHD in the next generation (Pagnin, 2018).
In treating adult ADHD, medication is a very important factor. Medication is an internationally recognised standard treatment; under the supervision of a psychiatrist, it is mostly safe and does not lead to dependence or addiction. That said, medication can still have certain side effects — for example insomnia, tension, a faster heartbeat, effects on appetite, and so on. Beyond this, counselling is also a form of treatment for ADHD. Through counselling and cognitive behavioural therapy, those affected can improve their time-management and organisational skills, learn to reduce impulsive behaviour and build ways of managing their emotions, improve their relationships with the people around them, and more.
Although people with ADHD have to face difficulties with attention and the like, they also have plenty of positive traits. While they find it hard to focus on dull, tedious, or repetitive work, they can concentrate intensely (hyperfocus) on things that interest them (Brown, 2006; Conner, 1994; Ozel-Kizil et al., 2016). For example, when they are doing something they find interesting, they can be fully absorbed in it for several hours without ever feeling tired. Rather than saying people with ADHD have an attention deficit, it is more accurate to say their attention is simply "borrowed" for a while and placed where they feel it is more worth spending. Many scientists, writers, and artists with ADHD have built highly successful careers as a result. What is more, most people with ADHD are very creative, which is why many of them enjoy working in the arts or creative industries. In one study, researchers asked a group of university students with and without ADHD about how they preferred to solve problems (White, 2010). Those with ADHD preferred to come up with new ideas, while those without ADHD preferred to use or develop existing ones. Students with ADHD also outperformed students without ADHD in certain academic fields, including the arts, creative writing, scientific discovery, and architecture.
Of course, the symptoms and presentations of ADHD described above are for reference only. If you suspect that you or someone close to you has ADHD, do not hesitate to seek professional help. And even if you or someone close to you is diagnosed with ADHD, remember to be understanding of the behaviour of those around you, and do not feel ashamed of being someone with ADHD — instead, make the most of ADHD's positive traits. Remember: every person is a unique being. When God closes a door, He also opens a window for you!
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Biederman, Joseph. (2005). Attention-Deficit/Hyperactivity Disorder: A Selective Overview. Biological Psychiatry (1969), 57(11), 1215-1220.
Flippin, R. (2021, March 2). Hyperfocus: The ADHD Phenomenon of Intense Fixation. ADDitude. https://www.additudemag.com/understanding-adhd-hyperfocus/.
Hupfeld, Kathleen E, Abagis, Tessa R, & Shah, Priti. (2019). Living “in the zone”: Hyperfocus in adult ADHD. Attention Deficit and Hyperactivity Disorders, 11(2), 191-208.
Mayo Foundation for Medical Education and Research. (2019, June 22). Adult attention-deficit/hyperactivity disorder (ADHD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adult-adhd/diagnosis-treatment/drc-20350883.
Sprich, S., Biederman, J., Crawford, M. H., Mundy, E., & Faraone, S. V. (2000). Adoptive and biological families of children and adolescents with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 39(11), 1432-1437.
Thapar, Anita, Cooper, Miriam, Jefferies, Rachel, & Stergiakouli, Evangelia. (2012). What causes attention deficit hyperactivity disorder? Archives of Disease in Childhood, 97(3), 260-265.
Thapar, Anita, Holmes, Jane, Poulton, Kay, & Harrington, Richard. (1999). Genetic basis of attention deficit and hyperactivity. British Journal of Psychiatry, 174(2), 105-111.
What Is ADHD? (n.d.). https://www.psychiatry.org/patients-families/adhd/what-is-adhd.
White, Holly A, & Shah, Priti. (2011). Creative style and achievement in adults with attention-deficit/hyperactivity disorder. Personality and Individual Differences, 50(5), 673-677.
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