Adult ‘Attention Deficit Hyperactivity Disorder’ ADHD and ‘Attention Deficit Disorder’, ADD – without Hyperactivity and Impulsivity; are conditions that affect approximately 6 % of children and adolescents and about 4% of adults, with a higher prevalence in men than women. The symptoms of ADHD, begin by definition, in childhood; with symptoms present from between 5 – 12 years.

It is important to note that ADHD is a lifespan disorder, meaning symptoms originate in childhood, and persist throughout an individual’s life, with symptoms potentially fluctuating in severity over time.

One of the primary features of ADHD is a relative deficit of the neurotransmitters Dopamine and Noradrenaline. Neurotransmitters help to communicate information between nerve cells. In particular the Frontal lobe functions of decision making, concentration, and focus are impaired; leading to inattention and impulsivity. This disruption also likely interferes with the Dopamine reward pathway connections to the Frontal lobes; changing how the brain perceives reward and pleasure ‘experiences’ in those with ADHD. Low levels of Dopamine are associated with this under-activity, which may lead to symptoms such as risk-taking, heightened social interactions, and increased energy. However some, with ADHD can experience periods of “hyperfocus”, in which they can concentrate intensely on tasks, especially if they have a particular interest in the subject.

ADHD is considered a lifespan Disorder. It is not uncommon for adults to struggle with ADHD symptoms that were not identified or treated during childhood. It is important to understand that ADHD is a condition that requires ongoing management, and seeking professional support can make a significant difference in managing its impact on Quality of Life.

Cognitive Symptoms of ADHD

Individuals with ADHD may display a variety of symptoms that can affect their ability to complete tasks and stay on track ‘task salience’. Some common symptoms include:

  • Difficulty paying attention to details, often leading to careless mistakes or incomplete work.
  • Struggles with sustaining attention, resulting in difficulty staying focused during conversations, tasks, or when reading. However, some individuals with ADHD may experience hyperfocus on topics that particularly interest them.
  • Distractibility, or not being able to listen when spoken to directly, even when there are no obvious distractions present.
  • Difficulty finishing tasks, with a tendency to lose focus, become bored quickly, or easily get sidetracked.
  • Challenges with organising tasks, including disorganised work, poor time management, missing deadlines, or leaving important things until the last minute.
  • Avoidance or dislike of tasks that require sustained mental effort, such as preparing written work or completing forms.
  • Misplacing items frequently, such as wallets, keys, paperwork, glasses, or mobile phones.

In addition to inattention symptoms, ADHD also causes hyperactivity and impulsivity symptoms, which may include:

  • Fidgeting or tapping hands or feet.
  • Nail-biting.
  • Feeling restless and frequently changing position or location; struggling to sit still when expected, and getting up in meetings.
  • Finding it difficult to switch off and relax, feeling “on the go” most of the time.
  • Talking excessively and loudly, sometimes without insight into how their behavior is perceived by others.
  • Interrupting or intruding on others; struggling to wait their turn in conversations or activities.

These hyperactive and impulsive symptoms often cause significant disruption in daily life, leading to difficulties in relational, social, educational and occupational settings. However, it’s important to recognise that not all individuals with ADHD will experience hyperactivity and impulsivity symptoms (Adult ADD), and symptom presentation will vary from person to person.

ADHD / ADD symptoms vary in severity and not all individuals will experience every symptom. However, understanding these common challenges can help individuals seek appropriate support and strategies for managing their symptoms.

Hyperactivity-Impulsivity

In adults, ADHD symptoms may manifest more as mental restlessness than physical hyperactivity, although fidgeting may still be present. Individuals may experience a constant, overactive mind with poorly controlled, active thinking.

Impulsivity can also be a significant challenge, leading to excessive spending, sensation-seeking, and impatience. Adults with ADHD may sometimes act or speak before fully considering the consequences.

Dual Diagnosis

It’s worth noting that adults with ADHD are often diagnosed with at least one other condition, with Anxiety Disorders being the most common. These can include Generalised Anxiety Disorder and Social Anxiety. Additionally, ADHD symptoms can co-exist with other neurodevelopmental conditions such Dyslexia, and Autistic Spectrum Condition ASC.

Whilst not Neurodevelopmental conditions, there is ann increase in the likelihood of having Bipolar Disorder and ADHD. Substance Use Disorders or Substance Dependence (Addiction) are also commonly associated with adult ADHD.

It’s important to recognise that these co-occurring conditions can further complicate ADHD management and treatment. Therefore, seeking appropriate support from clinicians who understand the complexity of ADHD and its potential co-morbidities, can be very helpful for the successful management of symptoms.

Substance Use

The reward system in the brain is located between various structures within the Midbrain, and connections to the Frontal Lobes. Research findings suggest that lowered levels of Dopamine occur in individuals with ADHD. As a result, adults with ADHD may be more susceptible to compulsive or addictive behaviours or substances; that promote Dopamine release, reduce anxiety, or induce relaxation. This may include Alcohol and other addictive substances, leading to a higher propensity for Addiction among adults with ADHD.

Research suggests that up to 20% of those in residential treatment centres for addiction, have Adult ADHD. This highlights the importance of understanding the relationship between ADHD and Addiction, and the need for comprehensive evaluation and treatment that addresses both conditions. Seeking appropriate support, diagnosis and treatment can help individuals with ADHD and co-occurring addiction problems achieve a better quality of life.

Mood Instability

Mood instability is not an official diagnostic criterion for ADHD, though it is frequently present. Mood instability is often characterised by propensity for irritability or anger, leading family members, partners, friends, and colleagues to describe someone as moody or needing to “tread on eggshells” around them. Individuals may experience dramatic changes in mood, ranging from happiness to sadness to anger or irritation, often with no specific trigger.

Mood instability can be a result of frustration or over-reaction created by attention deficit, impulsivity, or hyperactivity. For example, individuals with ADHD may become unduly angered when they forget something or feel that someone else is “too slow.” Additionally, many patients with ADHD may experience mood instability triggered by a heightened sensitivity to rejection or perceived rejection from others. This is known as Rejection Sensitive Dysphoria (RSD) and is a common finding.

It is important to recognise that mood instability can be a significant source of distress and impairment for individuals with ADHD, affecting their personal and professional relationships.

Treatment for ADHD & ADD in Adults

Medication that treats ADHD work by boosting Dopamine and Noradrenaline levels and are classified as stimulants of the “Amfetamine” class. These medications have been extensively researched, in both Adolescent and Adult populations. They and have been used for decades, with about 60 – 70% of people with ADHD benefitting from treatment.

Drugs such as Methylphenidate (Ritalin) and Concerta XL are examples of medicines that work by boosting dopamine levels in management of ADHD. Ritalin is a fast-release preparation, while Concerta XL is a sustained-release preparation of Methylphenidate.

Lisdexamfetamine (Elvanse) is another commonly prescribed stimulant for ADHD, although it is a bit more expensive than Ritalin and Concerta. Other treatment options are available if these medications do not suit the individual.

Medication can be quite expensive, ranging from approximately £40-90 per month, depending on the drug and dosage used. However, individuals with adult ADHD do not need to take medication all the time, and many choose to stop their medication during weekends or holiday periods.

In addition to medication, psychological interventions such as Mindfulness-Based Stress Reduction (MBSR), Cognitive Behaviour Therapy (CBT) can be helpful to manage anxiety disorders, and addiction therapy can all be useful for individuals with ADHD, depending on the individual.

With the right interventions, adherence to lifestyle management techniques, including the use of stimulant medication for some; those with ADHD can learn to manage their symptoms and enhance quality of life.

Dr. Simon Kelly

Author: Dr. Simon Kelly

Dr Simon Kelly is a highly qualified and respected Consultant Psychiatrist. He was appointed as a Consultant in the NHS in Southampton in 1999. He completed his medical training qualifying as a Doctor at Charing Cross and Westminster Medical School, which is now part of the Faculty of Medicine, Imperial College London in 1991. He obtained his Bachelor of Medicine and Bachelor of Surgery (MBBS) in 1991. He holds a Masters degree (MSc) in the Psychiatric Research of Depressive Disorder from the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), University of London; when he trained in Psychiatry at the Maudsley Hospital and IoPPN. Dr Kelly held, Consultant Psychiatric roles in a busy urban settings in Southampton and established a community base as well. He has been a Member of the Royal College of Psychiatrists (MRCPsych), since 1996, and was elected as a Fellow of the Royal College of Psychiatrists (FRCPsych.) in 2018. He provides specialised Psychiatric care for individuals seeking help to improve their mental health. Together, we can work towards improving your mental health and overall quality of life.