Attention Deficit Disorder (ADD) has become a very widely known term in many people’s family life. Whether you have a child that has been diagnosed through their pediatrician or their school, you are grateful that the issues your family struggles with have a name and an intervention or you believe that the condition is over-diagnosed and over-medicated in children, you likely have heard about this diagnosis.
In the clinical community, until about 20 years ago, ADD was mostly thought of as a childhood disorder and it was believed that children outgrew the symptoms as they matured into adulthood (Vingilis et al., 2014). However, research over the years has shown that 50-60% of childhood ADHD cases continue to show symptoms and impairments into adulthood (Okie, 2006).
While the primary features of ADHD are characterized by inattention and/or hyperactive behaviors, these features manifest differently in children and adults. In children, ADHD is typically identified in the school setting when hyperactivity or difficulty with inattention present academic and social challenges. In adults, predominant symptoms usually include inattention that present as disorganization, forgetfulness, unreliability and difficulty in planning, task completion, task shifting and time management (Rosler et al, 2010; Barkley, 2010).
What is Adult ADHD and how is it different from just being too busy?
Lives these days require people to play many roles simultaneously. We are employees, sometimes partners and/or parents, children, and sometimes caregivers. Our technology keeps us plugged in and connected to all of our professional, personal and social responsibilities at all times. We are pulled in so many directions at once that it is not surprising that people are having a difficult time balancing all their obligations and are feeling disorganized while having difficulty completing everything they need to do.
But, does that mean that a person suffering from the fall-out of an overly busy life has Adult ADHD? Should we all be on medication or in treatment?
The answer is – No. While there is considerable controversy as to whether Adult ADHD is a different category than non-ADHD behavior or a dimensional diagnosis marked by being on the extreme end of a normal distribution of behaviors, it is clear that people with ADHD are distinctly different in their behavior and even in biological markers than people without ADHD (McGough & Barkley, 2004).
The primary reason for identifying ADHD is based on the negative consequences resulting from the inattentive/hyperactive symptoms and the increased risk that these negative consequences bring for significant mental health issues. Clinical studies of adolescents and adults with ADHD have found higher rates of depression, anxiety, anti-social behavior, and substance use disorders (Barkley, Murphy & Kwasnik, 1996; Biederman et al, 2006; Angola, Costello & Erkanli, 1999; Fischer, Barkley, Smallish & Fletcher, 2002). Adults with ADHD seem to have lower self-esteem, less educational and professional success, relationship and marital difficulties, poorer health choices and increased rate of driving accident rates (Murphy & Barkley, 1996). Furthermore, investigations on the impact of ADHD on middle-aged individuals suggests that it takes fewer symptoms in older adults to create significant difficulties and that the negative consequences of being untreated seem to be cumulative over time leading to more and more impairment (Das et al, 2012).
Given the negative implications of leaving ADHD untreated, the benefits of proper diagnosis followed by appropriate intervention become clear.
How is Adult ADHD diagnosed?
Although research is beginning to identify biological markers and laboratory findings that differentiate people with ADHD from people without the diagnosis, these developments are in their early stages and are being used more to understand the diagnosis than to predict it or diagnose it (McGough & Barkley, 1996; Moulton-Sarkis, 2011).
At this time, diagnosis is done through comprehensive clinical interview, collection of information from collateral sources (such as family and/or friends), and sometimes neuropsychological testing of memory and executive function abilities (such as organization, planning, staying on task, task switching). A trained psychologist would focus on identifying whether the clinical criteria for ADHD are met, whether the impairment caused by the presence of inattentive and/or hyperactive-impulsive behaviors is significant in several areas of life and whether or not the described symptoms could be part of a different mental health condition (such as a mood disorder or anxiety).
An important diagnostic feature of ADHD is that the symptoms were present since childhood. The recent revision of the Diagnostic and Statistical Manual – 5th Edition raised the critical age from age 7 to age 12, meaning that in order to meet criteria for ADHD diagnosis as an adult the presented symptoms must have existed and caused meaningful disturbances by age 12.
Thinking back to the question of how can one tell the difference between having adult ADHD or simply being too busy in our current lives, perhaps one primary difference lies in how long the difficulties have been present. If the symptoms didn’t show themselves until the stress of adulthood intervened, then there is likely some other explanation for the current levels of distraction and difficulty coping. But, if the stress of adulthood aggravated or intensified problems that have been in existence since childhood, then further evaluation for ADHD may be warranted.
Ultimately, self-diagnosis is never a good idea. Proper diagnosis can only be done by a trained professional.
To Medicate or Not To Medicate – That Is the Question
Since medications have both positive effects and potentially negative side effects, the decision to medicate ADHD is very individualized.
There are both pharmaceutical and non-pharmaceutical interventions for the challenges and negative behaviors associated with ADHD.
From a non-pharmaceutical perspective, individual therapy, neurofeedback and couching approaches can help a person address the behavior challenges and can teach skills such as improving communication, delaying gratification, and learning time management (Moultin Sarkis, 2011). However, these skills are not beneficial exclusively for people with ADHD. Behavior issues emerging as a result of being too busy or overwhelmed by life demands can be equally improved through these interventions. Someone with ADHD may have a harder time bypassing the neurological issues of the disorder to implement these techniques, but this kind of assistance can be universally helpful.
From a pharmaceutical approach, both stimulant and non-stimulant medications have been shown to improve ADHD symptomatology (Moultin-Sarkis, 2011). Ironically, whereas giving a stimulant medication to a non-ADHD individual could increase their activity level and make them more hyperactive, giving these medications to individuals with ADHD increases ability to focus, complete tasks and concentrate. However, these medications also have potential side effects. Stimulants have a low potential for addiction and can aggravate co-existing anxiety issues. The decision as to whether medication is appropriate requires proper diagnosis, a full understanding of the potential benefits of medication given an individual’s symptoms and an evaluation of potential negative interactions with other conditions and medications. The more severe the ADHD symptomatology, the more likely it is that the benefits of medication will outweigh the risks.
Angola, A., Costello, E.J., and Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry and Allied Disciplines, 40 (1), 57-87.
Barkley, R.A. (2010). Attention Deficit Hyperactivity Disorder in Adults. Sudbury, Mass.: Jones and Bartlett Publishers.
Barkley, R., Murphy, K., & Kwasnik, D. (1996). Psychological adjustment and adaptive impairments in young adults with ADHD. Journal of Attention Disorders, 1, 41-54.
Biederman, J., Monuteaux, M., Mick, E., Spencer, T., Wilens, T., Silva, J., ... Faraone, S. (2006). Young adult outcome of attention deficit hyperactivity disorder: A controlled 10-year follow-up study. Psychological Medicine, 36(2), 167-179.
Das, D., Cherbuin, N., Butterworth, P., Anstey, K., Easteal, S., & Skoulakis, E. (2012). A Population-Based Study of Attention Deficit/Hyperactivity Disorder Symptoms and Associated Impairment in Middle-Aged Adults. PLoS ONE, 7(2), E31500-E31500.
Fischer, M., Barkley, R., Smallish, L., & Fletcher, K. (2002). Young Adult Follow-up of Hyperactive Children: Self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teens. Journal of Abnormal Child Psychology, 30(5), 463-475.
Mcgough, J., & Barkley, R. (2004). Diagnostic Controversies in Adult Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry, 161(11), 1948-1956.
Moultin Sarkis, S. (2011). Adult ADD: A Guide for the Newly Diagnosed. Oakland, CA: New Harbinger Publications.
Murphy, K. & Barkley, R.A. (1996). Attention Deficit Hyperactivity Disorder in Adults: Comorbidities and Adaptive Impairments. Comprehensive Psychiatry, 37, 393-401.
Okie, S. (2006). ADHD In Adults. New England Journal of Medicine, 354(25), 2637-2641.
Rosler, M., Casas M., Konofal, E., Buitelaar, J. (2010). Attention deficit hyperactivity disorder in adults. World Journal of Biological Psychiatry, 11, 684-698.
Vingilis, E., Erickson, P., Toplak, M., Kolla, N., Mann, R., Seeley, J., ... Daigle, D. (2014). Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample. Biomedical Research International.