What is adult ADHD?

ADHD is classified as a neurodevelopmental condition with genetic and neurobiological derivations. (Kieling) It is characterised by hyperactivity, impulsivity and/or inattention that interferes with normal functioning or development. (DSM-5)

ADHD has long been stereotyped as a condition present only in young males, however awareness of adult ADHD in both sexes is increasing. Previously thought to remit in adolescence and adulthood, retrospective and longitudinal studies show that the condition often persists into adulthood. (Kieling)

Adult ADHD is associated with dysfunction across all major domains of life. (Surman) Challenges faced by adults with ADHD include difficulty prioritising tasks, difficulty concentrating and forgetfulness, often leading to greater challenges in relationships, work performance, financial mismanagement and low self-esteem. (Kieling) Despite its prevalence, manifestations of adult ADHD are often vague and are not known to be characteristic of the condition. Various societal and pathological functions further contribute to late diagnosis of the condition. 

These include:

• The stereotype of ADHD being a condition pertinent to young boys may contribute to underdiagnoses, particularly in female adults. Common manifestations of the condition such as forgetfulness, disinterest, boredom and laziness may not be recognised as part of a condition and are often seen as a negative personality trait rather than a cause for investigation.
• Social scaffolding may play a role in late diagnoses. The commonly rigid social structures of school and family life during childhood can conceal symptoms of ADHD, with adults only manifesting symptoms once they have to self-manage their lives. Furthermore, parents and teachers may fail to identify ADHD in children thus missing diagnosis at onset of the condition.
• Adult ADHD may not be recognised as efficiently as childhood ADHD due to presenting symptoms being less apparent to those in childhood. Adults with ADHD are less likely to present with hyperactivity and have greater struggles with impulsivity, restlessness and inattention. These tendencies are not as outwardly visible as hyperactivity and therefore may not be detected by healthcare practitioners.
• Lower detection rates in adults may be due to its high comorbidity with other psychiatric conditions such as anxiety, depression, delayed sleep phase and substance abuse. (Oliva) ADHD has high rates of comorbidity and often a misinterpretation of symptoms leads to misdiagnosis as other comorbid conditions such as anxiety or depression.
• Adults with ADHD are better at masking their symptoms than children. ADHD patients with higher IQ have a greater social adaptation ability to mask characteristic ADHD symptoms complicating the diagnosis. (Kosaka)

Diagnosis is important to adult ADHD patients for both functional and personal reasons. Diagnosis can create confirmation of identity, validation and relief that negative labels are in fact part of their condition.

Treatment

The most common conventional treatment for uncomplicated ADHD is stimulant medication which must be prescribed by a psychiatrist. (Surman) Psychotherapy alone is not an effective solution for ADHD, however may be useful as an adjunct therapy in helping patients with organisation, planning and coping skills. (Gentile)

Naturopathic healthcare practitioners can play a supportive role in addressing the various pathophysiologies which may drive or worsen the presentation. Naturopathic treatments for ADHD centre around assessment and management of possible underlying drivers and contributing factors including: neuro-inflammation, diet and nutrient imbalances, gut-brain axis dysfunction and hormonal irregularities.

Practitioners, to learn more about adult ADHD screening and treatment, view our seminar Adult ADHD: A functional roadmap for clinicians.

To find a BioMedica practitioner, visit our Find a Practitioner listing

References

Kieling, R., & Rohde, L. A. (2012). ADHD in children and adults: diagnosis and prognosis. Current topics in behavioral neurosciences, 9, 1–16. https://doi.org/10.1007/7854_2010_115

Oliva, F., Malandrone, F., Mirabella, S., Ferreri, P., di Girolamo, G., & Maina, G. (2021). Diagnostic delay in ADHD: Duration of untreated illness and its socio-demographic and clinical predictors in a sample of adult outpatients. Early intervention in psychiatry, 15(4), 957–965. https://doi.org/10.1111/eip.13041

Kosaka, H., Fujioka, T., & Jung, M. (2019). Symptoms in individuals with adult-onset ADHD are masked during childhood. European archives of psychiatry and clinical neuroscience, 269(6), 753–755. https://doi.org/10.1007/s00406-018-0893-3

DSM5- Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/

Gentile, J. P., & Atiq, R. (2006). Psychotherapy for the patient with adult ADHD. Psychiatry (Edgmont (Pa. : Township)), 3(8), 31–35.

Surman, C. B., Hammerness, P. G., Pion, K., & Faraone, S. V. (2013). Do stimulants improve functioning in adults with ADHD? A review of the literature. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 23(6), 528–533. https://doi.org/10.1016/j.euroneuro.2012.02.010