Do You Have Adult ADHD?

ADHD isn’t always diagnosed in childhood

Attention-deficit/hyperactivity disorder (ADHD) doesn’t just affect kids. It’s also a concern for 4 to 5 percent of U.S. adults, says Michael Manos, PhD, founding Director of Cleveland Clinic’s ADHD Center for Evaluation and Treatment.

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Many more adults may have the disorder and not know it.

Partly, that’s because symptoms of adult ADHD are different than childhood ADHD. Kids may have difficulty paying attention in school or playing quietly at home. But in adults:

  • Inattention can appear as poor time management or difficulty completing things.
  • Hyperactivity can turn into a chronic sense of restlessness or always feeling overwhelmed.
  • Impulsivity can become irritability, agitation or being quick to get mad.

In addition, problems with organizing can wreak havoc on keeping appointments and keeping promises.

“Adults with ADHD sometimes have problems with relationships and employment because they tend not to do what they say they’re going to do,” says Dr. Manos. “They tend not to keep agreements. Subsequently they get depressed or anxious, or they constantly criticize themselves.

How adult ADHD is diagnosed

To diagnose adult ADHD, a mental health specialist will rely on:

  • History of the adult’s behavior as a child
  • Interviews with the adult’s spouse, partner, parent, close friend or someone else who knows them well
  • Psychological tests

According to American Psychiatric Association guidelines, symptoms of ADHD should have been evident by age 12. But what if an adult has ADHD symptoms now but didn’t as a child? Can adults grow into ADHD just like children can grow out of it?

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Dr. Manos doesn’t think so.

Can you grow into (or out of) ADHD?

“It’s not that you outgrow ADHD or grow into ADHD,” says Dr. Manos. “It’s whether or not the symptoms — which were probably always there — are impairing. Adaptability, the means to manage ADHD symptoms, is what changes throughout life. A child may be quite bright and manage symptoms well, but when demand gets huge in adulthood — like when starting a family or getting a challenging new job — strategies that worked before may not work anymore.”

That explains how an adult with ADHD may not have been diagnosed with ADHD as a child, and vice versa. Dr. Manos attributes this to “social scaffolding” — the life situations and relationships within which a person operates.

For example:

  • A child performs well in school and thrives in a regular routine managed by his parents. When he leaves home and enters college, his performance declines. ADHD symptoms are unmasked because now he has to self-direct rather than have schedules and demands dictated for him.
  • A child with ADHD grows up and begins an enjoyable career in a structured workplace. She marries a highly organized spouse who willingly manages the household and family finances. Her symptoms of ADHD may no longer be impairing — or even evident — because details are handled for her and she gets to do what she’s successful at.

When social scaffolding changes, so do ADHD symptoms.

“For adults newly diagnosed, their symptoms probably just weren’t detected in childhood,” says Dr. Manos. “It’s most likely that ADHD is a lifelong condition, but the jury is still out.”

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How to treat adult ADHD

Treating ADHD is the same in children, adolescents and adults. A combination of medication and behavioral intervention is the top-line treatment, although not everyone needs it, says Dr. Manos.

For adults, treatments may include:

  • Cognitive and behavioral therapy to enhance self-esteem
  • Relaxation training and stress management to reduce anxiety
  • Behavioral coaching to teach strategies for organizing home and work activities
  • Job coaching or mentoring to improve work performance and relationships

The goal of treatment is to help patients and families adapt to ADHD. Symptoms may never go away, but they can be controlled so patients can have productive lives and healthy relationships.

“Learning to accept yourself as you are is the first step to managing how you are,” says Dr. Manos. “When you stop fighting traits like getting sidetracked or always being late, you can place more energy on adjusting your environment so you can become more productive or punctual and feel better about who you are.”

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