What is ADHD in adults? | Corewell Health

At some point in the week, almost everyone experiences a moment of forgetfulness.

Or maybe a mood swing or a feeling of restlessness. Or even the occasional frustration.

But if you experience these issues often and have trouble setting priorities or following a plan — or your mood is racing and you’re having trouble dealing with stress — it could hint at something another is happening.

If you struggle with these issues as an adult, it could be a sign of attention deficit hyperactivity disorder.

“(ADHD) symptoms present differently in adults than in children,” said Lyndsay Volpe-Bertram, Doctor of Psychologyclinical psychologist and section chief of psychology at Corewell Health in western Michigan.

For adults, ADHD may be more related to inattention than hyperactivity. You can be too talkative, tap your pen all the time, forget to pay a bill, or get up from your desk frequently, she said.

“As adults, we’ve learned what’s socially acceptable and can control hyperactivity, but still show signs of being distracted,” Dr. Volpe-Bertram said.

About 3% of adults and about 5% to 6% of children in the United States have ADHD, she said.

“And about 30% to 50% of people with ADHD in childhood go out of it as adults,” said Jeffrey Guina, MDdirector of the psychiatry residency program at Corewell Health in southeast Michigan.

People don’t develop ADHD as adults, Dr. Guina said.

“If it’s diagnosed in adulthood, it’s only because it was missed in childhood,” he said. “Symptoms develop around the age of 12. People tend to say that ADHD is either overdiagnosed or underdiagnosed. Both are true.

It’s easy to confuse other conditions with ADHD, but it can also be easy to overlook it, he said.

Establishing a diagnosis can be a long and complex process, not just a simple test.

The gold standard of testing for ADHD begins with meeting with a trained mental health professional or physician who gathers information from multiple sources, he said.

A physical exam helps rule out other possibilities, such as poor sleep, nutritional problems, autism, traumatic brain injury, or stress.

“A person can suffer from depression or anxiety, especially since the pandemic and being isolated for so long,” said Dr Guina.

“Or a person might have a diagnosis of PTSD or bipolar disorder,” Dr. Volpe-Bertram said. “That’s why maintenance is so important. We talk to you and gather collateral information, and the testing process can take two to three hours.

Informative interview

THE evaluation process starts by putting together a story and a timeline of your life. During the interview, a clinician also observes behaviors.

If symptoms appear in only one place, at work but not at home, for example, the problem may be situational and not ADHD, Dr. Volpe-Bertram said.

“We collect collateral information, talk to family members, friends and colleagues,” Dr. Guina said. “Symptoms should appear in multiple areas of your life.”

There may also be tests of cognitive ability and academic achievement to rule out a possible learning disability.

Cannabis use can also create symptoms that mimic those of ADHD in adults, according to Dr. Guina.

“Now with legalization more people are using marijuana,” he said. “And frequent users experience an effect on the frontal lobe of the brain that can last up to six months.”

The frontal lobe of the brain is responsible for memory, attention, language and other cognitive functions. Drug addiction and certain medications can affect the brain and cause symptoms that mimic ADHD symptoms.

“We may perform lab work and/or psychological testing to assess other causes of inattention,”
said Dr. Guina. “The hardest part of diagnosis is ruling out all other possibilities.”

Treatment value

Once diagnosed, in most cases, stimulants are prescribed, often in conjunction with cognitive behavioral therapy, Dr. Volpe-Bertram said.

“In cognitive behavioral therapy, we can work on behaviors,” she said. “We work on developing consistency and routine, scheduling tasks, how to approach projects. We look at behavior patterns and develop skills.

Exercise, especially when using fine motor skills, can also be a good treatment for ADHD.

However, stimulants are the most important, Dr. Guina said.

“Therapy is beneficial, but the right medication can dramatically change your course of life,” he said.

Under treatment, adults with ADHD who are prone to car crashes due to distracted driving became more careful drivers, Dr. Guina said. They are also less likely to exhibit addictive behavior, which is common in adults with ADHD.

“While it may seem odd to prescribe stimulants to an overactive person, the frontal lobe in people with ADHD is underactive, so stimulants help the mind focus, filter out distractions, and regulate impulses,” said Dr. Guina.

If a patient has a history of substance abuse, non-stimulant drugs may be prescribed, but they may be less effective, he said.

Music can also benefit patients, especially learning to play an instrument, which helps focus and calm the mind.

Untreated ADHD, on the other hand, can lead to depression, stress, and low self-esteem.

“If you don’t succeed in life, it will affect how you feel about yourself,” Dr. Guina said. “It will not only frustrate you, but also those around you. So it can be difficult for all of your relationships, especially partners, when you don’t follow through.

Dr. Volpe-Bertram added a caveat: “We have recently seen a proliferation of online assessments for diagnosing ADHD. If it’s quick and easy, it’s probably not a good idea.

Instead, talk to your GP for a referral to a professional, reputable test, she said.