Attention-deficit/hyperactivity disorder (ADHD) is often thought of as a condition of children and youth, but it may persist for many adults. Many children with ADHD will continue to meet criteria for the disorder later in life and may have challenges that require ongoing treatment (Pliszka, 2007) because of significant negative life consequences of untreated ADHD in adults. (Goodman, 2007)
In addition, many children with ADHD go undiagnosed. Just because they are undiagnosed doesn’t mean they don’t have it.
Numbers and Trends
A recent study estimated that 6% of U.S. adults have an ADHD diagnosis, and about half of those adults received their diagnosis in adulthood. (Staley, 2024) New diagnoses of ADHD among adults increased from 2020 to 2023, following a downward trend from 2016 to 2020, according to another recent study. (Paul, 2024) Many factors may have contributed to the increase, such as more public and clinician awareness and destigmatization of ADHD, and the COVID-19 pandemic, which may have contributed to symptoms becoming more evident.
For men and women with ADHD, several differences are noted in the symptoms and experiences of ADHD. (Attoe, 2023) For example, women are more likely to have inattentive symptoms than hyperactive symptoms, which may be less likely to lead to a referral and diagnosis. Women with ADHD are more likely than men to experience decreased self-esteem, more difficulty in peer relationships, and increased anxiety. Women are also more likely to develop coping strategies that mask symptoms of ADHD.
Symptoms and Diagnosis
ADHD symptoms can change over time and may look different in adults than in children. For adults, impulsivity and hyperactivity may decrease or appear as extreme restlessness. Inattention may persist. The increasing demands of adulthood, and the decreasing ability to compensate may lead to more daily impairments. Adults with ADHD may face challenges with:
- Sustaining their attention.
- Completing lengthy tasks unless interesting.
- Staying organized.
- Controlling their impulsive behavior and emotion eruptions.
- Hyperactive symptoms, such as feeling internally restless and fidgety.
The accuracy of an ADHD diagnosis is often complicated by the presence of co-existing psychiatric and medical disorders. Anxiety disorders, mood disorders, substance use disorders, post-traumatic stress disorders, eating disorders, and personality disorders occur substantially more often in people with ADHD than in the general population. (Goodman, 2007; Kessler et al., 2006)) Medical disorders may contribute cognitive changes that exacerbate ADHD symptoms. One example is sleep problems that affect up to 70% of adults with ADHD. (NIMH)
Evaluation and Treatment
A comprehensive ADHD evaluation typically includes a review of past and current symptoms, a review of the presence and absence of other psychiatric disorders, a medical history, social and developmental history, use of adult ADHD rating scales and documentation of resulting life impairments.
Adults with ADHD are treated with medication (typically stimulant medication), psychotherapy or a combination. Cognitive behavior strategies, such as minimizing distractions, time management, increasing structure and organization, and support from immediate family members, can also be helpful. Understanding ADHD as a potentially lifelong condition is a critical factor for the person’s participation in treatment.
While psychiatrists are best trained to perform a comprehensive psychiatric examination, primary care physicians are increasingly a main source of care for adults with ADHD, according to the Centers for Disease Control and Prevention. Nurse practitioners and psychiatric nurses also provide ADHD care to adults. About one in four adults with private insurance receive ADHD care from a psychiatrist. With telehealth providing increased access to care, about half of adults with ADHD have used telehealth for ADHD services. (Staley, 2024)
An estimated one in three adults with ADHD take stimulant medication, and in 2023 more than two-thirds of them had difficulty filling their prescription because of a shortage of medication. (Staley 2024)
ADHD in the Workplace
ADHD is a protected disability under the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). This means that individuals whose symptoms of ADHD cause difficulty in the work setting may qualify for reasonable workplace accommodations under ADA.
For example, to address challenges with focus and concentration, minimizing distractions, providing a quiet workspace or allowing use of noise cancellation or white noise devices, might help improve work performance and decrease frustration. Read more about workplace accommodations from the Job Accommodation Network.
How to Help – Dos and Don’ts
Here are some suggestions about how to support someone with ADHD (adapted from MedlinePlus, ADHD Support Toolkit, April 2024)
| Do | Don't |
|---|---|
| Educate yourself. Take some time to learn about ADHD symptoms and challenges. | Blame or criticize. This means their brain works differently than others, and they may struggle with certain tasks or behaviors and use different strategies to succeed. |
| Offer practical help such as giving them a hand with tasks like cleaning and organizing. Simply being present and engaged while the person works, a practice known as body doubling, can help a person with ADHD stay focused and on task. | Make assumptions. Everyone’s experience is different, and they may use different strategies to cope. Ask questions about their challenges. |
| Be patient and understanding. ADHD can be frustrating both for those who have it and for the people in their lives. Try to be patient, flexible, and empathetic. | Try to “fix” them. The best thing you can do is be there for those with ADHD by offering support and encouraging them to learn how to manage their symptoms and compensate for impairments. |
| Encourage breaks. If a task requires sustained attention, short breaks during the task can be helpful. |
References
- Attoe DE, Climie EA. Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. J Atten Disord. 2023 May;27(7):645-657. doi: 10.1177/10870547231161533
- Centers for Disease Control and Prevention. ADHD in Adults: An Overview https://www.cdc.gov/adhd/articles/adhd-across-the-lifetime.html
- Centers for Disease Control and Prevention. Facts About ADHD in Adults | Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC • Danielson ML, Bohm MK, Newsome K, et al. Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2023;72:327–332. DOI: http://dx.doi.org/10.15585/mmwr.mm7213a1
- Goodman DW. The consequences of attention-deficit/hyperactivity disorder in adults. J Psychiatr Pract. 2007 Sep;13(5):318-27. doi: 10.1097/01.pra.0000290670.87236.18 • Job Accommodation Network (A services of the U.S. Department of Labor) https://askjan.org/disabilities/Attention-Deficit-Hyperactivity-Disorder-AD-HD.cfm • National Institute of Mental Health. Adult ADHD: 4 Things to Know. https://www.nimh.nih.gov/health/publications/adhd-what-you-need-to-know
- Paul, ML, et al. 2024. Incidence of Attention‐Deficit/Hyperactivity Disorder Between 2016 and 2023: A Retrospective Cohort. Psychiatric Research and Clinical Practice. In Advance. https://doi.org/10.1176/appi.prcp.20240121
- Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921. doi: 10.1097/chi.0b013e318054e724
- Staley BS, Robinson LR, Claussen AH, et al. Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults — National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. MMWR Morb Mortal Wkly Rep 2024;73:890–895. DOI: http://dx.doi.org/10.15585/mmwr.mm7340a1