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The Royal College of Psychiatrists Improving the lives of people with mental illness

Attention Deficit Hyperactivity Disorder (ADHD) in adults 

 

What is it?

ADHD is a pattern of problems which is usually picked up in childhood. Parents and teachers notice that a child:

  • is unusually over-active
  • gets distracted all the time, cannot stick to doing something for any length of time
  • is impulsive, and does things on the spur of the moment without thinking
  • and has great difficult in concentrating.

Many of us have at least some of these problems, but do not have the diagnosis. To have the diagnosis of ADHD, these problems must be bad enough to interfere with how you get on with other people or with how you perform at work or school.

 

What happens as time goes on?

It tends to get better with age but can continue into adulthood. The over-activity usually gets less, but impulsivity, poor concentration and risk-taking can get worse.These can interfere with your work, learning and how you get on with other people. Depression, anxiety feelings of low self-esteem and drug misuse are more common in adults with ADHD.

 

How is ADHD diagnosed?

If you have these difficulties as s child or teenager, you would usually see either a Child and Adolescent Mental Health Service (CAMHS) or a Paediatric Service. You would be seen by specialist staff for an assessment interview of 1-2 hours. They would also get information about your early childhood and current problems from your family and school teachers.A child or young person with a diagnosis of ADHD could then be transferred to an adult psychiatrist as they got older, should their problems remain.

If you are seen for the first time as an adult, you would also be assessed by a psychiatrist as part of a local mental health team. These assessments would identify both the problems described above, but also how troublesome they are. Most children diagnosed with ADHD in the UK find it hard to concentrate, are over-active and impulsive.

In the US, the DSM diagnostic system allows for an “inattentive” type without the overactivity. This is sometime called Attention Deficit Disorder (ADD).

How common is it?

  • It seems to be more common in boys than in girls.
  • Around 3 to 5 in every 100 school-aged children have ADHD.
  • More than 2 out of every 3 of those diagnosed with ADHD as children continue to have these problems as teenagers. 2 out of 3 of these will still have problems as adults.

What is it like to have ADHD?

You find that:

  • You may get easily distracted and find it hard to take notice of details, particularly with things you find boring.
  • It's hard to listen to other people - you may find yourself finishing their sentences for them or interrupting them, or just saying things at the wrong time.
  • It's hard to follow instructions.
  • You find it hard to organise yourself and start a lot of things without ever finishing them.
  • You find it hard to wait or when there's nothing much going on - you fidget and can't sit still.
  • You are forgetful and tend to lose or misplace things.
  • You easily get irritable, impatient or frustrated and lose your temper quickly.
  • You feel restless or edgy, have difficulty turning your thoughts off, and find stress hard to handle.
  • You tend to do things on the spur of the moment, without thinking, which gets you into trouble.

What causes it?

Genes do seem to be involved - one third of those with ADHD have at least one parent with similar symptoms.It also seems to be more common if your mother had problems in pregnancy and birth.  These include exposure to drugs or medications in pregnancy, low weight at birth, brain infections, exposure  to poisons and some forms of stress to the mother.

There is also evidence of differences in brain structure, but environmental factors in your life can also make you more likely to develop the disorder.

What can be done to help adults with ADHD

You can talk over the options with your psychiatrist. He or she can go over the advantages and disadvantages of both medication and psychotherapy. They can be used on their own or together.

Psychotherapy

Cognitive Behavioural Therapy (CBT) approaches can help you:

  • Find ways to make sure that you do important tasks.
  • Find ways to organise your life better.
  • Get self-critical thoughts into perspective and so feel better about yourself.
  • Reduce unhelpful feelings of anxiety.

Medications

These are mostly 'stimulant' medications, related to amphetamines. They include methylphenydate and dexamphetamine (also known as Ritalin, Concerta, Equasym, Dexadrine). They work quickly, but the effect wears off during the night. It sounds strange that they should be useful in people with ADHD, but there is good evidence that they are.  Slow-release preparations usually mean you can take tablets just once a day. These drugs can be abused, so in the UK are legally 'controlled' drugs. The side-effects include weight loss, and occasionally, psychosis.

 

Atomoxetine (also known as Strattera)

This is a 'non-stimulant' medication and takes several weeks to begin to have an effect. Side-effects can include stomach cramps and diarrhoea, and there have been reports of increased ideas of self-harm.

 

How effective are these treatments?

There has been little research done into the drug treatments for adults with ADHD, so there are very few medications licensed for this. Your psychiatrist can still prescribe these medications, but will need to make it clear that the prescription is 'off license'. The dose will usually be more than that prescribed for children.

 

What can I do to help myself?

1. ADHD and you

Think about how your ADHD affects:

  • how you think and feel?
  • the people around you?

2. Find out more about ADHD

There are lots of things to read about ADHD in books and on the internet and also support groups where you can find out more (see below).

 

3. Discuss your problems with people around you

Your friends, family, teachers or workmates know you well. Find out how they see your problems and if they have noticed things which make things better or worse for you.

 

4. What makes things better or worse?

Think about the things in your life that seem to help – or to make it worse.

 

5 . Doing things which help you

  • You may find it hard to organise things so that you get things done you really need to. Make lists, keep diaries, stick up reminders, and set aside some time to plan what you need to do.
  • Find ways of letting of steam, like exercise.
  • Find ways of relaxing - perhaps music or relaxation techniques.
  • Be realistic about your goals.
  • Remind yourself about the things you can do well.
  • Avoid things that make it worse for you. These can include arguments with other people, drugs and alcohol, and pressure at work.
  • Avoid spending time with people who encourage you to drink too much or use drugs, or get involved in stressful situations.

6. Ask for help

  • Your employer, tutor or teacher may be able to make allowances for you.
  • Join a self-help group, or use some of the web chat rooms for people with ADHD.
  • If you are becoming very distressed or depressed because of your symptoms, your GP may refer you to a community mental health team or counsellor. They should have more information about local resources that you can use.

“15 tips to help yourself”

Adapted from 50 tips by American psychiatrist Ed Hallowell in Driven to Distraction

  1. tell people: but don’t use the diagnosis as an “excuse”
  2. ask for help from your friends and family: but say exactly what you need
  3. get feedback about how you affect others: and ask for feedback about when you do things well
  4. use structure and prioritise:
    • make lists and note
    • use colour coding and reminders
    • write down plans
    • break down big goals into smaller, manageable tasks
  5. reward yourself when things go well: or don’t go too badly!
  6. respond to boring tasks quickly: “OHIO” = only handle it once
  7. accept that some things are just difficult: so it doesn’t get you down
  8. plan difficult meetings or conversations: anticipate problems
  9. find ways to help yourself concentrate: background music, silence, something to “fiddle with” in your hands
  10. have “blow-out time” or “time outs”: gym, dancing, running
  11. don’t beat yourself up: (or your parents!)
  12. join a support group: or start one!
  13. learn to tolerate your moods (without panicking or catastrophising): NOT “I’m hopeless” or “I never manage to…”
  14. find friends who are good for you: and spend time with them
  15. be proud of yourself: yes really…you’re trying to make things better!!

Useful links

  • UK Self help group:
  • ADDISS: Charity providing information and resources about ADHD for parents, sufferers, teachers and health professionals.
  • Adders: Attention Deficit/Hyperactivity Disorder Online information service.
  • UK Adult ADHD Network: Professional body that aims to support practitioners in rolling out the NICE clinical guideline 72 and establish clinical services for adults in the UK.

Further reading

  • ADHD in Adults: A Psychological Guide to Practice: Susan Young & Jessica Bramham: a cognitive behavioural model of understanding ADHD - accompanied by a website, which provides downloadable self help materials.
  • Driven to Distraction: Ed Hallowell & John Ratey: a book written by two American psychiatrists who themselves have ADHD.
  • ADD and Success: Lynn Weiss: a book about successful people with ADD – “understanding and embracing your ADD character to help you to lead a more enjoyable and productive life”.
  • You mean I'm not Lazy, Stupid or Crazy: A Self-Help Book for Adults with Attention Deficit Disorder: Kate Kelly & Peggy Ramundo: a book by ADD adults for ADD adults, practical help and moral support to adults who are struggling to understand themselves.

References

Crimlisk H (2011) Developing integrated mental health services for adults with ADHD. Advances in Psychiatric Treatment 17: 461-469.

Moncrieff J, Timimi S (2010) Is ADHD a valid diagnosis in adults? BMJ 340:547

Nutt DJ, Fone K, Asherson P. et al. (2007) Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendation from the British Association for Psychopharmacology. Journal of Psychopharmacology 21: 10-41.

 

This leaflet was originally produced by Dr Helen Crimlisk for the Sheffield Health and Social Care Trust and edited by the Royal College of Psychiatrists' Public Education Editorial Board.

Series editor: Dr Philip Timms

Expert review: Dr Helen Crimlisk

Service user and carer input: members of the RCPsych Service User Recovery Forum and Carers' Forum.

© February 2013. Due for review: February 2015. Royal College of Psychiatrists.

This leaflet reflects the best available evidence available at the time of writing.

This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

 
For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, Telephone: 020 7235 2351x 2552
 
Charity registration number (England and Wales) 228636 and in Scotland SC038369.
 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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