ADHD in adults

Attention deficit hyperactivity disorder (ADHD) is a diagnosis given to people who have challenges with:

• inattention - finding it hard to concentrate
• hyperactivity - feeling restless and struggling to sit still
• impulsivity - saying or doing things without thinking about the consequences first.

Most people experience these challenges at some point in their lives, or in certain situations. For example, someone might struggle to concentrate the following day if they’ve had a bad night’s sleep.

However, for people with ADHD, these challenges usually begin in childhood and for most people they continue as they grow up, though they may change or improve. These challenges will also affect someone in many areas of their life.

“For me, reading a book can feel like a carousel ride with the book held by someone in the crowd. Tasks can feel like a car journey where my impatient self is in control of the pedals, but my curious self is holding the wheel.” - A person with ADHD

ADHD is a ‘neurodevelopmental disorder’. These are disorders that can affect lots of different brain functions, including learning, communication, movement, emotions and attention.

Neurodevelopmental disorders start in childhood and for many people are life-long. This means that they can’t be ‘cured’. Instead, people with neurodevelopmental disorders can benefit from support and changes to their environment.

People who have one neurodevelopmental disorder are more likely to have another one, such as:

• autism spectrum disorder
• coordination difficulties
• speech, language and communication disorders
• Tourette’s syndrome
• dyslexia
• dyscalculia.

If someone has ADHD that isn’t recognised or treated properly, this can negatively affect their mental and physical wellbeing.

People with ADHD are frequently diagnosed with other mental and physical health conditions. This can make it difficult to recognise underlying ADHD.

ADHD affects about 3 to 4 in every 100 adults. People with ADHD can be of any background, but ADHD is more common in people who have:

• a sibling or close family member with ADHD
• epilepsy
• other neurodevelopmental conditions, learning disabilities or learning difficulties
• mental illnesses
• a history of alcohol or drug misuse
• been involved in the criminal justice system
• an acquired brain injury
• been in care

Or who were:

• born prematurely
• diagnosed with ‘oppositional defiant disorder’ or ‘conduct disorder’ as children
• thought to have a mental illness like anxiety or depression as children.
  

Is there a gender difference in ADHD?

ADHD is more commonly diagnosed in boys than in girls. However, in adults the diagnosis of ADHD in men and women is more equal. This might be because, as children, boys are more likely to show hyperactive and impulsive symptoms, which are more noticeable.

When it comes to diagnosis, girls and women might be more likely to:

• have undiagnosed ADHD
• not be referred for assessment for ADHD
• receive an incorrect diagnosis of another mental health or neurodevelopmental condition.

Below is a list of the core symptoms of ADHD. For someone to be diagnosed with ADHD, these symptoms need to cause significant difficulties in at least two areas of daily life. For example, home, education or employment, relationships and housing.

There are lots of other experiences that people with ADHD report having that might not be covered here. We have included examples that cover a broad range of ages, from young people who are still in education, to people who are in the workplace.

Not all of these symptoms will be obvious to others. People with ADHD will often develop ways to hide their symptoms, and doing so can be very exhausting and negatively affect their mental health.

Strengths of ADHD

It can be helpful to think of ADHD not just as a deficit or disorder but as a ‘difference’. Some people view some aspects of their ADHD as strengths in certain situations or environments:

• Hyperfocus – Some people with ADHD find that they can ‘hyper-focus’ on things they are interested in. This can mean they are very knowledgeable about certain topics, or very productive when they are feeling motivated and passionate about something.
• Responding to a crisis – Other people with ADHD find that they perform better in a crisis when the situation demands their full attention.
• Creativity – A tendency to get distracted can mean that someone with ADHD explores alternative and creative approaches to problems.

Some people with ADHD can use these traits to their advantage. Other people might need supportive structures to build on these strengths.

“I got fed up of being kept told I'm disruptive, I'm rude, I always interrupt. And not the fact that I was eager. I was keen. I was excited. One teacher I remember who was fantastic in my high school, she would say I love your eagerness, but just hold on for five minutes. It made me feel good.” – Hameed

Friends and family might notice signs of ADHD in someone they know. The Canadian ADHD Resource Alliance (CADDRA) has a helpful list that might indicate someone you know has unsupported ADHD:

• Problems organising. For example, poor time management, missed appointments, frequent late and unfinished projects
• Erratic work or academic performance
• Anger management problems
• Family or marriage problems
• Lack of routine. For example, poor sleeping patterns
• Difficulty managing finances
• Addictive behaviours like substance use, compulsive shopping or gambling
• Frequent accidents either through recklessness or inattention
• Problems with driving, such as speeding tickets, serious accidents, or losing their license
• Having to reduce their work load, or having difficulty completing assignments in education
• Low self-esteem or chronic under-achievement.

People who have a direct relative who has ADHD are also more likely to have ADHD themselves.

 “I celebrate my brain as much as I struggle with it. The balance here, for me, is important. This has taken me years, but I can recognise strengths in myself because of my neurotype. I won’t be reduced to ‘deficits’. My difference is MY experience to own.” - Clare

In recent years, ADHD services across the UK have seen an increase in the number of referrals. There are lots of possible reasons for this, including:

• more widespread awareness of ADHD amongst the general public and healthcare professionals
• the COVID-19 pandemic, which has meant that working and educational environments have changed. This may have made ADHD behaviours more noticeable.

More people being referred for ADHD assessments is a positive thing, because it means that those who do have ADHD can receive the support they need. Those who find out that they don’t have ADHD, but have related support needs, can also get help.

Some people incorrectly say that ADHD is ‘fashionable’ or ‘made up’. In fact, the first description by a doctor of a disorder resembling ADHD was in the 18^th century. The name of the disorder has changed over time but the same challenges are described that we recognise as ADHD today.

There is agreement between health care professionals and scientists around the world that ADHD is a valid diagnosis. There are clear guidelines describing how ADHD is diagnosed, and how it should be assessed, supported and treated.

In childhood

ADHD can start to show itself at an early age, and is often first noticed when someone is at school. However, some people might not experience challenges until adulthood, or these challenges might not be noticed until they are much older.

Although people with ADHD share common, ‘typical’ symptoms, ADHD can look different from person to person. What ADHD looks like can depend on a person’s:

• background
• personality
• fit with their environment
• level of support and structure
• positive and negative life experiences
• stage of life.

Hyperactive and impulsive symptoms tend to be more common in childhood and be less of a challenge for some people over time. Inattentive symptoms tend to become more of an issue in teenage years and adulthood.

Growing up

Usually, as young people grow up, they experience more challenges and receive less support. For example, if someone has lived at home and had lots of support, their ADHD might not cause them problems until they move out of home.

Young adults with ADHD often face new challenges, such as:

• work or education
• living independently
• relationships
• finances.

In adulthood

Throughout life, new challenges like parenthood might further increase a person’s overall level of stress. This can mean that their ADHD causes more challenges as they get older.

As the overall level of demand and stress increases, people with ADHD are more likely to struggle to keep up. When this happens, they can become overwhelmed and unwell. This can be avoided through appropriate support. You can find out more about this in the section on support further on in this resource.

“I was told just yesterday by my GP… and she’s referred me for confirmation. I’m processing the feelings about it right now. I’m 38 - it’s been missed throughout my entire life. I could never vocalise how I felt until now.” Rachael

For most people with ADHD, the condition is caused by a combination of genetic and environmental factors.

• Genetics – The genetic factors that lead to someone developing ADHD are generally made up of lots of small genetic differences rather one single gene.
• Environmental factors – environmental factors can include things like:
  • difficulties when you were in the womb
  • birth complications
  • exposure to toxins
  • nutritional deficiencies
  • brain injury.

Studies have shown that the genetic and environmental factors leading to ADHD are also found in other common mental and physical health conditions.

Research has shown that other mental and physical health conditions are more common in people with ADHD. These include:

• anxiety
• depression
• bipolar disorder
• substance use disorders
• obesity
• disordered eating
• allergies
• asthma
• sleep disorders
• diabetes
• autoimmune disorders, e.g. arthritis, psoriasis
• joint hypermobility.

If you think you have ADHD and it is having a negative effect on your life, speak to your GP, who will be able to refer you to the most appropriate service for you. This is often a Community Mental Health Service or a specialised Neurodevelopmental Service.

Unfortunately, we know that some people struggle to be referred for an ADHD assessment. This might be because of a lack of knowledge about adult ADHD, or because their challenges are thought to be caused by something else. For example, some people are diagnosed with a mental health problem like anxiety, depression or a substance use disorder, when this only explains part of their difficulties. When this happens, underlying ADHD can be missed.

We also know that waiting lists for assessments can be very long, which means some people have to wait a long time for a diagnosis. How long you have to wait might depend on where you live.

You might have used a questionnaire or quiz to find out whether you have ADHD. Questionnaires can help with the assessment process but ADHD can only be accurately diagnosed with:

• a comprehensive interview
• a consultation-based assessment

NICE (the National Institute for Health and Care Excellence) have guidelines that apply in England and Wales for diagnosing ADHD. Regardless of where you live in England or Wales, your assessment should follow these guidelines.

A thorough assessment report would include, at least, all of the following:

• the role, qualifications, and experience of the person assessing you
• discussion of your ADHD symptoms and whether these meet the criteria for a diagnosis. This is usually supported by structured assessment tools and questionnaires
• a full review of your mental health
• information about your childhood, development, schooling, and your ability to function in areas of daily living
• reviewing any physical health problems
• information about you from others who know you, especially how you were as a child, if available.

Private assessments

In addition to NHS services there are many providers who offer ADHD assessments privately.

If you have an assessment elsewhere, specialist NHS Adult ADHD services will check that your report includes all of the detail above before accepting you into the NHS service. This is because prescribers of ADHD medication need to ensure that they have all information required to prescribe safely, and for the right condition.

For this reason, before getting an assessment from an alternative provider you should make sure that it will be accepted by your local NHS service.

After getting a diagnosis of ADHD, you might go through an adjustment period. You might experience different emotions, including:

• Relief at getting an explanation for some of your difficulties, and finding out that you aren’t alone. You might also feel relief at knowing that you aren’t ‘lazy’, ‘unwilling’, ‘messy’ or any other labels you might have been given in the past.
• Frustration over the fact that the condition was not diagnosed and treated sooner. You might even feel anger towards your parents, or education and health providers who didn’t notice it earlier.
• Sadness over missed opportunities and the impact untreated ADHD has had on your life, and the lives of the people you know.

If you have been diagnosed with ADHD, this diagnosis might become an important part of how you see yourself. It can be hard to get the balance right between:

• seeing yourself as someone whose life is affected in many ways by ADHD
• not seeing ADHD as being the most important thing about you.

A solution-focused approach, which looks at what is difficult in your life, and what can be done to make things less difficult, can help with this balance.

“I’m in an emotional rollercoaster at the moment. I wish it had been noticed sooner. I only considered it after listening to lived experience rather than stigmatised stereotype.” – Rachael

After diagnosis

If you have received a diagnosis of ADHD, the person who assessed you should talk with you about:

• how ADHD affects you
• your goals
• things that have been helpful to you in the past
• any other conditions you have and whether they could affect your ADHD.

They should also refer you to any services or information that might be helpful.

Before starting medical treatment

Before starting treatment, the person who assessed you should talk to you about:

• environmental modifications at home, work and in education
• helpful lifestyle changes
• benefits and side effects of treatment
• your preferences for treatment
• any concerns you have.

Something that can make the biggest difference is being around people who understand ADHD, and being in environments that bring out the best in you. This could mean being offered reasonable adjustments at work, or an Occupational Therapist helping you to develop a successful home routine.

We explore these things in more detail below, but remember that environmental modification can be one of the most important parts of the support you get for ADHD.

It is important to remember that there isn’t one solution that will make all ADHD symptoms go away. As you read through this information, it might be helpful to think about how your symptoms effect different areas of your life.

“Whilst ADHD can be extremely difficult to manage, with help I have been able to learn about my tendency to get very absorbed in activities I love and to use this in a constructive way.” - James

Understanding your ADHD

Peer support groups

Peer support groups provide free or low-cost services where people with ADHD can listen and share experiences, advice, strategies and tips. They are also an opportunity to socialise. Group meetings may be online or face-to-face. The availability and quality of peer support groups will vary, depending on where you live.

Online information

Learning more about a health condition can be useful, and a lot of information about ADHD can be found online. It is important to remember that the quality of online information varies. Unfortunately, online information can be inaccurate, misleading or even false. We have included some helpful websites at the end of this resource.

Occupational Therapy (OT)

Occupational Therapists can work with people with ADHD to help them to:

• organise their physical and social environment
• develop effective time management skills
• develop effective planning schedules to help meet job requirements
• develop the discipline to stick to planned activities despite distractions while also remaining flexible to changes.

The aim of occupational therapy is to help people to live as independently as possible and to participate in meaningful activities.

You might be able to get a referral for free occupational therapy from the NHS or social services. This will depend on your circumstances. You might also choose to pay for an independent occupational therapist. The Royal College of Occupational Therapists has a list of qualified and registered occupational therapists.

“If I had known that people with ADHD start a lot of things and don’t finish them… that was definitely me. And if I had known it was because of ADHD I would have been more cautious about doing things on impulse without thinking.” -  Hameed

Employment and education

Reasonable adjustments

Under the Equality Act 2010, employers, colleges and universities must make ‘reasonable adjustments’ so that people with protected characteristics are not put at a substantial disadvantage. These protected characteristics include disability, which covers ADHD. You can find out more about disability and the law on the government website.

The kind of reasonable adjustments someone with ADHD will get depends upon:

• how their condition affects them
• practicality
• the size of the organisation
• availability of money and resources
• whether the adjustment would overcome the disadvantage they experience.
  

Some examples of reasonable adjustments include:

• providing a desk in a quiet area of the office
• giving written instructions as well as verbal
• delegating work when appropriate
• helping with structuring tasks.
  

The Association of Graduate Careers Advisory Service offers more examples.

Access to Work

Access to Work is a service provided by the Department for Work and Pensions. It can offer practical and financial support to people with disabilities. It is available to people who are employed, self-employed, or looking for employment.

It is only available to people who need support or adaptations beyond the ‘reasonable adjustments’ which employers are legally required to provide. For example, Access to Work may help pay for a job coach or providing additional training. 

More information about eligibility and the application process is available on the UK Government’s website.

Psychological therapies

Some psychological therapies can help you to manage the symptoms of ADHD. These include:

• Psychoeducation courses
• Mindfulness
• Cognitive behavioural therapy (CBT)

You can find out more about therapies that can be helpful in ADHD on the NHS website.

When you are looking for a therapist, find out if they are knowledgeable about ADHD, or are willing to learn. This will help you to get supportive, positive care. It is also important because some of the challenges that come with ADHD could impact your therapy. For example, forgetfulness could mean that you miss or are late to an appointment, or you might struggle to work on set tasks outside of appointments.

Find a talking therapy service near you on the NHS website.

Cognitive behavioural therapy (CBT)

CBT is a structured programme of therapy that helps people identify unhelpful thought patterns and develop techniques for overcoming them.

If you have ADHD, CBT can help you with:

• organisational and time management skills
• emotional regulation and control
• developing empathy and understanding perspectives of others
• strategies for improving attention and impulsivity management.  

In ADHD, CBT tends to be most effective when it is combined with medication.

Coaching and mentoring

Coaches or mentors can help with building daily life skills such as time management, and making environmental modifications. There are coaches who specialise in helping people with ADHD.

It is important to remember, however, that coaching and mentoring are self-regulated professions without regulatory legal standards. Coaching and mentoring services vary in quality and expertise.

Medication

If you have tried environmental modifications and are still struggling, you might find medication helpful.

Before starting medication, the person treating you should check your mental and physical health. They should inform you about the risks associated with taking stimulant medications if you have any other health conditions, and should support you to monitor yourself for any side-effects. Once you are taking a medication that is working for you, it should be reviewed at least once a year.

There are several different medications available for treating ADHD. These fall into two groups:

Stimulant medications:

• methylphenidate
• dexamfetamine

Stimulant medications increase the availability of the neurotransmitters Dopamine and Noradrenaline in areas of the brain that help to control attention and behaviour. There is good evidence for using stimulants to treat ADHD, and in most people they are effective, safe, and well tolerated. You will usually be able to tell quickly if they are helpful or not.

The medication needs to be built up gradually to minimise any side-effects and to find the right dose for you. Most people get noticeable benefits from the first medication they try. Other people might need to try a different medication to get the best results.

Many people wonder why simulant medications are used to treat a condition that causes hyperactivity. These medications strengthen a part of the brain that can help to control the areas of the brain that drive hyperactivity. 

Non-stimulant medications:

• atomoxetine
• guanfacine

Non-stimulant medications increase the availability of Noradrenaline or mimic its effects. They tend to take longer to start having an effect than stimulant medications. They are generally used if stimulant medications haven’t worked for you or if you find them difficult to take.

Many people with ADHD who use medication find it very helpful, but there are also people who choose not to take medication or are unable to. All medications have side effects, and some people find these more noticeable than others.

Non-prescribed medication

Some people will buy ADHD medications without a prescription. This might be because they suspect they have ADHD but don’t want to or can’t get an assessment. Other reasons for taking non-prescribed ADHD medications include:

• improving academic or occupational performance
• partying and socialising
• weight loss.

Buying ADHD medication online or getting it without a prescription can be dangerous, because you:

• won’t necessarily get the medication you asked for
• won’t have the support of a doctor to find out if the medication is working for you or how to use it correctly
• won’t be able to receive necessary monitoring.

There is no conclusive evidence that taking ADHD medication improves performance in people who don’t have ADHD.

“There are black market websites out there that sell things, but they’re not regulated and you don’t necessarily know what you’re getting, and it’s very risky.” - James

There are a number of things that people with ADHD can do to support their overall health and wellbeing.

1. Tell the people around you how they can help

As with any health condition, people often want to help but don’t know how, and end up giving unhelpful advice. Tell the people in your life about the things you do and don’t find helpful.

2. Try to get some regular exercise

Regular exercise is good for everyone. In people with ADHD, it has been shown to significantly reduce symptoms related to anxiety and depression, which can make ADHD symptoms worse. Exercise has not been shown to have a positive impact on hyperactive, impulsive, or inattentive symptoms.

3. Get enough good-quality sleep

Not sleeping well can make ADHD symptoms worse. Developing good sleeping habits can be challenging, but there are some things you can try:

• Develop and maintain a comforting bedtime routine, e.g. having a bath, listening to music.
• Go to bed and get up at the same time each day, including at weekends.
• Avoid screen time for at least an hour before bedtime.
• Do not consume sugar, caffeine or alcohol within a couple of hours of bedtime.
• Get enough exercise during the day.
• Keep the bedroom dark and quiet. If you can, leave a window open for fresh air.
  

4. Aim for a regular and balanced diet

A large study has shown that there is a relationship between inattentive symptoms and unhealthy eating habits, including eating foods high in added sugar. An unhealthy diet negatively impacts physical health and possibly mood, which could make it more difficult to manage ADHD symptoms.

5. Driving

By law you must tell the Driver and Vehicle Licensing Agency (DVLA) about any condition that may affect your ability to drive safely.

If you’re not sure if your ADHD, or your ADHD medication affects your ability to drive safely, speak to your doctor. If ADHD does affect your driving and you do not tell the DVLA, you can be fined up to £1,000. If you’re involved in an accident you may be prosecuted.

You can find out more about this on the DVLA website.

If you know someone who has ADHD, there are a number of things you can do to make life easier for them, and yourself.

1. Learn about the condition

Just because you’ve met one person with ADHD doesn’t mean you’ve met them all. Finding out more about the condition can help you to get a stronger understanding of ADHD. It will also show the person that you care about them.

“It's exhausting, variable and infuriating multiple times a day. It can impact every aspect of your life and a lot of that is hidden, especially with the mental load of women juggling home, work, family. People have no idea.” - Margaret

2. Join a peer support group

Some adult ADHD peer support groups run separate groups for partners and spouses, or allow them to participate in the ADHD groups. Check with the group first before attending. You will usually be able to find out more about a peer support group online.

3. Speak to the person you know

Ask the person you know if there is anything you can do to help. If they can’t think of anything right now, you can let them know you are there if they need someone to talk with in the future.

4. Be aware of stigma

There are a lot of misconceptions about ADHD and the people who have it. You can help by informing yourself and other people about the realities of ADHD.

5. Manage your frustrations

If you find the behaviour of the person you know upsetting or frustrating, talk through your feelings with someone you trust. If there are problems you want to bring up, try to explain clearly what the issue is and what you think could help. There may be things that both of you can do to help solve the issue.

“Sometimes when we talk about disability, we make assumptions that it’s got to be something visible. And when you have ADHD it’s not so visible, and people just put it down to your personality.” - Hameed

NICE guidance on ADHD

These guidelines cover recognising, diagnosing and managing ADHD in children, young people and adults. They aim to improve recognition and diagnosis, as well as the quality of care and support for people with ADHD.

• Information for the public, Attention deficit hyperactivity disorder: diagnosis and management, NICE Guidance – Information written for the public on what you can expect if you have been diagnosed with ADHD.
• Attention deficit hyperactivity disorder: diagnosis and management, NICE Guidance – Full clinical guidance on the treatment and diagnosis of ADHD.

Information on ADHD

• Attention deficit hyperactivity disorder (ADHD), NHS – Information from the NHS on ADHD, diagnosis and treatment.
• ADHD and mental health, Mind – Information from the mental health charity Mind on ADHD and mental health.
• Attention deficit hyperactivity disorder (ADHD) and driving, GOV.UK – Information from the Government on ADHD and driving.
• An employer’s guide to ADHD in the workplace, Scottish ADHD Coalition – The Scottish ADHD Coalition have produced information to help employers support people with ADHD in the workplace.

ADHD charities

Below we have included details of some charities that work with and for people with ADHD:

• ADHD Aware – A charity run by volunteers, some with experience of ADHD themselves, who offer information and support meetings.
• ADHD Foundation – A charity advocating for people with ADHD and other physical and psychological health conditions.
• Scottish ADHD Coalition - A charity providing support to adults and children with ADHD in Scotland, and their parents, carers and families.

Peer support groups

• Support groups, ADHD UK – ADHD UK run peer-support groups, informative lectures and Q&A sessions.
• ADHD support group meetings, ADHD Aware - ADHD Aware run peer support group meetings to provide a safe space. These groups are for people with ADHD and their friends and families.

Wellbeing information

• Live Well, NHS – Information from the NHS on healthy living.
• Mindfulness, NHS – Information from the NHS on mindfulness.
• Sleep and tiredness, NHS – Information from the NHS on sleeping and tiredness.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Dietmar Hank and Dr Kate Franklin

Thank you to the people with lived experience of ADHD who helped to develop this resource, and kindly agreed to share their experiences as quotes:

Clare Dudeney, Hameed Khan, James Downs, Margaret Reed Roberts and Rachael Taylor.

Special thanks to Susan Dunn Morua, founder and facilitator of the Bristol Adult ADHD Support group.

Full references available on request.