ADHD in adults

This information is about Attention Deficit Hyperactivity Disorder in adults.

It describes what ADHD feels like, some of the help that is available, how you can help yourself and how to help someone else who has been diagnosed with ADHD.

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This information reflects the best available evidence at the time of writing. We aim to review our mental health information every three years, and update critical changes more regularly.

© February 2019 Royal College of Psychiatrists, all rights reserved. This leaflet may not be reproduced in whole or in part, without the permission of the Royal College of Psychiatrists. 

What is Attention Deficit Hyperactivity Disorder (ADHD)?

It is a pattern of behaviours which usually appear in childhood. Parents and teachers notice that a child is:

  • unusually over-active.
  • distracted, cannot stick to anything for any length of time. 
  • impulsive, does things on the spur of the moment or without thinking.
  • unable to concentrate for any length of time. 

Many of us might have one of these problems, but we do not have all of them. To have a diagnosis of ADHD1, these problems must be bad enough to interfere with:

  • How you get on with other people - or 
  • How you get on at work or school.

What happens as time goes on?

It tends to get better as you get older, but can continue into adult life2. The over-activity usually gets less, but the impulsivity, poor concentration and risk-taking can get worse. These can make it hard to work, learn and get on with other people. It’s not surprising that adults with ADHD are more likely to experience depression, anxiety, feelings of low self-esteem and drug misuse and can feel overwhelmed and struggle in less structured environments.

 

 

If you have these difficulties as a child or teenager, you would usually see either a Child and Adolescent Mental Health Service (CAMHS) or a Paediatric Service. 

Specialist staff would see you for an assessment interview of 1-2 hours. They would need to talk to your family and teachers to understand your early childhood and any current problems. 

If you have become aware of these problems as an adult, you would see a professional with expertise in ADHD from either a Community Mental Health team or a Neurodevelopmental Service.  This is often a psychiatrist but may also be a specialist nurse or psychologist. The assessment will take 1-2 hours and will focus on the problems described above, and how troublesome they are. 
 
The classification used in the UK is the ICD 10 system3. In the US, the DSM system4 allows for an “inattentive” type, without the over-activity. This is sometimes called Attention Deficit Disorder (ADD).
 

 

Around 3-6 in every 100 school-aged children have ADHD5. For about 1 in 7 children with ADHD, their ADHD will continue into adulthood. About half will have some problems as adults,  although not full ADHD6. In children, boys are more commonly diagnosed than girls, where as in adults, there are more equal numbers of men and women seen in clinics7.

 

You may find that:

  • You 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 - you 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. 
Genes do seem to be involved - one-third of those with ADHD have at least one parent with similar symptoms8. There is increasing evidence that negative early life experiences such as maternal smoking and other toxins (both before and after birth) can result in genetic changes which can make it more likely for people to develop ill health, including ADHD9,10
 

Your psychiatrist or mental health professional can go over the advantages and disadvantages of medication and psychological interventions. They can be used on their own or together.

 

Psychotherapy

Cognitive Behavioural Therapy (CBT) and Mindfulness techniques and psychoeducational groups11,12,13 can help you to:

  • 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 methylphenidate (Ritalin, Concerta, Equasym), dexamphetamine (Dexadrine) and lisdexamfetamine (Elvanse). 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 misused so, in the UK, they are legally 'controlled' drugs. The dose will usually be more than that prescribed for children1,11,14. The side-effects include weight loss and occasionally, psychosis. 

Atomoxetine (also known as Strattera) is a 'non-stimulant' medication. It can be useful in people who have side effects or where stimulant medication is less suitable. It takes several weeks to begin to have an effect. Side-effects can include stomach cramps and diarrhoea, and some people have reported ideas of self-harm.
 

How effective are these treatments?

Less research has been done into the medication treatments for adults with ADHD, than with children, so some medications are not yet licensed in adults, even though they are commonly used. Your psychiatrist can still prescribe them, but may need to make it clear that the prescription is 'off license'. 
 

Adjustments and support

You may cope better or be affected less by the symptoms of ADHD if your environment suits you. ADHD is considered a disability in the UK and therefore your school / college or place of work must make “reasonable adjustments” to support you. 

Seeking help from others who understand the problems may be useful to both you and your partner or family. There are a number of self-help groups for adults with ADHD across the country and also some online forums. 
 

 

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 is now a lot of information about ADHD in adults and you can find out more (see below)

  • in books
  • the internet
  • support groups 

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 what things make it 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. 

These are things which have been helpful for people with ADHD. These will not work for everyone and there may be other things which you have discovered for yourself.
 
  • 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 off steam, like exercise, dance, sport
  • Find ways of relaxing – like music or relaxation techniques. 
  • Set yourself realistic goals. 
  • Remind yourself about the things you can do well. 
  • Avoid things that make life more difficult. These could be arguments with other people, using drugs and alcohol, and pressure at work. 
  • Don’t spend time with people who encourage you to drink too much or use drugs, or who create 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 can 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

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. 
  • How to succeed as a Hunter in a Farmer’s World. Thom Hartmann – a book exploring the evolutionary theories behind ADHD and why people with ADHD feel out of place in the modern world. 
  • Fast Minds – How to thrive if you have ADHD (or think you have):  Craig Surman, Tim Bilkey Karen Weintraub – a book to empower those with ADHD, using a model of neuro-diversity rather than deficit with lots of exercises to create personalised strategies. 

 

 

1 NICE Guidelines (NG87) 2018 https://www.nice.org.uk/guidance/NG87

2 Asherson, P; Buitelaar, J; Faraone, S.V. et.al. Adult attention-deficit hyperactivity disorder: key conceptual issues. The Lancet Psychiatry, 3: 6; 2016: 568-578.

3 ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva. World Health Organisation (1992).https://www.cdc.gov/ncbddd/adhd/diagnosis.html

4 DSM-5 Diagnostic and statistical manual of mental disorders (5th Edition). Washington, DC: Author American Psychiatric Association (2013) .https://www.cdc.gov/ncbddd/adhd/diagnosis.html

5 Polanczyk, G., de Lima, M.S., Horta, B.L., Biederman, J., and Rohde, L.A. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am. J. Psychiatry. 2007; 164: 942–948.

6 Faraone, S.V., Biederman, J., and Mick, E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol. Med. 2006; 36: 159–165.

7 Kooij, S.J., Bejerot, S., Blackwell, A., et al. European consensus statement on diagnosis and treatment of adult ADHD: The European network adult ADHD. BMC Psychiatry. 2010; 10: 67.

8 Larsson H, Asherson P, Chang Z, et al. Genetic and environmental influences on adult attention deficit hyperactivity disorder symptoms: a large Swedish population-based study of twins. Psychol Med 2013; 43: 197-207.

9 Froehlich TE, Lanphear BP, Auinger P, et al. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics 2009; 124: e1054-e1063.

10 Latham KE, Sapienza C, Engel N. The epigenetic lorax: gene-environment interactions in human health. Epigenomics (2012) 4:383–402.

11 Philipsen, A., Jans, T., Graf, E., et al. Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: a randomized clinical trial. JAMA Psychiatry. 2015; 72: 1199–1210.

12 Cairncross, M. and Miller, C.J. the effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. J. Atten. Disord. Feb 2, 2016;

13 Hirvikoski T, Lindström T, Carlsson J, et al. Psychoeducational groups for adults with ADHD and their significant others (PEGASUS): A pragmatic multicenter and randomized controlled trial. Eur Psychiatry. 2017 Jul;44:141-152.

14 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.

Produced by the RCPsych Public Engagement Editorial Board
 
Original Author: Dr Helen Crimlisk, Consultant Psychiatrist, Sheffield Health and Social Care NHS Foundation Trust
Thomas Nicoll, Medical Student, Sheffield Medical School
 
Many thanks to the members of the Sheffield Adult ADHD Support Group, who reviewed, commented on and made suggestions for the wording and content of this updated leaflet
 
Series Editor: Dr Phil Timms  
Series Manager: Thomas Kennedy