Attention Deficit Hyperactivity Disorder (ADHD) in
adults
Mental
Health: have you been affected by the recession? We
would welcome your views.
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
- tell people: but don’t use
the diagnosis as an “excuse”
- ask for help from your friends and
family: but say exactly what you need
- get feedback about how you affect
others: and ask for feedback about when you do things
well
- use structure and
prioritise:
- make lists and note
- use colour coding
and reminders
- write down plans
- break down big goals into
smaller, manageable tasks
- reward yourself when things go
well: or don’t go too badly!
- respond to boring tasks
quickly: “OHIO” = only handle it once
- accept that some things are just
difficult: so it doesn’t get you down
- plan difficult meetings or
conversations: anticipate problems
- find ways to help yourself
concentrate: background music,
silence, something to “fiddle with” in your hands
- have “blow-out time” or “time
outs”: gym, dancing, running
- don’t beat yourself
up: (or your parents!)
- join a support group: or
start one!
- learn to tolerate your moods (without
panicking or catastrophising): NOT “I’m hopeless” or “I
never manage to…”
- find friends who are good for you: and spend
time with them
- 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.
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.
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