Does any of this sound familiar?
I’m always on edge. Even minor frustrations and unexpected hiccups make me melt down.
My home is a disaster with piles of paper and unfinished projects everywhere.
As a child, I was a solid student and turned papers in on time. Now, I’m always late, constantly losing things and often need my family to remind me about our conversations.
My friends tell me I’m too hard on myself, but it feels like my days are filled with me making one mistake after another. Why can’t I just be like everyone else?
You might assume these are reflections of individuals living with depression, anxiety or even memory impairment. But another condition could be responsible for these challenges, and it is one that is increasingly being diagnosed in adults over age 50—attention-deficit/hyperactivity disorder (ADHD).
Bottom Line Personal asked Tamara Rosier, PhD—who was diagnosed with ADHD at age 40 and wrote Your Brain’s Not Broken—to explain the signs of ADHD in adults and how it is treated.
We associate ADHD with children who can’t sit still at the table or who daydream at school, but more adults now are being diagnosed with this neurological disorder. Adults with ADHD often report feeling antsy or have difficulty concentrating, but they also are likely to struggle with a list of physical, mental and emotional challenges, including…
These symptoms are emotionally draining and interfere with home life, interpersonal relationships, work, self-esteem and more. Compared with neurotypical adults, people with ADHD have a higher risk for divorce, financial debt, addiction, job loss, accidents and more.
More adults have ADHD than you might think. About 4% of US adults are moving through life with significant deficits in executive dysfunction, emotional regulation, working memory and more due to ADHD. Diagnoses are on the rise, growing four times faster than those in children. Between 2007 and 2016, adult ADHD diagnoses increased 123%, versus a 26% increase among children, according to a recent JAMA study.
Why are so many adults being diagnosed? Many people attribute this uptick to the stress of the COVID pandemic. For millions of men and women with undiagnosed ADHD, the disruption to daily life and the stress created by the pandemic overpowered whatever coping mechanisms they had in place. People with ADHD compensate for their challenges by creating rigid routines to keep themselves and their families on track or they structure their work spaces to minimize interruptions. These compensatory mechanisms, also referred to as masking, are exhausting to maintain but widely adopted as a means of fitting into society.
An even bigger reason for the uptick may be genetics. About 75% of children with ADHD have a relative with the condition. Oftentimes, after a child is diagnosed with ADHD, his/her parent realizes that he has many of the same symptoms. These people weren’t diagnosed as children, perhaps because their families had routines and structures in place that kept them organized and punctual…or, for women in particular, because ADHD was overlooked. Boys tend to exhibit more obvious signs, including bounce-off-the-walls hyperactivity and chattiness, while girls often have subtler, more internalized symptoms such as inattentiveness, sensitivity to criticism and constantly churning brains. In most cases, these adult patients have chalked their symptoms up to stress or a “That’s just how I am” mentality. Many have been misdiagnosed with anxiety and depression and never questioned whether something else might be at play.
ADHD is not caused by laziness, flakiness or any moral failing, but by neurological differences, including differences in brain structure and neurochemical transmission. In an ADHD brain, the prefrontal cortex—the region responsible for telling us what to do and how and when to do it—is smaller and less efficient than in typical brains. This results in poor executive functioning, including trouble focusing, planning, organizing, controlling impulses and managing time. Research also reveals that levels of dopamine, a neurotransmitter that helps us regulate emotions and derive pleasure from life, are lower in ADHD brains. Low dopamine levels are linked with…
Mood dysregulation, including feeling intense anger, embarrassment, passion and more. The prefrontal cortex of someone with ADHD doesn’t kick in fast enough to help him slow down and think matters through, so he falls into a pool of deep emotions with no lifeguard to pull him out.
Poor motivation, particularly when doing mundane tasks. These tasks don’t provide the dopamine hit like something new and shiny, such as an ever-refreshing social-media feed.
Boredom, which people with ADHD try to combat with activities that trigger dopamine, including scrolling online…binge-watching TV…diving into new hobbies (only to ditch them when they start to feel routine)…and engaging in risky behaviors such as overspending, fast driving or using illegal drugs.
Despite the rising number of adult ADHD diagnoses, tens of millions of adults remain undiagnosed. (Fewer than 20% of adults with ADHD have been diagnosed or treated.) This is partly due to a lack of education and awareness amongst health-care providers, many of whom still consider ADHD a “kid’s diagnosis.” In fact, an official ADHD diagnosis requires that your symptoms started before age 12, but many children had support structures that camouflaged their symptoms. It also can be tricky for adults to think back four, five, even six decades and accurately recall their behavior in school, time-management skills or ability to handle stress.
Complicating matters is the fact that ADHD often is misdiagnosed as anxiety, depression or a mood disorder due to symptom overlap, especially among women. For these adults, the anxiety or depression they’ve been told they have actually is the inner restlessness or motivational inertia of ADHD.
Even more often, ADHD occurs alongside these conditions. Up to half of adults with ADHD also have depression. The same goes for anxiety—in some cases, depression or anxiety are caused by the stress of ADHD.
Also confusing is that “ADHD” is a misnomer. People who have ADHD don’t have an attention deficit—they almost have too much attention. Their brains struggle to screen out irrelevant information. They also have the ability to hyperfocus on things they enjoy, becoming so absorbed in dopamine-triggering activities that they lose track of time.
Fortunately, ADHD is highly treatable. Stimulant medications such as amphetamine/dextroamphetamine (Adderall) and lisdexamfetamine dimesylate (Vyvanse) work by regulating dopamine levels. These tend to be well-tolerated but may slightly elevate blood pressure, so make sure your prescriber knows if you have any heart conditions.
Nonstimulant medications for ADHD include atomoxetine (Strattera), which targets norepinephrine, another neurotransmitter implicated in ADHD…and bupropion (Wellbutrin), an antidepressant that impacts dopamine and norepinephrine.
Partnering with an ADHD-certified coach is another way to manage symptoms and work toward goals. An ADHD-certified coach is trained to help people with ADHD cultivate strategies to help their neurodiverse minds stay focused, productive, organized and emotionally regulated. Find an ADHD-certified coach through the ADHD Coaches Organization (ADHDCoaches.org) or get a recommendation from friends, family or a trusted health-care provider.
