Adult ADHD

Adult ADHD: A Guide to Symptoms, Signs, and Treatments

Adult ADHD symptoms include difficulty with time management, memory, organization, emotional regulation, and more. Learn what adult ADD looks like, and how it’s diagnosed and treated.

Adult ADHD: Overview

Adult attention deficit hyperactivity disorder (ADHD or ADD) is a neurological disorder that affects an estimated 4.4 percent of U.S. adults, and is more commonly diagnosed in men (5.4%) than in women (3.2%)1. ADHD in adults is characterized by a persistent pattern of inattention, hyperactivity, and/or impulsivity that interferes with and impacts work, home life, and relationships – especially if left untreated.

ADHD was historically considered a childhood condition, but it is now recognized as a lifelong condition that persists well into adulthood. Persistence rates, however, vary, ranging from 6%1 to 30%2 and perhaps even higher3. Individuals with ADHD may receive a diagnosis in childhood or well into adulthood. Trends show a rise in rates of ADHD diagnoses among U.S. adults in the last decade.4

Still, many adults with ADHD never receive a diagnosis in their lifetimes. Scientists believe ADHD is significantly underdiagnosed in adults.5

What Does ADHD Look Like in Adults?

Adult ADHD symptoms broadly resemble the common signs of childhood ADHD. However symptom intensity — especially hyperactivity — is known to decrease over time for many individuals.6

What are Common Adult ADHD Symptoms?

  • Inattention
    • Poor attention to detail
    • Difficulty getting started and completing tasks
    • Difficulty focusing and regulating attention
    • Forgetfulness
    • Poor time management, organizational skills
  • Impulsivity
    • Fidgeting
    • Restlessness
    • Interrupting frequently
    • Talking excessively
  • Emotional dysregulation
  • Low frustration tolerance

Challenges Associated with Adult ADHD

Adult ADHD impacts virtually every aspect of life, more so if the condition remains undiagnosed, untreated, or ineffectively treated – all of which can have detrimental effects on an individual’s psychological well-being and quality of life.6

Adult ADHD Impact on School and Work Performance

Adult ADHD symptoms like poor time management and concentration, procrastination, and forgetfulness can and do make school and the workplace difficult to navigate. Many studies have linked ADHD to difficulties in school (including higher education) and in the workplace.7 Individuals with ADHD are more likely to face difficulty gaining and maintaining employment compared to neurotypical adults, especially if they did not receive treatment in childhood.8

Adult ADHD Impact on Relationships

ADHD symptoms in adults like poor listening skills, low frustration tolerance, inability to follow through with tasks, and impulsivity can lead to a number of difficulties with romantic relationships, friendships, familial relationships, and other social connections.5

Adult ADHD Impact on Criminality and Safety

Research has linked ADHD in adults to criminality, rule-breaking, and other legal and safety issues – including greater risk of getting into car accidents compared to the general population.9 One study found that individuals who present ADHD symptoms in childhood are more likely to engage in criminal activities as young adults than are non-ADHD individuals.10 Another recent systematic review estimates that 26% of prison inmates have adult ADHD.11

Adult ADHD Impact on Substance Abuse

ADHD and substance abuse are strongly connected. ADHD adults are twice as likely to be diagnosed with substance use disorder (SUD) compared to individuals without ADHD.12 Many adults with ADHD and SUD report using substances like alcohol and other drugs as a way to self-medicate and manage ADHD symptoms.13

Adult ADHD and Comorbid Conditions

Adult ADHD seldom exists alone. Roughly 60% to 70% of adults with ADHD have a comorbid disorder.14 According to a 2006 national study on adult ADHD1:

  • About 40% have been diagnosed with a mood disorder.
  • Nearly 50% have been diagnosed with anxiety disorder, including social phobia (30%) and PTSD (12%)
  • About 15% also have a substance use disorder diagnosis

The following table from expert William Dodson, M.D., shows how childhood symptoms of ADHD can translate to adulthood.

ADHD in Childhood >>> ADHD in Adulthood
School failure or under-achievement Becomes Job failure or underemployment
Multiple injuries Becomes Car wrecks or risk-taking
Drug experimentation Becomes Drug dependence
Oppositional defiant disorder or conduct disorder Becomes Criminal involvement or antisocial personality disorder
Repetitive failure Becomes Hopelessness, frustration, resignation

If you think you might have adult ADHD, take this free, anonymous ADHD symptom test for adults.

Adult ADHD: Causes

What causes ADHD? It’s not entirely clear, but most research suggests these main factors:

  • Genetics or Heredity: ADHD is a highly heritable condition. Approximately half of parents with ADHD will have a child with the condition.6 Recent genetics research also points to several markers that appear to be associated with ADHD development.15
  • Environmental Factors: Studies suggest that exposure to extreme stress, trauma, or certain toxins – like lead16 or bisphenol-A17 –increase the risk or severity of ADHD symptoms.
  • Disruption of Development: Brain injury18 or events that affect the central nervous system during development, like preterm birth19 or alcohol use during pregnancy,20 may have a major role in ADHD development.

ADHD is not a result of poor diet, inadequate exercise, excessive screen time, or socioeconomic factors – though some of these factors and other stressors may worsen ADHD symptoms in some individuals. And while widely considered a childhood condition, researchers continue to explore whether ADHD onset can occur in adulthood.21

Adult ADHD Diagnosis

Healthcare providers use symptom criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to diagnose ADHD in adults.22 The DSM-5 lists nine symptoms that suggest predominantly inattentive ADHD (often called ADD), and nine separate symptoms that suggest predominantly hyperactive-impulsive ADHD.

An adult can be diagnosed with either ADHD subtype — or Combined Type ADHD — if they exhibit at least five of the nine symptoms in two or more settings – at work and at home, for example – for at least six months.

An adult ADHD symptom assessment often includes the following with a clinician experienced in adult ADHD:

  • A medical exam to rule out other commonly related conditions (see comorbid conditions above)
  • A clinical interview to gather information about family medical and symptom history, especially in childhood
  • ADHD rating scales completed by the adult and/or those known to them to assess symptoms, strengths, and weaknesses

A complete assessment may take several visits and/or visits with an ADHD specialist.

Adult ADHD Treatment

The best treatment for adult ADHD is a combination of therapy and medication.23 24 Adults should expect to work closely with their physicians to adjust medication and dosage, and to find the right ADHD treatment combination to alleviate symptoms.

Adult ADHD Medication

There are two main types of medication used to treat ADHD:

  • Stimulants
  • Non-stimulants

Stimulant Medications for Adult ADHD

Stimulants are considered first-line pharmacological treatment for adult ADHD25, and fall into two major categories:

All stimulant medications are different forms of these two types of medication.

Non-stimulant Medications for Adult ADHD

Several types of non-stimulants (considered second-line treatments) are used to treat ADHD.

  • FDA-approved non-stimulant medications, like Strattera or Intuniv, were specifically designed to treat ADHD.
  • Other non-stimulant medications are used “off-label” to address ADHD symptoms. These include clonidine for ADHD, Wellbutrin for ADHD, blood pressure medications, or wakefulness-promoting medications. Physicians turn to these medications when other ADHD treatment is not effective because they have similar mechanisms of action in the body as some ADHD medications.

Learn more about the various medications available to treat ADHD, in our extensive ADHD medication guide.

Adult ADHD Therapy

Most adults experience symptom reduction with ADHD medication, but many continue to struggle with work, day-to-day responsibilities, or low self-esteem due to a lifetime with attention deficit disorder. ADHD medication can regulate the brain neurologically. Psychotherapy or professional guidance can organize and motivate adults with ADHD to address specific challenges through conditioning. Common ones include:

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavioral therapy (DBT)
  • ADHD or life coaching

These therapies and interventions, combined with education about ADHD, can help adults recognize the places where ADD symptoms are causing difficulty in their lives and work to change negative patterns

Lifestyle Changes and Natural Remedies for Adult ADHD

Environmental factors play a big role in the severity of ADHD symptoms in adults. Adults with ADHD can positively impact their symptoms by modifying lifestyle factors like:

  • Sleep: Sleep problems are common among adults with ADHD. Adequate rest — 7 to 9 hours of sleep each night — has a positive effect on the ADHD brain and functioning, and can help with symptom management.26
  • Exercise: Studies show that exercise has a positive impact on ADHD brains and can help with reducing symptoms.27 28 Mindfulness and meditation activities can also help with symptom regulation.29
  • Diet: Everyone benefits from a healthy diet, and that includes adults with ADHD, many of whom self-report better symptom management by maintaining a balanced diet.
  • Supplements: Iron, zinc, and magnesium are often naturally low in people with ADHD. Many ADHD individuals take these as supplements, though research on the benefits are inconclusive.30 Melatonin can also help with sleep difficulties. There are also a wide variety of natural remedies for ADHD that may help to alleviate symptoms.

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Sources

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2 Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics. 2013;131(4):637-644. doi:10.1542/peds.2012-2354

3 Sibley, M.H., Swanson, J.M., Arnold, L.E., Hechtman, L.T., Owens, E.B., Stehli, A., Abikoff, H., Hinshaw, S.P., Molina, B.S., Mitchell, J.T., Jensen, P.S., Howard, A.L., Lakes, K.D., Pelham, W.E. and (2017), Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychol Psychiatr, 58: 655-662. doi:10.1111/jcpp.12620

4 Chung W, Jiang S, Paksarian D, et al. Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups. JAMA Netw Open. 2019;2(11):e1914344. doi:10.1001/jamanetworkopen.2019.14344

5 Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders, 16(3), PCC.13r01600. https://doi.org/10.4088/PCC.13r01600

6 Gentile JP, Atiq R, Gillig PM. Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management. Psychiatry (Edgmont). 2006;3(8):25-30.

7 Kuriyan, A. B., Pelham, W. E., Jr, Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of abnormal child psychology, 41(1), 27–41. https://doi.org/10.1007/s10802-012-9658-z

8 Halmøy, A., Fasmer, O. B., Gillberg, C., & Haavik, J. (2009). Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. Journal of attention disorders, 13(2), 175–187. https://doi.org/10.1177/1087054708329777

9 Chang Z, Quinn PD, Hur K, et al. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017;74(6):597–603. doi:10.1001/jamapsychiatry.2017.0659

10 Fletcher, J., & Wolfe, B. (2009). Long-term consequences of childhood ADHD on criminal activities. The journal of mental health policy and economics, 12(3), 119–138.

11 Baggio, S., Fructuoso, A., Guimaraes, M., Fois, E., Golay, D., Heller, P., Perroud, N., Aubry, C., Young, S., Delessert, D., Gétaz, L., Tran, N. T., & Wolff, H. (2018). Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis. Frontiers in psychiatry, 9, 331. https://doi.org/10.3389/fpsyt.2018.00331

12 Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021

13 Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Current psychiatry reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6

14 Piñeiro-Dieguez, B., Balanzá-Martínez, V., García-García, P., Soler-López, B., & CAT Study Group (2016). Psychiatric Comorbidity at the Time of Diagnosis in Adults With ADHD: The CAT Study. Journal of attention disorders, 20(12), 1066–1075. https://doi.org/10.1177/1087054713518240

15 Demontis, D., Walters, R. K., Martin, J., et.al. (2019). Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nature Genetics, 51(1), 63–75. https://doi.org/10.1038/s41588-018-0269-7

16 Donzelli, G., et al.”The Association between Lead and Attention-Deficit/Hyperactivity Disorder: A Systematic Review.” International Journal of Environmental Research and Public Health. January 2019, 16:3. doi: 10.3390/ijerph16030382

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18 Narad ME, Kennelly M, Zhang N, et al. Secondary Attention-Deficit/Hyperactivity Disorder in Children and Adolescents 5 to 10 Years After Traumatic Brain Injury. JAMA Pediatr. 2018;172(5):437–443. doi:10.1001/jamapediatrics.2017.5746

19 Ask H, Gustavson K, Ystrom E, et al. “Association of Gestational Age at Birth With Symptoms of Attention-Deficit/Hyperactivity Disorder in Children.” JAMA Pediatrics online, 25 June 2018. doi:10.1001/jamapediatrics.2018.1315

20 Eilertsen, E.M., et al. “Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD): a prospective sibling control study.” International Journal of Epidemiology. October 1, 2017, 46:5, pp. 1633-1640. doi: 10.1093/ije/dyx067

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22 American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders. DSM-V. Washington, DC: American Psychiatric Publishing

23 Geffen, J., & Forster, K. (2018). Treatment of adult ADHD: a clinical perspective. Therapeutic advances in psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977

24 Wolraich, M. L., Hagan, J. F., et.al. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528

25 Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 4(2), 389–403. https://doi.org/10.2147/ndt.s6985

26 Wajszilber, D., Santiseban, J. A., & Gruber, R. (2018). Sleep disorders in patients with ADHD: impact and management challenges. Nature and science of sleep, 10, 453–480. https://doi.org/10.2147/NSS.S163074

27 Christiansen, L., Beck, M. M., Bilenberg, N., Wienecke, J., Astrup, A., & Lundbye-Jensen, J. (2019). Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. Journal of clinical medicine, 8(6), 841. https://doi.org/10.3390/jcm8060841

28 FRITZ, KATHRYN M.; O’CONNOR, PATRICK J. Acute Exercise Improves Mood and Motivation in Young Men with ADHD Symptoms, Medicine & Science in Sports & Exercise: June 2016 – Volume 48 – Issue 6 – p 1153-1160 doi: 10.1249/MSS.0000000000000864

29 Mitchell, J. T., McIntyre, E. M., English, J. S., Dennis, M. F., Beckham, J. C., & Kollins, S. H. (2017). A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. Journal of attention disorders, 21(13), 1105–1120. https://doi.org/10.1177/1087054713513328

30 Villagomez, A., & Ramtekkar, U. (2014). Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder. Children (Basel, Switzerland), 1(3), 261–279. https://doi.org/10.3390/children1030261

Updated on October 14, 2020

3 Related Links

  1. I am grateful for posting this comment. I will keep the details out and report positive outcomes! I have been seeing a psychiatrist for my Adult ADHD for 5 years at least and never had the proper RX experiences I feel a loss of trust and robbed from years of managed Adult ADHD. I recently was on “God knows what!” It felt like atomoxetine , or strattera? Mixed in a capsul with a stimulant. Recently tried blue 10 mg. A/D scored adderall tablets 10 mg. And WOW I AM CLEAR! FOCUSED AND NOW KNOW WHAT IVE MISSED OUT ON!… WHY HAS MY PSYCHIATRIST DENIED ME THIS TREATMENT? IF ANYONE CAN ANSWER THAT WOULD BE SOO APPRECIATED. LIFE IS BACK AND BETTER FOR THE TIME BEING. I HAVE 4 TABLET’S TO TRY. IS IT NORMAL TO FEEL A LOSS OF TRUST? AFTER IVE BEEN DEALT WITH A Series of terrible, terrible meds! When all it took was 1 tablet.. A REAL TABLET and a desire to fix my own ADHD ISSUE BECAUSE I KNEW THERE WAS MORE TO LIFE THAT I WAS BEING HELD FROM! THANKS. ENJOY THE READ AND SOMETIMES WE AS PEOPLE NEED TO ALTER OUR OWN LIVES. FREEDOM WORKS!

  2. My biggest issue with the natural treatments is these are good things for everyone and may help cope but it is not a cure and if it does then the person was misdiagnosed.

  3. To be honest here… didn’t get tested for years until a few months ago, I am 29 years of age. my family knew I had add or ADHD but always told me that nothing was wrong with me. when I used to serious about working out I used to have a strict diet on myself as well of what Vitamins to take and it was more like the foods that I am now eating but I am even more careful of what I eat today.
    I take Adderall 20mg a day to help me. I also take vitamins after I have eaten something such as iron, magnesium, Omega 3 fish oil (EPA 300mg/DHA 200MG), B12, D3.

    plus meditating and getting in shape again has been helping allot so far.
    I am still learning what to eat and what to take, vitamin wise.

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