ADHD is often thought of as something children experience. However, adult ADHD is more common than you might have imagined.
Perhaps you know someone or you are someone who may have adult ADHD.
BY READING THIS ARTICLE YOU WILL:
- Understand Adult ADHD Prevalence
You may hear more now about ADHD than ever, but just how common is it? That's hard to say exactly, because researchers have used different techniques to answer that question.
Many reports estimate that anywhere from 5% to 8% of school-age kids have the disorder. But the CDC now puts it at 11%.
Some studies have relied on parents saying that a health care provider told them their child has the disorder. But that doesn't necessarily mean that the child meets all the criteria for the condition, says Craig Surman, MD, co-author of Fast Minds:
How to Thrive if You Have Adult ADHD (Or Think You Might).
Some doctors might give children an ADHD label even when they may have another educational, behavioral, or mental issue. The flip side is that some kids who truly have the disorder aren't getting diagnosed with it.
"ADHD often overlaps with a lot of other problems, and many clinicians don't know how to categorize what they're seeing," Surman says.
But just how common is ADHD in adults? Well to answer that question we dug into Harvard Medical Schools database and this is what we found.
ADHD prevalence among adults was 4.4% in the U.S. as of 2001-2003, according to Harvard Medical School. However, the rate of ADHD in adults is likely underreported as 85% of children with ADHD will likely have the disorder as adults.
Diagnostic criteria for ADHD were initially developed for children, and therefore, the diagnosis of ADHD among adults is growing four times faster than ADHD diagnoses among children in America (JAMA Psychiatry, 2019). The following figures represent the known estimated percentage of adults with ADHD per age group:
(Harvard Medical School, 2007)
“Research suggests that the majority of youth with ADHD will also have ADHD as adults,” says Nekeshia Hammond, Psy.D, a psychologist at Hammond Psychology and Associates in Florida. “One critical thing for youth to do is learn to manage their ADHD symptoms, which may positively impact their adult outcomes. Anecdotally, some adults have described experiencing milder impairments in functioning because they have learned triggers and ways to cope with their ADHD symptoms.”
Some adults previously diagnosed with ADHD have learned to cope with their symptoms well and do not meet the criteria for ADHD later in their life. “They would not necessarily meet ‘full criteria’ for ADHD (they may still have some of the attention symptoms, but not enough to receive a diagnosis),” Dr. Hammond says. “Most research suggests that ADHD does not really ‘go away,’ but more so adults report less symptoms. For instance, hyperactivity symptoms typically decrease with age.” Only 11% of adults with ADHD receive treatment.
In addition, some adults may go undiagnosed and therefore untreated because of co-occurring mental health conditions that mask the symptoms of ADHD. These include:
(Primary Care Companion to the Journal of Clinical Psychiatry, 2009)
CAN YOU GROW OUT OF ADHD?
Those symptoms can change over time, too, so ADHD in adults rarely looks the way it does in kids. While some young children with the disorder, especially boys, might have problems sitting still and end up running all over a classroom, adults are much more likely to have trouble focusing and staying organized.
"It's very unusual to have hyperactive-impulsive symptoms as the main problem [in adulthood], but inattentive problems tend to persist," Surman says.
About 60% of people who had the condition in childhood still have symptoms as adults. Do the other 40% "grow out" of it? Not exactly, he says.
ADHD in adulthood may cause patients to experience impairment in their home, social, and work life.
In a case-controlled family study, adults with ADHD reported significantly lower quality of life compared to non-ADHD control participants, based on survey scores.
One study estimated that up to 48% of adults who meet criteria for ADHD may fail to have a conversation about their symptoms with a healthcare provider.
The most effective ADHD treatment is a combination of medication and behavioral therapy. Stimulant medications, like Adderall and Ritalin, are usually prescribed first. If stimulants don’t work, a healthcare provider might try a non-stimulant medication such as Strattera.
These medications affect dopamine and/or norepinephrine to help patients concentrate and feel less impulsive.
Cognitive behavioral therapy (CBT) is a popular form of behavioral treatment for people, especially children, with ADHD. A professional therapist can teach children how to express their thoughts and feelings without being disruptive to others. Parents and teachers can also gain insight through CBT for learning how to reward positive behaviors.
As of 2016, 77% of children with ADHD aged 2 to 17 were receiving some form of treatment, with approximately one-third (32%) receiving both medication and behavioral treatment.
(Journal of Clinical Child and Adolescent Psychology, 2018)
Before I tell you about these special brain chemicals, let me explain a bit about brain anatomy.
There are millions of cells, or neurons, densely packed into various regions of the brain. Each region is responsible for a particular function.
Some regions interact with our outside world, interpreting vision, hearing, and other sensory inputs to help us figure out what to do and say. Other regions interact with our internal world — our body — in order to regulate the function of our organs.
For the various regions to do their jobs, they must be linked to one another with extensive “wiring.” Of course, there aren’t really wires in the brain. Rather, there are myriad “pathways,” or neural circuits, that carry information from one brain region to another.
Information is transmitted along these pathways via the action of neurotransmitters (scientists have identified 50 different ones, and there may be as many as 200). Each neuron produces tiny quantities of a specific neurotransmitter, which is released into the microscopic space that exists between neurons (called a synapse), stimulating the next cell in the pathway — and no others.
How does a specific neurotransmitter know precisely which neuron to attach to, when there are so many other neurons nearby? Each neurotransmitter has a unique molecular structure — a “key,” if you will — that is able to attach only to a neuron with the corresponding receptor site, or “lock.” When the key finds the neuron bearing the right lock, the neurotransmitter binds to and stimulates that neuron.
Brain scientists have found that deficiencies in specific neurotransmitters underlie many common disorders, including anxiety, mood disorders, anger-control problems, and obsessive-compulsive disorder.
ADHD was the first disorder found to be the result of a deficiency of a specific neurotransmitter — in this case, norepinephrine — and the first disorder found to respond to medications to correct this underlying deficiency. Like all neurotransmitters, norepinephrine is synthesized within the brain.
The basic building block of each norepinephrine molecule is dopa; this tiny molecule is converted into dopamine, which, in turn, is converted into norepinephrine.
ADHD seems to involve impaired neurotransmitter activity in four functional regions of the brain:
• Frontal cortex. This region orchestrates high-level functioning: maintaining attention, organization, and executive function. A deficiency of norepinephrine within this brain region might cause inattention, problems with organization, and/or impaired executive functioning.
• Limbic system. This region, located deeper in the brain, regulates our emotions. A deficiency in this region might result in restlessness, inattention, or emotional volatility.
• Basal ganglia. These neural circuits regulate communication within the brain. Information from all regions of the brain enters the basal ganglia, and is then relayed to the correct sites in the brain. A deficiency in the basal ganglia can cause information to “short-circuit,” resulting in inattention or impulsivity.
• Reticular activating system. This is the major relay system among the many pathways that enter and leave the brain. A deficiency in the RAS can cause inattention, impulsivity, or hyperactivity.
These four regions interact with one another, so a deficiency in one region may cause a problem in one or more of the other regions. ADHD may be the result of problems in one or more of these regions.
Mental health conditions
If you have certain mental health conditions like depression, anxiety, or attention-deficit/ hyperactivity disorder (ADHD), you may find it hard to enjoy your daily tasks. These mental health conditions often trigger fatigue, sleeplessness, or trouble concentrating. These symptoms can drain your motivation and make it difficult to get through the day.
Fortunately, treatment can help enhance your quality of life. If you have symptoms of depression, anxiety, ADHD, or other mental health conditions, speak with your healthcare provider and/or a mental health professional. The right treatment (which may consist of psychotherapy and medication) often improves energy levels and boosts motivation.
Hormone imbalances
The hormones in your body act as chemical messengers. They send important signals throughout your body and regulate many physical functions. Hormones can affect your weight, appetite, energy levels, and sex drive.
But an imbalance in certain hormone levels can affect motivation. If your hormones are imbalanced, you may also feel tired or have trouble sleeping. Many people with hormone imbalances also report weight gain, hair loss, or a reduced sex drive.
In both men and women, low testosterone can be a common culprit for diminished motivation. To easily check for low testosterone without the inconvenience of heading over to a lab, consider taking the Lab Me at-home neurotransmitter health test.
Emotional exhaustion or occupational burnout
Lack of motivation can sometimes be linked to issues in your personal life that cause emotional exhaustion, or result from job burnout. To cite a couple of examples, if you feel stuck in an unhappy marriage, or if you're constantly stressed out at work, your motivation may be blunted.
A therapist or counselor can often help you work through these challenges. By digging deeper into the psychological factors behind your emotional exhaustion or occupational burnout, they may be able to identify cognitive strategies you can use to reframe your outlook to one that is more balanced and resilient.
Standard treatments for ADHD in adults typically involve medication, education, skills training and psychological counseling.
A combination of these is often the most effective treatment. These treatments can help manage many symptoms of ADHD, but they don't cure it. It may take some time to determine what works best for you.
Medications
Talk with your doctor about the benefits and risks of any medications.
Stimulants, such as products that include methylphenidate or amphetamine, are typically the most commonly prescribed medications for ADHD, but other medications may be prescribed. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters.
Other medications used to treat ADHD include the non stimulant atomoxetine and certain antidepressants such as bupropion. Atomoxetine and antidepressants work slower than stimulants do, but these may be good options if you can't take stimulants because of health problems or if stimulants cause severe side effects.
The right medication and the right dose vary among individuals, so it may take time to find out what's right for you. Tell your doctor about any side effects.
Psychological counseling
Counseling for adult ADHD generally includes psychological counseling (psychotherapy), education about the disorder and learning skills to help you be successful.
Psychotherapy may help you:
Common types of psychotherapy for ADHD include:
Cognitive behavioral therapy.
This structured type of counseling teaches specific skills to manage your behavior and change negative thinking patterns into positive ones. It can help you deal with life challenges, such as school, work or relationship problems, and help address other mental health conditions, such as depression or substance misuse.
Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Such counseling can improve communication and problem-solving skills.
Working on relationships
If you're like many adults with ADHD, you may be unpredictable and forget appointments, miss deadlines, and make impulsive or irrational decisions. These behaviors can strain the patience of the most forgiving co-worker, friend or partner.
Therapy that focuses on these issues and ways to better monitor your behavior can be very helpful. So can classes to improve communication and develop conflict resolution and problem-solving skills. Couples therapy and classes in which family members learn more about ADHD may significantly improve your relationships.
Many people find it helpful to meditate or write in a journal. These activities can help you learn how to focus better and identify negative feelings or sources of stress.
Keeping a schedule can help you stay focused. Create a list of tasks for each day and check each one off as you complete it. Marking off each completed task can boost your motivation and self-esteem. Checklists also help you track progress toward your goals.
Diminished motivation can sometimes be a sign of fatigue or a poor diet. Maintaining a healthy lifestyle (including regular exercise and a well-balanced diet) can make it easier to stay motivated.
Avoid heavy drinking as this can drain your motivation.
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ADHD RESEARCH USED FOR THIS ARTICLE
