The manifestations of ADHD originate from decreased executive functions, such as managing attention, restraining impulses, and sustaining working memory. These functions constitute a group of mental processes crucial for effectively choosing and overseeing actions that aid in achieving desired objectives. The deficiencies in executive functions seen in individuals with ADHD lead to challenges in remaining structured, managing time effectively, avoiding chronic procrastination, retaining focus, sustaining attention, warding off distractions, controlling emotions, and recalling particulars. The symptoms also encompass restlessness, particularly in calm environments, habitual fidgeting, troubles in focusing on tasks, heightened physical activity, talkativeness, impulsivity, and a tendency to disrupt conversations (Figure 1).
Generally speaking, there are three types of ADHD: 1) inattentive, 2) hyperactive-impulsive, and 3) combined. The most common type is the combined with subjects manifesting both inattention and hyperactivity-impulsivity (JHU Medicine). Symptoms of inattention include the following:
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Is often easily distracted
- Is often forgetful in daily activities.
Symptoms of hyperactivity-impulsivity include:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often talks excessively.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
ADHD is considered to be one of the most prevalent mental health disorders. According to the World Federation of A.D.H.D., nearly 6 percent of children and 2.5 percent of adults are afflicted with it. According to the CDC, roughly 8 percent of U.S. children (aged 3 to 17) are thought to have ADHD.
Boys are twice as likely to receive an ADHD. diagnosis during childhood compared to girls. This discrepancy is partly due to the tendency for girls to exhibit less hyperactive and more inattentive symptoms even when they are very young.
ADHD in adults has been a controversial topic. For many years, experts believed that ADHD was confined to childhood, ceasing to exist post-adolescence, i.e. people outgrew the symptoms. However, in the 1990s, research showed that ADHD could persist well into adulthood. Presently, it is estimated that at least 60 percent of individuals who had ADHD as children will continue to experience symptoms in their adult life.
The symptoms may change over time, however, with inattentive type symptoms becoming more prominent while the stereotypical hyperactive/impulsive symptoms fade somewhat. As a result of the more subtle symptom manifestations, as well as the above mentioned sex differences in presentation, adult ADHD may be underdiagnosed (NYTimes):
“Approximately 4 percent of adults in the United States have enough symptoms to qualify for A.D.H.D., but only an estimated one in 10 of them is diagnosed and treated. For comparison, roughly 9 percent of children in the United States have been diagnosed with the condition, and three-quarters have received medication or behavioral therapy for it....“With adults, it’s oftentimes not necessarily hyperactivity or impulsivity, it’s more executive functioning issues,” Dr. Anbarasan said. “It’s more subtle.”
As an aside, adult ADHD is not the same as adult-onset ADHD. The latter refers to cases in which the individual does not experience significant ADHD symptoms until they reach adulthood, whereas the former is the more commonplace situation in which symptoms persist to a greater or lesser extent from childhood to adulthood. However, the prevalence of adult-onset ADHD is hotly debated. Indeed some have argued that "adult-onset ADHD is rare — if it exists at all" (NYTimes):
"The paper, published Friday in the American Journal of Psychiatry, could deepen the debate over these symptoms rather than settle it. Previously, three large analyses had estimated the prevalence of the disorder at 3 to 10 percent of adults.The new study, while smaller, mined more extensive medical histories than earlier work and found that most apparent cases of adult-onset attention deficits are likely the result of substance abuse or mood problems.”
Fortunately for those with ADHD, both children and adults, there are effective treatments starting with medications. According to Wikipedia, "Methylphenidate (e.g. Ritalin) and amphetamine (e.g. Adderall) or its derivatives are first-line treatments for ADHD as they are considered the most effective pharmaceutical treatments. About 70 per cent respond to the first stimulant tried and as few as 10 per cent respond to neither amphetamines nor methylphenidate." Although not a cure, they may "help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills” (link).
In addition there are effective non-pharmaceutical treatments, such as psychological counseling and behavioral therapy (e.g. CBT). These methods assist individuals in better understanding the impact of ADHD on their everyday lives, and provide tools to manage it effectively. Benefits from counseling include the following (Mayo Clinic):
- Improve your time management and organizational skills
- Learn how to reduce your impulsive behavior
- Develop better problem-solving skills
- Improve your self-esteem
- Develop strategies for controlling your temper
The significance of the underdiagnosis of adult ADHD is that when not recognized, the disorder can lead to dysfunction in daily life. One example was highlighted in a recent article in The New York Times that described the financial difficulties of some women which was exacerbated by their undiagnosed ADHD. For some, identifying attention deficit hyperactivity disorder in their adult years has clarified a longstanding puzzle, aiding them in achieving better financial management.
One person interviewed in the article noted that the absence of impulse restraint led to excessive spontaneous purchases (which is also a coping mechanism), while challenges with executive functioning disrupted any budgeting plans. Now that she has been diagnosed and is on ADHD medication, she feels in greater control of her spending.
Figure 1. Symptoms of ADHD in adults. Compared to children, adults may display more inattention symptoms and fewer hyperactivity/impulsivity symptoms (Cleveland Clinic).
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