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ADHD in Adults

ADHD Treatment
 How do you procrastinate?

Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder with symptoms including hyperactivity, impulsivity, and inattention. It’s estimated that about 7% of children meet the criteria for the diagnosis. Roughly two-thirds of these patients’ symptoms will continue to meet the criteria as adults.
The two main clusters of symptoms within ADHD are the “Inattentive Symptoms” and “Hyperactive Symptoms.” I often tell my patients that the H does not necessarily have to be present for the diagnosis.
They’ll often ask, “Well, doc, doesn’t that mean I have ADD instead?” That’s a great question. The diagnosis is still referred to as ADHD, yet there are subtype specifiers: Predominantly Inattentive, Predominantly Hyperactive, or Combined Type.
Historically, ADHD was thought to first only occur in children. Like, somehow, they would magically grow out of it the day they turned 18? Over time, it has been recognized that ADHD continues into adulthood. More recently (and what most doctors are unaware of), is that ADHD can initially present in adulthood. 
Some of the most recent research has shown that upwards of 65% of individuals diagnosed with ADHD in adulthood would not have met the criteria for ADHD at ages younger than 12.
As we move on through the various transitions of life, the demands upon us change. For instance, being a parent is different than taking an Algebra class. Managing a project at work requires a different skill set than writing a book report in grade school. Let’s take these examples one step further and say in each example; the person excelled earlier in life. 
I’ve lost count of how many physicians and psychiatrists say, “If she was able to get good grades in high school (or college), why can’t she _____?” Maddening. I’ll speak more about the reasons why ADHD is not fully recognized until adulthood in a future blog post.
 While we certainly have stigmas against receiving treatment, it does not help that most physicians (in my professional experience) have been reluctant to treat adults with ADHD.
As a physician and a psychiatrist, I’m able to advocate for myself. That’s not something most patients should expect to have to do. 
It’s easy to see why 62% of adults with ADHD do not receive treatment for ADHD-related symptoms.
Unfortunately, this has some very serious and life-altering consequences. Untreated ADHD can negatively impact just about every aspect of life: educational and professional achievement, family life and relationships, impulsive spending, substance use, accidents, and other injuries. 
Dr. Russell Barkley, Ph.D., conducted a study that was released in a 2019 issue of the Journal of Attentional Disorders, demonstrating that compared to a control group, Adult ADHD had a decreased life expectancy of 12.7 years. To put things in perspective, smoking cigarettes is estimated to reduce your life expectancy by ten years. 
Given the prevalence of cigarette smoking and the acceptance of needing to address it, the data behind the 10-year reduction in life expectancy is much stronger than the preliminary study on ADHD and life expectancy.
On the bright side, awareness and acceptance of Adult ADHD are gradually improving. Additionally, treatment for ADHD can significantly reduce these burdens for the majority of patients pursuing treatment. 
ADHD treatment is usually treated with a combination of lifestyle changes, problem-solving skills, ADHD medication management, ADHD coaching, and individual therapy. Treatment can significantly improve quality of life, and I’m optimistic that one day we’ll see data that demonstrates treatment of Adult ADHD significantly improves life expectancy as well.