Key takeaways
ADHD is not only a childhood disorder; about 5% of adults worldwide have ADHD, characterized by inattention, hyperactivity, and impulsivity.
Formal diagnosis by a mental health professional is crucial for adults suspecting they have ADHD, especially since symptoms can overlap with other mood disorders (such as anxiety, depression, or bipolar disorder).
Treatment for adult ADHD includes a protocol of evaluation, education, medication (primarily a stimulant like an amphetamine or methylphenidate drug), accommodation, and modification.
Non-stimulant medications for ADHD are considered for patients with concerns about addiction, anxiety disorders, or tic disorders, but they are generally not as effective as stimulants.
“Everyone is a little ADD.” Or so the saying goes. If you’ve ever struggled to stay on task at work, or complete projects on time, you may have wondered if that’s true. If you weren’t diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) as a child, it can be hard to know when distractibility crosses over from annoying, to a symptom of a health problem. A diagnosis of ADHD—and treatment with adult ADHD medication—is crucial to keep functioning when the demands of work or your personal life start to pile up.
What does ADHD look like in adults?
ADHD is not just a childhood and adolescent disorder. According to a study published in the American Journal of Psychiatry, the worldwide prevalence of adults with ADHD is around 5%. To put that into perspective, according to the Centers for Disease Control, the worldwide prevalence of Autism Spectrum Disorder is between 1% to 2%.
But what exactly is ADHD? The National Institute of Mental Health describes it as a brain disorder that centers around inattention, hyperactivity, and impulsivity. It affects the brain’s executive function, which results in trouble with disorganization, memory, low self-esteem, ability to concentrate, time management, and attention to detail. Hyperactivity is more commonly seen in children, but adults who fidget or feel internally restless may also have the hyperactive component.
As with many psychiatric disorders, the symptoms of ADHD exist along a spectrum; in the current world of social media and the 24-hour news cycle, everyone has some trouble concentrating. Duane Gordon, president of the Attention Deficit Disorder Association (ADDA), the largest adult ADHD support network in the country, explained the distinction. “Is it negatively affecting the quality of your life in a way you can’t compensate for?” he says. So, for example, if you can’t finish a book because you’re too busy playing video games, Gordon explains that’s really not a big deal. If you need—or want—to read that book for a project at work and no amount of focus or special techniques helps you, that may be a sign of something bigger than the normal distractions. Gordon describes ADHD as “a chronic condition that you have no control over.”
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Diagnosing adult ADHD
If you suspect you may have ADHD, Gordon highly recommends you pursue a formal diagnosis from a psychologist or other mental health professional. One of the major reasons for this is because many mood disorders (including depression, bipolar disorder, anxiety disorder, and sleep apnea) mimic ADHD symptoms.
“It’s important to get a proper diagnosis from a clinician outside of your family doctor, because around 80% of people with ADHD have a secondary disorder,” says Russell Barkley, clinical professor of psychiatry at the Virginia Treatment Center for Children and the Virginia Commonwealth University Medical Center.
What is the treatment for adults with ADHD?
Dr. Russell is also the author of Taking Charge of Adult ADHD and When an Adult You Love Has ADHD. He says there are five steps in the ADHD treatment protocol he recommends to adults who are trying to determine if they actually have the disorder:
- Evaluation
- Education
- Medication
- Accommodation
- Modification
According to ADDA, at your evaluation appointment, your doctor will give you a complete physical and psychiatric assessment, as well as a number of different diagnostic rating scales. The next step is education. Dr. Barkley likens this to diabetes—it’s important to own and learn your ADHD diagnosis because it’s not going away if you ignore it. The third step—ADHD medication—is crucial because there is nothing more effective than ADHD medication for adults, according to Dr. Barkley. “If we’re doing head-to-head comparisons, then medication will beat any psychosocial intervention by a factor of three,” he says.
What is the best adult ADHD medication?
ADHD medication falls into two categories: stimulants and non-stimulants. Typically, patients are prescribed stimulants because overall they are considered the most effective. Non-stimulants are used as second-line therapy and if there are any prominent tics or significant anxiety, which stimulants can worsen.
Stimulant ADHD medication for adults
“As for stimulants,” Dr. Barkley says, “there are only two and they’ve been around for decades: amphetamines and methylphenidate.” It’s important to note that amphetamines (like Adderall) and methylphenidate (like Ritalin) are classified by the FDA as Schedule 2 drugs, which means they are potentially addictive, when taken improperly, but shouldn’t be as long as they’re taken as prescribed. Mood swings, sleeplessness, and weight loss are some possible side effects of stimulant medication.
As Dr. Barkley mentioned, these two types of stimulants have been around for decades, but what’s new is their methods of delivery. Previously, stimulants had very short half-lives, requiring patients to take medication every 3–4 hours to maintain efficacy. Now, any ADHD stimulant with -XR, -LR, or -SR at the end of its name indicates an extended-release time, allowing the medication to last far longer in the patient’s bloodstream without being broken down too quickly in the body.
There is also a medication called Concerta, which has a special drug delivery system that allows for the methylphenidate to be released over a 12-hour period. Finally, Daytrana—also containing methylphenidate—can be worn on the skin via a patch. These would typically be prescribed to patients who face challenges taking a drug multiple times a day.
Non-stimulant ADHD medication for adults
The non-stimulant drugs prescribed for ADHD work for about 75% of people, Dr. Barkley says, but they aren’t quite as strong or effective. The difference is that these medications are not addictive at all, and generally better for patients with a history of substance abuse, anxiety disorders, or a tic disorder. The first drug atomoxetine, also known as Strattera, is prescribed to both children and adults, but according to the FDA label, the exact reasons for its efficacy are unknown.
The second class of non-stimulants were originally hypertensive medications—for high blood pressure—that were discovered to have psychoactive properties. The two available are clonidine (Kapvay) and guanfacine (Intuniv). Kapvay has only been FDA-approved for treatment of ADHD in children and adolescents. Similarly, Intuniv is also FDA approved for children and adolescents, but both types of medication are used off-label by adults for the same purpose. “These are third choice drugs,” Barkley said, “because they lower blood pressure, which, if you already have low blood pressure, is not a good thing.”
Alternative adult ADHD treatment
Accommodations for adults with ADHD
The fourth step of Dr. Barkley’s approach to ADHD treatment is accommodation, which he explains as learning to rearrange the physical environment around you—perhaps with the help of an ADHD coach—so that you’re less impaired by your condition. ADHD coaches are certified by the International Coach Federation and Professional Association for ADHD Coaches who can help with executive function challenges you may face. Other coping mechanisms include:
- Taking a stress ball into a meeting
- Making space for regular physical activity
- Cognitive behavioral therapy and mindfulness-based methods
- Getting adequate sleep
Brain training for adults with ADHD
The fifth, and final, step is modification of your symptoms, perhaps through a brain training program like Lumosity, or regular meditation. Dr. Barkley stressed that while these are great treatments to pursue, they have the lowest success rate, which is why they’re listed last.
More than anything, don’t try to negotiate this journey to diagnosis alone. Finding the right team to support you, from healthcare professionals and fellow adults with ADHD to loved ones and family members, will go a long way in helping you feel less alone and in making the right choices for you.