ADHD in adults

Hyperactivity usually attenuates with age. For that reason, it was previously believed that ADHD was something people ‘grew out of’. Today we know from research that approximately two in three children who have been diagnosed with ADHD are also affected as adults.

The core symptoms may mean that people with ADHD have difficulties functioning in their daily life. This may be in relation to their family, at work and in leisure activities. The difficulties may also increase with growing demands. This may, for example, be when you move away from home or when you have children. These challenges may lead to low self-esteem. Adults with ADHD may also have significant sleep disorders. This may aggravate their symptoms in the daytime.

Research has shown that as many as 80% of adults with ADHD develop other mental disorders, including depression and anxiety.

Scans have shown that people with ADHD have changes in several places in the brain. The changes are, for example, seen in the area responsible for planning, impulse control and attention.

The cells of the brain use different neurotransmitters to communicate with each other. Disturbances in these neurotransmitters are seen in people with ADHD. Especially the level of the neurotransmitters dopamine and noradrenaline is low. Medical treatment of ADHD increases the amount of these two neurotransmitters in the brain. This improves the functioning of the brain.

ADHD symptoms are also seen in people who normally do not meet the criteria for ADHD. For example, a number of persons develop symptoms in connection with stress or depression. It is consequently normal that your attention is impaired for reasons other than ADHD.

Likewise, ADHD may manifest itself very differently. This depends on a number of factors, including personality and circumstances in life, for example whether you have a supportive family. 

Some adults with ADHD are good at mastering their symptoms, and are apparently therefore not affected so severely. Others are affected more severely in terms of both symptoms and functions.

It is important to remember that you are not your diagnosis. You are a person with a diagnosis.

Virtually all adults with ADHD describe that they have always had problems concentrating. They often have difficulty reading and performing other tasks that require concentration. The reason for this difficulty is that they are disturbed by everything that is going on around them or by their own thoughts. Many have therefore never read books.

They may also have difficulty following conversations unless they find the content very interesting. They often avoid activities that require a lot of concentration, such as lectures and meetings. If they nevertheless participate, they do not get much out of it.

However, they can also experience being highly focused. This is most often the case if they find that something is very exciting and interesting. These may be activities involving some kind of immediate ‘reward’, such as computer games. Here, the experience can be that the whole outside world is shut off.

Serious negative consequences of not performing a task may also be a motivational factor. This may, for example, be a boring, but important, task that you know that you have to perform.

Certain symptoms of hyperactivity must be present for a diagnosis of ADHD to be made. Hyperactivity often attenuates with age. It may, for example, change from running around to being restless.

You may sit restlessly and move about a lot during meals or when watching TV.

Many also fidget with things and are engaged in multiple activities, such as TV watching, text messaging and using a computer, concurrently.

Adults with ADHD often live according to a here-and-now principle. They may find it difficult to make use of their experiences and predict the future outcome of their current actions.

Many therefore find it difficult to manage their finances. Some are therefore listed in registers of bad payers. Impulsivity often attenuates with age. But it can make itself felt in conversations in the form of verbal impulsivity.

In addition to the core symptoms, ADHD also often manifests itself as difficulties with:

• Short-term memory
• Sense of time
• Regulation of feelings

ADHD also causes problems with racing thoughts and difficulty sleeping. These difficulties are nearly always present throughout life.

You may repeat yourself as you often forget what you have just said. For example, you forget what you were doing when the telephone rang. You go from one activity to another and often forget what your purpose is. You also often forget where you put your things. You often spend time looking for, for example, your keys or mobile phone.

Many feel that they have a poor sense of time. They might forget appointments, be late for the bus and get night and day mixed up.

Almost all ADHD sufferers have a hard time regulating their emotions. This is most often a lifelong problem. They may be highly temperamental as children. In adulthood, there can be large emotional fluctuations ranging from great joy to a feeling of hopelessness.

The shifts may occur from one moment to the next and without either an external or internal cause. The fluctuations are present several times during the same day. Adults with ADHD often also get easily irritated. This may lead to conflicts in the family.

Many adult patients with ADHD describe a phenomenon that one might call popcorn thoughts. All sorts of thoughts often pop up in their heads. The thoughts are not related to what they are talking about or the activity in which they are engaged. It may have a disruptive effect on the activities that they were performing.

85% of adults with ADHD suffer from sleep disorders of various kinds. They often have difficulty falling asleep and difficulty sleeping all night. They may also find it difficult to wake up in the morning. They are often not rested, which impacts their daily life

The symptoms can present many challenges in your daily life because adult life makes many demands on you. You should preferably meet your obligations and:

• Attend appointments, which requires a sense of time
• Be able to assess and perform assignments in your studies and at work
• Be able to regulate your emotions so that you can be together with others in a proper manner
• Be persistent when things are boring so that you can complete an education or training programme and hold onto a job
• Avoid impulsive actions so that you do not do anything rash
• Pay your bills on time and stick to a budget.

Due to internal and external agitation, some ADHD sufferers also end up in substance or alcohol abuse.

ADHD symptoms may vary in degrees of severity. Furthermore, not all symptoms are necessarily always present. Stress and distress conditions such as divorce, unemployment and substance abuse often aggravate the symptoms. Supportive relationships in family, education and work result in an alleviation of symptoms.

In order for you to be diagnosed with ADHD, the following must be met:

• You experience the criteria described under either attention deficit or hyperactivity/impulsivity
• Some of the symptoms of hyperactivity and inattention have been present from before you were seven years old.
• The problems are seen in several contexts (for example both at work/at school and at home)
• There must be clear proof that you are experiencing significant problems socially, in your studies or in your work.

There is no other cause for your symptoms – such as schizophrenia or anxiety.

ADHD is a clinical diagnosis. This means that the diagnosis is made by your psychiatrist. The psychiatrist conducts thorough consultations with you and your relatives. They are used to make the diagnosis. In connection with the consultations, you are systematically asked about what symptoms and difficulties you have had throughout your life.

In the course of the examination, it will be assessed whether these symptoms have been present in your childhood, adolescence and adulthood. It will also be assessed whether they have had a severity that meets the criteria for making the diagnosis. No single examination can establish the diagnosis.

The aim of the examination is to establish whether your symptoms have been present since your childhood. Therefore, information from your relatives will normally also be needed. In addition, information will often be obtained about what your years at school were like. If you have previously had psychiatric examinations done, they can also contribute to making the diagnosis.

We know from research that especially adolescents with ADHD are often prone to underestimate their own difficulties. It is often not until around the age of 25-30 that you have a more realistic picture of yourself and your abilities. Therefore, supplementary information from relatives and previous healthcare professionals (for example a general practitioner) will be important.

In connection with the examination, the psychiatrist will also establish whether you are experiencing symptoms that are not due to ADHD. This may, for example, be symptoms of depression or anxiety. The psychiatrist will also ask you about physical symptoms.

ADHD has traditionally been divided into three subtypes. They are based on the presence of the core symptoms:

• The combined type
  Has all three core symptoms
  
  
• The primarily attention deficit type – also called ADD
  Has problems remaining attentive, but is not hyperactive
  
  
• The primarily hyperactive/impulsive type
  Mainly has problems with motor agitation and impulsivity

About 85% of adults with ADHD have the combined type. Approximately 10% have the primarily attention deficit type and approximately 5% have the primarily hyperactive/impulsive type.

However, it is important to know that you may change type during the course of your life. For example, you can go from the combined type as a child to the primarily attention deficit type as an adult.

Living with untreated ADHD entails a significantly increased risk of developing other disorders. Firstly, there is an increased risk of developing other mental disorders. Secondly, there is an increased risk of developing lifestyle diseases. These are diseases associated with overweight and smoking, for example diabetes and heart diseases.

Many also have chronic wear injuries after many years of hard physical work. Fortunately, it is often the case that the severity of the concomitant disorders decreases when you receive treatment for your ADHD.

Your psychiatric contact person will decide how your treatment will be organised together with you. This is done on the basis of an expert assessment and in some cases in consultation with a doctor or psychologist.

Below we write about different types of treatment. You will not always be offered all types of treatment. Medication will typically be a central part of your treatment.

If you have ADHD, pharmacological treatment is often necessary. The medication works by affecting selected neurotransmitters in the brain.

The most commonly used drugs are methylphenidate and lisdexamphetamine. Atomoxetine is also commonly used. Methylphenidate and lisdexamphetamine act faster on symptoms.

The treatment principles are that you are to have an effect of the medication during the hours of the day in which you need it.

Sometimes, it may be necessary to increase or reduce the dose of the medication or switch to another drug to achieve the best possible effect and avoid side effects. There is good documentation of the efficacy and safety of the medical treatment.

Before starting on the medication, you will be asked whether you have other physical or mental disorders that may be of importance to the choice of medication. You will have your blood pressure, heart rate, weight and height measured. You will also have blood samples taken and have your heart rhythm measured with an ECG (electrocardiogram). You will also be asked about your life situation.

You may be offered education about ADHD. Education about mental disorders is also called psychoeducation. Here, you will learn about relevant aspects of ADHD. There will be particular focus on how to handle your life with ADHD. You will also receive information about the support options available at home, at work or in connection with your studies. Psychoeducation is usually conducted in groups.

Consultations with a doctor, psychologist or nurse are part of the treatment. Initially, the consultations will be very much about the pharmacological treatment so that it can be adapted to your needs.

The consultations will also focus on how you alone and together with your relatives can deal with the difficulties associated with having ADHD. This will typically include information about whether there are aids that you can use in your daily life. This may, for example, be notes or alarms that help you remember tasks.

In the course of your treatment, you will often also experience psychological reactions. This may, for example, be frustrations and grief reactions. You and your contact person will also deal with these issues in the consultations.

During these consultations, your therapist may see signs indicating that you may have another physical or mental illness. If so, you will be examined for this. Read more on the page about examination for ADHD in adults.

Psychotherapy is generally not part of the treatment offered. However, it may be offered in rare cases. Here, it will typically be a prerequisite that you are also undergoing pharmacological treatment.

Studies indicate that psychotherapy in the form of cognitive behavioural therapy may have a good effect in combination with medication. This type of therapy is highly structured and focuses on the day-to-day challenges associated with ADHD.

Support from the municipality will often be needed. Your psychiatric contact person can help you establish and maintain contact with the municipality. If you have a mastery supervisor, he or she can also participate in the consultations.

You may, for example, need assistance with the daily functions in your home or a mentor scheme at your workplace. It may also be that you need to apply for disability compensating state education grant if you are enrolled in an education or training programme. Changes to the physical environment are often also necessary at your educational establishment or workplace. This may be in the form of shielding you from external distracting stimuli.

Most people with ADHD have to live with the disorder throughout their life. However, you may well experience periods in which you feel better than normally. Correspondingly, there may also be particularly difficult periods. This may, for example, be if you experience bullying or a death in your family. 

There are several things you can do to make your daily life easier:

Remember your medication

To prevent your condition from worsening, it is important to take your medication as agreed. Persons with ADHD may, however, be at risk of forgetting to take their medication. It may also be difficult to maintain your structure and rhythm.

Maintain a normal daily rhythm and structure

As an adult with ADHD, you may need to use aids and memory rules on a daily basis to structure your daily life.

Involve relatives in your treatment

Your relatives can, for example, help you remember to take your medication. They can also help you maintain structure in your daily life. Your relatives will most often be the ones who first notice changes in your behaviour and temperament. They can often also be aware of whether you are becoming depressed.

Learn about your ADHD

Receive offers of psychoeducation.

Comply with your medical treatment

Do not stop taking your medication on your own. Discuss it with your doctor first.

Make use of your psychiatric contact person

Talk to your doctor, nurse or psychologist.

Talk to those closest to you

It is important that you talk to your relatives about the difficulties that arise in connection with your ADHD.

Avoid excessive quantities of alcohol

It is also important that you avoid sleeping pills and sedatives, which often worsen the condition.

Exercise

This can often help reduce stress, inner agitation and a sense of discomfort.

Make reasonable demands of yourself

Many people with ADHD think that they can do much more than they actually can.

Make sure to plan your day

Use a weekly calendar and a structured daily schedule. Fill in the calendar together with your closest relatives.

Make sure you sleep well and eat healthy food

Good habits can give you extra energy

Switch off your computer and TV at fixed times

It is important to maintain a stable daily rhythm (sleep-wake cycle). Try setting an alarm to remind you of when it is time to go to bed.

Be open about your disorder, when appropriate

This applies in your family, in education and training and at work.

Participate in psychoeducation

You can acquire a better understanding of ADHD if you participate in psychoeducation together with your child. This often relieves the sense of guilt and feeling of inadequacy that many relatives have. The psychoeducation can also help you with how to handle daily challenges at home in the most expedient way.

Contact patient and carer associations

You can join an association for patients and relatives such as the Danish ADHD-Association or SIND’s (the Danish Association for Mental Health’s) advisory service for relatives. The associations hold meetings and courses and have hotlines.

Take care of yourself

It is also important that you give yourself permission to meet your own needs. You cannot have the energy to help and be the person responsible all the time.

Seek help from public services

Perhaps your family may need extra support via the municipal system? Your contact person can often help with this.

Consult your own doctor, if necessary

If, after several years of emotional strain, you develop distinct symptoms of anxiety or depression yourself, you should consult your own doctor to get help. In some cases, you can get a referral to a practising psychologist with health insurance reimbursement.

Pay attention to children

If the adult with ADHD has children, special attention must be paid to their needs and reactions. Many places offer consultations for children. There may, for example, be family consultations at the treatment site. Some municipalities set up children’s groups for children of parents with mental disorders.

Often, when an adult is diagnosed with ADHD, close relationships may already have been strained for a number of years, for example with siblings and parents, or a cohabitant/spouse.  Many relatives have felt powerless, angry or deeply frustrated.

A parent of a child with ADHD may have faced considerable demands in terms of keeping track of things, planning and the ability to create structure. Even after the child has grown up and left home, help may still be needed. As a cohabitant or spouse of a person with ADHD, you may also find that you need to provide help in making daily life function.

Some of the things that you can do as a relative are:

Participate in the treatment to the extent to which this is possible and makes sense

It is important to have knowledge about the disorder and the treatment. It is a good idea to participate regularly in follow-up consultations with the psychiatric contact person.

Help with everyday chores

Planning and starting lots of specific tasks may be difficult for someone with ADHD. For example, help may be needed with opening mail and dealing with the content of mail, laundry and cleaning. Important information often needs to be repeated and possibly written down.

Try to find a good role distribution

Relatives may often find it difficult to strike a balance. How much help should you give? It can be particularly difficult for parents during the phase in which the person with ADHD transitions from adolescence into adulthood, and when the young person wants to manage on his or her own without parental interference. For spouses and cohabitants, it may be difficult to remain equal partners in a relationship in which the balance has shifted in terms of overview and planning.

Help structure daily life

Parents of adolescents with ADHD who live at home can support their children in structuring their everyday life, maintaining a stable rhythm and supporting any medical treatment. The same applies to the cohabitants/spouses of people with ADHD. Use of technical aids such as calendars, mobile phones and weekly schedules may be a help in daily life.