Understanding Adult ADHD: Symptoms and Strategies for Adults

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental difference that affects individuals of all ages. ADHD has a strong genetic component which means it is highly heritable and often runs in families. Understanding Adult ADHD, its symptoms, and effective strategies can significantly improve the quality of life for those affected.

Illustration of a brain to represent the neurodevelopmental differences faced by adults with ADHD.

ADHD is often diagnosed in children, however, diagnosis can be missed in childhood for many reasons such as poor access to healthcare, lack of awareness of different presentations of ADHD, and the overlap of symptoms with other development concerns. We know that in Australia ADHD is underdiagnosed, particularly for girls and adults. ADHD symptoms can vary significantly in type and severity, with some people having mild symptoms, and some having severe ones. While symptoms don't tend to change, and must have been present before age 12 to be diagnostically recognised, adults with ADHD might find symptoms are more noticeable due to increased responsibilities and less structure, highlighting the importance of access to awareness, support and strategies for adults with ADHD.

Different Types of ADHD

There are three main types of ADHD, predominantly inattentive, predominantly impulsive-hyperactive and combined.

ADHD - Inattentive can look like:

• distractibility and forgetfulness

• overlooks details

• processing speed impacts - for example, taking longer to absorb and respond to information and/or take longer to make decisions,

• difficulty following multi-step instructions

• difficulty regulating attention and focus

• difficulty with routine chores

• difficulty listening

• hesitating to take on tasks that require sustained focus

• difficulty managing time

ADHD- Impulsive-Hyperactive can look like:

• fidgeting and restlessness

• difficulty waiting turns and turn taking

• interrupting conversations

• constantly talking

• on the go

• impulsivity

• impatience

• acting before thinking

• Impulsivity, for example, impulse spending or driving recklessly

ADHD -Combined is where an individual experiences a combination of both inattentive and impulsive-hyperactive symptoms, however, there are overlaps between the two including:

• sleep issues

• sensory processing

• impacts on self esteem

• executive function and working memory impacts

Not everyone with adult ADHD will experience all of these symptoms, and symptoms can overlap with other conditions, therefore it is important to seek an assessment by a health professional.

ADHD and masking

ADHD masking is when an individual hides or alters behaviour to fit in with societal expectations. Masking can include mimicking behaviours, overcompensation, and suppressing symptoms.

ADHD masking can look like:

• stimming - making the same movements or actions repeatedly to self soothe/self stimulate

• writing everything down

• being extra early to avoid being late

• using multiple alarms and reminders

• excuses for being late

• putting in twice the effort and time than others to achieve a goal

• checking work multiple times

• creating strict routines and symptoms

• hiding emotions or reactions

• suppressing the urge to fidget or move around

Masking is not always bad but it can take a lot of energy and become exhausting. Masking can also delay diagnosis as the true extent of symptoms are not realised.

Adult ADHD and assessments

In Australia adults seeking support and treatment with symptoms can be diagnosed by psychiatrists and psychologists for a range of mental health conditions including adult ADHD.

Psychiatrists can prescribe medication as well as other medical treatments and talk therapy. Psychologists can assess and diagnose mental health conditions, but cannot prescribe medication, instead, primarily provide psychotherapy (talk therapy) and strategies to manage symptoms.

The first step is seeing your GP who may refer you to a psychiatrist or psychologist. The assessment process usually includes clinical interviews covering symptoms, childhood development, physical and mental health history, as well as the use of diagnostic tools and other questionnaires to complete a comprehensive assessment.

Adult ADHD and Treatment

While science has shown there are differences in brain size, networks and brain development in individuals with ADHD, we do not fully understand how these differences lead to the cause and symptoms of ADHD. Treatments for ADHD currently address the levels of neurotransmitters, in particular dopamine and noradrenaline.

Adult ADHD Treatment can include medication, therapy or a combination of both. The most common type of medication for ADHD is stimulants such as methylphenidates and amphetamines. These medications can help with ADHD symptoms such as impulsivity, hyperactivity and inattention. These stimulants work by increasing the levels of neurotransmitters dopamine and noradrenaline in the brain. There are two forms of stimulants- short acting and long acting.

It is important to have regular appointments with your psychiatrist to monitor medication benefits and any side effects and find the type of stimulant (methylphenidates or amphetamines), long or short acting and dosage that fits for you.

For some adults with ADHD stimulants may not be effective or come with intolerable side effects such as insomnia, loss of appetite, headaches or increased anxiety. Non stimulants for ADHD may be effective and work by increasing levels of noradrenaline in the brain.

ADHD strategies for Adults

ADHD is a useful framework for understanding neurodevelopment differences across the neurodiverse spectrum. Whether or not you have been diagnosed with ADHD, and irrespective of medication usage, identifying effective strategies for individuals with ADHD is an important part of managing symptoms and enriching quality of life and wellbeing.

Strategies for managing ADHD in adults can target several areas including organisational strategies, attentional strategies, social and communication strategies, cognitive strategies and lifestyle strategies.

ADHD and organisational strategies

These strategies address executive functioning differences such as time management, planning and prioritisation. These can include strategies around planners, calendars, reminders and scheduling.

ADHD and attentional strategies

ADHD attentional strategies look at ways to improve focus and concentration. This can look like eliminating distractions, concentration techniques and mindfulness.

ADHD and social and communication strategies

These strategies help individuals manage the challenges of social interactions and build communication skills. This can look like self soothing techniques, assertive communication skills, active listening, and emotional regulation skills.

ADHD and cognitive strategies

Cognitive strategies for adults with ADHD help with addressing core issues of focus, emotional regulation, and procrastination. These strategies can look at addressing negative beliefs or thinking patterns, developing coping strategies, recognising triggers and boosting self esteem and confidence.

ADHD and lifestyle strategies

Lifestyle strategies for adults with ADHD help with addressing factors such diet, sleep, exercise and environment. Lifestyle strategies aim to improve mood and focus and reduce impulsivity.

Tailoring adult ADHD strategies

Tailoring strategies for adults with ADHD requires understanding the specific challenges. An ADHD coach or counsellor can assist in creating a personalised plan. Learning a new skill involves more than knowing a strategy/awareness. Being able to reduce barriers to implementation and the application of being able to tailor the strategy and put the strategy into practice can require additional support.

Conclusion

Understanding and managing ADHD in adulthood requires awareness, adaptive strategies and support. Seeking professional support can further enhance application of strategies for managing ADHD symptoms and provide additional tools.