ICD-10 code: F90.2
Attention-Deficit/Hyperactivity Disorder (ADHD) affects 30-50% of adults who had ADHD in childhood.
Approximately 5% of adults in the U.S. have some form of ADHD.
There are three types of ADHD that can occur:
Approximately 1.1% of U.S. adults display ADHD, Combined Presentation.
These disorders are characterized by difficulty regulating attention and behavior. Symptoms are divided into two categories of inattention and hyperactivity-impulsivity. Adults with ADHD, Predominantly Hyperactive Presentation may talk excessively, exhibit restlessness, have difficulty waiting in line, and frequently interrupt others. In contrast, those with ADHD, Predominantly Inattentive Presentation might have difficulty sustaining attention on tasks or activities, struggle with organization, and often lose needed materials. Adults with ADHD, Combined Presentation show both inattentive and hyperactive-impulsive symptoms.
Adults with ADHD show a persistent pattern of inattention and/or hyperactivity and impulsivity that is present in multiple settings. These behaviors result in disruption in social, occupational, and/or family settings and impair one's functioning in these areas of life. Although historically considered a condition of childhood, ADHD is now recognized as a chronic condition, with many individuals with ADHD in childhood continuing to show symptoms into adulthood.
ADHD, Combined Presentation is a neurobehavioral disorder that is characterized by both hyperactivity (moving constantly including in situations where this is not appropriate, fidgeting, excessive talking, restlessness, "wearing others out") and impulsivity (making hasty, unplanned actions such as interrupting others or making big decisions without considering consequences and/or a desire for immediate rewards or inability to delay gratification) as well as inattention (difficulty concentrating or sustaining attention, procrastination, hesitation, and forgetfulness).
This subtype is different from the other two subtypes of ADHD in that one set of symptoms does not predominate. ADHD, Combined Presentation is approximately twice as prevalent in adult men as adult women.
ADHD is characterized by two main categories of symptoms:
The Combined Presentation of ADHD is diagnosed if five or more symptoms of hyperactivity/impulsivity, and at least five symptoms of inattention, have been present for the past six months:
Inattention symptoms:
Hyperactivity/impulsivity symptoms:
In order to meet criteria for ADHD, Combined Presentation, five or more symptoms of inattention and five or more symptoms of hyperactivity/impulsivity must be present in adults. These symptoms must be present for at least six months and inappropriate for the person's developmental level. Additionally, the following conditions must be met:
ADHD symptoms can range from mild to severe, with approximately 40% of those diagnosed with ADHD considered to be severe cases. Adults with ADHD may have difficulties at work and in their interpersonal and family lives related to ADHD symptoms, such as inconsistent performance in their careers, difficulties with day-to-day responsibilities, relationship problems, and chronic feelings of frustration, guilt, or blame.
Historically, ADHD was considered to be a childhood disorder that most people outgrew. However, recent data suggest that symptoms of ADHD continue into adulthood in up to half of individuals with childhood ADHD. Although research on adult ADHD is reduced compared to childhood ADHD, there is growing evidence that ADHD may present somewhat differently in adulthood.
ADHD is characterized by deficits in neurocognitive processes. Specifically, individuals with ADHD have difficulty with executive function, which includes processes that are important for regulating attention and behavior, such as attentional control, inhibitory control, cognitive flexibility, and planning.
There are many known causes of ADHD, including a strong genetic component. Genetics appears to be the principal cause of ADHD, likely accounting for up to approximately 75% of all cases. In a smaller percentage of cases, ADHD may arise from early brain injuries, low birth weight, exposure to environmental toxins during gestation (e.g., maternal smoking) or youth (such as lead). Research does not support the claim that ADHD is a result of food additives, preservatives, or sugar.
In adults, ADHD frequently occurs with other psychiatric conditions, including mood disorders, anxiety, learning disorders, and substance use disorders. In fact, a large national study found 51% of adults with ADHD suffered from co-morbid anxiety and 32% suffered from co-morbid depression. Because of the amount of overlapping symptoms with other disorders, diagnosing ADHD can be complicated.
Proper diagnosis and treatment of ADHD can improve functioning. Published guidelines from the U.S. Department of Health and Human Services and National Institute for Health and Clinical Excellence and the National Institute of Mental Health recommend the following:
First Line Treatments
Second Line Treatments
Third Line Treatments
For more information about drug prescribing for ADHD in adults, click here.
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments listed above, might be considered:
Healthcare professionals are encouraged to stress the value of a balanced diet, good nutrition, regular exercise and sleep schedules for adults with ADHD. Daily routines can be particularly helpful for individuals with ADHD to manage symptoms.