Adult ADHD is a real condition defined by the DSM-5 in 2013. Until recently, it was believed that children outgrew ADHD but we now know that ADHD is a developmental disorder that continues throughout the life span. Around 5% of children suffer from ADHD and, of these: at least half continue to experience clinically significant symptoms into adulthood. The ratio of males to females is 5:1 in children but evens out in adulthood.
ADHD in adulthood can have serious ramifications:
- Academic difficulties in childhood and adolescence transcend into later employment difficulties, including lower job status, frequently changing jobs, co-worker relationship difficulties quitting and losing jobs, more unexplained days off work. Adults with ADHD achieve lower levels of education and are less likely to reach the financial status of their parents or non-ADHD peers.
- Adults with ADHD have poor impulse control and deficits in following rules. This increases the risk of legal charges and incarceration. Studies of prison populations show the incident of ADHD in prison populations to be between 26 and 40%.
- Difficulties in emotion regulation manifest as interpersonal difficulties, poor frustration tolerance and anger dysregulation.
- ADHD can have a significant impact on self-esteem. Difficulty completing tasks entrench a negative self-view.
- Social issues include talking too much, interrupting, intruding on others, being restless and fidgety.
Paula* and Jay* have come for marriage counselling. Paula is at her wits end because Jay is erratic, disorganised and easily angered. He cannot keep a job and spends impulsively.
Sam is highly intelligent yet cannot complete his degree. He has difficulty organising his work, planning and executing projects and finishing what he starts. He often loses his paperwork.
Maureen has an anger problem. She was arrested for hitting the person next to her in a cinema with a coke bottle because the person was talking. She says she cannot help it. She just “loses it”.
Sadly, adult ADHD is frequently under -diagnosed and under-treated. Why?
- One reason ADHD is missed is because, even today, many individuals do not believe that ADHD is a real disability. They believe that ADHD is a conspiracy perpetrated by practitioners to make money
- Another reason is that, until recently, ADHD was seen as a childhood problem only and not looked for in adults.
- A major cause of misdiagnosis is that ADHD co-exists frequently with anxiety, depression, learning problems or substance abuse. 75% of adults with ADHD will have one or more of these conditions as well. These conditions are often the focus of attention causing ADHD to slip through the cracks. For example, inattention can be a symptom of anxiety or ADHD.
- The most effective treatment for ADHD at the moment is medication and many people refuse to be medicated.
- Another factor causing adult ADHD to be under-treated is that people do not know that helpful psychological treatments exist or where to source them. On the flip side this is a new and developing field and there are not many experienced practitioners.
- The nature of ADHD makes seeking treatment and sticking to it difficult. Lateness, disorganisation, resistance to doing homework will undermine even the best psychologist’s work.
- Cost can be a detterant since there are no publicly funded programs to treat ADHD in adults. However, there are Medicare rebates available for psychologists.
For a diagnosis of ADHD, you must have several symptoms at the same time, they must have started before you were 12 years old, and your difficulties must be present in 2 or more settings such as work and home.
If you are worried that you have ADHD, do not diagnose yourself. You need to be assessed and treated by a team including your GP, a knowledgeable psychologist and a psychiatrist. However, this checklist will help you get started.
Treatment of adult ADHD
If you have been diagnosed with moderate to severe ADHD, drug treatment is the most effective treatment. Over the years, I have seen remarkable and almost immediate positive effects from medication. Coupled with cognitive behavioural therapy (CBT), you can obtain the best results.
In the case of Jay, it saved his marriage and changed his life. Within 2 days of starting the pills, he became less angry. He was able to hold down a job and worked with his wife to control spending. They continued couple counselling and their marriage improved markedly.
Sam took medication and worked with me to improve his organisational skills. For the first time, his work load became manageable and he experienced success.
There are a variety of drugs available (not only Ritalin!) and a reputable psychiatrist who specialises in ADHD is the best person to prescribe medication and monitor your progress. Sometimes it takes a while to find the best medication to suit your needs so patience and perseverance is necessary – which can be difficult for some-one with ADHD.
For clients with mild ADHD, psychological interventions alone can be effective.
Maureen did not require medication. I taught her CBT tools to manage her anger which was very effective long term.
Psychological management includes:
- Psycho-education which provides you with information about ADHD and how to manage it. The more you understand your condition, the better armed you are to manage it.
- Enhancing daily functioning by improving your ability to manage time, plan, organise and execute tasks.
- Building self-esteem.
- Social skills.
A word of caution: ADHD is not curable. It is a lifelong condition that needs to be managed. Ongoing treatment and maintenance is often required. However, the results can be remarkable.
What we offer
At Anxiety Solutions CBT, we understand adult ADHD and have worked with many adults with this disorder. We are competent at unpacking your symptoms and can discern if your poor attention (or any other symptom) is a consequence of ADHD or anxiety.
We are here to help and support you on what can be a very frustrating journey. We are able to assist you with psycho-education, enhancing daily functioning, building self-esteem, self regulation and social skills.
Our CBT program is unique and ideally suited to teach emotion regulation. Moreover, the structure and predictability of the course creates a safe environment which enhances learning.
Call Lisa now for an obligation-free appointment where we can discuss your options. Ph: 02 9328 5899.
*Not their real names