Adult ADHD is getting the attention it deserves
When we hear the words Attention-Deficit/Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD), we might visualize a child in a classroom wandering aimlessly, unable to sit still, while other classmates busily complete what's been asked of them. In fact, when we think of these disorders, we may think of them as pediatric conditions only.
That's why it was perplexing for many of us to hear of Lisa Ling's recent diagnosis of an attention disorder — at age 40. She is, after all, a successful television journalist — a role model for our children.
However, inspired from working on an episode about ADHD in children for “Our America with Lisa Ling,” the journalist wanted to know if she, too, might suffer from an attention disorder. She decided to be evaluated by an ADHD/ADD expert on camera.
“As a journalist, when I'm immersed in a story, then I feel like I can laser-focus. But if I'm not working, my mind goes in every direction but where it's supposed to go,” Ling said during her report. “I've been like that since I was a kid.”
Ling also revealed she had “focus issues” in elementary school. In high school, she said she could “go through an entire period and not retain a sentence if I [wasn’t] interested in the topic or the subject matter.” When asked how she did in college, Ling answered, “I dropped out.”
With testing complete and cameras still rolling, Ling got her diagnosis. “Dr. (Craig) Liden believes I actually do have ADHD, the kind without hyperactivity often called ADD,” she said.
While it was surprising to learn Ling had ADD at age 40, it also was inspiring for other adults who might be suffering from the condition but not yet know it.
“It is very courageous for a high-profile individual like Ms. Ling to reveal her condition — and very educational and inspiring for adults who might also have ADHD,” says Deborah Pearson, Ph.D., professor of psychiatry and behavioral sciences at The University of Texas Health Science Center at Houston (UTHealth) Medical School. “She has shed light on a condition for which there are so many misconceptions. She is also a very successful individual who is a living contradiction to the notion that ADHD leads to failure.”
Diagnosis: adult vs. child
While the diagnosis of adult ADHD is still lower than it is in children, Pearson says the condition is becoming more widely recognized in adults.
“According to the American Psychiatric Association, ADHD is thought to affect about 2.5 percent of adults, as compared to about 5 percent in children,” she says, adding that other sources, such as the Centers for Disease Control and Prevention (CDC), suggest the prevalence rate is actually higher than 2.5 percent.
The average age of childhood diagnosis is 7 or around the time the child is in first grade. “What often happens is that the child with ADHD doesn’t settle down when they make the transition from the more free-wheeling pre-K or daycare setting to the kindergarten or first grade classroom,” Pearson says. “When their peers are able to make this transition, the child with ADHD will stand out in sharp contrast.”
Ling's diagnosis of an attention disorder at 40 is not completely out of the ordinary, as Pearson says there can be a wide age range for adult ADHD diagnosis. “Many intelligent and capable college students find themselves unable to cope in college and wind up being diagnosed in their late teens and early 20s,” she says. “Others are able to cope into their 30s, 40s and beyond — perhaps until a situation occurs in their lives that overwhelms their coping capacities.”
Other times, a family member or co-worker may bring up the issue of attention disorders, or parents become concerned with their own behaviors after exploring ADHD issues in their children. “I have referred many adults for ADHD assessments over the years when they bring their children into my clinic for an ADHD evaluation,” Pearson says. “The parent recognizes the symptoms in themselves and seeks help.”
Symptoms and consequences
Key indicators of adult ADHD include inattention, hyperactivity and impulsivity.
“Inattentive behavior in an adult with ADHD is similar to inattention in children,” Pearson explains. “These individuals are easily distractible, have difficulty focusing attention, are often disorganized, have trouble following through and finishing tasks, lose or misplace items and are more forgetful than others.”
Pearson says that hyperactivity symptoms often decrease with age. She adds, though, that many adults say they have a feeling of restlessness. “They will fidget with their hands and feet, and some still have trouble sitting still — they want to be up and about,” she explains. “They may also have trouble with talking too much or being too loud.”
Symptoms of impulsivity include having difficulty waiting their turn, interrupting or intruding on others and blurting out answers to questions before a question has been fully asked, Pearson says.
You might be thinking, “Wait, that sounds like me!” We all engage in some of these behaviors from time to time. “However, an adult with ADHD will engage in these behaviors frequently and do so to such an extent that they undermine the individual’s ability to function at home and work,” Pearson explains.
Being hyperactive, impulsive and not paying attention can have real-life consequences for grown-ups. For example, adults who have trouble focusing their attention on key tasks may not remember to file their taxes, and balancing a checkbook can be monumentally challenging. They may misplace important items like keys, purses or wallets.
“Impulsivity can lead to unfortunate consequences, such as telling off the boss at work or belittling the police officer who has stopped them for a minor traffic violation — and then proceeds to carefully inspect their car to find an expired inspection sticker and bald tires that the adult with ADHD neglected to attend to,” Pearson adds.
Pearson says that ADHD looks less “motor-like” in adults than children, and the symptoms of inattention and impulsivity also may be more subtle. “Running around the classroom gives way to pencil tapping and a sense of restlessness,” she says, adding that these behaviors can be very irritating in a workplace environment, college dorm room or even in a living room.
The first step for adults concerned about ADHD is to speak with their family physician to rule out any underlying conditions, such as depression and anxiety, which may be contributing to their situation.
“An adult who is referred for an evaluation for ADHD is typically screened over the telephone and then given a packet of behavioral questionnaires to complete either at home or in the clinic,” Pearson says. “These rating scales can help identify specific areas of concern and the severity of these concerns. They are also a starting point for a thorough developmental/clinical interview with a clinician.”
Many adults with ADHD have limited insight into their own condition, and gathering information from someone who knows them well, such as a spouse or partner, can be useful in the evaluation. Additionally, clinicians may wish to speak with someone who knew the adult when they were younger, such as a parent, sibling, teacher or faculty adviser.
“If the adult has their school report cards, college transcripts and/or performance evaluations from work, these items can also be very helpful in identifying areas of concern that have emerged over time,” Pearson says. “Psychological testing can also be helpful in exploring specific areas of concern, such as the possible presence of an intellectual disability or a learning disorder. There are also some specific tests of attention that can help to identify which components of attention or related processes may be weaker than others and how significant this weakness is.”
Lack of insight is often the case for diagnosing an attention disorder later in life, Pearson says. More often, she says, a delay in diagnosis is due to the fact that not much was known about ADHD in adulthood until recently.
“When I was in my training several decades ago, I was taught that children with ADHD outgrew their ADHD in adolescence,” Pearson says. “What really happened was that the most obvious symptoms of ADHD, like running around the classroom, tend to lessen over time. However, symptoms of inattention and impulsivity can very much persist into adulthood — and seriously undermine the ability of an adult with ADHD to function at their optimal level.”
Pearson also says that some adults with ADHD do not believe they had symptoms when they were younger. “Many times they did,” she says, “but they were able to compensate for them. For example, the highly intelligent college student who was structured very carefully in high school by their teachers and their parents — but then experiences failure when faced with the increased academic expectations and diminished external structure of college life.”
Prescription stimulants are often helpful in treating ADHD in children, and Pearson says, many adults respond well to these same kinds of medications. Of course, a physician must first determine if an adult can safely take these medications.
“Many adults with ADHD may have developed other conditions, such as low self-esteem or limited social skills, especially if their condition remained undiagnosed and/or untreated for many years,” Pearson says. “Counseling, social skills training and specific problem-solving techniques may be helpful.
“Another important part of intervention is education about the nature of ADHD and the reasons for treatment,” she continues. “This information process should involve both the patient, and ideally, the individuals around them.”
Ling openly shared her diagnosis with the world. Not only is she a courageous and positive role model, but she is proof that most adults with attention disorders can and do make a successful transition to adulthood.
Perhaps now, more adults will be curious enough to step forward to find out if they too have attention disorders.
“After learning that a high-achieving individual like Ms. Ling has ADHD, other adults with these concerns might feel less embarrassment in broaching their symptoms with their family physician or with a mental health professional,” Pearson says. “Her candor may open the door to many adults seeking help — and that is a very good thing.”
As more and more research about ADHD becomes known, misconceptions about it will continue to lessen. “As this happens, hopefully more adults will recognize their own symptoms, will get the help they need, and will then go on to live happier and far more productive lives,” Pearson says.