Attention Deficit Disorder (ADHD) in Adults
Ivan is a 40-ish year old, who despite being smart and funny, struggles with work and relationships. When younger, despite teachers saying that "Ivan has great potential", he found school painfully boring and was relieved when he finally completed high school. He thought things would get easier once he finished school, but as an adult, he faces other challenges:
- With work, its hard to focus on the boring parts of his jobs. He forgets deadlines, has troubles getting tasks done. As a result, he has had troubles staying in the same field, and has been through several jobs, while he sees his friends around him stay in the same job, become promoted, etc.
- With relationships, although things go well in the beginning of relationships when things are interesting and exciting, he gets bored quickly. As a result, he has been through numerous relationships, while he sees his friends around home keep long-term relationships, and become occupied with kids and family.
Ivan knows he has great potential, but wonders why he is struggling with his work and personal life.
Attention deficit/hyperactivity disorder (AD/HD) (also known as attention deficit disorder, aka ADD) are brain conditions that make it hard to pay attention. Although everyone has trouble paying attention from time to time, in ADHD/ADD, it is so severe that it causes problems with school, work and relationships.
The main types of ADHD/ADD are:
ADHD, combined type, where individuals have troubles with
- Inattention (so its hard to remember what people are talking about, or its hard to get tasks done), and
- Hyperactivity (where a person tends to need to move or fidget a lot). Unlike children and youth, who can be so hyperactive that they can't even sit still in their seat, adults with ADHD can usually sit still, but they may still need to fidget with their hands, feet or mouth (i.e. need to chew things).
- Impulsivity (where a person tends to act impulsively without first thinking through the consequences of their actions).
ADHD, primarily inattentive type (also commonly known as simply Attention Deficit Disorder or ADD), where a person has troubles with
- Inattention, however is not particularly hyperactivity nor impulsive.
ADHD, primarily hyperactive-impulsive type, where a person has troubles with being
- Hyperactive (i.e. needing to move constantly) or
- Impulsive (i.e. acting on things without fully thinking through the consequences)
Other symptoms that may be seen in individuals with ADHD/ADD
- Easily frustrated with mood swings: Many individuals with ADHD report getting frustrated easily, and having strong emotions. Strong emotions can make someone passionate and fun to be with, but the unpleasant emotions can cause troubles with anger and frustration.
- Easily bored: Individuals with ADHD crave stimulation, which can be a problem when there isn't enough stimulation around, because many situations in life (like school work and chores) aren't that exciting. This contributes to other difficulties such as troubles finishing tasks or being organized, both of which aren't terribly exciting things to do...
Because attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) are so similar, for the rest of this article, it will simply be referred to as ADHD to simplify things.
It is important to note that although many of the symptoms of ADHD can cause problems in some situations, in other situations, many features of ADHD can be seen as strengths. Classic strengths of those with ADHD include:
- Function well with excitement: People with ADHD do well in exciting, stimulating jobs, which tend to be jobs where you have to deal with people, as opposed to jobs where you are mainly dealing with paperwork. This includes the entertainment industry (like actors, comedians, performers such as dancers, musicians); hospitality industry (working in restaurants, hotels, tourism); or "911" professions, such as police, fire fighters, paramedics, or working in hospital emergency rooms (such as doctors or nurses)...
- Great ability to move around: People with the hyperactive type of ADHD do well in jobs where they can move around. Examples include outdoor work, trades (such as carpentry, construction, etc..), certain medical fields (e.g. nursing, surgery, etc..) On the other hand, people with ADHD do not tend to do well in clerical jobs where they sit behind a desk all day... !
- Creativity: People with ADHD tend to do well in jobs where they can be creative and use their imagination, as opposed to jobs where they are doing the same, boring tasks over and over again. This may explain why so many artists and performers report having ADHD...
Are you wondering if you might have ADHD? If so, then start by seeing your family physician, who can help make sure that there aren't any medical problems (such as low iron, hormone imbalances, sleep problems) that might be contributing to the troubles with attention. The doctor might suggest more specialized mental health services or professionals such as a psychologist or psychiatrist.
Are you wondering about a loved one having ADHD, such as a spouse or partner? If so, then recommending that they seek help might be a sensitive topic. It is probably not best to start by telling them that you think that they have ADHD and that they should see their doctor. Start first by ensuring that you have a good relationship and connection built up with them. Ensure you are spending 1:1 time with them. Ask general questions to see if they agree or not that they may have a problem, e.g. "I notice that its been hard for you to keep a stable job / relationship... I wonder if its because it's really hard to focus on things? Do you think that you have problems focusing, when things aren't exciting enough?" "I've been worried about you and see that you have all this potential. I was reading something and wonder if this might explain why it's been challenging for you to reach your full potential." And then give them some information about ADHD... If they agree, then offer to accompany them to their doctor's appointment.
When strategies alone are not enough, then prescription medications may be helpful such as:
- Stimulant medications such as Methylphenidate (Ritalin ® regular, Ritalin SR ®, or Concerta ® and Dextroamphetamine (Dexedrine ® , or Adderall XR ®).
- Caffeine is a stimulant as well, which helps explain why many people with ADHD find it helpful to "self-medicate" by drinking several cups of coffee a day.
- Nicotine and cannabis also have stimulating effects, which explain why many people with ADHD find smoking nicotine or cannabis helpful. Note that in the long run however, long-term, daily use of nicotine and cannabis can cause other significant problems.
- Non-stimulant medications such as Buproprion (Welbutrin SR ®) and Atomoxetine (Strattera ®)
Medications work by stimulating function in the focus areas of the brain, thus improving the core symptoms of ADHD.
Self-Regulation and ADHD
Remember the story of Goldilocks and the Three Bears? She tries the bear's porridge, and the porridge was either too hot, too cold, or "just right".
Our nervous systems are the same way - they can be "too hot" (overstimulated), "too cold" (understimulated), or "just right".
We are "too hot" when we are overstimulated. For example, after a loud, noisy day where you've been given too much work to do ...
We are "too cold" when we are understimulated. For example, having a very boring day or job where you had nothing to do, and where you just sat around all day doing nothing.
Neither too hot or too cold is good. People function best when they are "just right". There needs to be "just enough" stimulation - which includes sensory stimulation (such as movement, touch, sound, smell, visual) and emotional stimulation (such as getting along with others, doing interesting things in life), etc...
Self-regulation is about knowing what to do to make sure that you are getting "just enough" stimulation:
If you are "too cold" or underwhelmed:
Increase stimulation, or use soothing/calming stimulation. People with ADHD tend to need lots of physical stimulation, which is why they often do better if they have opportunities to move around, take frequent "body breaks", and have things to fidget with (e.g. stress balls to squeeze, or chewing gum to chew...)
If you are "too hot" or overstimulated:
Reduce the stimulation, or use soothing/calming stimulation. People with inattention can be easily overstimulated visually, which explains why they often do better if they clean up their work environments and reduce visual clutter. It also explains why people with ADHD shouldn't be doing important work sitting in front of a window, because its too easy to get distracted by stuff outside.
If you are "just right":
Keep doing what you are doing!
Learn how to organize in a way that works for you. People with ADHD often have trouble organizing, a fact that has been pointed out by others. But because they have ADHD, they may need different organization strategies compared to other non-ADHD people. Often times, visual strategies which involve writing things down on paper, or making diagrams or drawings are helpful. It might include things such as 1) writing a daily schedule, 2) writing a list of tasks to do, and crossing things off when they are done; 3) having Post-It notes to write down important things to do; 4) using personal data assistants (PDAs) such as a Blackberry or iPhone to organize things.
There are many other coping strategies for ADHD, and more information is available from the websites below...
One day, while out with a friend, his friend wonders out loud if Ivan might have ADHD. After all, he isn't hyperactive -- just inattentive. Ivan dismisses it but later that night, thinks about it more. At the next visit to his family doctor's, he asks his doctor about the possibility of adult ADHD. The doctor gives him a screening questionnaire, which suggests he might have ADHD.
Ivan learns more about ADHD and tries out some different strategies, such as:
- At work, when he has to do paperwork, he uses a standing desk so he can move around, and he tries his best to have 'walking' meetings with his colleagues. It helps, but he is still struggling, and so he goes back to his family doctor and is started on an ADHD medication. With the help of the medication, he has been able to focus better on tasks that used to be painfully boring, thus helping him stay in the same job.
- At home, with his girlfriend, he explains to her that he has ADHD, which gives her more understanding on why he is often late, forgets important events, etc. Instead of just telling him a list of things for him to remember, now she writes down key things on Post-It notes, e.g. important dates, activities, remembering the milk, etc. Their relationship improves.
Ivan takes out his friend who first wondered about ADHD -- "Thanks for being a good friend, and wondering about ADHD."
Centre for ADHD/ADD Advocacy, Canada (CADDAC)
CHADD Canada (Children and Adults with AD/HD, Canada)
Learning Disabilities Association of Canada (LDAC). Although ADHD is not a "learning disability", because it affects learning, the LDAC does have excellent information on their website.
Written by the eMentalHealth Team and Partners.
Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.
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Date of Last Revision: Aug 6, 2020