Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder and learning difficulty that starts in childhood and can often persist into adulthood.

 

It is categorised into 2 types of behavioural problems: inattentiveness (attention deficit), and hyperactivity and impulsiveness. Most people with ADHD have problems in both these categories (combined type) but this is not always the case, e.g. Inattentive type or Attention Deficit Disorder (ADD).

 

ADHD symptoms in children and teenagers are well-defined, and they are usually noticeable before the age of 6. They occur in more than one situation, such as at home and at school. Exaggerated emotional sensitivity and reactivity (emotional dysregulation), e.g. mood swings, and temper outbursts, are also common ADHD symptoms and signs. Attention can seem to be deficient (inattention) or sometimes excessive (hyperfocus).     

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Inattentiveness (attention-deficit) symptoms are:

• a short attention span

• often being easily distracted

• often making careless mistakes, e.g. in schoolwork or at work

• often appearing forgetful or losing things

• inability to stick to tedious or time-consuming tasks

• often appearing to be unable to listen when spoken to directly

• often not following through on instructions

• constantly changing activity or task

• difficulty organising tasks.

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Hyperactivity and impulsiveness symptoms are:

• often being unable to sit still, especially in calm or quiet surroundings

• constantly fidgeting

• often being unable to concentrate on tasks for long periods

• excessive physical movement and activity

• excessive talking

• often finding it difficult to wait your turn

• often acting without thinking first

• often interrupting others

• little or no sense of danger.

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These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline and the Police.

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Symptoms in Adults

Adult ADHD affects 3-5% of the adult population. However, it remains unknown and undiagnosed in the majority of sufferers. In adults, the symptoms are more difficult to define, largely due to a lack of research into adults with ADHD. Since ADHD is a neurodevelopmental disorder, it cannot suddenly develop in adults without having been present in childhood first. 

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By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.

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The symptoms in children and teenagers are sometimes also applied to adults with possible ADHD but some specialists say the way in which inattentiveness, hyperactivity, and impulsiveness affect adults can be very different. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressures of adult life increase. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.

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Symptoms associated with Adult ADHD:

• carelessness and lack of attention to detail

• continually starting new tasks before finishing old ones

• poor organisational skills

• inability to focus or prioritise

• continually losing or misplacing things

• forgetfulness

• restlessness and edginess

• difficulty keeping quiet, and speaking out of turn

• blurting out responses and often interrupting others

• mood swings, irritability, and a quick temper

• inability to deal with stress

• extreme impatience

• taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously.

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If you think you may be suffering from Adult ADHD then talk to your GP or contact our team today for initial Adult ADHD screening and private Adult ADHD assessment.

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What causes ADHD?

The exact cause is unknown but the condition has been shown to run in families. Genes do seem to be involved - one-third of those with ADHD have at least one parent with similar symptoms. Research has also identified a number of possible differences in the brains of people with ADHD when compared with those without the condition.

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Other potential factors include:

• being born prematurely (before the 37th week of pregnancy)

• having a low birth weight

• smoking, or alcohol or drug abuse during pregnancy.

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ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.

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Diagnosis in Adults

Diagnosing Adult ADHD in the UK is more difficult because there's some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults. In some cases, an adult may be diagnosed with ADHD if they have 6 or more of the symptoms of inattentiveness, or 6 or more of hyperactivity and impulsiveness, listed in diagnostic criteria for children with ADHD.

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As part of your private assessment, Adult ADHD specialist Dr Iqbal Mohiuddin will ask about your present symptoms. However, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood.

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If you find it difficult to remember whether you had problems as a child, or you were not diagnosed with ADHD when you were younger, your specialist may wish to see your old school reports or talk to your parents, teachers or anyone else who knew you well when you were a child.

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For a diagnosis of Adult ADHD to be made, symptoms should also have a moderate effect on different areas of their life, such as:

• underachieving at work or in education

• driving dangerously

• difficulty making or keeping friends

• difficulty in relationships with partners.

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If your problems are recent and did not occur regularly in the past, you're not considered to have ADHD as it's currently thought that ADHD cannot develop for the first time in adults.

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Treatment

ADHD treatment in the UK can help relieve the symptoms and make the condition much less of a daily problem.

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ADHD can be treated using medication or therapy but a combination of both is often best. Treatment is usually arranged by a specialist, such as a psychiatrist, although the condition may be monitored by your GP.

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Medication

There are 4 types of medication licensed for the treatment of Adult ADHD:

• Lisdexamfetamine (Elvanse)

• Methylphenidate, e.g. Concerta XL, Ritalin 

• Dexamfetamine

• Atomoxetine (Strattera)

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These medications are not a permanent cure for Adult ADHD but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practice new skills.

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If you're prescribed one of these medications, you'll be given small doses at first, which may then be gradually increased (titration). You will need to see Adult ADHD specialist Dr Iqbal Mohiuddin and your GP for regular check-ups to ensure the treatment is working effectively and check for any side effects or problems. It's important to let your GP know about any side effects and talk to them if you feel you need to stop or change treatment. Dr Iqbal Mohiuddin will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

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Lisdexamfetamine (Elvanse)

Lisdexamfetamine is a similar medication to Dexamfetamine and works in the same way. Adults may be offered Lisdexamfetamine as the first-choice medication instead of Methylphenidate.

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Lisdexamfetamine comes in capsule form, taken once a day.

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Common side effects of lisdexamfetamine include:

• decreased appetite, which can lead to weight loss or poor weight gain

• aggression

• drowsiness

• dizziness

• headaches

• diarrhoea

• nausea and vomiting.

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Methylphenidate (e.g. Concerta XL, Ritalin)

Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants, which work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

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The medication can be taken as either immediate-release tablets (small doses taken 2 to 3 times a day) or as modified-release tablets (taken once a day in the morning, with the dose released throughout the day over 12 hours).

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Common side effects of methylphenidate include:

• a small increase in blood pressure and heart rate

• loss of appetite, which can lead to weight loss or poor weight gain

• insomnia

• headaches

• stomach aches

• mood swings.

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Dexamfetamine

Dexamfetamine is similar to lisdexamfetamine and works in the same way. 

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Dexamfetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.

 

Common side effects of dexamfetamine include:

• decreased appetite

• mood swings

• agitation and aggression

• dizziness

• headaches

• diarrhoea

• nausea and vomiting.

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Atomoxetine (Strattera)

Atomoxetine works differently from other ADHD medications. It's a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing it can aid concentration and help control impulses.

 

Atomoxetine may be offered to adults if it's not possible to use methylphenidate or lisdexamfetamine. 

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Atomoxetine comes in capsule form, usually taken once or twice a day.

 

Common side effects of atomoxetine include:

• a small increase in blood pressure and heart rate

• nausea and vomiting

• stomach aches

• trouble sleeping

• dizziness

• headaches

• irritability.

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Atomoxetine has also been linked to some more serious side effects that are important to look out for, including suicidal thoughts and liver damage. If you begin to feel depressed or suicidal while taking this medication, speak to your doctor.

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Therapy

As well as taking medication, different therapies can be useful in treating Adult ADHD. Therapy is also effective in treating additional problems, such as anxiety disorders, that may appear with ADHD.

 

Some of the therapies that may be used are outlined below.

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Psychoeducation

Psychoeducation can help adults make sense of being diagnosed with ADHD and can help you to cope and live with the condition.

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Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. A therapist would try to change how you feel about a situation, which would in turn potentially change your behaviour.

 

Other possible treatments

There are other ways of treating Adult ADHD that some people with the condition find helpful, such as Adult ADHD coaching, Adult ADHD support groups, cutting out certain foods, and taking appropriate supplements. Seek specialist medical advice first. 

 

Diet

People with ADHD should eat a healthy, balanced diet. Do not cut out foods before seeking medical advice though reducing carbohydrates and increasing protein and water intake is likely to be beneficial. Some people may notice a link between types of food and worsening ADHD symptoms. If this is the case, keep a food and drink diary, and what behaviour follows. Discuss this with your GP who may refer you to a dietitian.

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Supplements

Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial for people with ADHD, although the evidence supporting this is very limited. It's advisable to talk to your GP before using any supplements because some can react unpredictably with medication or make it less effective. You should also remember that some supplements should not be taken long-term, as they can reach dangerous levels in your body.

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https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/

https://www.rcpsych.ac.uk/mental-health/problems-disorders/adhd-in-adults

https://www.nice.org.uk/guidance/ng87/chapter/Recommendations