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Adult ADHD

Signs and symptoms of ADHD in adults can be hard to spot. However, core symptoms start early in life — before age 12 — and continue into adulthood, creating major problems.

No single test can confirm the diagnosis. Making the diagnosis will likely include:

  • Physical exam, to help rule out other possible causes for your symptoms
  • Information gathering, such as asking you questions about any current medical issues, personal and family medical history, and the history of your symptoms
  • ADHD rating scales or psychological tests to help collect and evaluate information about your symptoms

Other conditions that resemble ADHD

Some medical conditions or treatments may cause signs and symptoms similar to those of ADHD. Examples include:

  • Mental health disorders, including mood disorders such as depression or anxiety, conduct disorders, learning and language deficits, or other psychiatric disorders
  • Medical problems that can affect thinking or behavior, such as a developmental disorder, seizure disorder, thyroid problems, sleep disorders, lead poisoning, brain injury or low blood sugar (hypoglycemia)
  • Drugs and medications, such as alcohol or other substance abuse and certain medications

Treatment

Standard treatments for ADHD in adults typically involve medication, education, training, and psychological counseling. A combination of these is often the most effective treatment. These treatments can relieve many symptoms of ADHD, but they don’t cure it. It may take some time to determine what works best for you.

Medications

Talk to your doctor about the benefits and risks of any medications.

  • Stimulants, such as products that include methylphenidate or amphetamine, are typically the most commonly prescribed medications for ADHD, but other drugs may be prescribed. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters.
  • Other medications used to treat ADHD include the nonstimulant atomoxetine (Strattera) and certain antidepressants such as bupropion (Wellbutrin, others). Atomoxetine and antidepressants work slower than stimulants do, but these may be good options if you can’t take stimulants because of health problems or a history of substance abuse or if stimulants cause severe side effects.

The right medication and the right dose vary among individuals, so it may take time to find out what’s right for you. Tell your doctor about any side effects.

Psychological counseling

Counseling for adult ADHD generally includes psychological counseling (psychotherapy), education about the disorder and learning skills to help you be successful.

Psychotherapy may help you:

  • Improve your time management and organizational skills
  • Learn how to reduce your impulsive behavior
  • Develop better problem-solving skills
  • Cope with past academic, work or social failures
  • Improve your self-esteem
  • Learn ways to improve relationships with your family, co-workers, and friends
  • Develop strategies for controlling your temper

Common types of psychotherapy for ADHD include:

  • Cognitive behavioral therapy. This structured type of counseling teaches specific skills to manage your behavior and change negative thinking patterns into positive ones. It can help you deal with life challenges, such as school, work or relationship problems, and help address other mental health conditions, such as depression or substance abuse.
  • Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Such counseling can improve communication and problem-solving skills.

Working on relationships

If you’re like many adults with ADHD, you may be unpredictable and forget appointments, miss deadlines, and make impulsive or irrational decisions. These behaviors can strain the patience of the most forgiving co-worker, friend or partner.

Therapy that focuses on these issues and ways to better monitor your behavior can be very helpful. So can classes to improve communication and develop conflict resolution and problem-solving skills. Couples therapy and classes in which family members learn more about ADHD may significantly improve their relationships.

Lifestyle and home remedies

Because ADHD is a complex disorder and each person is unique, it’s hard to make recommendations for all adults who have ADHD. But some of these suggestions may help:

  • Make a list of tasks to accomplish each day. Prioritize the items. Make sure you’re not trying to do too much.
  • Break down tasks into smaller, more manageable steps. Consider using checklists.
  • Use sticky pads to write notes to yourself. Put them on the fridge, on the bathroom mirror, in the car or in other places where you’ll see the reminder.
  • Keep an appointment book or electronic calendar to track appointments and deadlines.
  • Carry a notebook or electronic device with you so that you can note ideas or things you’ll need to remember.
  • Take time to set up systems to file and organize information, both on your electronic devices and for paper documents. Get in the habit of using these systems consistently.
  • Follow a routine that’s consistent from day to day and keep items, such as your keys and your wallet, in the same place.
  • Ask for help from family members or other loved ones.

Alternative medicine

There’s little research to indicate that alternative medicine treatments can reduce ADHD symptoms. However, one recent study indicates that mindfulness meditation may help improve mood and attention in adults who have ADHD, as well as those who don’t have ADHD.

Before using alternative interventions for ADHD, talk with your doctor about risks and possible benefits.

Coping and support

While treatment can make a big difference with ADHD, taking other steps can help you understand ADHD and learn to manage it. Some resources that may help you are listed below. Ask your health care team for more advice on resources.

  • Support groups. Support groups allow you to meet other people with ADHD so that you can share experiences, information and coping strategies. These groups are available in person in many communities and also online.
  • Social support. Involve your spouse, close relatives, and friends in your ADHD treatment. You may feel reluctant to let people know you have ADHD, but letting others know what’s going on can help them understand you better and improve your relationships.
  • Co-workers, supervisors, and teachers. ADHD can make work and school a challenge. You may feel embarrassed telling your boss or professor that you have ADHD, but most likely they’ll be willing to make small accommodations to help you succeed. Ask for what you need to improve your performance, such as more in-depth explanations or more time on certain tasks.

What you can do

To prepare for your appointment, make a list of:

  • Any symptoms you’ve had any problems they’ve caused, such as trouble at work, at school or in relationships.
  • Key personal information, including any major stresses or recent life changes you’ve had.
  • All medications you take, including any vitamins, herbs or supplements, and the doses. Also include the amount of caffeine and alcohol you use, and whether you use recreational drugs.
  • Questions to ask your doctor.

Bring any past evaluations and results of formal testing with you, if you have them.

Basic questions to ask your doctor include:

  • What are the possible causes of my symptoms?
  • What kinds of tests do I need?
  • What treatments are available and which do you recommend?
  • What are the alternatives to the primary approach that you’re suggesting?
  • I have these other health problems. How can I best manage these conditions together?
  • Should I see a specialist such as a psychiatrist or a psychologist?
  • Is there a generic alternative to the medicine you’re prescribing?
  • What types of side effects can I expect from the medication?
  • Are there any printed materials that I can have? What websites do you recommend?

Don’t hesitate to ask questions anytime you don’t understand something.

What to expect from your doctor

Be ready to answer questions your doctor may ask, such as:

  • When do you first remember having problems focusing, paying attention or sitting still?
  • Have your symptoms been continuous or occasional?
  • Which symptoms bother you most, and what problems do they seem to cause?
  • How severe are your symptoms?
  • In what settings have you noticed the symptoms: at home, at work or in other situations?
  • What was your childhood like? Did you have social problems or trouble in school?
  • How is your current and past academic and work performance?
  • What are your sleep hours and patterns?
  • What, if anything, appears to worsen your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What medications do you take?
  • Do you consume caffeine?
  • Do you drink alcohol or use recreational drugs?

QUESTION: Should we treat patients who are on Suboxone with stimulants?

ANSWER: Complex question. Suboxone is of course used for the treatment of chronic opioid addiction and has proven to be a helpful, lifesaving treatment for many patients.

Such patients often do have a high risk of attention-deficit/ hyperactivity disorder (ADHD) as a comorbid condition. Treatment with Suboxone will not treat the ADHD, and ADHD in many adults, if not treated, leads to significant life impairment. But, at the same time, the use of stimulants in patients with a well-established history of addictions is also fraught with abuse and diversion risk.

What is a clinician to do?

Here are a few suggestions I offer you for your consideration as you work your way through this complex issue:

1. Is the diagnosis of ADHD substantiated by more than the patient’s current report? For example, are there clinical notes from before, perhaps even preceding the opioid addiction that substantiate a diagnosis? Are there old school records available?
Is there a reliable family member you can talk to in order to obtain reliable historical collaborative data? Any or all of these would be hugely helpful.

2. Currently, is there a presence of both DSM-5 diagnostic symptoms and impairment arising from ADHD? Use of rating scales such as the ADHD-RS might be very helpful.

3. Is the patient fairly stable, with sustained abstinence from illegal opioid and other substances/medications?

4. Are the deemed reliable? Do they have a history of diversion?

5. If you do decide to offer a patient a trial of a stimulant, please ensure that the patient’s cardiovascular system is stable and there are no contraindications to their use.

6. Make sure no obvious drug-drug interactions are an issue in that individual patient.

7. Consider the use of nonstimulants first. If you do decide to use stimulants, consider using long-acting stimulant formulations. Avoid short-acting formulations.

8. Offer a limited number of capsules/tablets of the stimulants. If possible, ask a reliable family member to be the custodian of the medication.

9. Repeat scales to measure improvement after treatment.

10. Stay vigilant about abuse/diversion.
While all this may sound like “a lot of work,” stimulants can be hugely helpful even in such complex patients. Hence, this extra effort may really help you further improve the quality of the patient’s life.