If you struggle with poor attention, focus, or general disorganization, you may be among the 4.4% of American adults who have adult Attention-Deficit/Hyperactivity Disorder (adult ADHD). Until recently, ADHD was mainly diagnosed in children and adolescents, with 11% of American youth ages 4-17 receiving an ADHD diagnosis. Up to one third of these youth still have symptoms as adults, while others are receiving a diagnosis for the first time.
Adult ADHD - Diagnosed Later in Life
Adult ADHD often stems from undiagnosed symptoms in childhood or adolescence. In fact, to receive an adult ADHD diagnosis, several symptoms must have been present before the age of 12.
Adults with ADHD often recall being teased or bullied as children. They may report being called lazy or inattentive by teachers or peers. Adults diagnosed with ADHD later in life often have feelings of fear, anger, guilt, or shame that began in childhood. They may also face ongoing stigma and discrimination, since adult ADHD is still misunderstood.
Increased acceptance of adult ADHD means people can be more inclined to speak to their clinicians, family members, and close friends about their personal struggles with the disorder, and choose to seek treatment.
Receiving a long-overdue ADHD diagnosis allows adults to start connecting the dots, seeing how their earlier experiences may be tied to their diagnosis and current mental and emotional health concerns.
Challenges in Determining Adult ADHD
Adult ADHD can be difficult to diagnose. Symptoms may be subtle, and often overlap with other disorders. Men and women also have different symptoms, and adult symptoms are often distinct from childhood symptoms.
Symptoms of Adults ADHD
One misconception about adult ADHD is that it’s identical to childhood ADHD. Many children and teens with ADHD may experience fidgety behavior and hyperactivity, as well as symptoms of inattention. On the other hand, adults predominantly struggle with symptoms of inattention. Hyperactivity symptoms that are overt in children present more as feelings of restlessness in adults.
Gender differences also come into play. Men are more likely to have externalized symptoms of ADHD (impulsivity or hyperactivity), while women are more likely to have internalized symptoms (inattentiveness and low self-esteem). This helps explain why ADHD is underdiagnosed in girls, as boys’ symptoms are more readily observed by teachers and parents. Women are more likely to be diagnosed later in life than men.
According to the Attention Deficit Disorder Association, adults with ADHD report that this condition "significantly impacts their ability to focus at work, as well as their responsibilities at home and their relationships." These symptoms can influence every area of life, leading to conflict and misunderstandings. If you are concerned that you may have symptoms of ADHD, talk to your healthcare provider about your experiences.
Non-Medication Treatment for Adult ADHD
Using several interventions is often successful in treating adult ADHD, so most clinicians recommend a combination of medication and other therapies. There are several non-medication treatments that may reduce symptoms.
Cognitive Behavioral Therapy
Mental health professionals can help families and clients understand how ADHD affects adults. For example, the frustrations of living with an undiagnosed mental health condition for many years can lead to a self-defeating mindset. As a result, adults newly diagnosed with ADHD may have significant issues with self-esteem and self-worth.
Cognitive Behavioral Therapy (CBT) and counseling can help adults learn coping skills and understand how their emotions, behaviors, and thoughts are connected. CBT can help individuals recognize how their thoughts and attitudes affect their behaviors, and can teach strategies to change these thoughts and behaviors.
During exercise, the body releases dopamine, norepinephrine, and serotonin, chemicals that support focus, memory skills, and mood. Exercise can also improve attention in individuals diagnosed with ADHD. Exercise also helps in indirect ways by reducing stress, improving sleep, and increasing blood flow to the brain.
Meditation or mindfulness can help manage symptoms of adult ADHD. Mindfully paying attention to the breath and the body can increase focus, calm racing thoughts, and improve self-regulation.
Medication Options for Adult ADHD
Some medications are also prescribed to treat ADHD in children and adults. Medications do not cure ADHD, but they can be useful in managing symptoms. Both stimulants and non-stimulants may be used to treat ADHD.
Stimulants are considered first-line treatment for children over 6 years of age and adults with ADHD symptoms. Both methylphenidate and amphetamines increase the levels of dopamine and norepinephrine, chemicals that improve an individual's ability to focus. These long-action medications keep patients feeling steady throughout the day. Stimulant medications can work quickly, usually within an hour. They include:
- Methylphenidates: Focalin, Focalin XR, Concerta, Daytrana, Metadate CD
- Amphetamines: Adderall XR and Vyvanse
For some adults, stimulant medications can aggravate other symptoms such as anxiety. In these cases, non-stimulant medications may be preferred. Non-stimulants are also prescribed if an individual does not respond to stimulant medication. These medications take longer to start working than stimulants, but are still effective for ADHD. Common non-stimulants include:
- Strattera (atomoxetine) is a widely accepted choice for adults. It can give long-acting relief and has a low potential for abuse.
- Several antidepressants can be used off-label as non-stimulant medications for ADHD.
- Intuniv (guanfacine) and Kapvay (clonidine) are only approved for children.
Starting a New Medication
If you have recently been diagnosed with adult ADHD, it’s normal to have questions about medication. Medications can be helpful for many adults with ADHD symptoms, but everyone is unique. Individual genetic profiles can play an important role in determining the effect(s) of a medication. For example, every additional medication you take adds new risks, including uncomfortable or even dangerous side effects. Getting the best response from the fewest medications is a safer approach for finding symptom relief.
Lifestyle habits can also interact with medication(s). Smoking, caffeine, and other substances can interact with medications. Clinicians will also consider these lifestyle factors when recommending medication options.
Finding Appropriate Medication
Clinicians will often find out which medication(s) work best by having you try them one at a time. However, pharmacogenetic testing like Genomind® Professional PGx Express™ is designed to help clinicians make safer and more informed medication choices right away. The fast and painless cheek swab test is designed to try to minimize the trial and error process by providing your clinician with a detailed report about your genes and your personal metabolism profile.
Personalized Genetic Insights
The Genomind® Professional PGx Express™ tests for COMT and ADRA2A gene variants, helping your clinician make a more informed decision about ADHD medications from the start. Variations in both the COMT and ADRA2A gene are associated with the response to stimulants for ADHD.
- People with the COMT Val/Val genotype tend to respond better to stimulants while those with the Met/Met genotype tend to derive less benefit.
- Variations in the ADRA2A gene may increase or decrease the likelihood of response to methylphenidate.
Having genetic variations that could reduce the chance of responding to these stimulants may prompt your healthcare provider to consider non-stimulants, if appropriate.
Does Your Medication Work for You?
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Getting diagnosed with adult ADHD can cause mixed feelings. However, getting diagnosed after years of unrecognized symptoms means more answers and more appropriate treatment options. Pharmacogenetic testing for ADHD medications can help your clinician see another piece of the treatment puzzle, with the goal of more informed treatment options to help you manage symptoms and improve your quality of life.