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Introduction
It’s a classic, almost stereotypical scenario. A young school student, typically male, cannot sit still in class, lacks attention to detail, shouts during quiet time, has trouble turning in homework, and seems to “ignore” the teacher when spoken to. The school refers the student to a qualified physician who diagnoses him or her with Attention-Deficit/Hyperactivity Disorder (ADHD), a neurodevelopmental condition that affects around six million U.S. children aged 3 – 17. Post-diagnosis treatment for the student may include medications, behavioral training, and an individualized schooling plan. Without intervention, the child with ADHD is at risk for poor school performance, social troubles, anxiety, and depression. Scarily, a Finnish cohort study of 839 adults found that a childhood diagnosis of ADHD was associated with a higher risk of unnatural death and a younger age of death.
That being said, research is increasingly challenging the perception of ADHD as a condition that only exists in childhood. Here are two interesting tidbits on ADHD in people over 18.
#1. Adults with ADHD show a different range of symptoms than children.
Evidence indicates that the hyperactivity and impulsive behavior typical in childhood ADHD abate somewhat in adulthood, though inattentiveness may remain the same. Both children and adults with ADHD often struggle with external commitments (school and work) and have marked social difficulties. Still, adults are more likely than children to show deficiencies in emotional regulation to the point that some scholars consider it to be a primary symptom in that population.
Signs of emotional dysregulation include:
Trouble controlling emotions
Low inhibitions combined with strong negative and positive emotions
Mood changes
Hypersensitivity
Trouble expressing emotions such as anger
Low distress tolerance
Hirsch et al. (2018) theorize that long-term emotional dysregulation contributes to a vicious cycle of a poor self-concept influencing negative behavior and vice-versa. Adults with ADHD abuse substances, perform poorly at school and work, get into car accidents, and get into legal trouble at higher rates than the general population.
Another possible hallmark of adult ADHD is hyperfocus. Hyperfocus is not a conscious activity and does not require a directed effort. It happens when someone uncontrollably fixates on a single activity for many hours without doing anything else. This symptom is not currently recognized in diagnostic criteria. However, there is a growing interest surrounding hyperfocus and adult ADHD in the scientific community, as ADHD involves a lack of control of one’s attention. Hyperfocus may be one reason that some adults with ADHD actually do well in school or the workplace. If the object of the hyperfocused person’s interest is a school project, for example, they may neglect going to the restroom, eating, drinking, or other activities to finish it.
#2. Adults with ADHD may have masked their symptoms as children.
Adult ADHD is notoriously complex to diagnose. The typical diagnostic requirement is that symptoms of ADHD must be apparent before age 12. The idea that someone can develop first-onset ADHD in adulthood is controversial. Still, many adults with diagnosed ADHD did not have diagnoses as children. This may be related to the phenomenon of symptom masking. Some scholars theorize that if an intelligent child with ADHD grows up in a socially supportive environment, the child may learn to control impulsive behaviors and develop a better self-image. The child also learns to hide distressing emotions.
However, when that child grows up, they will likely experience a change in their social situation, such as a new school environment, a new job, or living in a different place. Such changes can disrupt their coping mechanisms, allowing their ADHD to become visible for the first time.
Conclusion: Help is out there!
Attention-deficit/hyperactivity disorder can be a devastating condition, but it is still poorly recognized and managed in adults. It is critical that a symptomatic adult see a knowledgeable medical professional to gauge symptoms, explore their mental health history, and rule out other physical or mental conditions.
For extra resources and support, the following websites are available:
(Disclaimer: The author claims no financial or professional relationships with the websites listed above. The websites are listed for informational and educational purposes only.)
References
Assessed and Endorsed by the MedReport Medical Review Board