By Mary Carpenter
MAINTAINING long-term relationships may be one of the biggest challenges for adults with Attention Deficit Hyperactivity Disorder (ADHD), according to Jessica McCabe, ADHD YouTube channel creator. In this population, more than 80% remain undiagnosed and untreated—more in the case of women than men; and among children, girls are less likely to receive the diagnosis. (Although the H in ADHD indicates hyperactivity, ADHD is the acronym often used to include everyone with attention deficit disorders, rather than the simpler ADD.)
On the other hand, adults make up one third of those prescribed ADHD-related medications. And in recent years, more adults have discovered ADHD at the root of their depression or extreme anxiety—while, conversely, anxiety is often misdiagnosed as the hyperactivity related to ADHD.
For adults with ADHD, about 80% will have at least one other psychiatric disorder in their lifetime, which in many cases is a result of living with ADHD—about 30% have depression, and about 50% have an anxiety disorder, such as OCD. ADHD-related problems such as executive functioning deficits —inability to organize and plan ahead—can cause difficulties at school or work, which contribute to problems sleeping and further increase anxiety.
A self-taught sufferer of the condition, McCabe created the YouTube channel “How to ADHD” in 2016 (the average age of subscribers is now between 18 and 34) with videos on an array of issues challenging adults with ADHD. A popular topic is the challenges of long relationships, and of being tempted by the closest new “human of the desired gender because they’re there and you’re bored,” as McCabe puts it.
The paucity of ADHD studies on adults—fewer than half as many as those on children—means that ADHD issues for adults are poorly understood and in turn rarely lead to ADHD diagnoses. As West Chester, Pa. psychologist Ari Tuckman told the New York Times, “It’s adults who are often overlooked.”
On the other hand, adults may be less likely to either seek or benefit from a diagnosis, because they have greater freedom than children to choose activities better suited to their interests— and to find “situations that are a better fit for their novelty-seeking behavior,” according to Richard Friedman, psychiatrist and pharmacologist at Weill Cornell Medical College in New York.
For adults with ADHD, significantly fewer dopamine receptors in the brain make their reward circuits less sensitive compared with healthy controls. As a result, explains Friedman, they respond better to anything varied and unpredictable, and can find repetitive and routine tasks so unrewarding as to become “painfully boring.”
Having a relative with an ADHD diagnosis is an important variable for diagnosing the condition—so that many women recognize their own ADHD for the first time when they have a child who is diagnosed. In one study, among parents of 79 children with ADHD, 41% of mothers and 51% of fathers had the disorder. On the other hand, for an ADHD diagnosis, symptoms must have been present in some form since childhood—before age 12.
Lack of focus is “the most telltale symptom of ADHD,” according to Healthline, and it can include finding it hard to listen to others, overlooking details and not completing tasks or projects. With the opposite problem, hyper-focus, it’s possible to become so engrossed in a task as to lose all awareness of time, as well as of other people.
Adults with ADHD also have problems with forgetfulness, often mistaken for carelessness; and impulsivity—which can take the form of interrupting conversations, impulse-buying and binge-eating. “A disorder of performance” is how spokeswoman for the Attention Deficit Disorder Association, Kylie Barron, described her ADHD: “always unintentionally messing up, sticking your foot in your mouth and doing the wrong thing at the wrong time.”
Disorganization and time management skills can look like lack of motivation and procrastination. And fatigue can result from sleep difficulties as well as from the constant effort required for focusing. A list of questions from the Anxiety and Depression Association of America includes: “Do you have a hard time keeping your temper or staying in a good mood?”; and “Have you had these problems since you were a child?”
But criteria listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) are subjective—with the important distinction being frequency: which behaviors happen “often,” said Dr. Martin Teicher, psychiatrist and editor of the Harvard Medical School guide on adult ADHD. Screening questionnaires cannot provide a diagnosis but can be helpful for recognizing signs—which range from serious challenges to minor inconveniences.
Jessica McCabe describes less familiar, ongoing issues for adults, such as the need to set up workspaces, closets and even refrigerators to make it easier to see important items. McCabe suggests organizing refrigerator shelves to make nutritious foods more visible.
A few years ago, a realtor touring my house called what others have criticized as clutter a “very understandable need” to spread out the clothes in my closet and the work on my desk in a way that makes immediate needs more visible. In high school, I struggled to read some textbooks and other lengthy, assigned books—although I raced happily through Peyton Place—but had fewer problems when I could select my courses in college. And over the years I have found strategies to help with time management, but I’ve also learned that the much-maligned procrastination can provide time for reflection—albeit often aided by playing Words With Friends.
—Mary Carpenter regularly reports on topical subjects in health and medicine.