ADHD and ADD in adulthood

11. September 2019

“ADHD? That’s something in kids, isn’t it, when they can’t concentrate properly and fidget and disrupt at school?”

You would probably hear this answer more often if you asked the general public what is behind the two abbreviations. This is because most people associate the disorders ADHD and ADD with children. But the disorder persists beyond childhood and adolescence and can cause enormous distress in adults.

ADHD and ADD: Abbreviations under the magnifying glass

ADHD stands for attention deficit hyperactivity disorder. ADD stands for attention deficit disorder. The disorders are similar, but ADD lacks hyperactive behavior (American Psychiatric Association, 2013).

Symptoms of ADHD and ADD

In an ADHD problem, the attention of the affected person is disturbed. This is required whenever a specific task is to be processed or a goal is to be pursued. Patients with ADHD cannot maintain their attention for as long as healthy individuals. They are quickly distracted by external stimuli and therefore cannot concentrate well. For ADHD sufferers, attentional performance requires significantly more effort and mental control than for healthy individuals.

One speaks of hyperactivity when there is an excessively high urge to move and motor impulses can only be suppressed with difficulty. The physical activity is then excessive and thus often not appropriate to the situation. Those affected suffer from excessive restlessness.

Although the term does not appear in the abbreviation, increased impulsivity is one of the main symptoms of ADHD/ADD. In impulsive behavior, there is a lack of action planning. While healthy individuals can plan through their actions step by step, individuals with ADHD are overwhelmed with this cognitive task.

Good to know: In German-speaking countries, ADHD/ADD is also referred to as hyperkinetic disorder (ICD 10 according to Dilling et al., 2012).

Effects of ADHD/ADD in adulthood

Pronounced ADHD/ADD symptomatology can make life quite difficult. All areas of life can be affected by the disorder:

  • Vocational life
  • Household/everyday life
  • Self-organization
  • Partnership and family
  • Friendships

For more information on the effects of ADHD and ADD in adulthood, see this article from ADHD Deutschland e.V

Late diagnosed ADHD/ADD

It happens that ADHD or ADD is diagnosed only in adulthood, although it always develops in childhood and adolescence (more on this later). Sometimes those affected just “somehow” fought their way through it or were optimally supported by their environment. Some people with ADHD/ADD are also particularly creative and innovative, so that one cannot really speak of a disorder, but rather of a special feature. In that case, ADHD/ADD is not diagnosed at all, even if it is actually present. The rule of thumb is always: A diagnosis is only made when there is suffering.

If ADHD/ADD is diagnosed at a late stage, it is often not the main reason why the person concerned seeks treatment. For example, there may be depression, anxiety disorder, or addiction, and ADHD/ADD may not be recognized until the causes are looked at closely. The diagnosis of ADHD/ADD can then even be relieving. It explains why those affected encounter so many more difficulties in life than their peers and opens up new treatment options.

The development and maintenance of ADHD/ADD

There are several explanatory models for the development of ADHD/ADD. Basically, it can be assumed that no model in isolation is sufficient to explain the development and maintenance of the disorder. It must be assumed, as with any mental disorder, that there is a coincidence of many factors. Factors that have been scientifically investigated and supported by studies are:

Genetic factors

Twin and family studies show that the development of ADHD/ADD is largely genetically determined. If a direct relative has the disorder, there is a five-fold increased risk of also developing ADHD/ADD.

Biological factors

To put it simply, the brain metabolism of ADHD/ADD patients has the following peculiarity, partly due to genetic factors: The neurotransmitter dopamine is less available. The hypothesis is that those affected try to compensate for this undersupply through their own activity (Döpfner, 2012). The well-known drug Ritalin is also based on this mechanism (see below).

Neuropsychological factors

There are abnormalities in the so-called neuropsychological abilities: These include attention, action control, memory and self-regulation. These are probably present from birth and do not develop only through the ADHD/ADD.

Psychosocial factors

Parent-child interaction may play a role in the development of ADHD/ADD. Parents can behave unfavorably, e.g. by being inconsistent in their own actions and instructions.

External factors

Pregnancy complications, prematurity, infections or toxins (nicotine, alcohol) can also promote the development of ADHD.

“ADHD/ADD: a chronic disorder?”

Over time, the conspicuousness of hyperactivity diminishes in many ADHD patients. By comparison, people not affected by ADHD/ADD also become more motor calm with age. Attention disorders, on the other hand, are more persistent. Scientists make the following basic assumption: If ADHD/ADD exists in childhood, it is 75% likely to persist into adolescence and 50% likely to persist into adulthood.

Important: If ADHD/ADD is suspected only in adulthood, it is mandatory for a reliable diagnosis that in retrospect the impairments were already present in childhood.

ADHD/ADD as a risk factor for further difficulties

People with ADHD/ADD may not cope as well with some of the developmental hurdles that we inevitably encounter in life. For example, social skills, self-control, and self-image may not develop as well because the calm to do so is simply lacking. The school and professional development suffers from this and so an ADHD/ADD can pull a real mountain of problems with itself.

The treatment of ADHD and ADS in adults

The treatment of ADHD/ADD in adults is composed of several components (Riechmann et al., 2017):

Psychotherapy in individual and group settings
In psychotherapy What to expect in psychotherapy?, mechanisms for dealing with the disorder can be learned. Psychotherapists often refer to this as coping strategies. The English word coping stands for the use of one’s own resources to deal with personal and interpersonal problems in a solution-oriented manner (Solanto et al., 2008). In group therapy, there can be an exchange of experiences with other affected persons, which can have a very relieving and strengthening effect.

Medicinal treatment
Drug treatment is similar to that used in childhood. Particularly well known and widespread is the administration of the active substance methylphenidate – better known as Ritalin. Ritalin normalizes brain metabolism and ensures that those affected have more dopamine available (Döpfner, 2004). As a result, people with ADHD/ADD become calmer and can concentrate better, since they do not have to drive up the dopamine concentration through their own activity. In addition, after thorough medical clarification, medications are used to treat mental disorders that occur as a complication of ADHD/ADD, e.g., depression and anxiety disorders.

Neurofeedback
Neurofeedback is a computer-based method designed to train attention and self-control. The idea is that the computer provides feedback whenever attention goes down, and individuals receive a signal reminding them to self-regulate attention. Part of the process also involves measuring brain activity and teaching patients how to influence their brain’s electrical activity.

ADHD in adults: Are you affected?

If you or a loved one has a diagnosis of ADHD/ADD in adulthood, the good news is that awareness and research of this disorder has improved greatly over the past two decades (review in research by de Zwan et al, 2012). Well-tested concepts are available on how to treat such a disorder in a meaningful way.

How to live well with ADHD/ADD as an adult

Many behaviors that make living with ADHD/ADD easier can be learned with help and long-term training. Solanto et al (2008) indicate areas where small tricks and exercises can make everyday life easier: Time management, “procrastination,” distractibility, and organizational skills are just a few. Setting priorities, keeping a calendar, and dividing larger tasks into subgoals – all of these can be practiced specifically! Living well is possible even with ADHD/ADD. Do not be afraid to seek external help and get advice – for this I wish you success and the necessary portion of calm at this point!

References

(1) Berberich, G., & Zaudig, M. (2015). The alternative model for personality disorders in DSM-5. Forensic Psychiatry, Psychology, Criminology, 9(3), 155-163

(2) Bohus, M., Landwehrmeyer, G. B., Stiglmayr, C. E., Limberger, M. F., & d Christian, G. S. (1999). An open-label trial. J Clin Psychiatry, 60, 598-603

(3) Fiedler, P. (2009). Personality disorders. In Textbook of behavior therapy (pp. 515-531). Springer, Berlin, Heidelberg

(4) Linehan, M. (2008). Dialectical-behavioral therapy of borderline personality disorder. Munich, Germany: Cip Media

(5) Skodol, A. E., Pagano, M. E., Bender, D. S., Shea, M. T., Gunderson, J. G., Yen, S., … & Zanarini, M. C. (2005). Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychological Medici-ne, 35(3), 443-451.

Categories: ADS/ADHD Depression

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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