ADHD in adults

The key signs and symptoms of ADHD cover two main areas of difficulty: inattention and hyperactivity/impulsivity, although in adults, hyperactivity and impulsivity may be less obvious.

Inattention

• Difficulty concentrating 
• Difficulty staying focused 
• Forgetfulness 
• Trouble organising tasks and activities 
• Tendency to lose things.

Hyperactivity/ Impulsivity

• Fidgeting and restlessness 
• Difficulty sitting for long periods of time 
• Difficulty engaging in quiet activities 
• Difficulty waiting for a turn 
• Acting or speaking before thinking things through.

For a person to be diagnosed with ADHD, they must currently have several symptoms which must have started before the age of 12, and difficulties must be present in two or more settings (such as at home and at work).

Symptoms that arise later in life are unlikely to be ADHD and should be assessed immediately.

There are three types of ADHD, depending on the main difficulties the person is experiencing. These are:

Predominantly inattentive: The person mostly has symptoms of inattention, rather than hyperactivity or impulsivity.

Predominantly hyperactive-impulsive: The person mostly has symptoms of hyperactivity and impulsivity, rather than inattention.

Combined: The person has symptoms of both inattention and hyperactivity-impulsivity.

There is no single cause of ADHD; rather, there are a range of factors relating to people’s genes, neurobiology (the structure and function of the brain) and environment that increase their chances of developing ADHD.

Genes

There appears to be a strong genetic component to ADHD. ADHD runs in families and having a relative with the disorder is one of the strongest risk factors. 

Neurobiological factors

In adults with ADHD, research has found some differences in areas of the brain and brain activity that relate to short term memory, the ability to focus, and the ability to make choices.

Differences have also been found in brain activity associated with attention and self-regulation, that is, the ability to focus attention, as well as manage emotions, thinking and behaviour.

Environmental factors

Certain environmental factors might also play a role in the development of symptoms of ADHD. These include:

• Pregnancy and birth factors: Maternal smoking, alcohol and substance misuse, and stress during pregnancy, as well as low infant birth weight and prematurity are all factors linked to ADHD.

• Certain environmental toxins: Toxins such as lead can affect brain development and behaviour and have been linked to ADHD.

• Dietary factors: For some people (even without ADHD) attention and concentration might be affected by nutritional deficiencies (e.g., zinc, magnesium, polyunsaturated fatty acids) and sensitivities to certain foods (e.g., sugar, artificial food colourings). There is no evidence however that these cause ADHD and a medical practitioner should be involved to evaluate these issues if they are considered of possible concern.

In adulthood, ADHD is assessed by a team of professionals with training and expertise in ADHD, with their findings put together to make a diagnosis. In the assessment of ADHD in adults, this team of professionals often includes:

GP or other medical practitioner: to assess and treat any related health issues

Psychologist: a mental health professional with training in the assessment and treatment of developmental, learning, behavioural and mental health disorders

Psychiatrist: a mental health professional with medical training who assesses and treats a range of mental health disorders, and who can prescribe medications to address mental health symptoms.

This team of professionals assess for the following:

• Does the person present with ongoing signs of inattention, hyperactivity or impulsivity?
• Do these symptoms significantly and negatively impact on the person’s day-to-day functioning?
• Were these symptoms present before age 12?
• Do they occur in different settings (e.g., work and home)?
• Could another reason better explain the symptoms?

Answering these questions involves interviews, taking a detailed history of the person’s development, physical health, and mental health, and careful consideration of other information such as previous records, prior school reports, and family accounts.

The psychologist might test the person’s memory, attention, and other skills. The assessor might also observe the person across different settings to see how they behave in different environments with different demands on behaviour.

There are a range of treatments which show good outcomes for adult ADHD. These include medication, cognitive-behavioural therapy for adult ADHD, and couples counselling for those experiencing relationship difficulties.

Medication

There is significant evidence supporting the use of medication in the treatment of ADHD in adults. Using medication in combination with psychological strategies is likely to lead to the best outcomes.

CBT for adult ADHD

Research suggests that cognitive-behavioural therapy (CBT) for adult ADHD is the most helpful approach to managing problems associated with ADHD in adulthood. In CBT for adult ADHD, a psychologist, or other qualified health professional, helps the person learn a range of skills that can reduce the impact of ADHD.

CBT for adult ADHD includes:

• education about adult ADHD, and how it can affect different areas of people’s lives
• organisation, planning, and time-management skills training, including strategies such as the use of calendars and task lists, prioritising, and breaking down large tasks into smaller, more manageable goals
• training in effective problem solving, which involves defining the problem, brainstorming solutions, trying out a solution, and evaluating its success
• strategies for reducing distractions and increasing attention span, for example, structuring small tasks around the person’s realistic attention span, removing environmental distractions, and setting reminders, and
• thinking in more helpful and realistic ways, particularly around situations that cause distress. Overly negative thoughts and assumptions can prevent people from using skills that may help them manage their ADHD, and may contribute to other problems such as depression and low self-worth. Learning to identify and challenge these thoughts can be particularly helpful. 

Couples counselling

While not a treatment for ADHD, couples therapy might be useful for those experiencing difficulties in their relationships, which is not uncommon for adults with ADHD. Couples counselling involves helping both partners understand how their attitudes and behaviours influence the relationship, learn to express caring and accepting emotions, improve communication, identify and change problem behaviours, and focus on the positive aspects of the relationship.

Seeing a Psychologist

If you are finding it difficult to concentrate or focus, and this is affecting your day-to-day life, an assessment should be organised with a GP to discuss whether ADHD or another health issue might explain your symptoms. They can refer you to a psychologist or psychiatrist for assessment if necessary.

You might benefit from referral to a psychologist for an assessment, and to help you develop strategies to address issues that you are concerned about. Psychologists are highly trained and qualified to diagnose and treat people with ADHD using a range of methods based on best available research. Psychologists understand the factors that can affect attention and concentration, and can help people with ADHD improve these skills and reduce the impact ADHD has on their lives.

Psychologists usually see clients individually, but can also include family members to support treatment where appropriate. Psychologists sometimes offer group therapy, involving a small number of people with similar issues.

There are a few ways you can access a psychologist. You can: 

• Use the Australia-wide Find a Psychologist service or call 1800 333 497
• Ask your GP or another health professional to refer you.

If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate that may assist you in meeting the costs of treatment. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.

Decrease distractions

Set up your workspace to be free from distraction - away from the door (where people come and go), away from the window (and distractions outside), and free from clutter, electronic media, and other distractions.

Get organised

Use time management and organisational strategies to streamline your day. To help get more organised, you can:

• set goals
• write to-do lists, and use these to plan and prioritise tasks for the day
• use a diary and set reminders for jobs that need doing
• group similar tasks that can be done together. 

Break tasks down into smaller chunks

Smaller tasks are easier to complete, easier to organise and are less overwhelming. They are also more easily done while your mind is fresh and before your concentration wanes.

Include breaks in activities and tasks

Breaks after work is completed can help you to refocus on the next task.

Use problem-solving

Effective problem-solving includes defining a problem you want to work on, brainstorming solutions, selecting a solution and trying it out, and reviewing the outcome.

Head to Health

The Federal Government’s website linking the public to reputable and evidence-based digital mental health services.
www.headtohealth.gov.au

beyondblue

Provides information on anxiety, depression, and related disorders 
www.beyondblue.org.au

headspace

Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25
www.headspace.org.au

Lifeline

A 24-hour counselling, suicide prevention and mental health support service
Telephone: 13 11 14 
www.lifeline.org.au

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