ADHD in Adults: Can You Develop ADHD Later in Life?

Attention Deficit Hyperactivity Disorder (ADHD) is often considered a childhood disorder, but research suggests it can become evident for the first time in adulthood. According to a study published in the Journal of the American Academy of Child & Adolescent Psychiatry, approximately 4.4 percent of adults in the U.S. have ADHD. This percentage suggests that millions of adults live with the disorder. ADHD in adults is often undiagnosed and can significantly affect quality of life and productivity.

What is ADHD?    

ADHD is a neurodevelopmental disorder, a term that refers to disabilities associated primarily with the neurological system and the brain. It’s characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Common symptoms include disorganization, trouble focusing, difficulty multitasking, impulsiveness and problems completing tasks. While many people occasionally experience these symptoms, ADHD is diagnosed when the symptoms are severe, persistent and significantly disrupt daily life.

Covenant Health family physician James Schindler, MD, explains, “Adults with ADHD often struggle with ‘executive function’ – they might have trouble planning, organizing and completing tasks. They can be inattentive, impulsive, restless and have trouble managing emotions.”

Types of ADHD  

There are three main types of ADHD. Each has distinct patterns of behavior:

1. ADHD Combined Type: This is the most common form. Combined ADHD includes both inattentive and hyperactive-impulsive symptoms.
2. ADHD Predominantly Hyperactive-Impulsive Type: This type involves significant hyperactivity and impulsivity. Inattention is a less prominent characteristic.
3. ADHD Predominantly Inattentive and Distractible Type: Also known as ADD (Attention Deficit Disorder), this type is marked by inattention and distractibility, but without significant hyperactivity.

ADHD vs. ADD  

ADD is the term used previously to describe what we now recognize as the inattentive type of ADHD. Today, ADHD is the accepted terminology because it encompasses both hyperactive-impulsive and inattentive symptoms. Dr. Schindler explains, “ADHD includes hyperactivity while ADD does not. People with ADD mainly struggle with attention and executive function issues.”

What Causes ADHD?  

Experts don’t fully understand the exact cause of ADHD. Research indicates a combination of genetic, environmental and neurological factors. Genetic studies suggest a hereditary component; individuals with a family history of ADHD are more likely to have the disorder. Environmental factors such as exposure to toxins during pregnancy, low birth weight and premature birth also have been linked to ADHD. Nutrition deficiencies and high sugar intake have been studied as possible contributors, but evidence is less conclusive.

ADHD Brain vs. Non-ADHD Brain  

Neuroimaging studies show structural and functional differences between ADHD and non-ADHD brains. Persons with ADHD often show reduced volume in certain brain regions like the prefrontal cortex. This area is involved in executive functions like planning, decision-making and impulse control. Functional MRI studies also have shown differences in brain activity patterns, particularly in areas responsible for attention and behavioral regulation.

Dr. Schindler notes, “Within the brain, we see decreased activity of [neurotransmitters] dopamine and norepinephrine in the areas that influence behavior and cognition. MRI studies suggest smaller volumes of brain tissue in some areas in the brains of children with ADHD.”

Can You Develop ADHD as an Adult?  

The concept of adult-onset ADHD has gained attention in recent years. Although ADHD typically is diagnosed in childhood, some people may not show symptoms until adulthood. This delayed onset of ADHD in adults could be related to factors including an increase in life stressors, higher demands for executive functions and changes in brain structure or chemistry over time.

“The current thinking is that most people diagnosed with ADHD or ADD in childhood continue to meet the criteria as adults,” Dr. Schindler says. “However, a significant number of people with ADHD or ADD as adults did not have classic symptoms or performance issues as children.”

ADHD in Men vs. Women   

ADHD in adults often presents differently in men and women. Men typically exhibit more hyperactive and impulsive behaviors, while women are more likely to experience inattentiveness. This difference can lead to underdiagnosis in women because their symptoms may be less evident.

Dr. Schindler observes, “It’s generally thought that boys – and later men – may have more issues with hyperkinesis [excessive movements] and impulsivity, while girls and women often struggle more with attention. Both can have issues with impulsive speech and emotional regulation.”

How Do Doctors Test for ADHD in Adults?  

Diagnosing ADHD in adults involves a comprehensive evaluation that includes clinical interviews, self-report questionnaires and sometimes neuropsychological testing. Doctors assess the individual’s symptoms, duration, and how extensively symptoms impair daily functioning. It’s important to rule out other conditions that can mimic ADHD, such as anxiety, depression or substance abuse disorders.

How is ADHD Treated in Adults?  

Adult ADHD treatments typically use a combination of medication, psychotherapy and lifestyle modifications. Stimulant medications like methylphenidate and amphetamines may be prescribed because they increase dopamine and norepinephrine levels in the brain. Read more about amphetamines and their effects here.

Dr. Schindler recommends a multifaceted approach. “Structuring the work environment, avoiding distractions and using tools like concentration practice programs can help. Medications that affect dopamine and norepinephrine levels can be very effective for attention and focus.” Behavioral therapy, cognitive-behavioral therapy (CBT) and coaching can also help adults develop organizational skills, manage time and cope with stress.

“Integrating various treatment modalities provides a comprehensive path to managing ADHD in adults. These modalities can improve overall functioning and quality of life,” Dr. Schindler says.

How to Schedule an Adult Assessment for ADHD  

If you think you may have ADHD, the best place to start is with your primary care provider. Your provider can do an initial evaluation and refer you to a specialist if necessary. Dr. Schindler recommends involving both primary care and behavioral health professionals, so you get a full assessment and a treatment plan that works for you.

“Your primary care provider can take a good history and perform necessary tests,” he explains. “They can refer you to a behavioral health specialist if needed, especially if other conditions like anxiety or PTSD might be present.”

In summary, ADHD is usually associated with childhood, but also can be evident in adults. Symptoms may be a new onset or a continuation of childhood characteristics. Understanding the nuances of ADHD in adults is important for accurate diagnosis and effective treatment to improve the quality of life.

If you or someone you know is struggling with symptoms of ADHD, don’t wait to seek help. Visit covenanthealth.com/find-a-doctor/ to find a primary care physician who can provide the services you need.