Adult ADHD: Risks, Symptoms and Causes Explored
Attention-deficit/hyperactivity disorder (ADHD) gets a lot of attention these days. This is largely because of improved diagnostic and education efforts, helping more people understand this condition and receive a diagnosis.
Attention-deficit/hyperactivity disorder typically affects the executive functions involved in inhibitory control, working memory and cognitive flexibility. Research published in January 2023 suggested ADHD is less a problem with a lack of attention and more about how it alters the nervous system to more heavily require novelty and interest for a person to function optimally.
There are many negative outcomes to undiagnosed and untreated adult ADHD, such as job loss, school dropouts, physical and mental health issues, social problems, injuries, etc. When it comes to sexual health and well-being, adults with ADHD have increased problems related to poor decision-making, sexually transmitted diseases (STDs), sexual assault, risky sexual behaviors and relationship difficulties.
Recognizing the common symptoms, risks and causes will help you on the path toward successful diagnosis and testing.
To understand the symptoms of ADHD, we need to understand what it is and how it impacts the nervous system.
John Kruse, M.D., Ph.D., of San Francisco, a psychiatrist and neuroscientist with expertise in ADHD, noted that people with the disorder have an interest-driven attentional nervous system. Once we understand this, all the various symptoms fall into place, but it's important to know ADHD symptoms vary widely from person to person.
"The attention of those with ADHD tends to hover over a variety of activities and projects, flitting from one to another until finding something truly captivating," Kruse said. "At that point, the individual may become so absorbed in the object that they become oblivious to time, to those around them, and to projects that others have deemed urgent or important."
An ADHD nervous system requires novelty or tasks that create interest. Without that, the brains of people with attention-deficit/hyperactivity disorder struggle to focus or hold attention to tasks. This is not to say the tasks can't be done, but it can make them more challenging.
Here are a list of common symptoms:
- Avoiding tasks that take sustained mental effort
- Inability to fully listen when spoken to
- Lack of attention to details
- Losing things or being forgetful
- Not finishing important tasks
- Rushing through tasks
- Blurting out answers or thoughts
- Feeling like you have an internal engine continuously going
- Getting up to pace or walking around frequently
- Talking too much or interrupting
Symptoms often shift in adulthood. Kruse said this occurs because adults with attention-deficit/hyperactivity disorder have learned how to mask or cover the less desirable symptoms in order to better fit in with mainstream society. This is especially true for hyperactive symptoms, which may go "underground" in adulthood. Often, a detailed history reveals more hyperactive symptoms in childhood.
Kruse said many of his adult patients think they are not hyperactive because they present no signs, such as fidgeting, rapid speech, pacing or constant gesturing. However, adult ADHD can often produce further symptoms such as addiction, low self-esteem, mood instability, procrastination, risky behaviors and mental health issues.
Risks and causes
Research published in September 2021 indicated a strong genetic component to ADHD, which means if a parent has ADHD, it's highly likely some of their children have it, too.
Kruse drew attention to the fact that adult ADHD was discovered in the '90s due to so many parents of kids with attention-deficit/hyperactivity disorder showing signs of the condition as well. Kids who were diagnosed would come into clinics for treatment, but parents were forgetting their kids' medications, showing up late and being altogether disorganized.
However, there are many other risks that may increase the chances of ADHD. Studies revealed that prenatal issues such as smoking, prematurity, toxin exposure, vitamin deficiencies and maternal health problems are also associated with a higher incidence of attention-deficit/hyperactivity disorder.
Kruse suggested our environment could be a reason why ADHD is becoming more common in his book: "Recognizing Adult ADHD: What Donald Trump Can Teach Us About Attention-Deficit/Hyperactivity Disorder."
He said environmental feedback loops such as sleep deprivation, inadequate exercise, poor diet, social media and excessive screen time all may be contributing to more incidences of attention-deficit/hyperactivity disorder and in instances where people may have only had subsyndromal ADHD, they could now have full-blown ADHD due to these environmental issues.
Diagnosis and tests
Kruse noted that diagnosing ADHD requires an in-depth analysis from a trained professional, which involves looking deeply into objective behaviors and the history of those behaviors.
This can make it complicated because there are really no tests that can accurately pinpoint the condition, he explained. There are surveys that can help steer clinicians in the right direction but they only scratch the surface. Therefore, deep clinical evaluation is required, but can be time-consuming and expensive.
Kruse pointed out that neuropsychological testing has been hotly debated by clinicians. Often, schools or workplaces require a "test" in order to provide accommodation for individuals with ADHD. Although this is helpful in terms of providing an environment that supports people with the disorder, these tests are somewhat useless in actually understanding the condition.
Moreover, he observed that other conditions such as co-occurring mental health problems (that can be present with or without ADHD) could skew the results of these tests, which means they're not very good at isolating actual ADHD symptoms.
The gold standard for Kruse in the diagnosis of attention-deficit/hyperactivity disorder is a lengthy and in-depth evaluation by a trained clinician who can more accurately understand the nuances in a person's history. His professional opinion is backed up by research published in June 2021, which states that diagnosis of ADHD requires the following:
- Developmentally inappropriate inattentive and hyperactive behaviors for over six months
- Some impairments must have occurred in childhood
- Symptoms cause impairments in daily living
- Symptoms occur in multiple settings (i.e. school, work, etc.)
- No other disorder explains the impairments
What happens when ADHD goes undiagnosed?
Many cases of attention-deficit/hyperactivity disorder, particularly in adults, go undiagnosed. There have also been recent conversations in the media around "over-diagnosing" ADHD.
However, Kruse said there are likely more cases of under-diagnosing ADHD rather than over-diagnosing. And the burden of undiagnosed attention-deficit/hyperactivity disorder can be significant, he added.
These burdens fall in almost every area of a person's life, including work, school, health and social issues. For example, people with untreated and undiagnosed ADHD show higher rates of dropping out of school, car accidents, incarceration, divorce and suicide. Undiagnosed ADHD also leads to increased mental illness, addiction and physical health problems. Finally, the burden placed on family and friends can be high and cause a ripple effect of health and social issues too.
The more we learn about ADHD, its symptoms and diagnosis, the more people can seek out proper diagnosis and treatment quickly and avoid the potential burdens of the condition.