What is ADHD? Diagnosis, support, therapy
ADHD (Attention Deficit Hyperactivity Disorder) is characterized by symptoms of inattentiveness, over-activity, impulsivity, or combination of both. ADHD typically begins in childhood and persists in adolescence and adulthood. As individuals grow older, the symptoms often become less pronounced compared to the earlier stages of childhood and adolescence. Some people are only diagnosed with ADHD in adulthood.
Prevalence (Proportion of ADHD individuals in 100 people of a particular population)
ADHD is a common mental disorder. The exact prevalence numbers vary depending on which criteria (according to ICD-10 or DSM-5) are used for diagnosis and how the diagnosis is obtained.
Globally, an average prevalence rate of around 5% to 6% is assumed for children and adolescents, using the less strict diagnostic criteria according to the American classification system DSM-5. When the very strict criteria of ICD-10 are used, the rate is estimated to be 1 to 3%.
In all studies, gender-specific differences in the prevalence of ADHD can be observed, with boys being significantly more affected than girls.
Diagnosing ADHD. Criteria
Experts have agreed upon specific criteria that must be met for an ADHD diagnosis (see our article about ADHD diagnostics). They describe various manifestations of inattentiveness, hyperactivity, and impulsivity. ADHD tends to manifest differently in adults. Hyperactivity often diminishes, while inattentiveness, inner restlessness, and difficulties in regulating emotions become more prominent.
ADHD in adulthood
It is not uncommon for ADHD to be diagnosed first during adulthood. The reason is simple: the full understanding about ADHD in adults has been established around 30 years ago but got the full attention after 2000. Individuals born before the year 2000 or short after haven’t been screened for ADHD and remained untreated. During this period medical insurances refused the payment for ADHD treatment by people older than 18.
Even today adults with ADHD may encounter challenges in finding adequate support. Due to the prevailing perception of ADHD as primarily a childhood issue, the availability of counselling and treatment options for affected adults is not as widespread as those for children and adolescents.
How does ADHD manifest in adulthood?
Adult ADHD is less apparent than in hyperactive children and adolescents. Adults with ADHD primarily struggle with organizing their daily lives or work, maintaining focus on tasks for extended periods, or meeting deadlines.
However, they can also be very impulsive. For instance, adults with ADHD tend to be talkative and frequently interrupt others. Some may easily get into trouble, end relationships prematurely, switch jobs abruptly, or resign without having a new position lined up. Difficulties can also arise in traffic due to reckless driving.
Many adults with ADHD find it challenging to regulate their emotions. They are easily irritable and have a low frustration tolerance. When under stress, fulfilling their responsibilities becomes difficult. Adults with ADHD may also encounter difficulties in setting and achieving goals.
It’s highly advisable seeking professional advice when someone experiences symptoms of ADHD that significantly and persistently affect their quality of life. Therefore, it’s crucial to ensure a careful ADHD diagnosis to avoid unnecessary or incorrect treatments keeping in mind that other psychiatric conditions can be misdiagnosed as ADHD.
To whom I can turn for support?
Adults with ADHD usually seek assistance from specialized medical professionals such as psychiatrists, or psychologists. When young individuals with ADHD reach adulthood, it is advisable to start searching for an adult psychiatrist. However, in some cases, individuals who have turned 18 can continue receiving treatment from their child and adolescent psychiatrist until they reach the age of 21.
What helps to deal with ADHD?
Many adults with ADHD face challenges primarily due to their inattention and impulsivity. However, some develop effective strategies to deal with it, for example by:
- Carefully planning the day and creating reminder lists to avoid forgetting things, while being mindful not to take on too much.
- Breaking tasks down into smaller steps to make it easier to accomplish them gradually.
- Placing reminders in important locations, such as the front door, refrigerator, or car, to aid memory.
- Recording important appointments and tasks in a notebook or mobile app.
- Establishing routines and consistently keeping essential items like keys or wallets in the same place.
Since the challenges of ADHD are highly individual, it is difficult to provide universally applicable advice. However, many individuals discover over time what can help them navigate daily life more effectively. Support from friends and family proves valuable in this process.
Should I disclose my ADHD diagnosis?
Individuals with ADHD often question whether they should share their diagnosis with others. Close friends and family members may already be aware, but the situation can be different in the workplace. Deciding whether to inform colleagues or supervisors about one’s diagnosis is a challenging and personal consideration. Many people choose to keep their diagnosis to themselves because they fear losing their job or facing difficulties in obtaining employment.
However, there are also reasons that support being open about one’s diagnosis. Heiding continuously the condition from others can be mentally exhausting and often not possible. Being open and honest about one’s challenges can be relieving.
Without knowledge of the diagnosis, it is impossible to seek necessary treatment. Colleagues and supervisors who might be aware of the diagnosis are more likely to provide support and understanding. In larger companies, there is often an option to approach the works council or occupational health service in strict confidence.
It’s highly important to acknowledge that ADHD is a treatable condition. The first step in the treatment process is contacting the psychiatrist or psychologist to diagnose the condition. In the majority of the cases the symptoms of ADHD can be fully controlled allowing the individual normal work and social performance.
Multimodal support and treatment for ADHD
The results of studies have shown that a multimodal therapy concept is the most successful for ADHD. In a multimodal approach, different interventions and therapeutic techniques are tailored to the individual case and can be applied in an outpatient, as well as a partial or full inpatient setting. Suitable measures are modularly integrated into the therapy concept.
Some interventions that can be applied include:
- Informing and advising the social environment of the affected individual, particularly involving family, teachers or the workplace.
- Cognitive behavioral therapy to reduce impulsive and disorganized task-solving, as well as self-management training to modify problematic behaviour.
- Pharmacotherapy to alleviate hyperkinetic symptoms.
- Separate treatment of any comorbidities.