While it’s common to think of attention deficit disorder (ADD) as something seen in school-age children, it’s actually fairly common in adults as well. Jay Fawver, MD, PPG – Mind-Body Medicine, Ambulatory Section Chief, Parkview Behavioral Health Institute, walks us through the condition, from diagnosis to helpful tools for navigating day-to-day challenges.

What is attention deficit disorder? 

Attention deficit disorder (ADD), which sometimes includes hyperactivity and impulsivity (ADHD), is characterized by daily difficulties with attention span and distractibility that were apparent since early adolescence, leading to impairment in school, social and work functioning. 

Similar to nearsightedness (where an individual cannot clearly see objects at a distance), ADD/ADHD is a medical condition that can be corrected with medications (similar to eyeglasses for nearsightedness), but often causes untreated individuals to struggle to adapt (similar to an individual with nearsightedness without eyeglasses adapting by squinting, sitting closer to objects, etc.). Individuals with ADD/ADHD are often considered to be intellectually “brighter” but are often told that they are “not applying themselves.” They are often able to hyperfocus on topics that are interesting, novel or challenging, but struggle more than expected with mundane but necessary tasks.

How common is ADD/ADHD with adults? 

In the U.S., approximately 4.4% of adults have ADD/ADHD (3 4% worldwide). If someone is diagnosed with ADD/ADHD as a child, 50-70% will continue to experience it into the adult years.  “Adult-onset” ADHD typically refers to ADD/ADHD being first diagnosed in adulthood. If these symptoms have their initial presentations as an adult, the cause would be more characteristic of clinical depression, a head injury, hypothyroidism, diabetes, menopause, sleep apnea, etc.

What causes ADD/ADHD? 

Genetics appear to play a large role in ADHD, with twin studies suggesting inheritance of approximately 76% (Biederman J, et al. Lancet. 2005;366(9481):237-248). Magnetic resonance imaging (MRI) of the brain revealed that five brain regions in those with ADHD were smaller than in those without ADHD (caudate nucleus, putamen, nucleus accumbens, amygdala, hippocampus). These differences were more prominent in children with ADHD than in adults with the disorder (Hoogman, et al. The Lancet Psychiatry. February 2017).

What’s the role of untreated ADD/ADHD that may have been present in childhood?

Untreated ADD/ADHD in childhood is associated with inefficiency, procrastination and greater impulsivity than expected for the child’s age. It’s associated with a greater likelihood of frequent injuries, being expelled from school (8 times greater risk), being less well-liked by peers, fewer friendships, tobacco smoking (2 times higher risk), alcohol abuse (2.5 times greater risk), illicit substance abuse (2.5 times greater risk) and reckless driving (2.2 times greater risk) (Goodman, DW Primary Psychiatry Vol. 17, No. 2. February 2010).

What are the consequences of untreated ADD/ADHD in adolescence? 

Adolescents with untreated ADHD/ADD are 2-6 times more likely to have a suspended or revoked driver's license, more traffic violations and speeding tickets, more motor vehicle accidents and greater vehicular damage. They are twice as likely to smoke cigarettes, 2.5 times more likely to use alcohol and twice as likely to use other illicit substances. 

Untreated ADHD/ADD leads to an 8 times greater likelihood of school dropout. Socially, individuals with untreated ADHD/ADD have difficulty retaining friendships but tend to be much more sexually impulsive, having a 10 times greater risk for an unplanned pregnancy (Goodman DW. Primary Psychiatry. Vol 17. No. 2, February 2010). However, if adolescents are treated for ADHD/ADD, they are less likely to smoke, drink alcohol or use illicit substances compared to untreated individuals (Arch Pediatric Adolescent Medicine 2008;162:916-921).

What are the consequences of untreated ADD/ADHD in adults? 

Untreated adults often have a lower educational attainment than their IQ would predict and are less likely to finish college. It doubles the risk of marital separation or divorce, and people are less satisfied with social relationships. 

These individuals are at a 4 times greater risk to have contracted a sexually transmitted disease. They are 3 times more likely to be unemployed and are more likely to be fired or impulsively or quit a job. They may receive lower salaries, have poor work evaluations, and have frequent job changes over 10 years. 

They are 3 times more likely to have more accident claims (Goodman DW. Primary Psychiatry. Vol 17. No. 2, February 2010). Among patients with ADHD, rates of motor vehicle crashes were lower during periods when they received ADHD medication (Chang Z, et al. May 10, 2017 JAMA Psychiatry, May 10, 2017). Individuals with untreated ADD/ADHD are twice as likely to have been arrested or convicted (3 times greater risk) and are more likely to be incarcerated (15 times greater risk). 

In Sweden, 25,656 patients with a diagnosis of ADHD were studied over 3 years, examining their association with pharmacologic treatment for ADHD and subsequent criminal conviction.  This study demonstrated that their rates of criminality were lower during periods when they were receiving ADHD medication (Lichtenstein, P et al. N Engl J Med 2012; 367:2006-2014, November 22, 2012).

Typically, ADHD is more associated with depression and anxiety disorders in the adult years due to daily frustrations associated with these consequences.

What are some behavioral tips for ADHD with adults?  

• Identify and avoid distractions. 
• Prioritize and complete the most important tasks before moving to the next. 
• Organize your physical space for bills, messages and reminders. 
• Use electronic calendars, day planners, tape recorders, note pads, and set reminder alarms and other task-specific tools. 

A systematic review of literature did not find enough research data to support novel diets, vitamin and mineral supplementation, or food supplements at this point (Rytter MJH et al. Nordic Journal of Psychiatry, 2015;69(1):1-18.).

What are resources for further information? 

I recommend the following books:

• "Driven To Distraction:  Recognizing and Coping with ADD from Childhood to Adulthood" (Hallowell and Ratey, 1994)
• "Delivered from Distraction" (Hallowell and Ratey, 2005)
• "Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Client Workbook (Treatments That Work)" in paperback by Steven A. Safren, Susan Sprich, Carol A. Perlman, Michael W. Otto (Oxford University Press, 2005)