ADHD in adults: symptoms and treatment

ADHD stands for attention deficit hyperactivity disorder. The condition usually manifests itself in childhood through persistent difficulties in maintaining concentration, hyperactivity and impulsive behaviour. However, the symptoms are very diverse. The impact ADHD has on a person’s everyday life doesn’t depend solely on biological factors; psychological aspects and social environment also play an important role.

Boys are diagnosed with ADHD more often than girls. This is because the symptoms are usually less obvious in girls and are therefore more easily overlooked by parents and professionals. However, researchers assume that girls and boys are affected at a similar rate. In Switzerland, around 5.9% of children and adolescents and 2.5% of adults have been officially diagnosed with ADHD. The figures are constantly changing, and it’s likely that there are a number of unreported cases, as it’s only when a person’s level of distress becomes severe that an assessment is actually carried out.

Many children with ADHD continue to show clear symptoms even as adults. At the same time, there are cases in which the condition is not diagnosed during childhood, but only in adolescence or adulthood. In cases like these, distinguishing ADHD from other conditions is a particular challenge.  

The core symptoms of ADHD in adults are essentially similar to those in children and adolescents. While the condition is often more obvious in children due to restlessness, ADHD in adults is more commonly characterised by inattention and impulsivity. In addition, many find it difficult to organise their daily lives. 

When it comes to ADHD symptoms, experts around the world rely on the International Classification of Diseases, 11th Revision (ICD-11) published by the World Health Organization and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) published by the American Psychiatric Association. 

Diagnoses are made on the basis of a comprehensive clinical assessment in accordance with international diagnostic criteria. From an administrative perspective, the ICD-10-GM is currently the predominant system used in Switzerland, while clinical practice is increasingly guided by the ICD-11 and, to a lesser extent, the DSM-5. Both define three core symptoms: inattention, hyperactivity and impulsivity. 

Inattention

• Difficulty maintaining concentration for long periods: this is particularly the case with tasks that are mentally demanding and offer little stimulation or reward. As a result, people with ADHD often make careless mistakes at work or at school, overlook details or fail to complete tasks they’ve started.
• Easily distracted by external stimuli: as a result, people with ADHD often appear to be daydreaming or look as if they are not listening.
• Forgetfulness and difficulty planning and organising activities and tasks: people with ADHD often lose things.

Hyperactivity

• Restlessness: those affected find it difficult to sit still and tend to fidget. They feel uncomfortable when doing quiet activities.
• People with ADHD talk excessively.

Hyperactivity is particularly evident in structured environments, such as at work or at school.

Impulsivity

• People with ADHD tend to respond immediately to stimuli without thinking first or considering the consequences.
• They find it difficult to wait their turn: they blurt out answers, interrupt other people or intrude on their conversations, games and activities.

Different forms of ADHD

A distinction is made between different forms of ADHD, depending on which symptoms occur: 

• ADHD with predominantly inattentive presentation: this does not involve hyperactivity and is particularly common in adults. People with this form of the condition are inattentive, but they have fewer problems with impulsive behaviour and restlessness.
• ADHD with predominantly hyperactive-impulsive presentation: hyperactivity and impulsivity dominate here, while attention is less impaired.
• ADHD with combined presentation: this hybrid form is characterised by inattention, hyperactivity and impulsivity.

Why is ADHD often overlooked in women?

Boys and men are diagnosed more often than girls and women. One reason for this is that the condition manifests itself differently in girls and women. While hyperactivity and impulsivity are generally visible in men, adult women are predominantly the inattentive ADHD type without symptoms of hyperactivity. Inner restlessness tends to manifest itself as tension, racing thoughts or stress and often remains invisible to those around them.

In addition, many women are better at controlling impulsive behaviour and adapting to social expectations. Experts refer to this as “masking”: symptoms are consciously or unconsciously concealed or compensated for. As a result, ADHD in women often goes undetected or is only diagnosed in adulthood. At the same time, women with ADHD are at increased risk of developing anxiety disorders and depression.

ADHD is diagnosed by specially trained professionals such as psychiatrists or psychotherapists. The assessment process is particularly time-consuming and complex in adults. On the one hand, a certain number of symptoms must be present. These manifest themselves in various areas of people’s lives – at home and at work, for example – and persist for a period of at least six months. On the other hand, it is crucial that the first signs of ADHD were already visible during childhood. This is why school reports are often taken into account or people close to the individual, such as friends or partners, are interviewed.

In many adults, ADHD goes undiagnosed for a long time. The symptoms are often only noticed when the demands of work or family life increase and the coping strategies that person had previously relied on are no longer sufficient. Careful diagnosis therefore considers not just individual symptoms, but the person as a whole. The assessment takes account of the individual’s developmental history, their current circumstances and their existing strengths and resources. Neuropsychological tests can provide additional information – however, even if the test results are within the normal range, this does not rule out ADHD.

Differentiation and concomitant illnesses

People who are often forgetful, have difficulty concentrating or suffer from inner restlessness do not automatically have ADHD. The same symptoms can also occur in other disorders or may appear temporarily in stressful periods of a person’s life. Specialists therefore carefully assess whether the symptoms are actually due to ADHD or are better explained by other causes.

At the same time, ADHD often comes with comorbidities. In particular, these include:

• Anxiety disorders and panic attacks
• Depression
• Sleep disorders
• Addiction
• Eating disorders
• Autism spectrum disorder (ASD)
• Dyscalculia (difficulty understanding and working with numbers)
• Dyslexia (learning difficulty which affects reading and writing)
• Disruptive behaviour or dissocial disorders
• Personality disorders
• Post-traumatic stress disorder

The treatment of ADHD in adults depends on individual symptoms, circumstances and needs. No single treatment is therefore equally suitable for everyone.

In most cases, treatment consists of several components. These include psychoeducation, psychotherapy, medication and supportive measures in everyday life.

Psychoeducation

The first step is to gain a better understanding of ADHD and make sense of your own behaviour. Those affected learn how their symptoms have developed in relation to school, work, family and other areas of their lives. Psychoeducation thus provides a good basis for managing the condition.

Psychotherapy

In psychotherapy, adults with ADHD reflect on their own behavioural patterns and conditioning. They develop useful strategies and work on their ability to cope with distressing symptoms and feelings. For ADHD symptoms such as irritability or aggression, for example, they practice responding in a calmer manner. Concomitant illnesses such as anxiety disorders, depression or sleep disorders are also treated in therapy.

Different forms of therapy are available depending on individual needs, including behavioural therapy approaches and body-oriented methods. Psychotherapy is available as individual and group therapy. Sharing experiences with other people with ADHD can provide additional relief.

It’s worth noting that self-help groups also offer the opportunity to discuss the condition. Some services are designed specifically for relatives. Suitable support groups include those offered by the adhs20+ counselling centres and the ADHD organisation elpos Schweiz.

Medication

Methylphenidate and amphetamines are some of the most commonly used active ingredients. Both are stimulants. They stimulate the central nervous system, improve concentration and reduce impulsive behaviour. Possible side effects include sleep disorders and an elevated heart rate. These types of medication are not suitable for people with cardiovascular diseases.

Non-stimulant medications such as atomoxetine are also available. This active ingredient affects the neurotransmitter noradrenaline in the brain. This improves information processing in certain areas of the brain, which has a positive effect on concentration and memory.

Exercise, nutrition and mindfulness training

Key supportive measures include regular exercise, getting enough sleep and a balanced diet. Mindfulness exercises can also be a useful complement to psychotherapy or medication. For example, yoga and meditation help people to cope better with stress, regardless of whether they have any specific ADHD symptoms. 

People with ADHD face a variety of challenges depending on the severity of their symptoms and their circumstances. This makes it all the more important to develop individual strategies with the help of a therapist. The following tips may also be useful:

Create structure and calm

• So you can concentrate on your work, organise your environment so that it causes as little distraction as possible. Position your desk in front of a wall rather than a window, and try wearing headphones or earplugs.
• Be sure to plan in regular breaks. Other activities that bring a sense of balance to your day are also important, such as endurance or resistance training. Set aside specific times for this.
• Rituals will help you to structure your daily life and make it easier to wind down. A regular evening routine is also a good idea for those suffering from sleeping disorders, so try cutting down on your screen time and reading a book instead. It’s important to stick to these habits at the same time every day.
• Be realistic when planning your day and don’t take on too much. Tackle any unpleasant tasks as soon as possible and treat yourself to a small reward to keep you motivated. More time-consuming tasks are best broken down into several smaller tasks.

Keep things tidy

• Store important items such as your wallet and keys together in one place. Always put them there straight away as soon as you get home. It’s the best way to avoid things getting lost.
• Tracking devices that you can attach to important items are helpful.
• There are various apps that can make everyday life easier for adults with ADHD. They can be used to plan and organise tasks or draw up a cleaning schedule.

ADHD presents particular challenges when it comes to relationships. Difficulties with attention, impulsivity and emotional regulation can lead to misunderstandings and conflict. At the same time, people with ADHD are often creative, spontaneous and sociable. As in any relationship, it’s important that both partners are aware of their own patterns of behaviour and talk openly about their needs and problems. Remember to bear the following basics in mind: 

• Express your opinion appropriately, without raising your voice. Respect your partner’s opinion, even if you disagree.
• Be tolerant. Don’t always try to have things your own way. Stay calm; in most cases, problems can be solved by coming to a compromise.
• Be mindful of your tone of voice and choice of words. If you’re criticising your partner, it’s best to speak in the first person and say things like: “I feel offended” or “I don’t feel taken seriously”.
• Try to see things from your partner’s perspective. They may feel differently to you. 

If you do have ADHD, it’s particularly important to reflect on your own behaviour. Be aware of your unique characteristics and name them clearly. This promotes understanding within the relationship and helps you identify patterns of behaviour you’d like to work on. 

Conversely, it’s important for partners of people with ADHD to learn about the condition and the various symptoms it can have. This will give you a better idea of which types of behaviour are linked to ADHD. Always keep in mind that people with ADHD do not behave disruptively on purpose. 

Sexuality can also be influenced by ADHD. Some people with the condition have an increased need for intimacy, while others are less sexually active. Women in particular sometimes find their minds wandering in intimate situations. Here, too, it’s important to talk about your personal preferences. 

People with ADHD are often considered lazy or undisciplined. However, these perceptions don’t do justice to the complexity of the condition. ADHD symptoms are not about a lack of discipline or motivation. Conversely, being diagnosed with ADHD does not justify problematic behaviour. It should serve as an incentive to gain a better understanding of the challenges you face and to find constructive ways of dealing with them. Being diagnosed can also help to break down prejudices and put difficulties into perspective.

Many adults with ADHD lead complete, fulfilling lives. For some, getting the right treatment is a real turning point. With the support of professionals, they can develop strategies for managing their symptoms, discover their strengths and take a conscious, active approach to shaping their daily lives.