En español | Neil Swanson says his wife of 52 years was always trying to understand why a guy like him, who seemed so smart, had so much trouble keeping track of time and staying organized.
Swanson, 79, says that when the couple, from Warrenton, Virginia, were raising their twins, his wife “wasn't sure she felt safe leaving them with me. She thought I would forget they were there. I would get distracted or hyper-focus on something."
He bounced from job to job — as a minister, a counselor, a construction contractor and a building consultant. Without stability, the family was in debt, and he blamed himself. “I thought my failure to function might just be my own lack of self-discipline,” he says.
Finally, about 17 years ago, Swanson was diagnosed with attention-deficit disorder/hyperactivity disorder, or ADHD. “That was quite a revelation,” he says.
What is ADHD?
In the 1960s children who appeared unable to control their behavior were described as having “hyperkinetic impulse disorder,” a diagnosis formally recognized by the American Psychiatric Association in 1968. It was renamed ADHD in the 1980s and now is one of the most commonly diagnosed childhood neurodevelopmental disorders. Its symptoms can include attention difficulties, hyperactivity and impulsiveness. Someone may have one or multiple symptoms, sometimes distinguished with a more specific diagnosis of impulsive/hyperactive-type ADHD, inattentive-and-distractible-type ADHD (once described as ADD, but no longer) or combined-type ADHD.
The Centers for Disease Control and Prevention (CDC) estimates that 6.1 million children have a diagnosis of ADHD — with the percentage of diagnoses increasing since 1997, the first year of the now-annual national survey. Experts don't know whether the numbers are growing because more kids have ADHD or because doctors are more likely to identify it. There's no clear cause, but it tends to run in families. Low birth weight, brain injury, exposure to environmental toxins such as lead, and a mother's cigarette smoking and alcohol or drug use during pregnancy are also risk factors for the disorder.
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About 70 percent of people who are diagnosed with the disorder as children continue to have symptoms as adults, but it doesn't spontaneously appear for the first time in adulthood, says Mary Rooney, chief of the Child and Adolescent Psychosocial Interventions Research Program at the National Institute of Mental Health in Bethesda, Maryland. “You just don't have ADHD onset in adulthood without evidence of impairment in childhood,” she explains.
Nearly 13 percent of boys are diagnosed with ADHD, compared with 5.6 percent of girls, according to the National Survey of Children's Health by the Maternal and Child Health Bureau of the Health Resources and Services Administration. It's a gender split comparable to other neurodevelopmental disorders, says Stephen Hinshaw, professor of psychology at the University of California, Berkeley, and professor of psychiatry and behavioral sciences at the University of California, San Francisco. “Boys are slower to develop in terms of language and social abilities and self-regulation than girls,” he observes.
They also tend to have different symptoms, Rooney says. “Boys tend to display more of the hyperactive and impulsive symptoms of the disorder than girls, who often display primarily inattentive symptoms.”
That's why females of all ages are often underdiagnosed, notes Hinshaw, a leading researcher on ADHD in girls. Because “a girl is less likely than a boy with ADHD to be defiant, oppositional and ornery,” he says, “she is not as noticeable. “
ADHD in adulthood
It's unclear how many adults have ADHD. Estimates vary from about 1 to more than 4 percent. Because they were never diagnosed as children, many may not be aware that they have the condition — especially older adults, who grew up before the disorder was understood, Hinshaw says. “Many, many were missed; they were thought to have a learning disability, or they were just [perceived as being] super anxious."
Plenty of adults live happy, successful lives with ADHD, including some great thinkers and celebrities — Albert Einstein, Winston Churchill, John Lennon and Henry Winkler, to name a few. But sometimes the disorder can interfere with daily living.
Although the hyperactivity symptoms of ADHD usually decrease with age, the inattention symptoms tend to continue or worsen over time. Impulsivity also often persists into adulthood, sometimes manifesting in risky behavior, Rooney says. For example, adults diagnosed with ADHD have a rate of car crashes 1.45 times higher than those without this diagnosis, according to an August 2020 study in the Journal of the American Academy of Child & Adolescent Psychiatry.
And, of course, the consequences of ADHD's core symptoms grow larger in adulthood, Hinshaw points out. As one needs to show more and more self-regulation in jobs and close relationships, ADHD-related symptoms can cause employment and interpersonal problems, as well as sleep issues, anxiety and depression.
That's why it's so important to recognize ADHD in adults and help them find treatment if necessary, says Jyoti Bhagia, a consultant in the department of psychiatry at the Mayo Clinic in Rochester, Minnesota. “It's treatable, and treatment helps people gain self-esteem, build better relationships and helps them be more effective on the job."
Diagnosing and treating adult ADHD
To get the right help for the disorder, you need to first get the right diagnosis, Rooney says. Don't leave that to your primary care doctor. Seek out clinicians, such as psychologists and psychiatrists, who are best at exploring the diagnosis with adults. They'll ask retrospectively about your symptoms and impairment during childhood and do a full assessment to rule out psychiatric or other neurological disorders (such as mild cognitive impairment, anxiety or depression) that have similar symptoms.
The most common treatment is medication, Bhagia says. Stimulants, including Adderall, Concerta and Dexedrine, can reduce symptoms and improve the ability to focus, she explains. But they can also have cardiac implications, such as raising blood pressure and heart rate and increasing anxiety, so they need close monitoring.
Antidepressants such as imipramine (Tofranil) and Burpropion (Wellbutrin) are also commonly prescribed for ADHD.
If you can't or don't want to take medication, cognitive behavioral therapy with a specially trained therapist, or guidance from an occupational therapist, can help you develop strategies to manage problems like organization and planning, and forgetfulness.
Once adults are diagnosed with ADHD, they often feel a sense of relief. Swanson says that's true for him and he now feels more comfortable delegating tasks he finds challenging, and concentrating on his strengths. He also finally found himself in a new, “delightfully satisfying role,” working as an ADHD life and clergy coach. He helps other people with ADHD to discover their strengths and to adapt their work situation to best use those strengths so they can “contribute their gifts to the world.”
"I'm so enjoying helping others,” he says.