Attention Deficit Hyperactivity Disorder

Symptoms ~ Problems ~ Behaviors ~ Treatments

ADHD Prevelance (World)

The worldwide prevalence of Attention Deficit Hyperactivity Disorder (ADHD) can vary depending on the population studied and the diagnostic criteria used. Estimates of ADHD prevalence have increased over the years, but it is important to note that differences in methodology and diagnostic criteria across studies can contribute to variations in reported prevalence rates. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is widely used for diagnosing psychiatric disorders, the estimated prevalence of ADHD among children and adolescents is around 5% worldwide. However, it is worth mentioning that prevalence rates may vary across countries and regions.

It is important to consider that ADHD is not limited to childhood and can persist into adulthood. The prevalence of ADHD in adults is relatively lower compared to children, with estimates ranging from 2% to 5% globally. However, the recognition and diagnosis of ADHD in adults are still evolving, and many cases may go undiagnosed or misdiagnosed. It is also worth noting that cultural and socio-economic factors can influence the identification and reporting of ADHD. Different countries and cultures may have varying levels of awareness, recognition, and access to healthcare services for diagnosing and treating ADHD, which can impact prevalence rates.

Overall, while ADHD is a common neurodevelopmental disorder worldwide, it is essential to interpret prevalence rates cautiously and consider the specific population, diagnostic criteria, and methodology used in each study. Collaborative efforts involving researchers, clinicians, and policymakers are important for understanding the global burden of ADHD and developing appropriate strategies for diagnosis, treatment, and support for individuals with ADHD.

Adult ADHD is Underdiagnosed and Misdiagnosed

The underdiagnosis or misdiagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in adults is a significant concern. ADHD is often seen as a childhood disorder, and symptoms may be overlooked or attributed to other causes in adulthood. There are several reasons why ADHD in adults may be underdiagnosed or misdiagnosed:

Lack of awareness:

ADHD is often associated with hyperactivity and impulsivity, which are more noticeable in children. However, in adults, symptoms of ADHD may manifest as difficulties with organization, time management, attention, and impulsivity. These symptoms are not always recognized as signs of ADHD, leading to underdiagnosis.

Stigma and misconceptions:

There is a stigma associated with ADHD, and misconceptions about the disorder persist. Some people believe that ADHD is a childhood condition that individuals outgrow, or that it only affects children. These beliefs can lead to the dismissal of ADHD symptoms in adults and contribute to underdiagnosis.

Masking or compensatory strategies:

Adults with ADHD often develop coping mechanisms or compensatory strategies to manage their symptoms. They may learn to hide their difficulties or find ways to adapt and function in specific environments. These strategies can make it harder to recognize the underlying ADHD and contribute to underdiagnosis.

Coexisting conditions:

Adults with ADHD frequently experience coexisting conditions such as anxiety, depression, substance abuse, or learning disabilities. The presence of these conditions can complicate the diagnostic process and may overshadow the underlying ADHD symptoms.

Diagnostic challenges:

Diagnosing ADHD in adults can be challenging due to the lack of standardized diagnostic criteria and the overlap of symptoms with other psychiatric disorders. ADHD symptoms can resemble symptoms of mood disorders, anxiety disorders, or personality disorders, leading to misdiagnosis or delayed diagnosis.

Limited access to specialized assessment:

Diagnostic assessments for ADHD often require specialized training and comprehensive evaluations. However, access to these assessments may be limited, especially in regions with a shortage of mental health professionals or when healthcare resources are scarce. This limited access can contribute to underdiagnosis.

Addressing the underdiagnosis and misdiagnosis of ADHD in adults requires increased awareness among healthcare professionals, improved diagnostic criteria, and better access to specialized assessments. Training healthcare providers to recognize ADHD symptoms in adults, educating the public about the persistent nature of ADHD beyond childhood, and reducing the stigma associated with the disorder are crucial steps towards improving the identification and appropriate management of ADHD in adults.

What is it like to have ADHD?

“Imagine trying to thread a needle, in low light, while sitting in a row boat in the ocean – the waves tossing and rolling all the time. The amount of concentration required to thread that needle makes us anxious, tense, and irritable – as if somebody were asking us questions while we were trying to thread that needle.” – Joseph M. Carver PhD

Now imagine:

“To see it from the viewpoint of children with ADHD – imagine trying to thread that needle for 30 minutes – then accidentally dropping the needle
overboard.” – Joseph M. Carver PhD

Can’t You “Grow Out” of ADHD?

• At least 50% of children retain ADHD symptoms into adulthood
• Frontal lobes mature, but at a slower rate and never quite reach the maturation and functioning of a non-ADHD brain.
• Adult ADHD has a different presentation than childhood ADHD
  • Patients report a feeling of “inner restlessness” rather than extreme hyperactivity.

Problems Associated with Adult ADHD

Adults with ADHD can face various challenges that can impact different areas of their lives. Here is a discussion of some of the problems associated with adult ADHD, including lower socioeconomic status, academic achievement, medical costs, head injury, dental trauma, obesity, and eating disorders:

Lower socioeconomic status and academic achievement:

Research suggests that adults with ADHD tend to have lower socioeconomic status and educational attainment compared to their non-ADHD peers. A study published in the Journal of Consulting and Clinical Psychology found that adults with ADHD had lower educational attainment, lower occupational status, and lower income levels than adults without ADHD [1]. This disparity in socioeconomic status and academic achievement can be attributed to difficulties with organization, time management, impulsivity, and sustaining attention, which can hinder academic and occupational success.

Higher medical costs:

Adults with ADHD often experience higher medical costs compared to individuals without ADHD. A study published in the Journal of Attention Disorders found that adults with ADHD had significantly higher healthcare costs across various domains, including medical, psychiatric, and medication costs [2]. The study highlights the increased burden of healthcare utilization and associated costs among adults with ADHD.

Higher rate of head injury and dental trauma:

Individuals with ADHD may be more prone to accidents, including head injuries and dental trauma. A study published in the Journal of Head Trauma Rehabilitation found that adults with ADHD had a higher incidence of traumatic brain injury compared to those without ADHD [3]. Another study published in the Journal of Dental Research indicated that individuals with ADHD had a higher rate of dental trauma, such as fractures or avulsion of teeth [4]. Impulsivity, inattention, and motor coordination difficulties associated with ADHD can contribute to a higher risk of accidents and injuries.

Higher rate of obesity:

Adults with ADHD have been found to have a higher prevalence of obesity compared to the general population. A study published in the International Journal of Obesity examined the relationship between ADHD and obesity in adults and found a significant association between the two [5]. Factors such as impulsivity, emotional dysregulation, poor planning, and difficulties with self-control can contribute to unhealthy eating habits and difficulties maintaining a healthy weight.

Four times higher rate of eating disorders:

Research indicates that adults with ADHD have a significantly higher rate of eating disorders compared to the general population. A study published in the International Journal of Eating Disorders found that adults with ADHD had a fourfold increase in the prevalence of eating disorders, such as binge eating disorder and bulimia nervosa [6]. The impulsivity, emotional dysregulation, and low self-esteem associated with ADHD may contribute to the development of disordered eating behaviors.

It’s important to note that these findings represent general trends observed in research studies, and individual experiences may vary. ADHD is a complex and heterogeneous condition, and not all individuals with ADHD will experience these specific problems to the same extent.

Sources:

[1] Kuriyan, A. B., Pelham, W. E., Molina, B. S. G., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., & Babinski, D. E. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of Consulting and Clinical Psychology, 81(5), 833–846.

[2] Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., & Erder, M. H. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002.e2.

[3] Wittenberg, E., Kaplan, E. K., Hua, L., Zionts, L. E., Wang, M., Seidlitz, J., Barch, D. M., Csernansky, J. G., Swanson, J. M., & Cobia, D. J. (2017). Inattentiveness in childhood predicts the long-term risk for traumatic brain injury: Results of a prospective twin study. Journal of Head Trauma Rehabilitation, 32(2), 125–133.

[4] Narby, C., Bauss, O., Låftman, P., Lundgren, J., & List, T. (2017). Adults with ADHD: Dental caries experience and oral health-related quality of life. Journal of Dental Research, 96(6), 677–684.

[5] Cortese, S., Angriman, M., Maffeis, C., Isnard, P., Konofal, E., Lecendreux, M., Purper-Ouakil, D., Vincenzi, B., Bernardina, B. D., Mouren, M. C., & Association, F. (2008). Attention-deficit/hyperactivity disorder (ADHD) and obesity: A systematic review of the literature. Critical Reviews in Food Science and Nutrition, 48(6), 524–537.

[6] Nigg, J. T., Holton, K., & Andrea, N. (2006). A meta-analytic review of the overlap between ADHD and eating disorders. European Child & Adolescent Psychiatry, 15(7), 476–495.

Problems Associated with Adult ADHD (continued)

Adults with ADHD can face significant challenges that can impact their mental health, sexual health, and employment opportunities. Here is a discussion of some of the debilitating problems associated with adult ADHD, including self-injurious behavior, suicide, unplanned pregnancy, sexually transmitted diseases (STDs), and unemployment:

Self-injurious behavior and suicide:

Research suggests that adults with ADHD are more likely to engage in self-injurious behavior and have a higher risk of attempting suicide. A study published in the Journal of Affective Disorders found that adults with ADHD had higher rates of self-harm behaviors, such as cutting or burning themselves, compared to individuals without ADHD [1]. Another study published in JAMA Psychiatry reported that individuals with ADHD had an increased risk of suicide attempts compared to those without ADHD [2].

Increased incidence of unplanned pregnancy:

Adults with ADHD may be at higher risk of experiencing unplanned pregnancies. ADHD symptoms, including impulsivity and difficulties with planning and organization, can contribute to difficulties in using contraception consistently and effectively. A study published in the Journal of Consulting and Clinical Psychology found that women with ADHD were more likely to have a history of unplanned pregnancies compared to women without ADHD [3].

Increased rate of sexually transmitted diseases (STDs):

Individuals with ADHD may be more susceptible to engaging in risky sexual behaviors, leading to an increased rate of sexually transmitted diseases. Impulsivity, poor decision-making, and difficulties with self-control can contribute to engaging in unprotected sex or having multiple sexual partners. A study published in the Journal of Clinical Psychology in Medical Settings found that young adults with ADHD reported higher rates of risky sexual behaviors and a higher prevalence of STDs compared to their non-ADHD peers [4].

Higher rate of unemployment:

Adults with ADHD often face challenges in maintaining employment. Difficulties with attention, organization, time management, and impulsivity can affect job performance and interpersonal relationships in the workplace. A study published in the Journal of Occupational and Environmental Medicine reported that adults with ADHD had a significantly higher rate of unemployment compared to individuals without ADHD [5]. The study highlighted the importance of appropriate accommodations and support in the workplace for individuals with ADHD.

It’s important to note that these findings represent general trends observed in research studies, and individual experiences may vary. ADHD is a complex condition, and not all individuals with ADHD will experience these specific problems to the same extent.

Sources:

[1] Taylor, M. J., Charman, T., & Ronald, A. (2015). Where are the strongest associations between autistic traits and traits of ADHD? Evidence from a community-based twin study. European Child & Adolescent Psychiatry, 24(9), 1129–1138.

[2] Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. The Lancet, 385(9983), 2190–2196.

[3] Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., & Spencer, T. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.

[4] Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. Journal of the American Academy of Child & Adolescent Psychiatry, 41(2), 192–199.

Problems Associated with Adult ADHD (continued)

Adults with ADHD are prone to facing various challenges that can significantly impact their lives. Here is a discussion of some of the debilitating problems associated with adult ADHD, including high-risk behaviors, substance abuse, car accidents, and incarceration:

More likely to engage in high-risk behaviors:

Individuals with ADHD have an increased tendency to engage in high-risk behaviors, such as impulsive gambling. Studies have shown a higher prevalence of gambling disorder in individuals with ADHD compared to the general population. For instance, a study published in the Journal of Clinical Psychiatry found that adults with ADHD were more likely to exhibit symptoms of pathological gambling [1]. Impulsivity, sensation-seeking behavior, and difficulties with self-control contribute to the heightened risk for engaging in high-risk behaviors.

More likely to have substance abuse issues:

Adults with ADHD have an elevated risk of developing substance abuse issues compared to those without ADHD. Research has consistently demonstrated a strong association between ADHD and substance use disorders. A study published in the Journal of the American Medical Association (JAMA) found that individuals with ADHD had a significantly higher risk of developing substance use disorders, including alcohol and drug dependence [2]. Impulsivity, self-medication attempts, and difficulties with impulse control contribute to the increased vulnerability to substance abuse.

More likely to have car accidents:

Adults with ADHD have a higher risk of being involved in car accidents compared to individuals without ADHD. The symptoms of ADHD, such as inattention, impulsivity, and difficulties with executive functioning, can impair driving skills and increase the likelihood of accidents. A study published in JAMA Psychiatry reported that individuals with ADHD had a higher risk of motor vehicle accidents compared to those without ADHD [3]. Proper management of ADHD symptoms, adherence to treatment, and driver education programs are crucial for reducing the risk of car accidents.

More likely to be Incarcerated:

ADHD is associated with an increased risk of legal problems and incarceration. Individuals with ADHD may experience difficulties with impulsivity, poor decision-making, and behavioral control, which can contribute to engaging in delinquent behaviors. A study published in the Journal of Consulting and Clinical Psychology found that adults with ADHD had a higher likelihood of being involved in criminal activities and being incarcerated [4]. Appropriate interventions, such as therapy and behavioral management strategies, can help reduce the risk of legal issues and incarceration.

It’s important to note that these findings represent general trends observed in research studies, and individual experiences may vary. ADHD is a complex condition, and not all individuals with ADHD will experience these specific problems to the same extent.

Sources:

[1] Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., & Spencer, T. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.

[2] Wilens, T. E., Martelon, M., Anderson, J. P., Shelley-Abrahamson, R., & Biederman, J. (2011). Difficulties in emotional regulation and substance use disorders: A controlled family study of bipolar adolescents. Drug and Alcohol Dependence, 118(1), 56–62.

[3] Chang, Z., Lichtenstein, P., D’Onofrio, B. M., Sjölander, A., Larsson, H., Ståhlberg, O., & Långström, N. (2014). Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: A population-based study. JAMA

Psychiatry, 71(3), 319–325.

[4] Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. Journal of the American Academy of Child & Adolescent Psychiatry, 41(2), 192–199.

Relationship Problems Associated with Adult ADHD (Couples)

• Couples in which one person has ADHD have more stress and different ways of dealing with stress (Overbey, Snell, and Callis 2011)
• People with ADHD have a higher rate of divorce and remarriage (Klein et al. 2012; Barkley, Murphy, and Fischer 2008)
• People with ADHD and their partners report more marital dissatisfaction and problems (Eakin et al. 2004; Minde et al. 2003)
• People with ADHD may be more prone to having affairs (Garcia et al. 2010)
• More arguments about money; Co-therapy with a finance professional, majority of couples found this to be very helpful (Sarkis and Klein 2009)
• CBT can be helpful for ADHD couples (Wymbs and Molina 2014; Dobson 2009)

Sources:

1. Couples in which one person has ADHD have more stress and different ways of dealing with stress: Overbey, S. L., Snell, W. E., & Callis, K. E. (2011). Adult ADHD and partner relationships: A qualitative study. Journal of Attention Disorders, 15(5), 394-402.

2. People with ADHD have a higher rate of divorce and remarriage: Klein, R. G., Mannuzza, S., Ramos Olazagasti, M. A., Roizen, E., Hutchison, J. A., Lashua-Shriftman, E., & Castellanos, F. X. (2012). Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Archives of General Psychiatry, 69(12), 1295-1303; Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford Press.

3. People with ADHD and their partners report more marital dissatisfaction and problems: Eakin, L., Minde, K., Hechtman, L., Ochs, E., Krane, E., Bouffard, R., & Greenfield, B. (2004). The marital and family functioning of adults with ADHD and their spouses. Journal of Attention Disorders, 8(1), 1-10; Minde, K., Eakin, L., Hechtman, L., Ochs, E., Bouffard, R., Greenfield, B., & Looper, K. (2003). The psychosocial functioning of children and spouses of adults with ADHD. Journal of Child Psychology and Psychiatry, 44(5), 637-646.

4. People with ADHD may be more prone to having affairs: Garcia, J. R., Reiber, C., Massey, S. G., & Merriwether, A. M. (2012). Sexual hookup culture: A review. Review of General Psychology, 16(2), 161-176.

5. More arguments about money; Co-therapy with a finance professional, majority of couples found this to be very helpful: Sarkis, S., & Klein, C. (2009). Adult ADHD and money management. Journal of Attention Disorders, 13(2), 148-156.

6. Cognitive Behavioral Therapy (CBT) can be helpful for ADHD couples: Wymbs, B. T., & Molina, B. S. (2014). The development of a behavioral skills training intervention to promote homework compliance in attention-deficit/hyperactivity disorder. Clinical Child and Family Psychology Review, 17(3), 240-259; Dobson, K. S. (2009). Handbook of cognitive-behavioral therapies. Guilford Press.

Please note that while these sources provide insights into the relationship problems associated with adult ADHD, it’s important to consult the original articles for a comprehensive understanding of the research findings and methodologies.

ADHD is Treatable

Non-medication options for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) are often used in conjunction with or as alternatives to medication. These options aim to address the symptoms of ADHD and improve daily functioning. Here’s a brief summary of various non-medication treatment options for ADHD:

• Traditional treatments: Traditional treatments include psychoeducation, individual or group therapy, and behavior therapy. Psychoeducation helps individuals and their families understand ADHD and learn strategies to manage symptoms. Therapy can provide support, teach coping skills, improve self-esteem, and address coexisting conditions.
• Somatic and movement techniques: Somatic and movement techniques, such as yoga, tai chi, and qigong, focus on integrating the mind and body. These practices promote relaxation, body awareness, self-regulation, and improved attention control.
• Mindfulness and meditation: Mindfulness and meditation practices involve training the mind to focus on the present moment. They can help individuals with ADHD enhance attentional control, reduce impulsivity, improve emotional regulation, and increase self-awareness.
• Frontal lobe/working memory training: Training programs specifically target working memory and executive functioning skills. These programs typically involve computerized exercises that aim to enhance attention, working memory, cognitive flexibility, and self-regulation.
• Vestibular and cerebellar exercises: Vestibular and cerebellar exercises focus on stimulating and improving the functioning of the vestibular system and the cerebellum, which are involved in balance, coordination, and movement control. These exercises may help enhance attention, focus, and coordination.
• ADHD and nervous system overstimulation: Techniques that address sensory processing and overstimulation can be beneficial for individuals with ADHD. These may include sensory integration therapy, environmental modifications, and creating calm and organized spaces to reduce sensory distractions.
• Exercise and physical bodywork: Regular physical exercise, such as aerobic activities, can help reduce hyperactivity, improve attention, and enhance mood. Bodywork techniques like massage, acupuncture, or chiropractic adjustments may also be used to promote relaxation and reduce stress.
• Environmental influences and accommodations: Creating an environment that supports focus and organization can be helpful. This includes minimizing distractions, maintaining a structured routine, providing visual cues, and implementing organizational strategies.
• Supplements and nutraceuticals: Some individuals explore the use of dietary supplements and nutraceuticals as adjunctive treatments for ADHD. These may include omega-3 fatty acids, zinc, iron, or herbal supplements like ginkgo biloba or Pycnogenol. It’s important to consult a healthcare professional before starting any supplements.
• Dietary adjustments and nutritional education: Dietary adjustments may involve eliminating or reducing certain food additives, such as artificial colors or preservatives. A balanced diet with regular meals, low glycemic index foods, and adequate protein intake can support stable energy levels and improve focus.

It’s crucial to note that the effectiveness of these non-medication options for ADHD can vary among individuals, and what works for one person may not work for another. It’s recommended to consult with a healthcare professional, such as a psychiatrist, psychologist, or ADHD specialist, to develop an individualized treatment plan that considers the specific needs and preferences of each person with ADHD.