Adult ADHD (attention-deficit/hyperactivity disorder) is a mental health disorder that includes difficulty paying attention, hyperactivity and impulsive behaviour. It can impact a person’s life and cause low or poor performance at school or work, low self-esteem, unstable relationships, and others. Although it is called adult ADHD, symptoms start in early childhood and continue into adulthood. Adult ADHD produces different impacts on different ages. So, in many cases, symptoms are not clear in children or diagnosed until the person is an adult.
Teens and Young Adults
Many teens or young adults with ADHD benefit from continuing treatment and care after age 18 after they leave pediatric care. It is important to consider the many things during the transition from pediatric care to adult care, such as:
- Many young adults were never directly spoken to about their ADHD and their treatment options, and most decisions were made by their parents.
- Many young adults are not sure about continuing ADHD treatment. They are not fully prepared to make decisions on their own.
- Many young adults with and without ADHD stop seeing paediatricians around 18 and then do not see primary care for preventative or disease-specific care.
- Young adults may have different views from those of their parents or paediatricians.
- Many young adults start college or join the workforce and leave the area, disengaging from healthcare services.
The basic approach to care for teens or young adult groups is to:
- Assess the symptoms, their severity, and their impact using a centred assessment approach; inform patients directly about the outcome of this assessment.
- Assess physical health.
- Evaluate if medication is still required.
- Monitor side effects and adverse effects of treatments.
- Identify and manage coexisting conditions.
- Identify and provide appropriate non-pharmacologic treatments.
- Mitigate risks, provide education, and assist with support and skill-building services.
- Facilitate shared-care arrangements between primary and secondary care services to prescribe and monitor ADHD medications.
Women and Girls
ADHD will equally affect adults of both sexes, but its effects are not well studied in women and girls. The evidence shows that males and females have similar rates of ADHD in adulthood. However, the increased rate of ADHD between young boys and girls is based on developmental differences, different presentation of symptoms and other facts that are not yet clearly understood about ADHD in females. Inattentive type ADHD is more common in girls and women than it is in boys and men.
In females, ADHD may cause more subtle or internal problems (anxiety, inability to finish tasks, daydreaming, or inattention) and fewer external problems (aggression or challenging behaviour). Women with undiagnosed or untreated ADHD are at higher risk of having poor relationships, which may cause divorce or being a single parent. They have constant stress, which can cause insomnia, difficulty managing daily life tasks, undereducated, underemployed or unemployed. They may also have a lower life expectancy than those treated for ADHD due to accidents.
Girls with undiagnosed or untreated ADHD are also more prone to commit suicide than their neurotypical peers. Pregnancy and motherhood can bring extra challenges to women with ADHD. The timely diagnosis and medications are essential for females with ADHD. They can also seek other treatments, such as family therapy, peer support groups, physical activity, healthy nutrition, and promoting healthy habits. These can help them build self-esteem and learn time and stress management techniques. It is also important to manage the coexisting conditions in a person with ADHD, such as sleep problems, depression, eating disorders, and substance use disorders.
Pregnancy
Many natural treatments for ADHD are prescribed, such as exercise, cognitive CBT, behavioural therapy (DBT), and diet. Still, there is no firm or consistent data on how ADHD stimulants affect the fetus during pregnancy. There is a very low risk of having a baby born with birth defects after taking ADHD medicine. Still, more research is needed to determine the safest treatment options for managing symptoms of ADHD during pregnancy. Expecting women should talk with their doctors about options for managing ADHD symptoms before and during pregnancy.
Breastfeeding
It is important to remember that all substances, including vitamins, supplements, and medication, pass into your breast milk. There is limited evidence on breastfeeding and stimulant use. Amphetamine-type stimulant drugs are thought to concentrate in breast milk. They may cause irritability and disturbed sleep in babies, but their long-term effects are unknown. Nursing infants exposed to stimulants should be monitored for insomnia, poor appetite, weight loss, and irritability. Mothers can minimize infant exposure to stimulants via breast milk by feeding them just before or as long as possible after the dose.
Milk Production
All stimulants increase dopamine (neurotransmitter) activity. Dopamine acts as a hormone that can lower prolactin hormone levels. Nursing mothers taking stimulants may have lower breast milk production.
Substance Use Disorder
It is more common for people with ADHD to use tobacco, alcohol, and cannabis. Fewer studies on the relationship between stimulant use and illicit drug use and more research is required. So, managing ADHD in people with substance use can be challenging and vary from person to person. In cases of chaotic and uncontrolled patterns of drug/alcohol use, stimulants are not recommended.
In patients with previous substance use, stimulant medications are used with caution. The doctor may recommend the use of longer-acting stimulant formulations. Patients with substance use should be referred to substance use treatment programs. Where the person is monitored for substance use and drug-seeking behaviour. All patients should be educated, warned and reminded about the legal ramifications of diversion and non-medical use of stimulants at the time of stimulant prescription.
Coexisting Mental Health Conditions
It is recommended to provide medication treatment for non-ADHD disorder mental health disorders such as depression, bipolar or anxiety disorder first in patients with coexisting ADHD. Non-pharmacological treatments for ADHD and coexisting conditions can be started at the same time. The goal is to reduce the severity of non-ADHD mental health disorders symptoms. The doctor may carefully select and manage medication to treat ADHD, as stimulants can cause mood cycling and insomnia and can worsen anxiety. This can worsen the coexisting mental disorders, so they need to be very cautious in selecting a treatment. They should also monitor the effects of treatment and side effects.
Forensic Populations
Adults with ADHD may have traits that result in poor judgment and criminal acts with consequences. It is estimated that the prevalence of ADHD in prison populations is between 25% and 40%. However, it is important to highlight that most people with ADHD never commit criminal acts. To reduce the risk of future criminal offences, efforts should be made to evaluate for and treat ADHD in prison populations.
ADHD and Seniors
Limited evidence is available on ADHD in adults over 60 years. Some emerging studies show that symptoms of ADHD continue into senior years and can probably be confused with signs of ageing or cognitive decline. Studies show that motor hyperactivity in adults often presents as inner hyperactivity.It can be in the form of restlessness, excessive talking and fidgeting, inability to relax, and difficulty sitting quietly for long periods. Impulsive behaviour in adulthood can manifest impatience, anger, making decisions without thinking, and careless driving.
Signs of inattention may include poor performance in planning and completing tasks, time management, disorganization, task shifting, and forgetfulness. Many adults will not fully exhibit the diagnosis criteria because of this developmental change in symptom expression. They remain significantly impaired. There is a lack of research on the diagnosis and treatment of ADHD in older adults, and more research is required.
Personalized therapy and risk-benefit assessment for each elderly patient should be recommended.
