What is ADD & ADHD?
ADHD stands for attention-deficit/hyperactivity disorder, and it is a neurodevelopmental issue with an estimated global prevalence of about 4%, meaning that about 4% of the world's population has ADHD. It is marked by symptoms that are grouped as "inattentive" and "hyperactive/impulsive."
This article discusses ADHD and how it differs from ADD, how ADHD is diagnosed, and explains treatment options available to adults with ADHD.
What Is the Difference Between ADD and ADHD?
In previous versions, the Diagnostic and Statistical Manual of Mental Disorders (DSM) differentiated ADD from ADHD.
People with primarily inattentive symptoms were diagnosed with ADD, and those with predominantly hyperactive/impulsive symptoms were diagnosed with ADHD. However, many people were diagnosed with both ADD and ADHD, and both presentations have similar treatment protocols.
When Is ADHD Diagnosed?
Neurodevelopmental disorders, by definition, develop in infancy or early childhood. The DSM-5 requires that symptoms begin before age 12 for a diagnosis of ADHD. However, many individuals with ADHD are not diagnosed until adulthood.
Teachers often recommend a referral for ADHD testing when a child is having difficulty at school. Because of this, children who have strong academic skills might go under the radar if they are not struggling in an obvious way.
White children are more likely than Black, Asian, and Latinx children to be diagnosed with ADHD. In addition, girls with ADHD are often missed and do not get referred for testing.
If someone was not diagnosed in childhood but notices that they have many of these symptoms, they can seek ADHD testing as an adult.
The DSM-5 breaks ADHD down into three different types:
Predominantly Inattentive Presentation
Predominantly Hyperactive/Impulsive Presentation
Predominantly Inattentive-type ADHD
Predominantly Inattentive-type ADHD requires that an individual have six or more of the following symptoms:
Making careless mistakes or overlooking details in homework, work, or other activities
Difficulty holding attention to tasks
Difficulty listening when spoken to directly
Difficulty following through on instructions or failing to finish tasks
Avoiding or disliking tasks that require "sustained mental effort"
High distractibility by external stimuli or thoughts
Forgetfulness in activities
Hyperactive/Impulsive-type ADHD requires that an individual have six or more of the following symptoms:
Fidgeting or squirming
Leaving their seat at inappropriate times
Running or climbing at inappropriate times
Making noise when working or playing
Moving as if they are "on the go" or "driven by a motor"
Blurting out answers before someone finishes their question
Difficulty waiting their turn
Interrupting in conversations
Combined-type ADHD requires that an individual meet criteria for both inattentive-type and hyperactive/impulsive-type ADHD.
ADHD Assessment for Adults
Since ADHD is a lifelong diagnosis, you are never too old for an ADHD evaluation. Psychologists, psychiatrists, and other medical and mental health professionals with appropriate training can diagnose ADHD. Most physicians have referral information for where their patients can get an ADHD evaluation.
There are many psychological assessment measures that can be used to diagnose ADHD in adults, including:
The Test of Variables of Attention (TOVA) The TOVA is a computerized, standardized test that measures an individual's ability to pay attention through a visual and auditory task. Scores compare the client's performance to that of same-age, same-gender individuals with ADHD and without ADHD.
The Conners Adult ADHD Rating Scales (CAARS) The CAARS is a norm-referenced rating scale that determines whether someone has difficulty with attention, impulsivity, and hyperactivity, as well as whether those symptoms meet the diagnostic criteria for ADHD. Clients complete a self-report form, and someone close to the client completes an observer form.
The Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A) The BRIEF-A is a norm-referenced rating scale to gather information about someone's ability to regulate impulses, complete tasks, organize, focus, and other symptoms of ADHD.
The Barkley Adult ADHD Rating Scale (BAARS) The BAARS links clients' symptoms to the DSM diagnostic criteria through self-report and observer data.
The evaluator will also gather detailed information about the client's history, usually in the form of a diagnostic interview, which provides context for the assessment measures used.
ADHD Treatment for Adults
When it comes to treatment for any mental health diagnosis, the individual's unique needs are prioritized. Talk to the providers on your treatment team about your concerns, questions, and preferences to determine what approach best fits you, and ask about the different options available to you.
Typically, ADHD treatment options for adults include medication, therapy, skill building, and appropriate accommodations.
Medication options for ADHD treatment in adults include stimulant and non-stimulant medications.
Stimulants are either amphetamine-based or methylphenidate-based and typically have immediate, sustained, and extended release forms. Examples of amphetamine-based stimulants include Adderall IR, Adderall XR and Vyvanse. Examples of methylphenidate-based stimulants include Ritalin IR, Ritalin LA and Concerta.
Non-stimulant options may include meds such as Strattera and guanfacine.
Medications help regulate impulses and sharpen focus. Some take ADHD medication daily, and some take it specifically on days when they need to complete specific tasks that require a lot of focus. Consult your primary physician about medication options for your ADHD diagnosis.They will either discuss options with you or refer you to a specialist who can help.
Adults with ADHD often benefit from ongoing therapy services to process life stressors and develop behavioral skills for symptom management. Cognitive-behavioral therapy, mindfulness-based therapy, and brief motivational interviewing offer evidence-based approaches for ADHD treatment in adults.
Ongoing support is essential to every person's well-being. If an adult with ADHD is in a long-term, committed relationship, their partner can benefit from support to help the couple through the unique challenges that ADHD could bring to their relationship.
Treatment for Comorbidities
More than half of adults with ADHD have at least one comorbid diagnosis. The specific treatment plan depends on the individual's needs and diagnoses. For example, those with ADHD might also have a diagnosis of a disruptive, impulse-control, or conduct disorder, bipolar disorder, anxiety disorder, obsessive-compulsive disorder, depression, trauma-related disorder, substance use disorder, or personality disorder.
In addition, a high number of individuals with ADHD also meet the diagnostic criteria for autism spectrum disorder or a learning disorder.
Adults with ADHD can access treatment resources, regardless of whether or not they were diagnosed in childhood. Talk to your healthcare provider about which treatment is the best for you.