Health and Wellness

By Ranu Boppana, MD

ADHD in Adolescents and Adults

Despite the fact that ADHD (Attention Deficit Hyperactivity Disorder) is highly prevalent, it remains frequently misunderstood, especially in adults. Once thought to remit in adulthood, we now know that ADHD frequently persists into adulthood, though its symptoms change through the life cycle. Hyperactivity, for example, which is an easily recognized symptom, decreases over time, making ADHD in adults less apparent. Also, because ADHD was not as well-understood in the past, many of today’s adolescents and adults with ADHD were never diagnosed as youngsters, and therefore still struggle with the consequences of its untreated symptoms.

These individuals, who may have been labeled “bad,” “stupid” or “lazy” by parents, educators or other students, have treatable symptoms that continue to impair their functioning and adversely impact relationships. Conversely, many highly intelligent individuals with ADHD may not be diagnosed until later in life because they were able to compensate for their impairment for a long time. In the South Asian community, which is sometimes resistant to seeking mental health services, an individual with these symptoms is even more likely to be undiagnosed. Additionally, many individuals with ADHD develop secondary psychological disorders, such as depression and substance abuse, because of the added stress of living with untreated ADHD. The National Institute of Mental Health (NIMH) estimates that 4.4 percent of adults experience symptoms of ADHD, though very few receive any treatment for it at all.

So what is ADHD? ADHD in adolescence and adulthood is characterized by restlessness, a variable attention span, difficulty getting started on tasks as well as completing them, difficulties with organization and setting priorities, impulsiveness, low frustration tolerance and a chaotic lifestyle. Of course, many individuals experience some of these symptoms at various times in their lives, and this does not necessarily mean that they have ADHD. It is the constellation of symptoms, their severity and the adverse impact on functioning that sets the disorder apart from the normal experience.

In adolescents, ADHD also results in more frequent motor vehicle accidents, as well as unwanted pregnancies and sexually transmitted diseases. Adolescents with the disorder tend to be more impulsive and sexually reckless than their peers.

In college students, ADHD often leads to problems with academic performance, organizational difficulties and social and interpersonal problems. These students also have more difficulty with time management and multitasking.

In adults with ADHD, symptoms often include “zoning out,” being late or forgetful frequently, speaking without thinking, hopping from topic to topic, being easily frustrated or bored, having difficulty starting or completing projects, being very messy, being quick to get angry, having difficulty keeping financial paperwork in order and shopping impulsively. These behaviors may result in frequent job changes, impaired occupational functioning and increased rates of substance abuse, legal problems, relationship problems, separation and divorce.

The known causes of ADHD include exposure to alcohol or cigarettes in utero, brain injury and genetics. Biological differences at the anatomical and neurotransmitter level are well-documented.

The treatment of ADHD in adolescents and adults includes therapy to gain better insight into the disorder, coaching to learn better time management and organizational skills, educational accommodations as necessary, medication if needed and treatment of any comorbid conditions such as depression or substance abuse. Awareness about ADHD is needed especially in the South Asian community, which highly values academic accomplishment and success. Individuals with ADHD and their families and friends must realize that an ADHD diagnosis should not bring stigma. Having the diagnosis and receiving appropriate treatment is a new opportunity to overcome problems and realize one’s own potential. More resources for ADHD are available from Children and Adults with Attention Deficit/Hyperactivity Disorder, also known as CHADD.

Ranu Boppana, MD is a Board Certified Adult and Child Psychiatrist in private practice in New York, New York. She is also a Clinical Instructor at the NYU School of Medicine and was recently selected for inclusion in the Consumer Research Council of America's "Guide to America's Top Psychiatrists 2007 Edition."

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