Symptoms of ADHD in Adults
Adults with ADHD predominantly present with inattentive symptoms rather than hyperactivity, including poor attention to detail, difficulty concentrating, organizational challenges, chronic lateness, forgetfulness in daily activities, and reluctance to engage in tasks requiring sustained mental effort. 1
Core Symptom Categories
Adult ADHD manifests through two primary symptom clusters that must cause functional impairment in at least two different settings (home, work, social) 1:
Inattentive Symptoms
- Poor attention to detail and frequent careless mistakes 1
- Difficulty concentrating or sustaining attention on tasks 1
- Appearing preoccupied or not listening when spoken to directly 1
- Difficulty completing tasks and following through on instructions 1
- Organizational challenges affecting work and personal life 1
- Reluctance to engage in sustained mental effort 1
- Forgetfulness in daily activities 1
Hyperactive-Impulsive Symptoms
- Frequent fidgeting or squirming 1
- Difficulty sitting still for prolonged periods 1
- Feeling of inner restlessness or agitation 1
- Often being loud and disruptive 1
- Always being "on the go" 1
- Talking excessively 1
Diagnostic Requirements
For adults aged 17 and older, at least 5 symptoms from either the inattentive or hyperactive-impulsive category must be present for at least 6 months. 1
Critical diagnostic elements include 1, 2:
- Symptom onset before age 12 years 1
- Symptoms present in 2 or more settings 1
- Clear evidence of functional impairment 1
Screening and Assessment
The Adult ADHD Self-Report Scale (ASRS-V1.1) Part A is the recommended initial screening tool, with a positive screen defined as checking "often" or "very often" for 4 or more of the 6 questions. 1
Other validated assessment tools include 1:
- Wender Utah Rating Scales 1
- Brown Attention-Deficit Disorder Scale for Adults 1
- Conners Adult ADHD Rating Scale 1
Important Clinical Considerations
Adults with ADHD are notoriously poor self-reporters and often underestimate the severity of their symptoms and resulting impairments. 1 This makes collateral information from family members or partners particularly valuable 2.
ADHD symptoms often become more challenging to manage as adults deal with increased demands of work, relationships, and parenting, even though it is a chronic condition that preceded these life stages 1.
Common Comorbidities
Approximately 10% of adults with recurrent depression and/or anxiety disorders have ADHD, and treatment of depression/anxiety alone will likely be inadequate without addressing the underlying ADHD. 1
Common comorbid conditions include 1:
A detailed history of drug and alcohol use must be undertaken, with consideration of urine drug screening, given the high rate of comorbid substance abuse 1.
Treatment Approach
First-Line Pharmacological Treatment
Long-acting formulations of stimulant medications (methylphenidate or amphetamines) are strongly preferred for adults with ADHD, with effectiveness in 70-80% of patients. 3 Amphetamine-based stimulants are preferred for adults based on comparative efficacy studies 3.
Long-acting formulations offer 3:
- Better medication adherence 3
- Lower risk of rebound effects 3
- More consistent symptom control throughout the day 3
Non-Stimulant Options
For patients unable to take stimulants or with specific comorbidities, alternatives include 3:
Non-stimulants have smaller effect sizes compared to stimulants and require 2-12 weeks to achieve full therapeutic effect. 3
Psychosocial Interventions
Cognitive Behavioral Therapy (CBT) is the most extensively studied and effective psychotherapy for adult ADHD, focusing on time management, organization, planning, and adaptive behavioral skills, with increased effectiveness when combined with medication. 3
Mindfulness-Based Interventions show increasing evidence for managing ADHD in adults, helping most profoundly with inattention symptoms, emotion regulation, executive function, and quality of life 3.
Monitoring Parameters
Regular vital sign monitoring (blood pressure, pulse) is necessary with stimulant use 3. Effectiveness evaluation should be based on reduction in core ADHD symptoms and improvement in functional domains 3.