Adult attention deficit hyperactivity disorder (ADHD) ( is a brain disorder, adult with ADHD may have trouble paying attention, controlling impulsive behaviors, and hyperactivity. The subtypes of ADHD include combined, inattentive, and hyperactive/impulsive.

The exact cause of ADHD is not clear, but many factors may increase the risk of developing  ADHD including gender, genetics, environmental factors, substance abuse during pregnancy, and neurophysiology.

The exact pathophysiology of attention deficit hyperactivity disorder (ADHD) is still unclear. Abnormalities in the functioning of neurotransmitters, brain structure and cognitive function are suggested mechanisms that promote ADHD. Decreased activity of dopamine have been linked to ADHD .

There are common symptoms that all types share such as poor planning, difficulty multitasking,  and frequent mood swings. However, there are some certain symptoms specific to subtypes such as the inability to follow instructions ,in addition to missing details for the inattentive type, and with fidgeting and squirming; twisting and turning while seated for the hyperactive/impulsive type.

Physical exam, information gathering, and ADHD rating scales or psychological tests such as inattention and memory problems, hyperactivity and restlessness may diagnose people with ADHD.

There is no cure for ADHD, but treatment may help control the symptoms and consists of medication such as stimulant medications and antidepressants, and psychosocial counseling such as cognitive behavioral therapy and marital counseling and family therapy.

If untreated, ADHD may be associated with poor work performance, unemployment, trouble with the law, and may lead to many complications , such as mood disorders , anxiety disorders, and other psychiatric disorders such as personality disorders.

Avoiding anything that could harm fetal development during pregnancy, protecting the child from exposure to pollutants and toxins, and limiting children’s excessive exposure to TV and video games in the first five years of the child’s life may prevent adult ADHD.

Serious and long-lasting impacts on a person's life are linked with ADHD. Symptoms of disorder will never completely go away in most people with ADHD, while learning how to manage symptoms effectively can lead to an improved quality of life for people with ADHD.

According to published study in The British Journal of Psychiatry, estimates of worldwide adult ADHD prevalence averaged 3.4%.

Definition of Adult Attention Deficit Hyperactivity Disorder

Adult attention deficit hyperactivity disorder (ADHD) is a brain disorder that represents a combination of persistent problems like difficulty paying attention, hyperactivity and impulsive behavior. Attention deficit hyperactivity disorder itself is considered one of the most common childhood disorders that could continue through adolescence and into adulthood. 

Subtypes of Adult Attention Deficit Hyperactivity Disorder

There are three types of ADHD in adult which are: 

• Combination Type

 This is the most common type of ADHD that is observed as a combination of hyperactivity/impulsivity and inattentive symptoms.

• Inattentive Type

 Behavior characterized by inattentiveness symptoms without the presence of hyperactivity and impulsivity.

• Hyperactive/Impulsive Type

 Behavior characterized by hyperactivity and impulsivity , but inattentiveness is missing. 

Causes of Adult Attention Deficit Hyperactivity Disorder

The exact cause of ADHD is still unknown, but there are many factors that increase the risk of developing  ADHD in adults. 

Risk factors of Adult Attention Deficit Hyperactivity Disorder

ADHD usually starts in childhood and often continues into adulthood. Risk factors that may be involved in the development of the disorder include:

• Gender

Attention deficit hyperactivity disorder is more common in males than females. The combined type of ADHD is predominant in males, whereas the inattentive type is in females. 

•             Genetics

Attention deficit hyperactivity disorder can run in families, so genetics may play a role of increasing the risk of developing ADHD. 

•             Environmental factors

Certain environmental factors may increase the risk of ADHD, such as exposure to lead or pesticides during pregnancy or at a young age. 

•             Substance abuse during pregnancy

Women using substances such as nicotine, cocaine, and alcohol during pregnancy may increase the risk of developing ADHD in the baby. 

•             Neurophysiology

Electrical activity and metabolism, in addition to altered brain structure or function and

improper central nervous system development may increase risk of development of ADHD. 

•             Adverse childhood experiences

Inattention and hyperactivity could go back to several factors such as the lack of early attachment for the baby with their parent or caregiver, or when the baby has traumatic experiences related to the attachment. 

•             Birth problems.

Birth problems such as premature delivery and low birth weight may increase the risk of developing  ADHD. 

• Dietary factors

Although dietary factors as risk factors are not well established, several  factors may increase the risk of developing  ADHD such as sensitivities to certain food chemicals, deficiencies in fatty acids and zinc, and sensitivity to sugar. 

Pathophysiology of Adult Attention Deficit Hyperactivity Disorder

Although the exact pathophysiology of ADHD is not clear, abnormalities such as functioning of neurotransmitters, brain structure and cognitive function have been suggested to be in relation with ADHD.  

• Neurotransmitters

Dopamine and noradrenaline could play a major role in the pathophysiology of ADHD since certain drugs such as psychostimulants and noradrenergic tricyclics have proved to be very effective in treating ADHD.  These drugs are able to minimize symptoms by aiding the release and function of dopamine or noradrenaline neurotransmitters. Therefore, deficient neural transmission could be related to symptoms and pathophysiology of ADHD.

Adult ADHD have been associated with decreased activity of dopamine.

• Brain Structure

Structural areas of the brain such as the frontal and prefrontal regions, parietal lobe, and cerebellum have been linked to ADHD. Altered activation of the brain when certain activities are being done have been recorded by magnetic resonance imaging (MRI), in children with ADHD. 

Children with ADHD can be associated with deformations of the basal ganglia nuclei which is a  group of subcortical nuclei .These deformations may be decreased by the efficiency of stimulant drugs in treating ADHD .

• Cognitive function

Neurophysiological deficits and abnormalities in the cognitive function are associated with ADHD. Such deficits can be usually seen in the resting brain .This results in difficulties regulating and maintaining attention in people affected. 

Signs & Symptoms of Adult Attention Deficit Hyperactivity Disorder

In early childhood, symptoms appear and continue into adulthood.  These symptoms could decrease by age or could cause life- challenging problems. Symptoms in Adult ADHD may not be as clear as ADHD symptoms in children. In some cases, ADHD is not recognized until the person is an adult. Adult ADHD  may include decreased hyperactivity, but ongoing struggles with impulsiveness, restlessness and difficulty paying attention. Signs and symptoms of ADHD include : 

Common symptoms include: 

• Poor planning.
• Trouble coping with stress.
• Poor time management skills, disorganization and problems prioritizing.
• Problems focusing on, following through and completing tasks.
• Trouble multitasking.
• Frequent mood swings.

Inattentive type include:  

• Appear to be unable to listen to or carry out instructions, in addition to missing details.
• Avoiding tasks that require sustained mental effort and losing things necessary for tasks.
• Become easily distracted by unrelated thoughts or stimuli.
• Forgetting  daily activities.
• Excessive activity or restlessness. 
• Hot temper.

Hyperactive/impulsive type include: 

• Fidgeting and squirming; twisting and turning while seated.
• Unable to stay seated when required.
• Sudden improper movements such as running or dashing around when the situation doesn’t need so.
• Being unable to play or engage in hobbies quietly.
• Being in constant motion, often restless.
• Speaking in improper times such as interrupting or intruding on others, blurting out an answer before a question has been completed, in addition to non-stop talking and the inability of waiting his or her turn. 

Diagnosis Adult Attention Deficit Hyperactivity Disorder

No single test can confirm the diagnosis. ADHD may be diagnosed using the following:  

• Physical exam

Medical exam that used to help rule out other possible causes for symptoms.

• Information gathering

Information gathering such as any current medical issues, personal and family medical history, and school records.

•             ADHD rating scales or psychological tests 

ADHD rating scales using four factors to help collect and evaluate information of adult symptoms that include:

• Inattention and memory problems such as losing or forgetting things, being absent-minded, and not finishing things.
• Hyperactivity and restlessness such constant fidgeting, and being easily bored.
• Impulsivity and emotional instability such as saying things without thinking first, interrupting others, and being annoying to others.
• Self-worth issues such as avoiding new challenges, and appears confident to others but not to oneself. 

Treatment of Adult Attention Deficit Hyperactivity Disorder

Combining medication, education, training and psychological counseling is often the most effective treatment of ADHD in adults for relieving symptoms despite the fact that they do not cure ADHD. 

Treatment for adult ADHD includes:           

• Medication

Types of medications used to treat ADHD include:

• Stimulant medications

Stimulant medications appear to boost and balance levels of brain chemicals called neurotransmitters, such as products that include methylphenidate or amphetamine. They could also improve signs and symptoms of inattention and hyperactivity in an efficient way and within a short time.

• Other medications

These are used when stimulants can’t be used , cause severe side effects, or a history of substance abuse is present. Medications that are used to treat ADHD include the nonstimulant atomoxetine and certain antidepressants such as tricyclics, and bupropion, which work slower than stimulants do. 

• Psychological counseling

Psychological counseling, education about the disorder, and learning skills are the approaches for counseling for adult ADHD. Common types of psychotherapy for ADHD include:

• Cognitive behavioral therapy

Teaching specific skills to manage behavior and change negative thinking patterns into positive ones. 

• Marital counseling and family therapy

Marital counseling and family therapy can improve communication and problem-solving skills, help coping with people who have ADHD and learn how to help them. 

• Alternative medicine

Few evidence have proved the efficiency of reducing ADHD symptoms through alternative medicine .However, one recent study published in an American journal, BioMed research international, indicates that mindfulness meditation may help improve mood and attention in adults who have ADHD.  Doctor consultation is needed before choosing any alternative medication. 

Complications of Adult Attention Deficit Hyperactivity Disorder

Adult ADHD has been linked to: 

• Poor work performance.
• Unemployment.
• Trouble with the law.
• Alcohol or other substance abuse.
• Frequent car accidents or other accidents.
• Unstable relationships.
• Poor physical and mental health.
• Poor self-image.
• Suicide attempts.

Disorders associated with ADHD and make treatment more challenging. These include:

• Mood disorders.
• Anxiety disorders.
• Other psychiatric disorders such as personality disorders and substance abuse.
• Learning disabilities. 

Prevention of Adult Attention Deficit Hyperactivity Disorder

ADHD, as one of the most common childhood disorders that often persists into adulthood, renders the same prevention measures done with children and these include: 

• Avoiding anything that could harm fetal development during pregnancy, such as abstaining from alcohol , or smoking cigarettes.
• Exposure to pollutants and toxins, including cigarette smoking and lead paint, should be avoided with children.
• Avoiding excessive exposure to TV and video games in the first five years of a child’s life. 

Prognosis of Adult Attention Deficit Hyperactivity Disorder

ADHD can have a serious and long-lasting impact on a person's life since the symptoms will never completely go away in the most people with ADHD. Improving quality of life of people with ADHD is done when patients learn to manage symptoms effectively. Subsequently, increased confidence and motivation that aim at a more fulfilling and achieving life style. 

Home, work and school can be negatively impacted by untreated ADHD. Furthermore, ADHD affects a person's day-to-day functioning and may lead to impulsive behaviors that may cause a wide range of problems such as financial, legal and relationship issues. 

Epidemiology of Adult Attention Deficit Hyperactivity Disorder

According to published study in The British Journal of Psychiatry, estimates of worldwide adult ADHD prevalence averaged 3.4% of 11,422 adults in 10 countries in the Americas, Europe and the Middle East.

Adult attention deficit hyperactivity disorder (ADHD) is a brain disorder that represents a combination of persistent problems like difficulty paying attention, hyperactivity and impulsive behavior. Attention deficit hyperactivity disorder itself is considered one of the most common childhood disorders that could continue through adolescence and into adulthood. 

There are three types of ADHD in adult which are: 

• Combination Type

 This is the most common type of ADHD that is observed as a combination of hyperactivity/impulsivity and inattentive symptoms.

• Inattentive Type

 Behavior characterized by inattentiveness symptoms without the presence of hyperactivity and impulsivity.

• Hyperactive/Impulsive Type

 Behavior characterized by hyperactivity and impulsivity , but inattentiveness is missing. 

The exact cause of ADHD is still unknown, but there are many factors that increase the risk of developing  ADHD in adults. 

ADHD usually starts in childhood and often continues into adulthood. Risk factors that may be involved in the development of the disorder include:

• Gender

Attention deficit hyperactivity disorder is more common in males than females. The combined type of ADHD is predominant in males, whereas the inattentive type is in females. 

•             Genetics

Attention deficit hyperactivity disorder can run in families, so genetics may play a role of increasing the risk of developing ADHD. 

•             Environmental factors

Certain environmental factors may increase the risk of ADHD, such as exposure to lead or pesticides during pregnancy or at a young age. 

•             Substance abuse during pregnancy

Women using substances such as nicotine, cocaine, and alcohol during pregnancy may increase the risk of developing ADHD in the baby. 

•             Neurophysiology

Electrical activity and metabolism, in addition to altered brain structure or function and

improper central nervous system development may increase risk of development of ADHD. 

•             Adverse childhood experiences

Inattention and hyperactivity could go back to several factors such as the lack of early attachment for the baby with their parent or caregiver, or when the baby has traumatic experiences related to the attachment. 

•             Birth problems.

Birth problems such as premature delivery and low birth weight may increase the risk of developing  ADHD. 

• Dietary factors

Although dietary factors as risk factors are not well established, several  factors may increase the risk of developing  ADHD such as sensitivities to certain food chemicals, deficiencies in fatty acids and zinc, and sensitivity to sugar. 

Although the exact pathophysiology of ADHD is not clear, abnormalities such as functioning of neurotransmitters, brain structure and cognitive function have been suggested to be in relation with ADHD.  

• Neurotransmitters

Dopamine and noradrenaline could play a major role in the pathophysiology of ADHD since certain drugs such as psychostimulants and noradrenergic tricyclics have proved to be very effective in treating ADHD.  These drugs are able to minimize symptoms by aiding the release and function of dopamine or noradrenaline neurotransmitters. Therefore, deficient neural transmission could be related to symptoms and pathophysiology of ADHD.

Adult ADHD have been associated with decreased activity of dopamine.

• Brain Structure

Structural areas of the brain such as the frontal and prefrontal regions, parietal lobe, and cerebellum have been linked to ADHD. Altered activation of the brain when certain activities are being done have been recorded by magnetic resonance imaging (MRI), in children with ADHD. 

Children with ADHD can be associated with deformations of the basal ganglia nuclei which is a  group of subcortical nuclei .These deformations may be decreased by the efficiency of stimulant drugs in treating ADHD .

• Cognitive function

Neurophysiological deficits and abnormalities in the cognitive function are associated with ADHD. Such deficits can be usually seen in the resting brain .This results in difficulties regulating and maintaining attention in people affected. 

In early childhood, symptoms appear and continue into adulthood.  These symptoms could decrease by age or could cause life- challenging problems. Symptoms in Adult ADHD may not be as clear as ADHD symptoms in children. In some cases, ADHD is not recognized until the person is an adult. Adult ADHD  may include decreased hyperactivity, but ongoing struggles with impulsiveness, restlessness and difficulty paying attention. Signs and symptoms of ADHD include : 

Common symptoms include: 

• Poor planning.
• Trouble coping with stress.
• Poor time management skills, disorganization and problems prioritizing.
• Problems focusing on, following through and completing tasks.
• Trouble multitasking.
• Frequent mood swings.

Inattentive type include:  

• Appear to be unable to listen to or carry out instructions, in addition to missing details.
• Avoiding tasks that require sustained mental effort and losing things necessary for tasks.
• Become easily distracted by unrelated thoughts or stimuli.
• Forgetting  daily activities.
• Excessive activity or restlessness. 
• Hot temper.

Hyperactive/impulsive type include: 

• Fidgeting and squirming; twisting and turning while seated.
• Unable to stay seated when required.
• Sudden improper movements such as running or dashing around when the situation doesn’t need so.
• Being unable to play or engage in hobbies quietly.
• Being in constant motion, often restless.
• Speaking in improper times such as interrupting or intruding on others, blurting out an answer before a question has been completed, in addition to non-stop talking and the inability of waiting his or her turn. 

No single test can confirm the diagnosis. ADHD may be diagnosed using the following:  

• Physical exam

Medical exam that used to help rule out other possible causes for symptoms.

• Information gathering

Information gathering such as any current medical issues, personal and family medical history, and school records.

•             ADHD rating scales or psychological tests 

ADHD rating scales using four factors to help collect and evaluate information of adult symptoms that include:

• Inattention and memory problems such as losing or forgetting things, being absent-minded, and not finishing things.
• Hyperactivity and restlessness such constant fidgeting, and being easily bored.
• Impulsivity and emotional instability such as saying things without thinking first, interrupting others, and being annoying to others.
• Self-worth issues such as avoiding new challenges, and appears confident to others but not to oneself. 

Combining medication, education, training and psychological counseling is often the most effective treatment of ADHD in adults for relieving symptoms despite the fact that they do not cure ADHD. 

Treatment for adult ADHD includes:           

• Medication

Types of medications used to treat ADHD include:

• Stimulant medications

Stimulant medications appear to boost and balance levels of brain chemicals called neurotransmitters, such as products that include methylphenidate or amphetamine. They could also improve signs and symptoms of inattention and hyperactivity in an efficient way and within a short time.

• Other medications

These are used when stimulants can’t be used , cause severe side effects, or a history of substance abuse is present. Medications that are used to treat ADHD include the nonstimulant atomoxetine and certain antidepressants such as tricyclics, and bupropion, which work slower than stimulants do. 

• Psychological counseling

Psychological counseling, education about the disorder, and learning skills are the approaches for counseling for adult ADHD. Common types of psychotherapy for ADHD include:

• Cognitive behavioral therapy

Teaching specific skills to manage behavior and change negative thinking patterns into positive ones. 

• Marital counseling and family therapy

Marital counseling and family therapy can improve communication and problem-solving skills, help coping with people who have ADHD and learn how to help them. 

• Alternative medicine

Few evidence have proved the efficiency of reducing ADHD symptoms through alternative medicine .However, one recent study published in an American journal, BioMed research international, indicates that mindfulness meditation may help improve mood and attention in adults who have ADHD.  Doctor consultation is needed before choosing any alternative medication. 

Adult ADHD has been linked to: 

• Poor work performance.
• Unemployment.
• Trouble with the law.
• Alcohol or other substance abuse.
• Frequent car accidents or other accidents.
• Unstable relationships.
• Poor physical and mental health.
• Poor self-image.
• Suicide attempts.

Disorders associated with ADHD and make treatment more challenging. These include:

• Mood disorders.
• Anxiety disorders.
• Other psychiatric disorders such as personality disorders and substance abuse.
• Learning disabilities. 

ADHD, as one of the most common childhood disorders that often persists into adulthood, renders the same prevention measures done with children and these include: 

• Avoiding anything that could harm fetal development during pregnancy, such as abstaining from alcohol , or smoking cigarettes.
• Exposure to pollutants and toxins, including cigarette smoking and lead paint, should be avoided with children.
• Avoiding excessive exposure to TV and video games in the first five years of a child’s life. 

ADHD can have a serious and long-lasting impact on a person's life since the symptoms will never completely go away in the most people with ADHD. Improving quality of life of people with ADHD is done when patients learn to manage symptoms effectively. Subsequently, increased confidence and motivation that aim at a more fulfilling and achieving life style. 

Home, work and school can be negatively impacted by untreated ADHD. Furthermore, ADHD affects a person's day-to-day functioning and may lead to impulsive behaviors that may cause a wide range of problems such as financial, legal and relationship issues. 

According to published study in The British Journal of Psychiatry, estimates of worldwide adult ADHD prevalence averaged 3.4% of 11,422 adults in 10 countries in the Americas, Europe and the Middle East.