General Information: Adult ADHD

What is Adult ADHD?

Simply put, a diagnosis of ADHD in adults can be established when an adult meets the DSM-V criteria for ADHD. While ADHD is often diagnosed in children and adolescents, many do not realize that approximately one-third of children with an ADHD diagnosis continue to meet the clinical diagnosis of ADHD in adulthood, and about 60% continue to struggle personally and/or professionally with symptoms of ADHD, even if not fully meeting ADHD criteria.

The Diagnostic Criteria (DSM-V) for Attention-Deficit/Hyperactivity Disorder includes:

• A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
  1. Inattention: Six (or more) of the following symptoms, must be present for 6+ months, to a degree inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities. For individuals 17 and older, five or more, will meet diagnostic criteria.
     1. Failure to give close attention to details, and frequent careless mistakes in schoolwork, at work, or during other activities.
     2. Difficulty sustaining attention in tasks, such as during lectures, conversations or while reading.
     3. Often does not seem to listen when spoken to directly, for example, one’s mind seems to wander elsewhere, even in the absence of obvious distraction.
     4. Difficulty following through with instructions and tasks. May start such tasks, but quick to lose focus and is easily sidetracked.
     5. Difficulty with organizing tasks and activities, which can result in difficulty managing several tasks, disorganized work, and failure to meet deadlines.
     6. Frequently avoiding, disliking, or is reluctant to engage in tasks that require sustained mental effort.
     7. Frequently losing items necessary for tasks and/ or routine activities, such as keys, books, glasses and phone.
     8. Is often easily distracted by extraneous stimuli, including unrelated thoughts..
     9. Forgetful in daily activities, which could include returning calls, paying bills, keeping appointments and others.
  2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities. For individuals 17 and older, five or more, will meet diagnostic criteria..
     1. Frequent fidgeting with hands and/or feet, or difficulty abstaining from squirming when seated.
     2. Often leaves seat in situations when remaining seated is expected.
     3. Feeling restless when seated.
     4. Difficulty engaging in leisure activities quietly.
     5. Feeling “on the go” as if “driven by a motor.”
     6. Excessive talking.
     7. Frequent blurting out answers before questions are completed, or difficulty waiting one’s turn in conversation.
     8. Difficulty waiting one’s turn in general, for example, in line.
     9. Frequently interrupting or intruding on others (for example, when in conversations with others, or when working with others on projects).
  3. Several symptoms must be present before the age of 12, in order to make a diagnosis.
  4. Several symptoms must be present in more than one setting. For example, at home, work, school, or when engaged in social activities.
  5. There must be clear evidence that symptoms interfere with, or reduce the quality of, social, academic or occupational functioning.
  6. The symptoms cannot be better explained by another mental health condition, such as a mood disorder, anxiety disorder, substance use disorder or personality disorder.

How Common is Adult ADHD?

It’s estimated that approximately 3-5% of children and 1-3% of the adult population meet criteria for ADHD.

What are the Main Types of ADHD in Adults?

1. Primarily Inattentive Type and Distractible ADHD: Symptoms are characterized by difficulty with attention, focus, organization and forgetfulness. Adults suffering with this type of ADHD may be less likely to have been diagnosed in childhood, or be less likely to seek treatment for ADHD, as many only think of ADHD as an illness related to hyperactivity and/or impulsivity.
2. Predominantly Hyperactive-Impulsive Type ADHD: Symptoms are characterized by difficulty with hyperactivity and/or impulsivity. Individuals with this type of ADHD may be more likely to have been diagnosed in childhood. Frequent difficulties include interrupting others, excessive talking, fidgeting and engaging in risky & impulsive behaviors.
3. Combined Type ADHD: This type of ADHD in adults is simply a combination of both inattentive ADHD symptoms and hyperactive-impulsive symptoms.

Why Treat Adult ADHD?

According to the World Health Organization (WHO) ADHD is one of the top 10 causes for missed work and reduced efficiency world-wide. Additionally, compared to age-matched controls, adolescents and adults with ADHD show serious impairment in multiple domains, including 90% in their home lives, 89% in their work lives, and 77% in their social lives (Adler LA et al, J Clinical Psychiatry). Individuals struggling with ADHD have higher rates of anxiety, depression, anger difficulties, nicotine dependence, substance abuse, divorce and even motor vehicle accidents. Treatment for Adult ADHD, can reduce the risk of serious adverse consequences of untreated illness, and can improve one’s social and occupational life, and even one’s relationship with their spouse or romantic partner.

What Treatment Options are Available for Adult ADHD?

There are various treatment options for Adult ADHD.

1. Additional information on the non-pharmacological treatment of ADHD, and ADHD skills training at Rittenhouse can be found here. This can be in-conjunction with medication management, or for the treatment of Adult ADHD without medications. Therapy for ADHD can also help individuals to taper off of ADHD medication over-time.
2. Non-stimulant medication management of Adult ADHD: There are various medications that can be used to treat Adult ADHD, that are not controlled and have limited abuse potential. These include Strattera (Atomoxetine), Intuniv (Guanfacine ER), Clonidine, Wellbutrin (buproprion) and others.
3. Non-Amphetamine and Non-Methylphenidate controlled medications: Provigil (Modafinil) and Nuvigil (Armodafinil) are two medications that can be used off-label for the treatment of Adult ADHD, and may have less abuse potential than medications such as Adderall, Ritalin and Vyvanse. They are often prescribed to individuals with shift work sleep disorder or narcolepsy.
4. Stimulant medications such as Adderall (amphetamine salts), Ritalin (methylphenidate) and medications derived from these parent substances (Vyvanse, Focalin, Concerta and others).

Additional Information and Resources for Adult ADHD?

Visit our ADHD Shortage Medication Guide, for detailed information on the ADHD medication shortage and treatment options for ADHD. “Substitutes” for various ADHD medications are listed, to help individuals find replacements for their ADHD medications, when their typical medications are out-of-stock at local pharmacies. Information on manufacturer coupons, for trade-name medications are also included.

How is Rittenhouse Different?

Unlike many online “ADHD Companies” offering “subscription plans” for Psychiatric medications, our providers:

• Are Board Certified Psychiatrists and Psychiatric Nurse Practitioners
• Will treat the entire patient, not just a singular diagnosis. For example, our providers are trained in the evaluation of anxiety, depression, bipolar disorder, personality vulnerabilities and substance use disorders, which are all conditions that are often co-occurring with ADHD.
• We will take the time to discuss the risks and benefits of psychiatric medications, and discuss non-medication options, and non-controlled options, for the treatment of Adult ADHD.
• In-office and Virtual Online Appointments available within 2 weeks.
• Most providers teach, or have taught at Academic Centers and most of our prescribers trained at either The Johns Hopkins Hospital or The University of Pennsylvania in Psychiatry.