Dealing with Adult ADHD

Many adults are unaware that there could be a valid medical explanation behind their impulsive behaviour and lifelong inability to concentrate.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that affects around one in 20 adults. It was once thought that children who had the condition would grow out of it, but scientists now believe 70 per cent of these children will continue to be affected in adulthood.

Experts estimate only a quarter of those with ADHD actually know that they have it. For decades, many adults may have struggled to understand their impulsive behaviour, trouble retaining information, and difficulty paying attention.

Is ADHD really severe enough to worry about a diagnosis, though?

On the positive side, people who have the condition can be creative, enthusiastic and excellent at brainstorming, as well as being capable of deep focus when engaged by a favourite topic. However, some can also be easily distracted, hyperactive, disorganised, and have difficulty sleeping and regulating their emotions.

Many adults live without understanding their behaviour, but when they finally learn they have ADHD, it means they can do something about it.

HOW IT WORKS

The brain of someone with ADHD operates differently to other people’s. It encounters difficulty when it comes to paying attention and organisational tasks, says medical doctor and psychiatry resident Dr Kieran Kennedy. “ADHD is a condition where the brain has a bit more trouble than usual moderating impulses and activity, and also moderating how much we’re able to focus.”

Science is not 100 per cent certain of the causes, but it’s believed there is a mixture of elements at play, including a genetic component. Other possible contributing factors might be differences in brain anatomy, exposure to drugs in the womb or to lead over a prolonged period, and failure to bond with a parent or caregiver at an early age.

There are three types of ADHD. Firstly, the predominantly impulsive/hyperactive type, which is the most common understanding of the condition, involving a tendency to talk too much and blurt things out, along with difficulty sitting still.

There is also the predominantly inattentive type of ADHD, where the person is not loud and zooming around being disruptive to others, but is more prone to daydreaming and gazing out a window when they should be concentrating.

Meanwhile, the third type of ADHD is a combination of the other two.

The symptoms can be misinterpreted by others who don’t properly understand how the condition works and thus can cause strain in relationships.

People with the condition can be affected by what’s called ‘time blindness’, meaning they can become so absorbed in an activity that they lose track of the hours ticking by. They then show up late for or completely miss important tasks they should be doing instead.

This can of course be misconstrued by others as the person with ADHD not being careful enough. It can also become something of a vicious circle for the person with ADHD, says Dory Connor, who is an adult ADHD coach and also has the condition herself.

“They do not view time in the same way,” she says. “They can become immersed in what they are interested in, miss deadlines or forget what day it is, which leads to an adrenaline boost, motivating them to do what is needed. Unfortunately, this can become an endless cycle, resulting in the ADHD-er perceiving they need the adrenaline to do the task.”

Another challenging symptom is hypersensitivity to the moods of the people around them or the overall atmosphere of a room, says Connor, although there are tricks you can use to remedy the situation.

“In a negative environment where people are arguing or sad, the person may show a depressed mood,” she says.

“The good thing is that ADHD can be affected by environment, which means the person can be calmed down or their mood can be improved by removing them from whatever is affecting them. If you have ADHD and can feel yourself going up or down, you can use this – it may be time for a quick toilet break.”

The sufferer might react in ways that don’t follow societal norms when they have trouble regulating their emotions. This is when a little understanding can go a long way.

“For those who have ADHD and those around them, it’s important to understand what is going on, learn strategies to disrupt the behaviour (ultimately learning new behaviours), and be patient and persist with incremental improvements until the person meets what is expected,” says Connor. “This will take time, compassion, consistency and determination to achieve.”

EVOLVING OPINIONS

ADHD has long been controversial. Over the years, fingers have been pointed at various explanations for its prevalence in children, such as lax parenting, too much sugar, food additives and vaccines. Many in the medical profession still believe ADHD to be overdiagnosed: traditionally, there has been doubt over whether it was a legitimate medical condition or merely an excuse for poor behaviour, says Dr Kennedy.

“There’s still that opinion out there that maybe some children aren’t disciplined enough or there’s another reason for why they’re not paying attention or staying in their chair,” he says. “How this has changed is that the science now backs up that this is a legitimate neurodevelopmental disorder and there are areas of the brain that are functioning slightly differently.”

Our knowledge and understanding of the condition has grown, especially regarding the inattentive type. The data has shown ADHD tends to afflict more boys than girls, although girls tend to present more often with the inattentive type. This might mean more female cases have been overlooked and the gaps between sexes might not be as wide as previously thought.

On an individual level, the type of ADHD a person has can also evolve over the years. “Most adults with ADHD won’t be impulsive, fidgeting, getting up and down out of their seat and calling out,” says Dr Kennedy. “It can and does change as the person gets older. It’s much more common for children to have the more hyperactive-type ADHD; [with] those children, as they get older, the hyperactivity symptoms tend to get better and die down, but the inattention symptoms can stay the same or even get worse.”

DIAGNOSIS TIME

So if you recognise some of these symptoms in yourself, how would you go about being diagnosed with ADHD as an adult? One of the main drivers for adults to discover they have the condition can be having a child who is diagnosed. The parent then recognises they have many similar symptoms and begin to reflect on whether they might also have ADHD. Earlier stigmas surrounding the condition being a failure of self-discipline, a choice or an excuse for poor behaviour are also lifting, making it easier for people to seek help to explain how their brain works without fearing judgement.

Although they’ve just put up with the symptoms since childhood and learned some ways to work around them, adults with ADHD may simply become weary of trying to play catch-up to others who don’t experience the same difficulties.

“Adults get to the point where they feel like compared to colleagues or siblings or friends and family they’re struggling with certain aspects of things and they’ve never quite been able to put their finger on it,” says Dr Kennedy.

The process of reaching an official diagnosis as an adult isn’t necessarily straightforward, though. The patient will need to demonstrate they have been experiencing ADHD symptoms since before they were 12 years old, which might involve a family member attesting to the struggles the patient had with paying attention to tasks as a child, or school reports and other examples.

To make the waters murkier, there are several other possible explanations for hyperactive behaviours or an inability to concentrate, and these can occur by themselves or in conjunction with ADHD. “Depression, stress, drug and alcohol issues, anxiety – those things can also affect our ability to concentrate or plan or remember things, so it can be a tricky thing to diagnose in adults,” says Dr Kennedy.

ADHD can also present in a similar way to post-traumatic stress disorder (PTSD). Those who have experienced a traumatic event or series of events in their past can develop changes in the way they process stressful incidents. Symptoms such as inattention, impulsivity, poor sleep, irritability, memory difficulties, and low self-esteem can occur across both: the interplay between the two conditions is not yet fully understood.

Despite the difficulties, finally finding out the cause of your lifelong frustrations with concentration and organisation can be a huge relief. It also paves the way for some big positive changes after treatment commences, including potentially alleviating symptoms of other conditions you might suffer from such as depression and anxiety.

TREATMENT OPTIONS

The main treatment is with medications called stimulants, a class of drugs related to amphetamines. This may sound surprising considering you’d think the last thing people with amped-up brains affected by ADHD would need is more stimulation. However, they target the right parts of the brain in the right way for those who have the condition.

“Someone with ADHD takes those medications and they feel calm, they feel focused, and in concentration mode,” says Dr Kennedy. “If someone who doesn’t have ADHD took those same classes of medications, they might make them feel very differently because those areas of their brain don’t need to be switched on or changed.”

Doses vary with the age of the person and are carefully timed throughout the day so the brain is up and firing when it needs to be, depending on the person’s schedule around study, hobbies and work. “Adults might take it at slightly different times depending on what their work-life balance and schedules are like,” says Dr Kennedy. “Too close to bedtime or too late in the afternoon might mean their brain can’t switch off and go to sleep later in the night.”

There are also therapies to help patients work around their difficulties. “It’s about recognising our brains aren’t all the same and that the traditional kind of sitting down for an hour or two hours at a time, some brains just don’t do well in that environment,” says Dr Kennedy. “Those behavioural, environmental ways that we can help someone with ADHD are important as well.”

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Last night I died. First, I was in hospital, helplessly clutching my husband’s hand, and then I was drifting like a ghost, watching my two sons moving through their days without me. I was ethereal, disembodied, yet still aware of tears soaking the neck of my T-shirt, the sound of sobbing, the distant bugle of someone blowing their nose. Then psychologist Mary Hoang’s soothing voice summoned us back to life. “Breathe,” she urged. “Feel the seat beneath you ... Feel the rhythm of your breath, feel the beating of your heart.”

Hoang had just led me, and about 100 others, through a death meditation. Cocooned in a dimly lit room and immersed in a stirring soundscape, we’d been gently guided to the edge of the abyss, and back again. Death meditation. It sounds morbid. Yet much like the traditional Buddhist practice of maranasati, or death awareness, the point is to illuminate what matters most in life. Having confronted us with a high definition preview of our own demise, Hoang invited us to write down what we planned to do differently. “We can’t keep living our lives as if they’re endless,” she said, as I scribbled furiously, filling the page.

I was profoundly moved by the experience. Afterwards, I forgave the driver who cut me off in traffic, declared my undying love for my husband and children, and hummed contentedly as I loaded the dishwasher and folded the laundry. My elder son eyed me suspiciously. “Are you going to be like this for the next few days?”

Hoang says the effects of death meditation practice, and their duration, are different for everyone. People recommit to relationships. Start new ones. Leave jobs. Have difficult conversations. She acknowledged that it’s easy to slide back into old patterns in time. “But death meditation and other practices are there to somewhat snap you out of that sleepwalking experience and bring you back to what’s really in front of us,” she says.

MEMENTO MORI

Logically, it shouldn’t be so impactful. Death is nothing new. The Latin proverb memento mori, meaning ‘remember that you die’, has inspired countless works of art and literature. But following the high casualty rates of the Spanish flu, and the two World Wars, death became almost invisible,

In Aboriginal culture, it is taboo to say the deceased’s name.

says health ethicist Sarah Winch, who wrote The best death: How to die well in 2017 after her husband died. Winch says few people have seen a dead body and many lack understanding of terms like ‘prognosis’ and ‘palliative care’. According to the Groundswell Project, 70 per cent of Australians die in hospital, instead of at home. “Death fell out of view, and became something to be feared, and it’s feared greatly,” Winch explains.

There are sound evolutionary reasons why we’d rather not talk or even think about death. Individually, our survival instincts are at odds with the knowledge of certain death, so we suppress the latter. Collectively, we’re aided and abetted by death-denying culture. But there are adaptive ways to face the final curtain. “The heart of the science, and the philosophy, is that facing difficult things actually leads to greater wisdom and knowledge and growth,” says Hoang. “The question is: Do we want to prepare ourselves for something that is inevitable? Or do we just want to get hit over the head with it when it actually happens?”

For many people, the pandemic forced that rude awakening. Even if we didn’t personally know someone who had fallen ill or died from COVID-19, media images depicting the digging of mass graves on New York’s Hart Island, or rows of burning funeral pyres in Delhi, served as visceral reminders that death stalks us all. Zenith Virago is a Byron Bay-based ‘death walker’, who accompanies both the dying and bereaved on their respective journeys. She says that COVID-19 has “woken people up to death and mortality” just as travel restrictions and social distancing rules changed memorialisation practices. “Some people know they’re going to miss the death of their person, but they never, never expected to miss the funeral, and that’s been very, very difficult for people,” she says.

Roadside memorials marking fatality sites are another unavoidable feature of modern life. There’s one beside the highway to Ipswich which gets me in the guts every time. It’s a stark white cross, offset with flowers, and bold lettering simply stating, ‘BABY GIRL’. Despite their ubiquity,