Adult attention deficit hyperactivity disorder (ADHD or ADD) is a neurological disorder that affects an estimated 4.4 percent of U.S. adults, and is more commonly diagnosed in men (5.4%) than in women (3.2%)1. ADHD in adults is characterized by a persistent pattern of inattention, hyperactivity, and/or impulsivity that interferes with and impacts work, home life, and relationships – especially if left untreated.
ADHD was historically considered a childhood condition, but it is now recognized as a lifelong condition that persists well into adulthood. Persistence rates, however, vary, ranging from 6%1 to 30%2 and perhaps even higher3. Individuals with ADHD may receive a diagnosis in childhood or well into adulthood. Trends show a rise in rates of ADHD diagnoses among U.S. adults in the last decade.4
Still, many adults with ADHD never receive a diagnosis in their lifetimes. Scientists believe ADHD is significantly underdiagnosed in adults.5
ADHD or ADD symptoms in adults broadly resemble the common signs of childhood ADHD. However symptom intensity — especially hyperactivity — is known to decrease over time for many individuals.6
Adult ADHD impacts virtually every aspect of life, more so if the condition remains undiagnosed, untreated, or ineffectively treated – all of which can have detrimental effects on an individual’s psychological well-being and quality of life.6
Adult ADHD symptoms like poor time management and concentration, procrastination, and forgetfulness can and do make school and the workplace difficult to navigate. Many studies have linked ADHD to difficulties in school (including higher education) and in the workplace.7 Individuals with ADHD are more likely to face difficulty gaining and maintaining employment compared to neurotypical adults, especially if they did not receive treatment in childhood.8
ADHD symptoms in adults like poor listening skills, low frustration tolerance, inability to follow through with tasks, and impulsivity can lead to a number of difficulties with romantic relationships, friendships, familial relationships, and other social connections.5
Research has linked ADHD in adults to criminality, rule-breaking, and other legal and safety issues – including greater risk of getting into car accidents compared to the general population.9 One study found that individuals who present ADHD symptoms in childhood are more likely to engage in criminal activities as young adults than are non-ADHD individuals.10 Another recent systematic review estimates that 26% of prison inmates have adult ADHD.11
ADHD and substance abuse are strongly connected. ADHD adults are twice as likely to be diagnosed with substance use disorder (SUD) compared to individuals without ADHD.12 Many adults with ADHD and SUD report using substances like alcohol and other drugs as a way to self-medicate and manage ADHD symptoms.13
Adult ADHD seldom exists alone. Roughly 60% to 70% of adults with ADHD have a comorbid disorder.14 According to a 2006 national study on adult ADHD1:
The following table from expert William Dodson, M.D., shows how childhood symptoms of ADHD can translate to adulthood.
What causes ADHD? It’s not entirely clear, but most research suggests these main factors:
ADHD is not a result of poor diet, inadequate exercise, excessive screen time, or socioeconomic factors – though some of these factors and other stressors may worsen ADHD symptoms in some individuals. And while widely considered a childhood condition, researchers continue to explore whether ADHD onset can occur in adulthood.21
Healthcare providers use symptom criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to establish an adult ADHD diagnosis.22 The DSM-5 lists nine symptoms that suggest predominantly inattentive ADHD (often called ADD), and nine separate symptoms that suggest predominantly hyperactive-impulsive ADHD.
An adult can be diagnosed with either ADHD subtype — or Combined Type ADHD — if they exhibit at least five of the nine symptoms in two or more settings – at work and at home, for example – for at least six months.
An adult ADHD symptom assessment often includes the following with a clinician experienced in adult ADHD:
A complete assessment may take several visits and/or visits with an ADHD specialist.
The best treatment for adult ADHD is a combination of therapy and medication.23 24 Adults should expect to work closely with their physicians to adjust medication and dosage, and to find the right ADHD treatment combination to alleviate symptoms.
Stimulants are considered first-line pharmacological treatment for adult ADHD25, and fall into two major categories:
All stimulant medications are different forms of these two types of medication.
Several types of non-stimulants (considered second-line treatments) are used to treat ADHD.
Learn more about the various medications available to treat ADHD, in our extensive ADHD medication guide.
Most adults experience symptom reduction with ADHD medication, but many continue to struggle with work, day-to-day responsibilities, or low self-esteem due to a lifetime with attention deficit disorder. ADHD medication can regulate the brain neurologically. Psychotherapy or professional guidance can organize and motivate adults with ADHD to address specific challenges through conditioning. Common ones include:
These therapies and interventions, combined with education about ADHD, can help adults recognize the places where ADD symptoms are causing difficulty in their lives and work to change negative patterns
Environmental factors play a big role in the severity of ADHD symptoms in adults. Adults with ADHD can positively impact their symptoms by modifying lifestyle factors like:
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1 Kessler, R. C., Adler, L., Barkley, R., Biederman, J., et. al. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American journal of psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716
2 Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics. 2013;131(4):637-644. doi:10.1542/peds.2012-2354
3 Sibley, M.H., Swanson, J.M., Arnold, L.E., Hechtman, L.T., Owens, E.B., Stehli, A., Abikoff, H., Hinshaw, S.P., Molina, B.S., Mitchell, J.T., Jensen, P.S., Howard, A.L., Lakes, K.D., Pelham, W.E. and (2017), Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychol Psychiatr, 58: 655-662. doi:10.1111/jcpp.12620
4 Chung W, Jiang S, Paksarian D, et al. Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups. JAMA Netw Open. 2019;2(11):e1914344. doi:10.1001/jamanetworkopen.2019.14344
5 Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders, 16(3), PCC.13r01600. https://doi.org/10.4088/PCC.13r01600
6 Gentile JP, Atiq R, Gillig PM. Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management. Psychiatry (Edgmont). 2006;3(8):25-30.
7 Kuriyan, A. B., Pelham, W. E., Jr, Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of abnormal child psychology, 41(1), 27–41. https://doi.org/10.1007/s10802-012-9658-z
8 Halmøy, A., Fasmer, O. B., Gillberg, C., & Haavik, J. (2009). Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. Journal of attention disorders, 13(2), 175–187. https://doi.org/10.1177/1087054708329777
9 Chang Z, Quinn PD, Hur K, et al. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017;74(6):597–603. doi:10.1001/jamapsychiatry.2017.0659
10 Fletcher, J., & Wolfe, B. (2009). Long-term consequences of childhood ADHD on criminal activities. The journal of mental health policy and economics, 12(3), 119–138.
11 Baggio, S., Fructuoso, A., Guimaraes, M., Fois, E., Golay, D., Heller, P., Perroud, N., Aubry, C., Young, S., Delessert, D., Gétaz, L., Tran, N. T., & Wolff, H. (2018). Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis. Frontiers in psychiatry, 9, 331. https://doi.org/10.3389/fpsyt.2018.00331
12 Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021
13 Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Current psychiatry reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6
14 Piñeiro-Dieguez, B., Balanzá-Martínez, V., García-García, P., Soler-López, B., & CAT Study Group (2016). Psychiatric Comorbidity at the Time of Diagnosis in Adults With ADHD: The CAT Study. Journal of attention disorders, 20(12), 1066–1075. https://doi.org/10.1177/1087054713518240
15 Demontis, D., Walters, R. K., Martin, J., et.al. (2019). Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nature Genetics, 51(1), 63–75. https://doi.org/10.1038/s41588-018-0269-7
16 Donzelli, G., et al.”The Association between Lead and Attention-Deficit/Hyperactivity Disorder: A Systematic Review.” International Journal of Environmental Research and Public Health. January 2019, 16:3. doi: 10.3390/ijerph16030382
17 Rochester, J.R., et al. “Prenatal exposure to bisphenol A and hyperactivity in children: a systematic review and meta-analysis.” Environment International. May 2018, 114, pp. 343-356. doi: 10.1016/j.envint.2017.12.028
18 Narad ME, Kennelly M, Zhang N, et al. Secondary Attention-Deficit/Hyperactivity Disorder in Children and Adolescents 5 to 10 Years After Traumatic Brain Injury. JAMA Pediatr. 2018;172(5):437–443. doi:10.1001/jamapediatrics.2017.5746
19 Ask H, Gustavson K, Ystrom E, et al. “Association of Gestational Age at Birth With Symptoms of Attention-Deficit/Hyperactivity Disorder in Children.” JAMA Pediatrics online, 25 June 2018. doi:10.1001/jamapediatrics.2018.1315
20 Eilertsen, E.M., et al. “Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD): a prospective sibling control study.” International Journal of Epidemiology. October 1, 2017, 46:5, pp. 1633-1640. doi: 10.1093/ije/dyx067
21 Faraone SV, Biederman J. Can Attention-Deficit/Hyperactivity Disorder Onset Occur in Adulthood? JAMA Psychiatry. 2016;73(7):655–656. doi:10.1001/jamapsychiatry.2016.0400
22 American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders. DSM-V. Washington, DC: American Psychiatric Publishing
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27 Christiansen, L., Beck, M. M., Bilenberg, N., Wienecke, J., Astrup, A., & Lundbye-Jensen, J. (2019). Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. Journal of clinical medicine, 8(6), 841. https://doi.org/10.3390/jcm8060841
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