Health & Fitness

A focus on distraction: A closer look at adult ADHD

Given our busy lives comprised of many daily demands, it is not surprising to hear people uttering, "I am sorry; I got distracted and forgot my appointment." However, such daily occurrences do not necessarily mean that you have an attention problem – such as attention deficit/hyperactivity disorder, otherwise known as ADHD - and may simply be the product of living in a complex society that places an increased burden on our cognitive abilities.

So, what is ADHD, and how do we know if, as adults, we are suffering from it?

Dr. Rene Hernandez-Cardenache.JPG
Dr. Rene Hernandez-Cardenach is a clinical neuropsychologist and assistant professor of psychiatry and behavioral sciences at the University of Miami Health System. UHealthSystem.com

ADHD is a neurodevelopmental disorder characterized by deficits with attention, hyperactivity, and impulsivity. In those affected by it, the condition is most often diagnosed during early childhood and commonly identified by the child’s behavior difficulty to cope with school leading to academic underachievement or behavioral hyperactivity and difficulty following rules at home.

Less is known about how these symptoms persist into adulthood and why some continue to be driven to distraction. Over the last three decades, however, there has been increased interests in knowing how ADHD manifests in adulthood. Once misunderstood to be exclusively a childhood disorder, it is now commonly accepted that approximately 4 percent of the adult population suffer from ADHD. Approximately, 60 percent of individuals diagnosed with ADHD during childhood will suffer from persistent ADHD symptoms across their lifespan.

Fortunately, this means that an estimated 40 percent of ADHD individuals will not show the symptoms by the age of 25, likely due to the brain’s ability to mature. It is not a coincidence that many of us will become more settled and focused after college at this developmental point of our lives. Although some symptoms like being easily distractible tend to continue in most ADHD individuals, the predominant features of ADHD in adults differ from the classic features observed in children.

ADHD in adults is most often characterized by recurrent problems with restlessness, impulsivity, problems with the management and planning of time, finances, and space, as well as problems regulating emotions. Rather than being hyperactive like children, adults with ADHD report experiencing an internal sense of fidgetiness and restlessness. Such symptoms can lead to problems when engaging in sedentary activities such as reading or watching a movie.

In general, the symptoms of hyperactivity are subtler in adulthood, although the daily struggles with distractibility and being “stimulus bound” to sights and sounds tend to persist in most. Many adults report that signs of inattention become more apparent through problems communicating with others when “tuning out” in conversations with supervisors, friends, or loved ones. Characteristically, many adults will show signs of executive dysfunction, which can directly affect their ability to plan and organize their lives, follow through on job-related tasks and deadlines, and adjust their maladaptive behaviors when receiving meaningful feedback from important people in their lives.

Upon entering the job market, many adults also experience obstacles in employment, and are at increased risk to be terminated due to repeated tardiness or absenteeism. Such difficulties all contribute to poorer employment outcome, and a lower likelihood of being employed in professional environments. Interpersonally, adults with ADHD often find it difficult to generate effective solutions to social problems. These deficits in social cognition can increase the likelihood of peer rejection, and social isolation, adding to struggles with depression and social anxiety. Likely due to a combination of inattention and impulsivity, ADHD adults also tend to have less overall stability in romantic relationships and higher divorce rates than others, all of which can further impact their quality of life if untreated.

The encouraging news for adults suffering from ADHD is that there are state-of-the-art instruments to test for adult ADHD, as well as many effective treatments aimed at reducing these unsettling symptoms. Stimulant medication is the first line of treatment for adult ADHD and has the greatest margins of efficacy with only mild tolerable side effects. Stimulant medications are effective in around 70 percent to 80 percent of properly diagnosed persons. In most cases, combining medication and cognitive behavioral modification treatment is recommended to teach adults effective ways to manage the persistent symptoms across the life span.

Dr. Rene Hernandez-Cardenach is a clinical neuropsychologist and assistant professor of psychiatry and behavioral sciences at the University of Miami Health System. For more information, call 305-355-9029 or visit umiamihealth.org/treatment-services/psychiatry.
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