For the millions of adults with ADHD, the right treatment can control symptoms and change life for the better.
Holding down a job. Caring for a family. Paying bills. Staying on top of chores. Having a social life. The business of life is tough enough, but for the estimated 10 million American adults with attention-deficit/hyperactivity disorder (ADHD), even mundane tasks are overwhelming. “These people find it increasingly difficult to handle the mounting responsibilities of adulthood,” says David W. Goodman, M.D., director of the Adult Attention Deficit Disorder Center of Maryland in Lutherville. Many people with ADHD have struggled for years. Whether the disorder has been apparent since childhood or has recently been diagnosed, adult ADHD can indeed be the challenge of a lifetime.
What Causes ADHD?
People with ADHD often have other psychiatric conditions such as depression, bipolar disorder, anxiety, or substance abuse. And they may have trouble getting diagnosed because their symptoms are attributed to their psychiatric condition or a problem such as a thyroid disorder, sleep apnea, or hypoglycemia.
“We know it’s a brain disorder,” says Dr. Goodman, assistant professor in the department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine in Baltimore, Maryland. In people with ADHD, he says, the frontal lobes, which are involved in thinking, planning, and decision-making, mature two to three years later than they do in people who do not suffer from the disorder. Low levels of dopamine, a brain chemical that regulates movement, emotional response, and sensitivity to rewards, may also be involved.
While there have been many theories about causes, including mercury exposure, vaccinations, and food additives, they have not been proven, most likely due to the difficulty of testing. Most toxicology research centers around the effects of high levels of substances, not low-level exposure, which some experts say could be the culprit. However, researchers have identified some associations. If a person has ADHD, chances are someone else in the family tree does, too. Exposure to lead or other toxins may play a role. Women who smoke or drink during pregnancy are more likely to have a child with ADHD. And low birth-weight babies and preemies are also at greater risk.
How Is Adult ADHD Treated?
Treating ADHD is a delicate balancing act because if someone has another psychiatric disorder, such as anxiety, depression, or substance abuse, that also has to be addressed. And a clinician has to make sure that the treatment for one condition doesn’t worsen the symptoms of another, or he may find that treating ADHD first in people with mild anxiety actually increases the anxiety.
Two classes of drugs have been approved for treating ADHD. Stimulants, including methylphenidates and amphetamines, are considered the front-line treatment for ADHD, but non-stimulants are also prescribed. The medications can be short- or long-lasting.
Depending upon the drug, side effects may include headache, decreased appetite, insomnia, dry mouth, agitation, anxiety, nausea, and sexual problems. Stimulants may also slightly increase blood pressure and heart rate, or in rare cases, trigger a serious cardiovascular event, such as heart disease or heart failure. So some people may need an electrocardiogram before starting them.
Despite possible side effects, for many people medication is a game changer. “There can be a rather substantial improvement in cognitive ability,” says Dr. Goodman. “And you can tell if it is going to help within a day.” He typically prescribes a low dosage to start, gradually increasing it until the patient experiences relief. If a patient is skittish about taking medication, Dr. Goodman recommends giving it a try to see if it helps. “The disorder won’t go away,” he adds. “The goal of treatment is to obtain the best quality of life and performance.”
Can Therapy Make a Difference?
Some people with ADHD may have difficulty planning, organizing, managing time, prioritizing, and executing tasks,” says Dr. Goodman. Cognitive behavioral therapy (CBT), a form of talk therapy, can teach people techniques that address those problems. Therapy serves another purpose: Adults with ADHD may be resentful they weren’t diagnosed and treated earlier in life, explains Dr. Goodman. “They may feel regret for opportunities squandered and lost,” he says. CBT helps them come to terms with these feelings. The result: “They realize their future can be written in a way they never conceived,” he says.
Alternative Approaches
There are also alternative strategies that may improve the quality of life in people suffering in silence from ADHD.
“Multiple issues can conspire to cause ADHD,” says neurologist David Perlmutter, M.D., of Naples, Florida, author of Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain—For Life. “You have to come at this situation with a multi-pronged approach.”
Here are the integrative strategies he and other physicians recommend for trying to manage symptoms:
Ease inflammation. One theory is that inflammation in the gut contributes to ADHD. “A diet that’s higher in sugar and lower in fat and lacks fiber sets the stage for changes in gut bacteria that turn on inflammation,” says Dr. Perlmutter. Among the inflammation-lowering foods he recommends are omega-3 fatty acids (the kind found in fish, walnuts, leafy veggies, flax seed, and flaxseed oil); good fats like those found in olive oil, avocados, nuts, grass-fed beef, and chicken; and fiber (30 to 40 grams of per day is recommended). On his list of no-no’s are sugar and sweet stuff like honey and agave nectar; artificial sweeteners; and foods containing gluten. And while carbs are okay, limit intake to 80 grams per day.
Get enough vitamins and minerals. Psychiatrist and brain disorder expert Daniel Amen, M.D., founder of the Amen Clinics, advises taking a daily multivitamin to compensate for dietary shortfalls. “We don’t get the nutrients we need,” he says. And instead of loading up on supplements willy-nilly, Dr. Perlmutter prefers “correcting deficiencies.” For instance, boosting blood levels of good-for-the-brain vitamins D and B12, if testing shows they’re low, is critical, he adds.
Do regular aerobic exercise. “It boosts blood flow to the brain and improves energy, concentration, and decision making,” says Dr. Amen. His Rx: A half hour of aerobic exercise per day with short bursts of intensity. For example, if walking’s your thing, break it up with some one-minute jogs.
Chill out. Try meditation or a calming cup of lemon balm tea, says Dr. Perlmutter. In mindfulness meditation, you focus on body sensations, thoughts, and feelings. Research at the UCLA Mindfulness Awareness Research Center shows that this meditation technique may improve attention, impulsiveness, and emotions in people with ADHD.
Get your zzzs. Being tired makes it hard to focus. Aim for seven to nine hours per night. And if you want to try melatonin, a natural sleep aid, ask your doctor to recommend a product and dosage.
Consider neurofeedback. A form of biofeedback, it strengthens and conditions the brain. During the therapy, brain waves are assessed and then sounds, lights, or games are used to signal when brain waves are following an orderly pattern and when they aren’t. “It’s like working out your frontal lobes,” says Dr. Amen.
While some experts extol the benefits of non-traditional approaches for managing ADHD, they may not be right for everyone or they may need to be paired with medication. If you prefer to start with complementary and alternative medicine (CAM) therapies, “set a timetable,” says Dr. Goodman. “If it helps at the end of a few months, great,” he says. “If not, move on.” But even if medication is the best choice for your symptoms, continuing good-for-your-health practices, such as a good diet, meditation, exercise, and sleep, makes sense and may also help. “I don’t take anything off the table,” says Dr. Perlmutter.
What Adult ADHD Looks Like
Like kids, adults with ADHD are dogged by hyperactivity, impulsivity, and inattentiveness. Here is a rundown of some symptoms that should raise a red flag in adults, according to Dr. Goodman.
Trouble paying attention
Making careless errors
Being easily distracted and forgetful
Trouble finishing tasks or concentrating
Disorganization; always misplacing things
Restlessness
Holding down more than one job
Working long hours and preferring active jobs
Feeling overwhelmed
Excessive talking
Changing jobs on impulse
Interrupting others
Getting frustrated easily
Driving too fast
