MINNEAPOLIS/ST. PAUL (10/12/2022) — According to the CDC, more than 9.4 percent of children in the United States have a diagnosis of ADD or ADHD as of 2016, making it one of the most common neurodevelopmental disorders among children. However, it is estimated that “fewer than 20% of adults with ADHD are currently diagnosed and/or treated by psychiatrists.” In adults, diagnostic criteria can present differently than in children, and is highly comorbid with other psychiatric conditions. Undiagnosed ADHD in adults is linked to decreased quality of life in overall mental health, personal relationships and work.

For National ADHD Awareness Month in October, Dr. Lidia Zylowska with the University of Minnesota Medical School and M Health Fairview discusses adult ADHD — what it is, how it is diagnosed and treated, and how both those with adult ADHD and those in their lives can create an environment of support and understanding.

Q: What is ADHD? 

Dr. Zylowska: ADHD — or Attention Deficit Hyperactivity Disorder — is an umbrella term that is used in scientific and professional contexts to describe the condition. In such contexts we also use additional terms to specify the most common ADHD symptoms someone has such as:

  • ADHD, Predominantly inattentive presentation

  • ADHD, Predominantly hyperactive/impulsive presentation, and

  • ADHD, Combined presentation

Q: What are the signs and symptoms of ADHD in adults? 

Dr. Zylowska: ADHD has two common buckets of symptoms: inattention/disorganization and hyperactivity/impulsivity. Some people have mostly one type of symptoms and some have a combined presentation. The combined type and the inattentive/disorganized presentation are the most common for adults. The typical struggles include trouble focusing, procrastination, forgetfulness and missing out details in a conversation. Hyperactivity can show up as inner restlessness with consequent trouble sitting through meetings, conversations or inability to relax easily. 

We also often talk about ADHD and executive function deficits, such as poor skills with planning, starting or finishing tasks, time awareness and management and managing emotions. In this way, ADHD can affect most aspects of one's life, including productivity at work, being a partner or a parent and taking care of daily responsibilities. Many adults with ADHD also suffer from indecision, self-doubt and self-criticism.

Q: How is ADHD diagnosed?

Dr. Zylowska: ADHD is typically diagnosed by taking a careful and thorough history of symptoms as a child and as an adult. Being a developmental condition, we look for evidence of behavior and difficulties consistent with ADHD in childhood or adolescence. It is helpful to have input from the adult with suspected ADHD as well as those who know them well. School history and school reports can be very helpful in this process, however, it is also true that some adults may do well in school and struggle mainly when they have to manage regular life. 

A careful evaluation will also look at other factors such as depression, anxiety, lack of sleep or physical conditions to make sure these other factors are not affecting focus and productivity. At the same time, it is also important to recognize that ADHD in adults is often present alongside other mental health conditions and may also be the driver of increased anxiety, mood fluctuations, irritability or substance use disorders. The diagnostic process is not always straightforward, as the behaviors can mimic ADHD or be part of ADHD. Finding a psychologist, psychiatrist or other clinician familiar with adult ADHD is important in getting the right diagnosis. 

Q: How can the people in the lives of adults with ADHD support them?

Dr. Zylowska: The best way to support an adult with ADHD is to educate yourself about ADHD and how it can affect one’s functioning in the world. Just as parents of children with ADHD need to understand how to interpret the behavior of their child through a lens of ADHD and not see it as a willful way of being difficult, people in the lives of adults with ADHD need to do the same. Strategies that can be helpful to adults with ADHD are setting up a system to get tasks done and be accountable, gentle reminders, meetings to review progress and dividing responsibilities to complement the adult with ADHD’s strengths and weaknesses. Lots of mutual appreciation, a sense of humor and forgiveness about ADHD mishaps can also go a long way.

Q: What work are you doing to further education about ADHD in adults?

Dr. Zylowska: My work has been focused on showing how mindfulness practice can be helpful in the management of adult ADHD. To that end, in the past I conducted the first feasibility study of mindfulness training in adult ADHD and have written two books on the topic: a self-help book called “The Mindfulness Prescription for Adult ADHD” and  a clinicians’ resource called “Mindfulness for Adult ADHD:  A Clinician’s Guide.” Mindfulness — when understood as an attention/awareness and attitude shift that can be done in daily activities — can strengthen the “attention muscle” and improve self-regulation skills.  

In addition to the work in mindfulness, I have been passionate about increasing awareness of ADHD in women. Many women with ADHD have inattentive symptoms which are often overlooked in childhood. Yet, ADHD can create a lot of difficulties and underachievement, often leading to increased risk of other mental health conditions — it is not uncommon that women with ADHD receive mental health treatment but their ADHD is still not recognized. Through speaking about this subject I hope to raise awareness in both patients and clinicians so that ADHD is considered as part of a complex clinical presentation. 

Lidia Zylowska, MD, is an associate professor in the department of psychiatry and behavioral science and director of the Integrative Psychiatry and Wellness Program in the University of Minnesota Medical School and a psychiatrist at M Health Fairview. She specializes in both adult ADHD and mindfulness-based interventions. Through her research, she pioneered the application of mindfulness in ADHD and developed the Mindful Awareness Practices (MAPs) for ADHD program. She is a co-founding member of the UCLA Mindful Awareness Research and an author of award-winning books “The Mindfulness Prescription for Adult ADHD: An 8-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals” and “Mindfulness for Adult ADHD: A Clinician’s Guide.”

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