Inattention in adults could be ADHD

Do you or someone you know often forget even important things, struggle to complete most tasks you start, or face difficulties in managing daily responsibilities systematically? Do you find it hard to showcase your skills effectively in your work, or do you experience habits like short temper, impulsiveness, or an inability to stay calm even for a short while? If so, pay attention—these symptoms could be signs of Adult ADHD (Attention Deficit Hyperactivity Disorder).

The manifestations of ADHD often become evident during childhood itself. Excessive restlessness, inability to focus on anything, and impatience are the hallmark traits of this disorder in children. Among those diagnosed with ADHD in childhood, around 70% continue to exhibit symptoms into adolescence, and about half carry them into early adulthood. As they grow older, the restlessness and impatience may gradually diminish, but the lack of attention and related issues often persist unchanged. This is what is referred to as Adult ADHD. Studies, including those by the World Health Organization, indicate that around 5% of the global population suffers from this disorder, yet only about 10% of them receive a proper diagnosis. Timely diagnosis, appropriate treatments, and lifestyle adjustments can significantly mitigate the disruptions this disorder causes to family life and work productivity. This article aims to introduce the symptoms, causes, and treatments of Adult ADHD.

How the Disorder Manifests

The primary difficulty experienced by those affected by this disorder is the inability to focus adequately on anything. Common struggles include procrastination, frequent distractions by irrelevant sights or sounds while trying to concentrate, inability to complete tasks properly, forgetting instructions or conversations, quickly losing interest in activities, and jumping from one task to another without finishing the previous one. Other issues include difficulty estimating how long a task will take, failing to meet deadlines, frequently breaking promises, struggling with multitasking, losing focus when switching tasks, making careless mistakes due to lack of attention to details, and avoiding responsibilities that require constant vigilance.

Excessive impulsiveness, impatience, and lack of self-control are also symptoms of Adult ADHD. Behaviors such as acting thoughtlessly, speaking without thinking, reacting without considering consequences, inability to wait for one's turn, interrupting others, reckless driving, careless spending, or an overly active sexual life may be observed. Sudden and unexplained emotional shifts, a perpetually unsettled mind, and quick temper are other problems associated with this disorder. Mild criticisms may become unbearable, leading to withdrawing from relationships or quitting jobs over minor provocations, inability to make major decisions independently, and frequently disregarding social norms are common behavioral traits.

In some individuals, excessive restlessness persists even into adulthood. Habits like constantly fidgeting, inability to stay still even in situations requiring calm, talking non-stop, or avoiding tasks that require sitting in one place for long are often seen in such people.

Consequences of These Symptoms

Some individuals with ADHD, despite their exceptional intelligence, may manage to overcome these challenges effectively. However, for the majority, these problems often lead to serious repercussions over time. Examples include losing interest in everything, diminished ability to handle stress, growing lack of self-confidence, feelings of insecurity, and a sense of guilt over being unable to accomplish anything in life.

Unemployment, financial struggles, unstable personal relationships, marital conflicts, divorce, and various accidents are also common consequences of this disorder. Those affected are more likely to engage in legal violations, face arrests, or even imprisonment. Studies suggest that between 10% to 70% of prison inmates may have ADHD. Additionally, around 80% of adults with ADHD also suffer from other mental health issues like depression, anxiety disorders, suicidal tendencies, sleep disorders, excessive alcohol consumption, or substance abuse.

Several studies have clarified that these associated problems often disrupt patients' daily lives more severely than the primary symptoms of ADHD.

Causes of Adult ADHD

The prefrontal cortex of the brain is responsible for abilities like remembering tasks, prioritizing them, estimating time requirements, completing responsibilities systematically, focusing amidst distractions, evaluating the consequences of actions, maintaining caution in interactions, and adapting to changing circumstances. ADHD arises due to disruptions in the development of the prefrontal cortex caused by genetic abnormalities or certain environmental factors during fetal or early childhood stages.

Genetics determine about 76% of the likelihood of developing ADHD. Research shows that one in three ADHD patients has at least one parent with the disorder, and one in three children of affected parents may develop ADHD. Most genes linked to ADHD are associated with neurotransmitters like dopamine, norepinephrine, and serotonin, which facilitate communication between brain cells. Genes such as DRD4 and DRD5 (dopamine receptors), HTR1B (serotonin receptor), DAT1 and 5HTT (involved in reuptake of dopamine and serotonin), and SNAP-25 (regulating protein production for nerve growth) play a role in ADHD. Genetic variations cause dopamine and norepinephrine to be reabsorbed too quickly from synapses, impairing memory and concentration.

Children born to women who experienced severe mental stress, smoked, consumed alcohol, used certain medications, were exposed to chemical toxins, or had high blood pressure during pregnancy are more likely to develop ADHD. Premature births, low birth weight, exposure to lead or pesticides in childhood, brain infections, or injuries also increase the risk.

Studies indicate that ADHD is more likely to persist into adulthood in individuals who exhibit both hyperactivity and inattention equally, have severe symptoms, suffer from depression or other mental health issues, come from families with ADHD or mental health disorders, or grow up in harmful social environments.

How is the Disorder Diagnosed?

Many of the symptoms described earlier can occasionally appear in individuals without any disorder. However, Adult ADHD is diagnosed only if these difficulties emerged before the age of 12 and cause problems in at least two areas such as work, family life, or social relationships.

While some may be diagnosed in childhood, often, due to lack of awareness about this disorder, symptoms exhibited in childhood are mistaken for mere mischievousness or bad habits. For many, suspicions of a disorder arise only when they fail to meet growing responsibilities as they age.

The primary method of diagnosis involves gathering detailed information about the patient's struggles from the individual and those who have known them since childhood. Questionnaires covering symptoms, psychological tests to assess focus and memory, and examinations to identify related physical or mental issues are also used. Old school records can provide accurate insights into when the problems started and their severity during childhood.

Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) scans reveal that glucose metabolism is reduced in the prefrontal cortex of ADHD patients, and the striatum region of their brains has a higher density of dopamine reuptake pumps. However, these tests are not routinely used for diagnosis outside research settings. In July 2013, the U.S. Food and Drug Administration approved the NEBA test, which measures electrical activity in brain cells to help diagnose ADHD in children.

For many, realizing that their lifelong struggles were not due to personal flaws, lack of willpower, or immaturity but rather a brain disorder since childhood brings immense relief.

A Brief on Treatment Methods

Various treatments are available today, including medications, psychotherapy, and counseling. Medications like methylphenidate, atomoxetine, and bupropion help regulate the imbalances in neurotransmitter levels mentioned earlier. These medications are effective for about two-thirds of users. Since they do not cure the disorder but only control symptoms, long-term use may be necessary.

Cognitive Behavioral Therapy (CBT) helps patients recognize and halt self-criticism, regain lost self-confidence, reduce unnecessary anxieties, and plan life better. Metacognitive therapy teaches them to break large goals into smaller, manageable steps and find motivation to work toward long-term achievements. Proper counseling can help identify suitable careers and navigate workplace challenges. Relaxation techniques can alleviate mental stress, while family or marital therapy can resolve conflicts in relationships.

A Few Practical Tips for Daily Use

Recognizing their weaknesses and strengths and adopting appropriate precautions can help individuals with ADHD overcome obstacles effectively. Many possess inherent qualities like creativity, agility, spontaneous thinking, and deep engagement in activities of interest, which can be leveraged to compensate for their shortcomings.

Cultivating suitable hobbies provides constructive outlets for excessive energy. Recognizing that emotional outbursts are part of their disorder, reminding themselves that these are temporary, avoiding self-blame or blaming others, and engaging in calming activities during such times are helpful strategies. Regular exercise and adequate sleep can reduce the severity of various symptoms. It is also important to avoid habits like unnecessary arguments or substance use that worsen symptoms.

(Published in the January 2014 issue of Mathrubhumi Health Magazine)

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Drawing: Restless Sleeper by Red Tweny