ADHD is a common condition that starts in childhood and can continue into adulthood. In adults, ADHD can cause difficulties with attention, planning and organisation,  impulsivity, restlessness, and managing emotions, which can affect work, studies, and relationships.

Studies estimate that about 2.6% of adults worldwide have ADHD. The rate is lower in resource-poor countries (around 1.9%) and higher in resource-rich countries (about 4.2%).

Adults with ADHD often have other mental health conditions at the same time. They are more likely to experience mood disorders, anxiety, substance use problems, and impulsive anger outbursts. The more co-occurring conditions a person has, the greater the impact—those with three or more are at the highest risk. In later life, problems like anxiety, depression, and substance use may become more obvious, while ADHD itself is often missed and untreated.

The exact cause of adult ADHD isn’t fully understood, but it involves both brain differences and genetic factors. Many difficulties are linked to problems with executive function—the brain’s ability to plan, organise, manage time, remember details, and control impulses. These challenges are connected to differences in brain networks, particularly in the frontal cortex and deeper brain structures. Imaging studies show structural differences in these regions, which affect attention, behaviour control, and processing speed. ADHD also involves lower activity of dopamine and noradrenaline in key brain circuits, which is why medications that boost these chemicals help manage symptoms. Genetics play a strong role—ADHD often runs in families, with about 76% heritability. Several genes linked to dopamine function have been associated with ADHD, suggesting that the condition results from a mix of genetic and environmental influences. Studies also show that ADHD in children and adults shares common genetic roots.

Adults with ADHD often struggle with inattention, impulsiveness, restlessness, and trouble managing emotions. These challenges can affect everyday life, work, relationships, and safety.

A key problem in adult ADHD is executive dysfunction. This means difficulty with planning, organising, managing time, remembering things, starting tasks, staying on track, and controlling impulses. Adults with ADHD often find it hard to focus for long, complete tasks, keep appointments, and meet deadlines. Forgetfulness and poor time management are common. They frequently only finish tasks at the last minute, if at all.

Difficulties with inattention are especially noticeable when trying to stay focused for long periods, organising activities, prioritising, and following through on tasks. These issues can also lead to driving problems, with studies showing that adults with ADHD are more likely to have accidents, receive traffic fines, and engage in risky driving behaviours such as hard braking and speeding.

Impulsivity in adults often shows in risky behaviour—such as speaking out of turn, ending relationships suddenly, or quitting jobs without a backup plan.

Hyperactivity tends to look different in adults than in children. Instead of being overly active, adults may feel restless or fidgety and may talk too much or interrupt others.

Many adults with ADHD also struggle with emotional dysregulation, meaning they have trouble managing strong emotions like anger, frustration, or low mood. They may feel more emotionally sensitive and react more strongly to stress, which can further impact their daily lives.

Adults with ADHD are at higher risk of job problems, relationship difficulties, accidents, criminal behaviour, and substance use. They also often have a history of childhood struggles at school or with relationships.

At work, they may face unemployment, lower productivity, more injuries, and a greater risk of traffic accidents. They are also more likely to have lower educational achievement and higher rates of substance use and involvement in crime.

Unfortunately, adults with ADHD are more likely to have a shorter life expectancy, often due to accidents. Large studies have shown that people with ADHD tend to die younger than those without ADHD, by several years on average.

Research shows that ADHD often continues from childhood into adulthood, with about 40 to 60% of children diagnosed with ADHD still having significant symptoms as adults. The likelihood of ADHD persisting is higher when the child had more severe symptoms, other mental health conditions, or a family history of mental health issues. Some adults do see their symptoms improve over time—around one-third may no longer meet full criteria after several years. However, outcomes in emotional, educational, and social areas can vary widely from person to person.

When assessing an adult for ADHD, the goal is to identify symptoms that match the diagnostic criteria, confirm that these symptoms cause significant difficulties in daily life, and rule out other conditions like mood or anxiety disorders. Input from someone who knows the person well can help. The most effective assessment combines an interview, rating scales to measure symptoms, and, if necessary, neuropsychological tests.

For most adults with ADHD, the best approach is a combination of medication and cognitive-behavioural therapy (CBT), especially for those with significant problems in planning and organisation (executive dysfunction). Both treatments are effective on their own, but research suggests that combining them is more effective than using either one alone. While no study has directly compared all options in a single trial, the evidence to date supports this combined approach.

For most adults with ADHD, stimulant medications (like amphetamines or methylphenidate) are recommended as the first choice over nonstimulants (such as atomoxetine or certain antidepressants). Stimulants work quickly, while nonstimulants can take weeks to show full effect. Though there are no direct head-to-head trials, existing studies suggest stimulants are more effective at reducing core ADHD symptoms compared to nonstimulants. Meta-analyses also show that stimulants generally have more substantial short-term benefits.

Stimulant medications help adults with ADHD by improving attention, focus, and daily functioning at work and in relationships. Studies show that people taking stimulants have clearer symptom improvement compared to placebo. They may also perform better at work and have higher self-esteem. Importantly, stimulant treatment lowers the risk of car accidents—people with ADHD are less likely to have crashes during periods when they are on their medication.

Stimulant medications for ADHD are generally safe and well tolerated when used correctly. Still, they can cause side effects such as dry mouth, insomnia, irritability, appetite loss, weight loss, and headaches. There is also a small risk of more serious effects, including:

·       Misuse and addiction: Some people may misuse stimulants, especially those with a history of substance use.

·       Tics: Existing tics can worsen, or new ones may appear.

·       Psychosis and mania: Rare, but possible in vulnerable individuals or those who misuse the medication.

·       Heart effects: Slight increases in blood pressure and heart rate are common. The link between stimulants and serious heart problems is unclear—some studies show a possible risk, others do not.

·       Rare complications: Priapism (painful, prolonged erections) is infrequent but has been reported.

Stimulants do not appear to increase the long-term risk of developing substance use problems, but people taking them should be careful with alcohol, as mixing the two can lead to unwanted effects. Regular monitoring is crucial for managing these risks safely.

Persistent Depressive Disorder, also known as dysthymia, is a mood disorder characterised by chronic and persistent feelings of depression. It differs from major depressive disorder in that the symptoms are less severe but persist longer, typically lasting for at least two years in adults.

The symptoms of persistent depressive disorder include: 

Depressed mood for most of the day, for more days than not, for at least two years (in adults) or one year (in children and adolescents). During this period, the person has never been without the symptoms for more than two months. 

While depressed, two or more of the following additional symptoms are present:

1. Poor appetite or overeating.

2. Insomnia or excessive sleep.

3. Low energy or fatigue.

4. Low self-esteem.

5. Poor concentration or difficulty making decisions.

6. Feelings of hopelessness.

Importantly, the person does not experience mania, and the depression cannot be attributed to a medical illness, medications or substances. 

If left untreated, persistent depressive disorder can significantly impact an individual's daily functioning, relationships, and overall quality of life. It can lead to social withdrawal, decreased productivity at work or school, strained interpersonal relationships, and an increased risk of developing other mental health conditions, such as anxiety disorders or substance abuse.

There are several treatment options available for persistent depressive disorder, including:

1. Psychotherapy

2. Medication

3. Lifestyle changes

4. Support groups

It's essential for individuals experiencing persistent depressive disorder to seek professional help as early as possible. A mental health professional can provide an accurate diagnosis, develop an individualised treatment plan, and provide ongoing support to manage the condition effectively.

Disclaimer:

The content on this website is provided for general information and educational purposes only. It is not intended to diagnose, treat, cure, or prevent any medical or psychiatric condition. This website does not constitute medical advice, and no doctor–patient relationship is formed by viewing the content or contacting the practice through this site. For personalised care, please consult directly with a registered healthcare professional.

If you are experiencing a medical or psychiatric emergency, please get in touch with your local emergency services immediately.
In South Africa, 10177 is the national emergency number for ambulances (landlines), and 112 can be dialled from any cellphone to reach emergency services, who will connect you to the appropriate help.