Adult ADHD – Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is often associated with children, but it can persist into adulthood. It seems every second person I know is either being diagnosed or is suspected of having this ‘neurodiverse’ condition. Many celebrities including Jamie Oliver, Bill Gates, Richard Branson, Jim Carrey, Will Smith and Justin Timberlake have been diagnosed with ADHD. Whilst it can be some people’s ‘superpower’, adult ADHD can also pose unique challenges, affecting various aspects of life, work and relationships. You can’t get ‘rid’ of ADHD, but fortunately, there are treatment options in the form of medications and natural support strategies to manage symptoms. In this blog, we’ll explore the landscape of adult ADHD, delve into medication choices, and discuss natural approaches to managing symptoms.

Understanding Adult ADHD

Adult ADHD is characterized by difficulties with attention, impulsivity, and hyperactivity. Unlike children, adults with ADHD may develop more sophisticated coping mechanisms, making it less obvious but equally disruptive. Being ‘hyperactive’ is not necessarily a feature. Common symptoms include:

1. Inattention: Struggling to focus on tasks, forgetfulness, carelessness, inattention to detail and disorganization. This is commoner in females.
2. Impulsivity/Hyperactivity: Making hasty decisions without considering consequences; Restlessness, difficulty staying still or quiet, impatience, interrupting or finishing people’s sentences. This is the more common presentation in kids as adults tend to adapt and become quieter.
3. Combined: This is the most common presentation and includes poor stress tolerance

Why the seemingly sudden rise in diagnosing adult ADHD?

There is a huge increase in awareness in social media, celebrities openly discussing their experiences (see Em Rusciano’s experience in her Press Club talk: https://www.youtube.com/watch?v=4v88Wd20GiU

Also COVID and the subsequent lockdowns that have led to an increase in symptoms; parents sitting in in their children’s assessment and seeing their own presentation reflected in the screening questions and a natural correction for the people who have been left undiagnosed for years.

Other Factors that can affect the Functional impact of ADHD:

1. Other neurodivergence – e.g., symptoms often overlap with those on the Autism Spectrum Disorder (ASD)
2. Life Stages – e.g., hormonal changes post birth, puberty and menopause
3. The Person’s Environment – calm and nurturing closed office vs a noisy open plan office
4. Mental Health – ADHD symptoms can aggravated if there is also depression
5. General Health – healthy eating, regular exercise, mindful practices can reduce expression of symptoms
6. Intellectual ability and Coping Strategies. Women are often underdiagnosed as their symptoms can be more internalised and less noticeable at school or the office, but meltdowns may occur at home when they can ‘let go’.

How is the ADHD brain different:

We have a number of networks in our brains that enable different regions to talk effectively to each other. These networks are:

The Active Network when we are actively performing a task or activity that involves thinking.

The Default/Resting Network which is active when we are idle. This is responsible for our self-awareness, social perception, language and speech, and memory and supports planning, reflection and imagination. However it is also involved in excessive thoughts, rumination and can lead to anxiety. There is increased connectivity in this network in ADHD brains so it can result in difficulty shifting into the active network and initiate activity. The ‘admin team’ of planning, coordinating and organising skills are under resourced. So working memory, attention and impulse control can be impacted and mental ‘time travel’ can occur where there is a loss of awareness of time (so tardiness or altogether forgetting appointments is not uncommon).

There are also differences in dopamine production, transmission and availability, and there is less dopamine availability in the ADHD brain. Dopamine is our ‘drive’ and motivational neurotransmitter. So seeking external sources of dopamine – risky behaviours (unsafe sex, substance abuse), high adrenaline sports (e.g., skydiving, rock climbing, racing), gambling and binge eating to name a few. Sleep is often an issue and insomnia further exacerbates symptoms.

How do I know if I have ADHD

A screening test can be given (see offer below) to start the conversation of whether a referral to a professional for an accurate diagnosis is warranted. The only people qualified to diagnose ADHD is a psychiatrist (Medicare claimable and needing a GP referral) or Psychologist (claimable if you have private health insurance that covers psychology or partly rebatable if you have a GP referral). The actual assessment is not claimable, only the appointment. If in doubt it’s better to be screened and have a negative diagnosis that missing someone with ADHD and not getting relevant support.

What else could it be if it’s not ADHD?

A proper diagnosis is important as other factors like hormonal imbalance (like post-natal depression and menopause), complex childhood trauma, acquired brain injury, other neuro divergences, situational/life stage factors, mental health conditions (like depression, anxiety and bipolar disorder), fatigue (like chronic fatigue, adrenal fatigue and burnout), learning processing & sleep issues may cloud a diagnosis. Around 80% of adults with ADHD have at least one other coexisting condition like mood and personality disorders or substance abuse conditions.

Medication Options

Medications are often the first line of treatment for adult ADHD. They can be highly effective in managing symptoms, improving concentration, and enhancing daily functioning. An official diagnosis and medications can only be given by a psychiatrist, which requires a referral from a GP. This can lead to lengthy delays in diagnosis and treatment. Some common medication options:

1. Stimulants: Stimulant medications like methylphenidate (Ritalin) and amphetamine-based drugs (Adderall) are commonly prescribed for adult ADHD. They work by increasing the levels of certain neurotransmitters, especially dopamine, improving focus and impulse control. However, they may have potential side effects like increased heart rate, headaches, muscle aches, anxiety, irritability, mood fluctuations, hair loss, tics, energy crashes in the afternoon, decreased appetite and weight loss, sleep disturbances, dry mouth, increased heart rate and blood pressure, sever depression and psychosis
2. Non-Stimulants: Some individuals may not tolerate stimulants or have a history of substance abuse, making non-stimulant options like atomoxetine (Strattera) or guanfacine (Intuniv) more suitable. These medications have a different mechanism of action and can help manage symptoms without the risk of addiction. Side effects include sleep disturbances, nausea, vomiting, constipation, dizziness, fatigue, irritability, mood fluctuations and dry mouth.
3. Antidepressants: Certain antidepressants, may also be prescribed for adult ADHD. They can be especially helpful when depression or anxiety co-occur with ADHD.
4. Lifestyle Changes and Behavioral Therapy: In addition to medication, adults with ADHD can benefit from behavioral therapy and lifestyle modifications. Cognitive-behavioral therapy (CBT) and coaching can provide strategies to improve time management, organization, and impulse control.

Natural Support for Adult ADHD

While medication can be instrumental in managing adult ADHD, some individuals prefer or benefit from complementary natural approaches to support their treatment. Natural strategies can help manage ADHD symptoms, reduce side-effects of medications, balance hormones and blood sugar levels and look for any underlying ‘drivers’. They aim to improve memory, focus, energy and concentration, reduce brain fog and negative impacts on work/relationships and mental health and improve overall quality of life. They include:

1. Healthy Eating: A well-balanced diet rich in whole foods, including fruits, vegetables, and lean proteins, can positively influence ADHD symptoms. Omega-3 fatty acids found in fish, flaxseeds, and walnuts have been associated with improved cognitive function. A healthy microbiome is very important (see my blog: https://www.holistichealth.com.au/why-keeping-our-gut-microbiome-healthy-is-important-and-how-to-test-it/ It’s important to exclude coeliac disease so gluten is removed if necessary as ADHD symptoms is markedly  overrepresented in untreated people with coeliac disease. Neuroinflammation begins in the gut, and increased gut permeability (colloquially known as ‘leaky gut’) can impact neurotransmitter production and brain function. There is a link between a high sugar/fat/processed food diet in pregnant women and development of ADHD symptoms in their babies.
2. Exercise: Regular physical activity can help reduce symptoms of ADHD by increasing the release of neurotransmitters that improve focus and mood. Activities like yoga, tai chi, and aerobic exercise can be particularly helpful.
3. Vagus nerve support/Mindful practices: The vagus nerve acts like a ‘brake’ on the ‘flight/fight’ (sympathetic) part of our nervous system and helps with rest and digestion. Importantly it is involved with dopamine release. Humming, ice therapy, singing, yoga and breathwork are some ways to support vagal tone. Meditation and  and mindfulness practices can enhance self-awareness and self-regulation, helping individuals with ADHD manage impulsive behaviors and stay more focused. ‘Insight Timer’ is an app that has thousands of different guided meditations, relaxing music and courses on mindfulness with many free options.
4. Targeted Supplements: Some people find supplements like zinc, magnesium, phosphatidylserine, & L-theanine beneficial in managing ADHD symptoms. Iron, zinc, magnesium, B vitamin and omega 3 and vitamin D deficiency are common findings. There are several wonderful herbs that can support focus and attention, calm anxiety and improve mood. However, it’s essential to consult a healthcare professional before adding supplements to your regimen and thorough testing is essential. CBD oil may be helpful for anxiety symptoms if there is associated autistic tendencies.
5. Sleep Hygiene: Maintaining a consistent sleep schedule and creating a sleep-friendly environment can help manage ADHD symptoms, as sleep disturbances can exacerbate them. There are many options to help getting to sleep and staying asleep including herbs, melatonin and minerals especially magnesium in the form of a glycinate. An expert can guide your choice or blend an individualised formula.
6. Support Groups/Counselling: A support group or seeking therapy can provide a safe space to share experiences and learn coping strategies with ADHD.
7. Adjusting the environment: Keeping your space free of clutter, noise, other people (open plan offices are the worst). Counselling and awareness around risky behaviour like safe sex, gambling support and limited short term content and replace with books and time in nature.

In summary it’s important to treat the individual, whether there is accompanying hormonal imbalance, mood disorders, gut issues, substance abuse, risky behaviour, eating disorders, fatigue or side effects of medications. I can’t overemphasies the important of thorough investigations to tailor the treatment approach to each person.

Conclusion

Managing adult ADHD involves a multi-faceted approach that combines medication options and natural support strategies. While medication can be highly effective in symptom management, natural approaches such as dietary changes, exercise, mindfulness, and supplements can complement treatment and improve overall well-being. It’s essential to work closely with a healthcare provider to determine the most suitable approach for your unique needs, as individual responses to treatment can vary significantly. With the right combination of medication and natural support, adults with ADHD can lead fulfilling lives, harnessing their unique strengths and talents.