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The main symptoms of ADHD (inattention, impulsivity and hyperactivity) usually appear by age seven and result in a chronic pattern of impairment for most individuals (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. [DSM-IV] 1994). ADHD is a condition that can be effectively treated and managed rather than “cured,” and it usually persists into adolescence and adulthood (Kern, Rasmussen, Byrd & Wittschen, 1999). When not diagnosed in childhood, adult ADHD is sometimes referred to as the “hidden disorder” because the symptoms are often masked by problems with relationships, organization, mood disorders, substance abuse, employment or other psychological issues (Wasserstein, 2005). Moreover, diagnosis of ADHD has also been reported to be delayed if an individual has protective influences such as a high IQ, a supportive family and strong social skills (Quinn, 2005).
Young women, in particular, are difficult to diagnose because symptoms are less overt than they are in young men. (Quinn, 2005). Young adults of both sexes usually exhibit less hyperactivity and more difficulty with executive functions like focus, impulse control and organization. Research has also shown that young adults with ADHD are more prone to being confrontational when stressed and less likely to be influenced by either constructive or critical feedback from others (Kern, Rasmussen, et. al., 1999). If you suspect you may have ADHD, it is important not to self diagnose. Seek an assessment from an experienced professional.
Young adults with ADHD may face a particular set of challenges connected to a phase of development where greater independence and self-management are required. They may have relied on assistance and reminders from parents, teachers and even friends in order to stay organized and focused -- supports which may no longer be readily available as they move away to college, start a new job or begin to live on their own. No one is there to remind them to wake up and get to a job or a class on time or to be sure to turn in an assignment. Bills have to be paid on time as well, money budgeted and any prescribed medications taken regularly. To complicate matters, many children with ADHD stop receiving treatment when they enter young adulthood, a time when such support would help smooth this major life transition (Barkley, Fischer, Smallish & Fletcher, 2004).
What follows are some areas that may pose challenges to young adults with ADHD, as well as some helpful strategies. Bear in mind that one size does not fit all. Every person with ADHD wiring is still an individual with a unique mind, personality and set of circumstances. Consider these suggestions as general guidelines to help you or someone you know map an individual road to success.
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FINDING AND HOLDING A JOB |
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Many young adults with ADHD have a hard time being disciplined and focused enough to do what it takes to search for a job successfully, including checking job lists, sending out resumes, going on interviews and following up on applications. Once on the job, a slew of new tasks and requirements may
become overwhelming and employers may lack the patience to repeat instructions that may not be easily retained because of executive functioning
challenges (link to exec. function page). Lateness, absences and failure to meet deadlines may also get the ADHD employee into trouble on the job.
Complaining excessively or reacting impulsively may also alienate bosses and
fellow employees. |
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Adult ADHD Treatment: Strategies for Success |
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First, understand your strengths and limitations in order to make an appropriate choice for a work setting. Conventional careers may not be the right for you.
Many individuals with ADHD are imaginative, creative, and incredibly disciplined when involved in their deep interests, so play to your strengths. Secondly know your rights. The American with Disabilities Act (ADA) requires that employers make “reasonable accommodations” for the disabled employee who is otherwise qualified to perform the job requirements.
Find a psychotherapist with ADHD and career counseling experience who can help you select a career or job within a chosen career that is a good match for your abilities, areas of weaknesses, ADHD tendencies and co-existing conditions (Nadeau, 2005). For example, an effective psychotherapist would help you to reframe your ADHD more constructively, to benefit from stimulant medication if you are not already taking it, to recognize and appreciate your strengths and abilities, to gain a better understanding of the need for support and to feel less fearful and defensive in relationships (Nadeau, 2005).
On a practical note, once on the job, structure yourself in the work environment to keep yourself on track with lists, reminders, color-coding, files and other strategies. Break down larger tasks into smaller ones. |
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COLLEGE EDUCATION |
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College may present a challenge for young adults with ADHD who may have a hard time realistically planning appropriate courses, jobs and internships to meet career goals (Biederman, 2008). |
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Adult ADHD Treatment: Strategies for Success |
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Self advocacy - inform necessary personnel about the need for assistance and
accommodation.
Know your legal rights for an appropriate education.
Take the time to read about and understand your own cognitive profile and
learning style (Check out the helpful books and articles listed in the bibliography at the end of the article).
Intersperse academics with exercise, sports or creative activities.
Study in an environment with few distractions. Pursue healthy friendships and other forms of support, such as a therapist or trusted older adult who can help you stay organized and give you encouragement.
Seek counseling to help you stay on track or if co-existing conditions, such as depression or anxiety, are present. Consider joining a peer support group if it exists, or start your own.
Consult the disability services office available at many colleges and universities to for assistance with needs such as time management and organizational skills. |
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MONEY MANAGEMENT |
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Young adults with ADHD often purchase impulsively and spend beyond their means, having difficulty balancing a checkbook or budgeting living expenses. (Wolf & Wasserstein, 2001). |
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Adult ADHD Treatment: Strategies for Success |
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Consult a financial advisor for help setting up money management systems to track and limit spending. |
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RELATIONSHIPS |
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While many young adults with ADHD are high energy, humorous and exciting to be around; many also find it difficult to sustain relationships that are mutually satisfying. They may either have difficulty committing to one relationship for a long period of time or they may fall into a pattern where a girlfriend or boyfriend acts as a kind of caretaker while not getting enough back in return. Such imbalanced relationships usually lead to resentment and conflict. Some individuals with ADHD have difficulty controlling their anger and other emotions,
which may also complicate intimacy. |
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Adult ADHD Treatment: Strategies for Success |
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Communication and effort are key to keeping any relationship alive. Noted relationship researcher and expert, Dr. John Gottman (www.gottman.com) suggests six basic skills for relationship success:
- Lower the level of tolerance for hurtful behavior at the beginning of the relationship.
- Recognize and avoid criticism, contempt, defensiveness and stonewalling (or shutting down) when interacting with a partner, all of which are very destructive to a relationship.
- Approach disagreements and conflict in a softer, more tactful way, avoiding harsh criticism or blame. Exit a disagreement and take a break if things get too heated.
- Allow your partner and his or her opinion and ideas to influence you at times.
- Repair conflict before it gets completely out of control. Successful repair attempts include changing the topic, using humor, showing empathy, backing down at times and offering signs that you appreciate your partner’s feelings.
- More often than not, focus on the positive. Gottman’s research has found that happy relationships have a ratio of 5 positive statements for every negative statement.
If you find yourself caught in a cycle of conflict or poor communication with your partner, consider the support of an experienced couples therapist. |
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PSYCHOLOGICAL AND MEDICAL CARE |
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Young adults living away from the family home for the first time may have trouble keeping up with therapy appointments and medication refills due to focus and planning issues. In addition, adults with ADHD are six times as likely as those without to suffer from one or more additional psychiatric disorders,such as anxiety or depression (Brown, 2006). Standard treatments for ADHD under these circumstances are not sufficient.
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Adult ADHD Treatment: Strategies for Success |
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Keep in regular contact with your doctor and psychologist, who will be able to evaluate medication dosages and keep track of possible anxiety or depression.
If you are living away from the family home, establish new medical and counseling contacts in your area. Focused psychotherapy around lifespan issues such as college enrollment, job change or romantic relationships can be extremely helpful if understood from a brain-based perspective. An effective clinician will carefully guide and structure his or her client in setting goals and determining the immediate steps to reach these goals (Nadeau, 2005).
Intermittent treatment may include improvement of social skills, teaching of self-advocacy, recommended reading, self-help groups like CHADD or ADDA, stress reduction, work assistance, environmental manipulation and school- based interventions (Resnick, 2005). Remember also that ADHD does not define you. It is only one of the factors that need to be considered as you work to feel and function as well as you can in your life (Nadeu, 2005).
In addition to seeking the support of a psychologist and physician, try to also find a balance between getting too much help from family members and too little (Brown, 2006). Independence is an important trait to foster in oneself, but don’t be too proud to ask for support and advice. All of us need it from time to time, and it is a sign of emotional health to be able to reach out to others. |
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SUBSTANCE USE |
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A young adult with ADHD is less likely to abuse drugs and alcohol if receiving adequate medical treatment and psychotherapy. Research has shown,however, that young adults with ADHD, if not receiving appropriate treatment, are more likely than their peers to fall into persistent substance abuse (Brown, 2006). Studies also suggest that teenage girls with undiagnosed ADHD engage in “at risk” behaviors, such as substance abuse and promiscuity, at a greater rate than their male counterparts. (Quinn, 2005). The overall major risk factor for drug use in young adulthood appears to be the combination of conduct disorder and ADHD, especially in young men (Barkley, Fischer, et. al., 2004).
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Adult ADHD Treatment: Strategies for Success |
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Keep in touch with your doctor and/or therapist. If you notice yourself struggling with sadness or depression or if you are worried you may be drinking or taking drugs excessively, don’t wait; talk it out and ask for help right away. |
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