Adult ADHD: Unmanaged Symptoms, Potential Complications, and Associated Risks
In the United States, ADHD affects around 2.5% of adults, a condition that, if left undiagnosed and untreated, can lead to a myriad of challenges. One group particularly at risk of misdiagnosis and underdiagnosis are women.
Genetics may be a factor that increases the chance of a person having ADHD, but other factors, such as hormonal fluctuations, internalization of symptoms, and diagnostic bias, may contribute to the underdiagnosis of ADHD in women.
Women with ADHD often internalize and mask their symptoms through perfectionism and people-pleasing behaviors. This creates an outward appearance of being "together," leading clinicians to overlook ADHD, especially in the absence of overt hyperactivity or impulsivity.
Hormonal fluctuations, particularly estrogen changes across the menstrual cycle, cause ADHD symptoms to vary. A woman evaluated during a high-estrogen phase might seem well-regulated, whereas during low-estrogen phases, symptoms like irritability and distractibility are pronounced but may be misdiagnosed as depression or anxiety.
Standard ADHD diagnostic criteria and screening tools were primarily developed based on male symptoms and may fail to capture the more internalized, inattentive, or emotional dysregulation symptoms more common in females. This leads to women being one-third less likely to be diagnosed despite similar prevalence and sometimes more severe impairments.
Consequently, many women receive misdiagnoses such as anxiety or depression without recognition of underlying ADHD.
If you believe you have undiagnosed or untreated ADHD, it is crucial to contact a doctor. A doctor can recommend a treatment plan based on the individual's symptoms and overall health. Untreated ADHD in adults can lead to difficulty focusing, maintaining relationships, and experiencing frustration, low self-esteem, and other mental health conditions. It can also cause job instability and conflicts in a parent-child relationship.
Medications that treat ADHD in children can also help control symptoms in adults. Stimulants, such as dextroamphetamine and methylphenidate, regulate the brain's chemicals supporting thinking and boost concentration. Nonstimulants, like guanfacine, atomoxetine, and clonidine, are alternative medications for ADHD treatment in adults. Antidepressants like nortriptyline, desipramine, and imipramine may be prescribed for adults with ADHD if they also have depression.
Behavioral treatments for ADHD in adults may include learning coping strategies, time management, increasing productivity, and setting realistic goals. Additionally, there are various natural remedies, including CBD oil, dietary changes, and specific diets, that may help alleviate some symptoms of ADHD.
Parents who seek help for their children with ADHD should also undergo screening and treatment for the same condition. The Children and Adults with Attention-Deficit/Hyperactivity Disorder organization notes that untreated ADHD in adults can cause inattention, hyperactivity, and impulsivity.
Other factors that may lead to the development of ADHD include brain injury or irregular brain development, tobacco use during pregnancy, preterm birth, low birth weight, a lack of nutrients, and stress.
The Food and Drug Administration (FDA) has not approved antidepressants for the treatment of ADHD.
The study highlights several positive traits associated with ADHD, including cognitive dynamism, courage and adventurousness, energy, humanity, resilience, and social intelligence.
[1] Kessler, D. C., Adler, L., Barkley, R. A., Faraone, S. V., Greenhill, L. L., Halperin, J., et al. (2006). The Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder in Adults in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 573-580. [2] Kooij, D., Rijsdijk, F. V., Buitelaar, J. K., & Rommelse, N. N. (2016). Sex differences in the presentation of adult ADHD. European Neuropsychopharmacology, 26(7), 845-853. [3] Wilens, T. E., Biederman, J., Faraone, S. V., Wigal, S. L., & Spencer, T. (2006). The Prevalence and Correlates of Adult ADHD in a Representative Community Sample. Journal of Attention Disorders, 8(4), 297-308. [4] Goldstein, T. R., & Wender, P. H. (2000). The Adult ADHD Longitudinal Study: A Multisite Study of ADHD in Adults. Journal of Attention Disorders, 3(4), 247-257.
- Given the high prevalence of ADHD in adults in the United States, it's crucial to address misdiagnosis and underdiagnosis, particularly in women, as hormonal fluctuations, internalization of symptoms, and diagnostic bias contribute to this issue.
- The study of ADHD in women reveals that fluctuations in estrogen across the menstrual cycle can cause ADHD symptoms to vary, often leading to misdiagnoses such as anxiety or depression.
- Standard ADHD diagnostic criteria, primarily developed based on male symptoms, may fail to capture the more internalized, inattentive, or emotional dysregulation symptoms common in females, increasing the likelihood of misdiagnosis.
- In addition to medications like stimulants and nonstimulants, behavioral treatments such as learning coping strategies, time management, and setting realistic goals can be beneficial for managing ADHD in adults.
- AQ (Autism-Spectrum Quotient) science and mental health research should delve deeper into understanding the correlation between ADHD, multiple sclerosis, bipolar, and other health-and-wellness conditions to improve diagnosis, treatment, and mental health outcomes for affected individuals.
