Imagine constantly having thousands of tabs open in your mind. Tasks that seem straightforward to others can feel overwhelming. You might start a project full of energy and enthusiasm but struggle to finish it. Deadlines are causing constant anxiety, and keeping track of appointments feels like a constant battle. This is the daily life experience for many adults with ADHD.
Beyond the inattentive and hyperactive symptoms, ADHD can manifest in emotional dysregulation, leading to frustration, impatience, and difficulty managing feelings. Social interactions can be challenging, and maintaining focus in conversations can feel like climbing a mountain. However, it's important to remember that ADHD is not a personality flaw; it's a difference in brain development and how the mind functions. With the right holistic support, there is a high rate of success to thrive and achieve your goals.
The recognised core symptoms of ADHD in adults fall into three main categories: inattention, hyperactivity-impulsivity, or a combination of both. A diagnosis can be considered when experiencing five or more of the inattentive symptoms, or five or more of the hyperactive and impulsive symptoms.
For the symptoms to be linked with ADHD it should be present throughout the person’s life, and not be episodic. Although many can identify ADHD symptoms, only a suitable trained professional can diagnose the condition and establish an official diagnosis.
The inattentive symptoms are generally more difficult to identify since these are silent and the person can internalise the experiences. Because people suffering from these symptoms silently suffer, they tend to be undiagnosed or linked with other conditions or personality traits.
Making careless mistakes in day-to-day life, such as losing things, wallet, keys, and bank cards constantly in search to find missing items. Some may develop coping mechanisms, such as having a system in place, e.g. wallet goes in the right pocket, a mobile phone goes to the left.
Sending text messages or emails to the wrong person, putting the mobile phone in the fridge, and not checking the pockets before doing the laundry. Booking a flight on the wrong date, airport or nearly filling the car with diesel instead of petrol. And the examples can be countless.
Working slowly to avoid making careless mistakes can often get the person in trouble. In the neverending mission to avoid making mistakes, the person double and triple checks. Finishing work late can be the norm, having less time to spend with friends and loved ones. People around may not understand why you are constantly finishing work late.
Not reading instructions carefully, be it reading the small print in a contract, or the instructions assembling the next piece of furniture. The person quickly wants to jump to the practical aspects of a particular task and avoid reading boring instructions. On the desk and around the house there are numerous notebooks, and despite this, you may forget important tasks and events.
Difficulty working in a detailed way occurs particularly in activities which are perceived as repetitive or boring. On the other hand, if there is something new and exciting the person can hyperfocus, and forget everything around them experiencing hyperfocus. Some may struggle with any tasks involving attention to detail, and would rather choose creative activities providing freedom.
Switching tasks: not being able to maintain attention on tasks for too long, always switching from one job to another. In this way almost nothing gets finalised, there are always multiple tabs open. Only you can understand the organised-disorganised clutter.
Becoming quickly distracted by own thoughts, be it the next purchase, holiday, event or adventure. Only you can understand the experience, whilst others may comment on your thoughts being somewhere else or daydreaming.
Not being able to watch a film throughout the end, or find it difficult to finish reading a book. Unless the movie is extremely fascinating, or waiting for its release for many years. The most preferred content is short videos or TV series. Anything going above the 30-minute mark is a struggle. Watching a 2-hour long movie, seems like climbing a mountain, although possible the person may pause and resume a few times until the end.
Quickly becoming bored with things, be it shopping, technology, computer parts, cameras, clothes. Always in a constant chase of dopamine, reading product reviews, and comparing the specs is only fuel for the ADHD brain. What is the best price/performance ratio, the journey itself can take days, weeks or sometimes years.
The people around you may comment about the large number of items which you are not using. Some of them may already be in the original packaging, past the return deadline.
Asking questions about the topics already discussed: For some reason, people around you do not understand why you are asking questions about what was previously talked about. Some may not understand this pattern, or think it is rude to the person silently suffering from ADHD not being able to remember. Others may feel dismissed, and this can easily lead to relationship tensions and breakdown.
Feeling dreamy or being preoccupied with something else be it during the class, conference or online meeting. In this scenario the person suffering from inattentive symptoms may not disturb others, but pay the price later at the next exam or when they need to implement the information.
The ADHD mind, slowly drifts to something more interesting for them, in particular, if the presenter is not perceived as engaging, or the material is delivered in a long-form content.
Difficulties participating in a conversation are quite frequent for people suffering from moderate-severe inattentive symptoms. In this situation, the person may avoid interactions altogether, appearing shy and withdrawn. In the other situation, may repeatedly ask questions, or appear to the communicator as rude or not interested. The situation only feeds into the rejection syndrome dysphoria.
Often changing the topics of conversation is a symptom part of the diagnosis criteria of attention deficit hyperactivity disorder. In this scenario, there is a constant interruption and change of topics which can be perceived as avoidant, or rude. The receiver may feel rejected or not listened to, once again having an impact on managing relationships.
Flying thoughts: Other people may comment your thoughts are somewhere else. This applies where the inattentive symptoms are quite evident to the untrained eye. Regardless this can be perceived by others as rejection, or lack of interest and few would think this may be due to undiagnosed ADHD.
Completing tasks in a muddled way: In the school environment, this may be described as a need to improve structure “lacking structure”. Nobody understands why the person have their way of doing things, such as managing their email inbox, PowerPoint presentations or completing an essay.
Difficulty completing tasks once the novelty has worn off is an inattentive symptom present in the DIVA-V diagnostic tool. In this area, the person suffering from ADHD is simply losing interest in finishing a project once they become bored. Because the interest is now gone, they are likely to start falling behind and end up getting in trouble.
Struggles in completing administrative work is a major setback for someone suffering from ADHD. Any paperwork that needs to be filled, mileage return, passport renewal, visa application, writing job descriptions, and reviewing contracts feel as difficult as climbing a mountain. Nobody understands why this is so difficult for them, some may think the person is lazy. In some situations, this is taken care of by a personal admin and doesn’t become evident until they lose the support.
Difficulties in following instructions are quite common since the person with inattentive and impulsive symptoms simply doesn’t have the patience to read. In the search for the next dopamine rush, would rather do it first and read later. Some examples are assembling furniture, building a product, a business or completing an exciting presentation.
Struggles in planning activities of daily life are another symptom recognised in diagnosing ADHD. Here we have someone going with the flow, day by day, or someone else may plan their schedule. For example, a student in a boarding school may not have difficulties in this area, similar to a manager or business person having good admin support.
The workplace or home environment is disorganised. Nobody can understand how a person can survive in this chaos, but somehow for them, it works. To some extent, until the coping mechanisms may become overwhelming. Some mitigating actions may be in having a regular person tidying up the place: a regular cleaner or office manager.
Having too many plans and double booking can sometimes be seen in people having difficulties with managing attention. From the outside people may see the person as busy, whilst others may say they are not efficient. Depending on the stage in life and level of support this may go unnoticed for many years.
Time management, arriving late or too early. Most of the time the person arrives late to meetings, and due to their behaviour starts to build a pattern within the team or community. Sometimes the behaviour may be accepted by the community, whilst in some instances may be penalised with the so-called ADHD tax: paying late the car park, car insurance, flights and many other commitments.
Time blindness or simply put poor sense of time. For the ADHD person time is perceived differently. For example, if an activity, or person is perceived as interesting 8 hours may feel more like two to three hours. In contrast, if the situation feels boring a two-hour presentation or mandatory training may feel like an eternity.
Master of schedules, but not using none. In this scenario, you are doing your admin by yourself and already identified there is a problem. The process starts by purchasing different diaries, or mobile apps promising to solve your scheduling problems. Because of the inattentive symptoms, it is very difficult to maintain a regular schedule. Some would compensate by creating rigid routines which others cannot understand, or by simply delegating the task to someone else.
Postponing boring and difficult tasks, whilst preferring to do first the nice and intriguing activities. Keep postponing tasks until the deadlines are missed. Sounds familiar? We all may enjoy doing it this way, however, when this is persistent and interferes with our day-to-day work it can be a symptom of ADHD.
Avoiding tasks which require concentration, and rather engage with practical stimulating activities. Building long-term multi-year strategies, and policies, or completing long maths equations requires sustained attention. While engaging in areas where it requires a quick solution, offers room to utilise creativity and imagination.
Mislaying mobile phones, bank cards, keys, and wallets in constant search for them or delegating them to the loved ones. Nobody understands your system and way of managing things, this behaviour can be a symptom of ADHD. In particular, if this has a significant impact on your quality of life. Some more mature adults may be developed compensating strategies for storing items in particular locations. Here the struggle starts when someone changes their routines. To the extent that they can get into panic or arguments when someone is interfering with their way of life.
External sounds, noises and difficulty in avoiding the distraction. The person affected by this symptom can be hyperaware of any slight noise. This can alter the ability to resume and finish a task. In social situations, external distractions can have an impact on the ability to filter and select information during the conversation. For example, asking questions about what was discussed. The receiver may not understand this behaviour, as they are not aware of the difficulties faced by the ADHD sufferer.
Forgetting appointments, leaving items behind, and returning home to fetch forgotten things can be all symptoms part of the ADHD diagnosis. Not being able to use a diary, or just forgetting to check it can lead to a missed opportunity or is sometimes followed by the ADHD tax.
Another example is going to the office and forgetting the laptop charger, or other items necessary for work. In the school, the student may frequently leave clothes, books or the gym kit behind. As a coping mechanism, some people may frequently return home to double-check if everything is ok, or have a spare item e.g. charger at work.
The hyperactive symptoms are easier to identify since these are visual and some can be identified by the untrained eye. Compared with the inattentive symptoms, they tend to disturb others and, therefore have a higher chance of being diagnosed earlier in life.
Finding it difficult to sit still, always on the go and avoiding situations where there isn’t enough space to move around. In situations where the person needs to stay in one place for a long time, they may fidget with their hair, move their legs or sometimes unconsciously bite their nails.
Sitting still at the beach, enjoying the breeze may be a foreign experience. The person suffering from hyperactive symptoms would rather be in the sea, running around or constantly on the mobile phone. Some adults may be able to control restlessness but as a result, end up uncomfortable or stressed.
Avoids quiet places and no escape zones, such as the theatre, opera, symposium or cinema. The hyperactive symptoms can lead to someone needing to move around, always on the go. In relationships, the other person may not be able to understand why they behave in this way. The person suffering from hyperactive symptoms may be misinterpreted as having a lack of interest in the loved one. The behaviour can go to places where they can make excuses to walk around and not wait in a queue.
Finding it difficult to relax, or having the feeling that you need to do something to release the tension. Others cannot understand why you cannot relax while enjoying the sunset or the sea breeze. In contrast, you may find relaxation in exploring or discovering new places and activities.
An excessive talker, needing a lot of words to say something can be as well part of the hyperactive symptoms plethora. Friends or family would describe the person as talking too much and interrupting others. Always having the right solution and giving answers before someone finishes to express their ideas. These symptoms can be internalised, or be present in certain safe perceived social circles. And some people may not have them at all if they suffer from inattentive ADHD.
Waiting in a queue, or traffic can be perceived as torture for the person experiencing hyperactive and impulsive symptoms. Constantly being impatient, starting or ending conversations, relationships or jobs quickly. Some compensate in this area by paying their way and finding creative ways of not waiting in a queue. In some instances, the person can find the right job which involves a constant change of scenery, people or types of tasks.
Interfering with others, interrupting, difficulty respecting boundaries, and having a quick opinion about everything can be symptoms of hyperactive-impulsive ADHD. Some unfortunate situations can lead to arguments, and relationship breakdowns. In other remote situations may be beneficial where a prompt intervention is needed.
The evidence-based research, recommends there are three types of ADHD:
Predominantly Inattentive Presentation: This type is characterized by inattention as the primary symptom, with minimal or no hyperactivity or impulsivity. This is quite a common presentation of attention deficit hyperactive disorder. Some used to describe this condition as ADD (Attention Deficit Disorder).
Combined Presentation: This is the most common type, and it includes symptoms of both inattention and hyperactivity-impulsivity. Understanding the symptoms and impact on daily functioning requires an in-depth ADHD assessment by a qualified professional.
Predominantly Hyperactive-Impulsive Presentation: This type is characterised by hyperactivity and impulsivity as the primary symptoms, with minimal inattention. This is a less common form of ADHD and is associated with conduct and antisocial personality disorder.
Diagnosing ADHD in adults can be challenging because symptoms can mimic other conditions like anxiety, depression, or sleep disorders. A comprehensive assessment by an ADHD specialist is essential for an accurate diagnosis. To read more about our approach to the private assessment visit Private Adult ADHD Assessment | London and U.K (adhdspecialist.com)
The good news is that ADHD is a condition which has a high response rate to treatment. Our approach to the treatment of ADHD involves lifestyle changes, coaching, therapy, and where appropriate medication. More than 80% of the cases diagnosed accurately, have a positive response and notice an improvement in their quality of life and well-being.
Licensed medicine
A medicine that is licensed for the indication that it is being prescribed for. To be prescribed at all times as recommended by the BNF NICE guidelines NG87.
Stimulant medications like Lisdexamfetamine (Elvanse), Methylphenidate modified release (Concerta XL), Dexamfetamine (Amfexa), and Methylphenidate (Ritalin) are the most effective and first line of treatment. This treatment option often works quickly by increasing levels of the happy hormone - dopamine and the fight or flight hormone norepinephrine. These neurotransmitters are present at the brain level and play a role in focus, attention and impulse control.
With this option, the person is in control of when they decide to be medicated. Some people may prefer to have medication-free days or to use the treatment only in certain situations.
Non-stimulant medications like Atomoxetine (Strattera) are also available. This works by increasing the levels of norepinephrine, however, compared with the stimulants have a more mild effect and a different mechanism of action. This option may be a good option for people who cannot tolerate the stimulant variants or may have a co-existing condition.
This option involves consistency with following the treatment plan and offers less flexibility. The treatment response usually takes between 4-6 weeks.
Off-label medicine - The medicine is licensed in the UK for a different indication to the one that it is being prescribed for. There is no suitable licensed alternative and other options failed. May be able to be used if evidence suggests efficacy, and safety. This option has obstacles to obtaining repeat prescriptions in the National Health Service NHS. Therefore a shared care agreement is unlikely, and the prescriptions would be provided via the private route. This option involves a significant repeat cost.
• Modafinil (Provigil) is licensed in the UK for use in sleep disorders – narcolepsy
• Bupropion (Wellbutrin) dopaminergic effect, licensed for smoking cessation treatment in the UK
• Guanfacine (Intuniv), licensed in children with ADHD in the UK. This option is currently, not licensed for adults with ADHD.
Unlicensed medicine
This medicine is not licensed in the UK and should not be prescribed. A rare example of such a treatment option is when the medication is used above the BNF dose of a licensed medication. Some examples are medications licensed for use in ADHD in other countries, but not within the United Kingdom.
Psychodynamic interpersonal therapy: is a form of psychotherapy that explores the unconscious mind and its impact on present-day personal relationships, work routines and behaviors. It focuses on how early and past experiences can automatically shape your current patterns and feelings. This is a long form of therapy, up to 20 sessions and sometimes longer. Indicated where other shorter therapies such as CBT had limitations.
Mentalisation-based therapy (MBT): as the name suggests, helps with developing a person's capacity for "mentalisation." Mentalisation is the ability to understand your own and other people's thoughts, feelings, and motivations. This is an area where curiosity becomes a main tool towards achieving success. This technique helps towards building an understanding behaviours of both sides.
Cognitive-Behavioral Therapy (CBT): This type of therapy has the most available research. It helps to identify and change negative thinking patterns that contribute to difficulties with focus, organisation, and emotional regulation. It teaches you practical coping skills intending to improve task management, time management, and emotional regulation. This is a time-limited therapy option of up to 12 sessions.
Dialectical Behavior Therapy (DBT): helps with developing emotional regulation, mindfulness and stress tolerance. These skills can be highly beneficial for adults with ADHD who struggle with emotional dysregulation, self-harm or face difficulties in maintaining healthy relationships. This is a long-term therapy option, lasting up to 6 months and sometimes the cycle may need to be repeated.
ADHD coaching is a personalised, goal-oriented and practical technique which helps individuals make changes in their day-to-day life. This technique's results should be more immediate and have an emphasis on practical solutions. In our follow-up sessions when time is available we offer and implement coaching techniques.
Benefits of ADHD Coaching:
Improved organisation and time management skills, enhanced focus and attention through specific techniques or use of gadgets. Reduced procrastination, identifying the cause of procrastination and developing tools to be in control.
Increased productivity and efficiency: by minimising distractions, and improving focus the person can become more productive. This can lead to more confidence and self-esteem. To some extent coaches may be able to help with strategies for developing healthy relationships, however, in some situations, the root cause may have a deeper psychological connection.
Coaching can equip you with stress management techniques, in particular when you find an effective system. This often leads to greater emotional stability, quality of life and well-being.
Closing words
With the right support and strategies, you can manage your ADHD and achieve your goals. We believe this is achieved with a combination of lifestyle changes, therapy, coaching, optimising social factors and where appropriate medication. In mental health there is no one size fits all, and the approach is tailored to the individual.
Note: symptoms adapted from the DIVA-V Manual- The Diagnostic Interview for ADHD in adults.
Medication options adapted from the ADHD Specialist Medication Management Policy.
Disclaimer: The information is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional. Information about mental health topics and treatments can change rapidly and we cannot guarantee the content's currentness.