1. Adult ADHD
Del Larkin, LCSW, CAADC, MBA
Director of Quality Assurance and Strategic Planning
The Salvation Army Harbor Light Center
Chicago, IL

2. How common is ADHD?
A 2013 report estimated that 11% of
children 4-17 have been diagnosed with
ADHD at some point in their lives.
Boys are nearly three times more likely
to have been diagnosed with ADHD
(13.2%) than girls (5.6%)
The estimated adult rate of ADHD is
4.4%, but experts caution that adults
not diagnosed in childhood are more
likely to remain undiagnosed, so the
true prevalence of adult ADHD may be
significantly higher than reported

3. Myth #1: ADHD is not a real
disorder
FACT: Brain imaging research has
revealed differences in the brains
of people with ADHD
Russell A. Barkley, PhD, a leading
ADHD expert has stated:
“ ADHD is a chronic disorder
that has a negative impact on
virtually every aspect of daily social,
emotional, academic and work
functioning”

4. Myth #2: Most children with
ADHD outgrow it
FACT:
At least 60% of children diagnosed with ADHD as
children will continue to have ADHD symptoms as
adults
Adult ADHD seems to affect men and women
equally
This does not include all adults who are diagnosed
with ADHD as adults and were not diagnosed as
children

5. Myth #3 Adults with ADHD don’t need
treatment – they just need to try harder
and get organized
FACT:
Effort and some behavioral strategies
can help with some ADHD obstacles
but Air Tuckerman, PsyD, ADHD expert
explains
“ Telling someone with ADHD to
work harder is like telling someone
with bad vision to try harder to see
well”

6. Myth #4: All adults with ADHD are
hyperactive
FACT:
Only some people with ADHD have hyperactivity.
While it can be the most visible symptom, it
often declines in adolescence and adulthood.
People with inattentive type of ADHD do not
struggle with hyperactivity but do struggle with
distractibility, forgetfulness, poor time
management, disorganization and other
symptoms.

7. Myth #5: Everyone has ADHD
these days
FACT:
While everyone can have periods of
distractibility and feeling overwhelmed, adults
with ADHD have these problems daily
Adults with ADHD have a complex disorder
that involves impairments with focus,
organization, motivation, emotional
modulation, memory and other functions of
the brain’s management system that interferes
with many areas of their lives on a daily basis.

8. Myth #6 : Too much sugar causes
ADHD or makes symptoms worse
FACT:
There is no evidence that sweets cause ADHD or make its
symptoms worse. Research in children indicates switching
to a sugar substitute, such as aspartame, does not reduce
symptoms of ADHD.
Some experts believe foods that provide quality brain fuel
could reduce symptoms of ADHD. High-protein foods,
including nuts, meat, beans, and eggs, may improve
concentration. Replacing simple carbs with complex carbs,
like whole-grain pasta or brown rice, can help ward off
mood swings and stabilize energy levels.

9. Myth #7: ADHD medication does not
work and causes substance abuse
problems
FACT:
Adults with mild ADHD may be able to manage without
medication
80-90% of adults diagnosed with ADHD will benefit from
treatment with medication
If you have a problem with poor eyesight, glasses will make
your life easier
Having untreated ADHD puts a person at greater risk of
having a drug or alcohol problem. People with ADHD who
take stimulant medication tend to have LOWER rates of
substance abuse than people with ADHD who do not take
medication

10. What Causes ADHD?
 In people with ADHD, brain
chemicals called
neurotransmitters are less
active in areas of the brain that
control attention.
 Researchers don't know exactly
what causes this chemical
imbalance, but they think
genes may play a role, because
ADHD often runs in families.
 Studies have also linked ADHD
to prenatal exposure to
cigarettes and alcohol

11. There are Three Types of ADHD
1. Inattentive type (DSM requires 6 of the 9 in children and
5 of the 9 in adults)
• Not paying attention to details
• Making careless mistakes
• Failing to pay attention and keep on task
• Not listening
• Being unable to follow or understand directions
• Avoiding tasks that require sustained effort
• Being distracted
• Being forgetful
• Losing thing that are needed to complete tasks

12. There are Three Types of ADHD
2. Hyperactive-Impulsive Type (6 of 9 or 5 of 9 for adults)
• Fidgeting
• Squirming
• Getting up often when seated
• Running or climbing at inappropriate times ( maybe limited to
restlessness in adults)
• Having trouble playing quietly ( quiet leisure activities)
• Talking excessively
• Talking out of turn or blurting out (completes other’s
sentences)
• Interrupting (in adults may intrude or take over what others are
doing)
• Often “on the go” as if “driven by a motor” (in adults can be
difficulty sitting still)

13. There are Three Types of ADHD
3. Combined Type
• Criterion are met for both Inattentive Type and Hyperactive-Impulsive type
for the past 6 months (DSM-5)
• Suggested that this is most common of three types.

14. Proposed Criteria for ADHD in Adults
Russell A. Barkley, et al ADHD in Adults; What the Science Says, 2008
Proposed criteria for DSM-V for adults ( 6 or more for a period of
at least 6 months)
1. Often easily distracted by extraneous stimuli or irrelevant
thoughts
2. Often makes decisions impulsively
3. Often has difficulty stopping activities or behavior when he or
she should do so
4. Often starts a project or task without reading or listening to
directions carefully
5. Often shows poor follow-through on promises or
commitments he or she may make to others

15. Proposed Criteria for ADHD in Adults
Russell A. Barkley, et al ADHD in Adults; What the Science Says, 2008
Proposed criteria for DSM-V for adults
6. Often has trouble doing things in their proper order or
sequence
7. Often is more likely to drive a motor vehicle much faster than
others ( excessive speeding) [ Alternate symptom for those
adults with no driving experience: Often has difficulty engaging
in leisure activities or doing fun things quietly]
8. Often has difficulty sustaining attention in tasks or play
activities
9. Often has difficulty organizing tasks and activities

16. Additional Study findings
“ ...items which emphasize distractibility, impulsiveness, poor concentration or
persistence and problems with working memory and organization will be the
best constructs for identifying adults with ADHD. Items reflecting
hyperactivity proved much less useful for doing so in both studies”
“... adults with ADHD are far more likely to complain of difficulties involving EF
[executive functioning] than they are of hyperactivity. Difficulties with
impulsive decision making, stopping, starting and organizing activities,
persistence toward goals and planning for future events will prove to be
among the most significant complaints in identifying these adults with ADHD.”
p. 204 Russell A. Barkley, et al ADHD in Adults; What the Science Says, 2008

17. What Is Executive Function Disorder
(EFD)?
People with executive function disorder exhibit a pattern of problems
with daily tasks, and commonly lack the ability to:
 Handle frustration
 Start and finish tasks
 Recall and follow multi-step directions
 Stay on track
 Plan, organize and self-monitor
 Balance tasks (like sports and academic demands)
It's estimated that as many as 90% of kids with ADHD also have
executive function disorder.

18. Executive Function Disorder

19. Deficient Emotional Self Regulation
(DESR)
• More than half of people with attention deficit hyperactivity disorder (ADHD)
also have trouble regulating their emotions, and that difficulty may be passed
through families, a new study shows.
• Researchers are calling this cluster of symptoms deficient emotional self-
regulation (DESR). It involves quick bursts of outsized anger, frustration,
impatience, or excitability in response to everyday events.
• Study researcher Craig B. H. Surman, MD. Surman is an instructor in psychiatry
in the Massachusetts General Hospital Pediatric Psychopharmacology and
Adult ADHD Program says
• “Folks who have deficient emotional self-regulation, we feel, don’t have
inhibitory capacity to censor emotional reactions even when they’re not under
these kinds of stresses
•

20. Deficient Emotional Self Regulation (DESR)
ccf.buffalo.edu/pdf/BarkleySlides_CCFSpeakerSeries0910.pd

21. Deficient Emotional Self Regulation (DESR)

22. Deficient Emotional Self Regulation (DESR)

23. Deficient Emotional Self Regulation (DESR)

24. Deficient Emotional Self Regulation (DESR)

25. Deficient Emotional Self Regulation (DESR)

26. Overview of Adult ADHD Symptoms
What might it look like
 Excessive talking - talks “too much”, finishes others
sentences, excessive interruptions, can have trouble
listening to others and verbal instructions
Poor Driving Record – speeding, impatient, road rage
Problems at Work – unproductive, takes more time
to get things do despite working hard, change or lost
jobs, misses deadlines, problems getting along with
coworkers

27. Overview of Adult ADHD Symptoms
What might it look like
Restlessness, Inattentiveness – has difficulty sitting through
(long) meetings, paying attention in lectures or meetings that
are not interesting, may fidget with pen or other objects
Lateness – trouble getting to work on time, trouble
remembering appointments or getting to meetings on time,
problems with time management, procrastination
Organizational problems – misplaces items at work or home
(more than average), trouble organizing files, papers, paying
bills on time

28. Overview of Adult ADHD Symptoms
What might it look like
Difficulty Concentrating – more easily distracted by
noise or other activity, more prone to careless mistakes,
moves from one project to the next, can have trouble
finishing tasks to completion once the “interesting” part
is done
Trouble Relaxing – can report feeling “driven by a
motor”, trouble with solitary, quiet activities (e.g.
reading, fishing, crafts or other hobbies), struggle to
relax and unwind
Bad Moods – tense, stressed, “on edge”, over-react,
quick temper, struggle to stay in a good mood, may have
a history of failed relationships

29. Overview of Adult ADHD Symptoms
Less Obvious or “Soft” Symptoms
Hypersensitivity/ Sensory Overload – Very
emotionally sensitive, take on the feelings of
others
Overwhelm or Overstimulation – Response to
stress, feelings of anxiety
Hyperfocus – Once focused on something, may be
hard to stop or change tasks, especially if task if of
interest, likely related to triggering of dopamine.

30. Overview of Adult ADHD Symptoms
Less Obvious or “Soft” Symptoms
 OCD-like coping skills –coping skills to manage the
chronic disorganization and feelings of overwhelm,
rigidness, perfectionism
 Rejection Sensitive Dysphoria – Not in DSM-V, a term
coined by William Dodson, MD, one of the top experts in
the field of ADHD. Similar to atypical depression, which
means not truly depression but dysphoria or “difficult to
bear”. Not and adulthood reaction stemming from
earlier experiences, but Dodson attributes it to “ hard-
wiring”, and that about half of his patients have shown
improvement with medication.

31. Co-Morbid Disorders
As many as 50% of adults with ADHD also
report problems with depression and/or
anxiety
About 20% of the people with ADHD also have
a mood disorder on the bipolar spectrum

32. Co-Morbid Disorders
Commonly reported co-morbid disorders of adults with
ADHD:
Depression
Anxiety
Bipolar II – more often than bipolar I
Drug abuse or dependence
Antisocial or borderline personality disorders
Learning disabilities
Sleep Problems
Health problems related to behavior associated with
ADHD, such as smoking

33. Girls and Women with ADHD
 Boys are three time more likely to be diagnosed with ADHD than girls
 In a Harris Interactive survey, nearly 50% of moms of tween girls with
ADHD first considered their daughter’s behavior to be a part of
adolescence and 59% hesitated to consult a doctor because they
thought their daughter would outgrow the behavior.
 In a survey by the University of California at Irvine of the general
public, parents of children with ADHD, teachers and children with
ADHD – 85% of the teachers and more than half of the general public
believed that girls are more likely to be undiagnosed with ADHD
 Girls often do not fit the stereotype of: out of control, defiant,
unorganized, fidgety, unfocused and aggressive.
 Girls tend to have the Inattentive type of ADHD
 Common symptoms of girls/women with ADHD - disorganized, day
dreaming, low self-esteem, talkativeness, forgetfulness, feeling
anxious and/or depressed, seem to fade into the background

34. Substance Abuse and ADHD
 Research has shown that children with ADHD have an elevated risk of
becoming abusers of drugs and alcohol
 11% of the boys and 3% of the girls without ADHD report drinking alcohol
 21 % of the boys and 13% of the girls with ADHD report abusing alcohol
 Children who were medicated for their ADHD were less likely to become
substance abusers during a 4 year follow up than children with ADHD who
were not medicated
 Administering ADHD medication to adults with ADHD who were cocaine
users reduced their cocaine use
 Why does medication reduce the risk? Not clear – but may decrease
impulsivity that results in risky behavior
 Cocaine users may start using as a way of “self-medicating” ADHD
symptoms
 ADHD is 5 to 10 times more common in adult alcoholics than it is in adults
without ADHD
 Up to 45% of adults with ADHD have a history of alcohol use or dependence
and about 33% have a history of illegal drug abuse or dependence.

35. Treatment – Use of Screening tools
(self report) WRAADDS
 good for adults, deals with emotional as well as
attention/hyperactivity
ASRS-vI.I
 was developed in conjunction with the World Health
Organization (WHO) ; does not deal with emotional
component, easy to complete and score
Wender Utah Rating Scale
 has questions regarding emotions, focuses on “when I
was a child”
Copeland Symptoms list
 has questions regarding emotions, wording of questions
can be overly negative sounding “Immaturity” “Bosses
other people” “Lacking in leadership”
All are available for free on the internet

36. Treatment
Stimulant Medication is usually the first line medication ( Ritalin,
Adderall etc.) prescribed
Non-stimulant medication (Strattera) can be effective, especially if
stimulant medication needs to be avoided.
CBT can be effective in helping with improving thinking and behavior
patterns
DBT and mindfulness exercises are also increasingly being used to
help with ADHD symptoms
ADHD Coaching can help with time management and organizational
issues related to ADHD which can affect work performance
Psychotherapy can assist in issues related to fluctuations and
management of emotions, low self-esteem and relationship issues
and addressing issues related to co-morbid disorders or substance
abuse.

37. Take Aways
Medication, while effective, does not solve or is not the total
treatment for adults with ADHD
Adult ADHD often interferes with multiple areas of an individual’s
life
Adults diagnosed with ADHD are often relieved to learn they are
just not “stupid” or “lazy” or just need to “try harder”
Unlike bipolar disorder, symptoms of ADHD are continual, they do
not “come and go”
The symptoms of girls and women with ADHD can be different from
the symptoms of boys and men with ADHD
There is often an Emotional/Self Regulation or Executive
Functioning problem with adults with ADHD that should not be
ignored.
Adult ADHD may not “look” like childhood ADHD and many adults
with undiagnosed ADHD have developed ways to “work around”
their symptoms and can have success in work and/or family life,
but can struggle in some situations or environments

38. Books for learning about and
coping with Adult ADHD
• By Edward M. Hallowell MD and John J Ratey MD
 Driven to Distraction
 Delivered from Distraction
• By Kate Kelly and Peggy Ramundo
 You Mean I’m Not Lazy, Stupid or Crazy
• By Ari Tuckman
 More Attention, Less Deficit

39. Thank You
Del Larkin, LCSW, CAADC, MBA
Director of Quality Assurance and Strategic
Planning
The Salvation Army Harbor Light Center
Chicago, IL 60607
del_larkin@usc.salvationarmy.org