March 18, 2011
Dear Mayo Clinic:
How common is attention deficit disorder in adults? Is it hereditary? How is it treated?
Attention deficit disorder (ADD) is a condition that begins in childhood and can continue into adulthood. Between 20 and 50 percent of children diagnosed with ADD will continue to have clinically significant symptoms in adulthood. Since 6 to 8 percent of all children are diagnosed with ADD, it stands to reason that between 1.2 and 4 percent of adults would display the disorder. Although the cause of ADD is unclear, there does seem to be a genetic component. ADD can usually be effectively managed in adults with a combination of medication and behavior changes.
People with ADD have significant difficulty focusing and sustaining their attention, to the point that it interferes with their work and other daily activities. Physicians use symptoms of inattention and impulsivity to diagnose ADD.
Inattention involves behaviors such as failure to give close attention to details, making careless mistakes, having difficulty sustaining focus in tasks, not listening well, not following instructions, failing to finish work, having difficulty being organized, losing things easily, being easily distracted, and being forgetful.
Impulsivity may include being fidgety, needing to get up frequently, feeling restless, feeling a need for constant activity, talking excessively, blurting out things you later regret, interrupting, and having difficulty waiting.
The exact cause of ADD is unknown, but it's common to see the disorder in successive generations within families. The genetic pattern of ADD seems to be transmissible in boys — so it passes from fathers to sons — more often than in girls. The gender difference may be overestimated a bit, however, since ADD can be missed in girls as they tend to be less hyperactive than boys.
ADD is a childhood condition that always begins before age 12 and often before age 7, although some people may not be diagnosed until later in life. Among children who have ADD, between 20 and 50 percent will have significant symptoms as adults.
Many adults who fear they may have ADD are instead struggling with mood problems or increased stress. Quite a few don't have good sleep habits. For example, many college-age people with attention difficulty have very poor sleep patterns. Rather than taking ADD medication, the best thing they can do is improve their sleep hygiene. In other people, seasonal mood disturbances may be to blame for inattention, particularly if symptoms seem worse during the winter.
Keeping in mind that new symptoms of inattention and impulsivity in adults aren't ADD, some adults — many age 40 and older — have ADD and were never diagnosed as children. During their childhood years, health care providers and educators didn't know as much about ADD. As children, many had frustrating school experiences, and may have been disciplined instead of getting appropriate medical attention. These adults have either found ways to cope with ADD, or they've just lived with it and struggled. Beginning ADD treatment during adulthood for this group can be helpful.
The first step in ADD treatment is usually medication. Ironically, the most common ADD medications are stimulants, such as Ritalin and Adderall. They work by boosting and balancing levels of brain chemicals called neurotransmitters. This helps people with ADD ignore distraction and remain more attentive over time. Another type of ADD medication is atomoxetine (Strattera), a variant of antidepressant medications called selective norepinephrine reuptake inhibitors.
If ADD symptoms have persisted past childhood, continuing with medication long term is generally a good idea. In some situations, people diagnosed with ADD take medication throughout childhood, then find that when they reach adulthood they can compensate without medication. Some adults with ADD might use medications during times when attention demands are high. For example, medication may be necessary for an adult who goes back to school or who needs to learn new, complex tasks. Once life becomes routine again, medication may not be necessary.
In addition to medication, people who have ADD can take steps that will make living with the condition easier. For example, using an organizer, making and prioritizing to-do lists and eliminating distractions can all help combat inattention and impulsivity.
— Glenn Smith, Ph.D., Psychiatry & Psychology, Mayo Clinic, Rochester, Minn.