ADHD Across the Lifespan

Attention -Deficit/Hyperactivity Disorder (ADHD) is a common neurobiological disorder that affects between 2.6% to 8.6% of Canadian children, and 2.7% to 2.9% of Canadian adults over the age of 20 years old. Among children with ADHD, the vast majority will continue to have ADHD symptoms throughout their entire lives. This means that ADHD does not magically disappear as people get older. Instead, the way ADHD may present may change as people get older. 

There are three different ways ADHD may present itself in people based on the symptoms that someone mainly shows:

• Predominantly inattentive presentation
• Predominantly hyperactive/impulsive presentation
• Combined presentation

Presentation refers to what sort of symptoms are mainly shown by a person, but it does not mean that someone has a different kind of ADHD - there is only one “kind” of ADHD. People with ADHD can have symptoms across both presentations (inattentive and hyperactive/impulsive), but need at least 6 out of 9 symptoms (5 out of 9 for adults) of either or both symptom categories to receive a presentation designation. Generally, as people get older, the number of people presenting with hyperactive/impulsive or combined presentations decreases, while the number of people presenting with inattentive presentation increases. The change in the way ADHD presents as children age is because of brain maturation and changes in academic expectations. For example, as children get older, schoolwork requires more attention to detail. This means that children with attentional weaknesses may become more noticeable because they have a harder time completing schoolwork as they get older. Although the way ADHD presents may change over time, it is still a diagnosis that affects a person throughout their life. 

Executive Functioning and ADHD

People with ADHD have executive functioning weaknesses, which are related to the primary symptoms of inattention and hyperactivity/impulsivity that are often seen. Executive functioning refers to skills that help a person regulate themselves and reach their goals. This includes skills such as organizing, planning, and thinking flexibly to problem solve. People with ADHD are generally around 30% behind their peers in their executive functioning development. Consequently, deficits in executive functioning can lead to weaknesses in other important life skills, such as emotion regulation, social skills, and self-monitoring. This means that ADHD doesn’t just affect their home life or academic performance, but also their friendships, physical health, and occupational productivity. I am sure you can imagine how much of a mental toll it can have on someone to be struggling in multiple areas of their life. That is why it is so important for people with ADHD to be supported, even as they enter adulthood. 

How ADHD Symptoms Present in Children and Adults

Inattention in children with ADHD often looks like the kid who is the “daydreamer.” They may miss instructions, zone out during lectures, and may ask questions they have asked before. Many children with ADHD perform poorly in their academics and are identified early due to concerns from parents and teachers. Children with inattentive symptoms often require instructions to be repeated, forget to hand in work, and can be easily distracted by sights and sounds. There are also many children with ADHD that still perform well academically by using compensatory strategies such as getting help from their peers for missed instruction and spending additional time reviewing at home. Sometimes, the compensatory strategies work until they hit a transition point in their life (e.g., high school, university, having a child), which is what often leads adults to seek an ADHD assessment. However, this does not mean that the ADHD symptoms were not present in childhood, but rather masked by strategies that were used at the time. In adults, inattentive symptoms do not change significantly, but may affect different areas of their lives outside of school. For example, adults with inattentive symptoms may miss appointments, forget to respond to work emails, and complete large projects slowly.

Hyperactivity and impulsivity in children can vary widely, from children who are able to stay seated but will fidget with objects in their hands, to children who interrupt or blurt out during class and are unable to stay seated for very long. Children with ADHD who present with a lot of hyperactivity and impulsivity are identified quickly in the classroom because their behaviors can be disruptive to their peers. As children mature to adulthood, they gain more autonomy which can lead to weaknesses in hyperactivity and impulsivity presenting differently. In adults, hyperactivity/impulsivity tends to look more like internal restlessness rather than outward behaviors, and can lead to a higher likelihood of risky behaviors. For example, adults with hyperactive and impulsive difficulties may speed while driving, be prone to substance abuse, and have a hard time developing good spending habits.

Here are some other ways ADHD related behaviors may present differently from childhood to adulthood:

Managing ADHD Symptoms

ADHD Medications

Research suggests that the best approach to treating ADHD symptoms is a mix of ADHD medication alongside executive functioning skills building in both children and adults. There is some evidence to suggest that methylphenidate-based medications (e.g., Ritalin, Concerta) work better in children and adolescents, while amphetamine-based medications (e.g., Vyvanse, Adderall) work better in adults. However, it is important to consult with a doctor and go through a medication trialing process regardless of your age to determine what medication and dosage works best for you. 

Choosing the Right Environment

Children with ADHD are helped by their parents and teachers to create a good working environment free of distractions. Adults also need to find the right environment to best support their own learning. Generally, a quiet space that has fewer distractions or temptations is recommended in creating a good learning environment. For example, it can be helpful to work at a library over working at home if there are game consoles at home which can act as a distractor, even if both locations are quiet. It can also be helpful to study with model peers who demonstrate good task adherence, although it is important to note that peers can also act as a distractor. It is important to consider what works best for the individual as each person works differently. 

Visual Reminders and Prompts

Children with ADHD are often provided strategies around visual reminders and prompts to help move things they need to remember out of their heads and on to paper. Adults benefit from the exact same things, except there are plenty of digital tools that make keeping track of what needs to be done much easier. 

• Google Calendar: A great tool that can help you keep track of appointments, deadlines, and other scheduled events. The calendar can link to both your computer and your phone, and can be set-up to send a notification in advance to remind you of upcoming schedules.
• Pomodoro Timers: These are customizable timers that cycle between work time and break time, with an alarm to let you know when to take a break and when to get back to work (e.g., 15 minutes for work/ 5 minutes for break). Short frequent breaks can help individuals with ADHD manage their fatigue.
• Checklists: Making a simple checklist of daily to-dos or a checklist of tasks ordered by highest to lowest priority can help people keep track of things that need to be done. It can also be rewarding to check off tasks as they are completed, which acts as a motivator.

Goal Setting and Rewards

Children with ADHD benefit from being rewarded after reaching their goals. However, being rewarded for the completion of goals works not just for children with ADHD, but everyone. Adults with ADHD may benefit from learning to set realistic and manageable goals, while setting up rewards to go with the goals. For example, if a big picture goal is to complete an essay, smaller goals can be set-up for each section of the essay on a checklist (e.g., Introduction, body paragraph 1, conclusion), with a reward at the end being the person’s favorite food.

In conclusion, ADHD is a life-long disorder that may present differently in children and adults. ADHD symptoms in adulthood can lead to academic, social, health, and occupational difficulties, which means that it is important to support children with ADHD as they enter adulthood. Fortunately, there are many strategies to help manage ADHD symptoms, which adults with ADHD can learn to implement. Educating oneself about the disorder and ways to work with it are a key part of any treatment plan, regardless of age. For more resources, please refer to the lists below.

Parent Resources:

• ADHD Families resources: www.adhdfamilies.ca 
• Book: Taking Charge of ADHD: The Complete Authoritative Guide for Parents, 4th Edition – Dr. Russell Barkley 
• CADDAC Website:  https://caddac.ca/ 
• Additude Magazine: https://www.additudemag.com/category/parenting-adhd-kids/

Adult Resources:

• Book: Taking Charge of Adult ADHD: Proven Strategies to Succeed at Work, at Home, and in Relationships, 2nd Edition – Dr. Russell Barkley
• CADDAC Support Groups: https://caddac.ca/programs-events/adhd-support-groups/
• CADDRA Resources: https://www.caddra.ca/public-information/adults/resources-and-links/