What is Adult ADD?
According to the National Institute of Mental Health (NIMH), attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are among the most common childhood brain disorders. Symptoms include difficulty paying attention, controlling behavior, and over-activity. Although ADD was initially considered a “childhood-limited disorder,” we now know that ADD can persist through adolescence and adulthood.
Adults with this condition often experience symptoms of inattention and impulsivity, which can make it difficult to focus, complete tasks, stay organized, exercise patience, and control impulsive behaviors. They may end up missing deadlines or forgetting important commitments because it is difficult to concentrate and prioritize. Since ADD has only been widely acknowledged, diagnosed and treated within the last two decades, researchers note that “many adults with ADD present for diagnosis and treatment after having suffered with the disorder, untreated, for the majority of their lives.”
What is the difference between ADD and ADHD?
Adult ADD Central uses the term AD/HD throughout the site for the sake of simplicity, but ADD and ADHD have different definitions. Depending on the symptoms, ADD is categorized into three types:
- Predominantly Inattentive Presentation, in which individuals have difficulty organizing or finishing a task, paying attention to details, or following instructions or conversations. Someone with predominantly inattentive presentation is easily distracted or forgets details of daily routines.
- Predominantly Hyperactive-Impulsive Presentation, in which an individual fidgets and talks a lot. They find it difficult to sit still, and often feel restless. There often have impulsive behavior, like interrupting others, speaking at inappropriate times, and having a hard time waiting their turn or listening to instructions.
- Combined Presentation, in which a person experiences symptoms of both inattentive and hyperactive-impulsive presentation in equal measure.
The “H” in ADHD refers to the symptom of physical hyperactivity or excessive restlessness. The definition of ADD does not include the hyperactivity symptom. The Diagnostic and Statistical Manual-V (DSM-V), which clinicians use to diagnose mental illnesses and disorders, actually defines ADD as “ADHD, inattentive sub-type.” Although motor symptoms of hyperactivity become less obvious in adulthood, adults may still struggle with restlessness, inattention, poor planning, and impulsivity.
ADD is more often found in girls and women, but it also occurs in boys and men. Because people with ADD do not fit the (white, male) hyperactive ADD stereotype, the condition may not be accurately diagnosed (see ADD and Gender, and Race, Culture & Ethnicity).
How it ADD Diagnosed?
ADD is commonly diagnosed using questionnaires and other tools that look for typical symptoms like disorganization, forgetfulness, and inattention. Adult ADD Central considers this an “inside the box” approach to adult ADD diagnosis. These tools may not take into account the fact that:
- “Attentional capacity” exists on a spectrum–even though subjective diagnostic tools indicate you either have it, or you don’t
- Several physical conditions, medications and other substances can have negative effects that mimic ADD symptoms
- Adults with ADD often suffer from comorbidities, or co-existing conditions, like mood or personality disorders, which can make an accurate ADD diagnosis very challenging
- Mental health diagnoses can be influenced by the patient’s race, ethnicity, cultural background and gender
That’s why Adult ADD Central promotes thinking “outside the box” about mental health diagnosis. This means:
- Recognizing that every adult has his or her own unique biological make-up, identity, culture, personal history, and day-to-day experiences, all of which play a role in emotional and mental health
- Acknowledging that attentional capacity exists on a spectrum, and each individual’s attentional capacity is different
- Going beyond standard ADD symptom checklists to consider how factors like stress, work environment, socioeconomic status and prior trauma affect one’s mental and emotional health
- Taking the time to listen to an individual’s whole story–not just looking at symptoms that might be caused by ADD.
Is Adult ADD a Mental Illness?
This classification is a double-edged sword: on the one hand, it legitimizes a condition that can cause significant impairment, and that is often dismissed or trivialized by adults without ADD due to a perception that is not a “real” disorder.
On the other hand, DSM-V critics argue that the neurodevelopmental disorder label over-emphasizes ADD’s biological causes, implying that medication is the only possible treatment. The label “mental illness” or “disorder” may contribute to stigma, which can discourage people from seeking mental health treatment and support. Also, as Dr. Richard Friedman notes, adults with ADD may not necessarily experience it as an illness if it suits their job and lifestyle.
What Causes ADD?
The National Institute of Mental Health reports that while scientists are not sure what causes ADD, results from several studies show that ADD is genetic, meaning it often runs in the family. First-degree relatives of a child diagnosed with ADD are 4–5 times more likely to have ADD compared to the general population, while there is up to a 10-fold risk of developing ADD among siblings of children with combined type ADD.
Although studies suggest that environmental factors may also increase children’s risk of developing ADD, prematurity/pre-term birth is the only environmental factor with enough evidence to associate it with ADD. There is not enough evidence to reliably link ADD with other environmental factors, such as low birth weight, maternal smoking, alcohol or drug use in pregnancy, severe head injury, and family psycho-social factors.
How Common is Adult ADD?
Because adult ADD is a complicated condition to diagnose, it is difficult to state the exact number of adults in the United States who have ADD. Until recently, most ADD research focused on the prevalence, or commonness, of ADD in children. There are significant differences in published estimates of adult ADD prevalence because researchers have used different methods and criteria to measure ADD in adult populations.
A 2009 review of prevalence data reported that ADD prevalence in the United States was 6-9 percent among children and adolescents, and between 3-5 percent among adults. If this is accurate, then at least 2.2 million of the 74 million adults in the U.S. are living with ADD.
A more recent study conducted in 2013 aimed to provide a better estimate of adult ADD by doing a telephone survey of 966 randomly selected adults. Participants who met the clinical criteria for both childhood and adulthood ADD were categorized as having “narrow” ADD (2.9 percent), while those who did not meet the full criteria were categorized as having “broad” ADD (16.4 percent).
Although ADD affects both males and females, ADD is diagnosed between 2-9 times more often among boys than girls. Among adults, however, men are only 1.5 times as likely to receive an ADD diagnosis compared to women. There are also significant differences in diagnoses across racial and ethnic groups in the United States: for example, ADD diagnoses are higher among non-Hispanic whites than for racial and ethnic minorities, even though actual prevalence is probably similar among all racial and ethnic groups.