How does ADHD present in adults?
Whilst we all know the classic presentation of ADHD in children, and the conventional treatment route with childhood diagnosis, the presentation in adults may be more complex. Adults who have only been recently diagnosed may have developed coping mechanisms, which may or may not be successful, in order to help them manage the symptoms of their ADHD. Latent diagnosis may be difficult for them to process, as by adulthood our behaviours are more set and habitual.
The classic signs of ADHD are disorganisation, procrastination, inability to prioritise, impulsiveness, and emotion dysregulation. The repercussions of these symptoms can be devastating. Many adults with ADHD are embarrassed by their perceived failures and lack confidence in themselves. This can, in turn, lead to unhealthy coping mechanisms such as alcohol abuse, substance misuse, or gambling. An individual talks about patterns in their family: “Alcoholism is rampant in my family, and I have no doubt it is a way of coping with the frustrations of ADHD.”1
Receiving a diagnosis can be an incredible turning point for many people. Sadly, receiving a later diagnosis will mean that the unhealthy patterns are well-established and it will require hard work to change their automatic responses. Therapy, and particularly Acceptance and Commitment Therapy (ACT), is an important tool, to help people build healthy coping strategies and break down the unhealthy approaches of the past.
How can ACT help with managing ADHD?
Different therapies can help different people. ACT can be extremely beneficial for working with people with ADHD. The first principle of ACT is acceptance. Accepting our difficulties, accepting the uncomfortable emotions, and accepting that we will face challenges, are incredibly important to all people, but in particular those with ADHD. People with ADHD can have a harder time sitting with uncomfortable emotions, and a greater tendency to engage in distracting activities. Learning to accept ourselves, and accept our feelings, can be transformative.
Another crucial element in acceptance is kindness, namely kindness towards ourselves. In an account by an individual with ADHD who has had ACT they say: “So, if you are feeling frustrated and dejected, instead of forcing yourself into onerous activities, you could take an hour just to comfort yourself…For me, it’s easy to get lost in a shame cycle, I did a crappy job, therefore I’m a horrible person and I need to work harder, which just makes me more anxious, makes my performance worse, which increases my shame, and so on. ACT is excellent at breaking that cycle.”2 Because ACT focuses on values rather than on importance, it sits better with the ADHD which struggles with the concept of importance. Values give us a longer-term overview of what we want to achieve, and we can hold onto our values even when the steps ahead seem difficult.
One of the strategies we work with in ACT is mindfulness. Mindfulness is not the absence of thought, but the awareness of the thoughts, and is the skill of gently bringing our mind back into the present. As one of the manifestations of ADHD is daydreaming, learning mindfulness can be a very useful skill. It may be harder for those with ADHD, but as long as this is approached with kindness and acceptance that it may be hard, it can be an invaluable tool for dealing with ADHD.
Given that ADHD can often present with comorbidities such as anxiety, depression, or learning difficulties, ACT is an excellent treatment route. As the principles of ACT are beneficial for a wide range of conditions, the work done will help the associated conditions, not just the primary one. It can be hard to unpick which condition is triggering which behaviour, but if we work with the principles of ACT, we can work with the presenting symptoms, no matter their root cause.
Research into the effects of ACT on ADHD
Some research has been done into the use of ACT on ADHD, and the initial findings, whilst sparse, are positive.
Research has been done to evaluate the efficacy of ACT on ADHD, and Munawar et al. (2021)3 carried out a scoping review of 6 studies looking at the evidence for ACT for ADHD. They found that the ACT was successfully used to treat the behavioural and psychosocial symptoms of ADHD, such as impulsivity, inattention, as well as having a positive impact upon associated issues including poor quality of life, depression and anxiety. The conclusion drawn was that ACT provided a flexible and adaptive approach that could be both targeted at the precise symptoms of ADHD, as well as having a more generalised benefits that would serve the recipients well. The report showed that whilst DBT, a comparative therapy, gave better results for hyperactivity, in general, the report showed that: “Nonetheless, ACT was found to be more effective than DBT in the comparison of these two treatments on overall QoL, mental health, QoL, and environmental QoL.”3
A more recent study by Bodalski et al. (2023) explored the relationship between ADHD symptoms and experiential avoidance.4 It concentrates on how ACT helps to improve EA, and the relationship between EA and ADHD, which tends to be stronger in those with ADHD, than neurotypicals. This study references the Munawar et al study and concludes that: “Lastly, acceptance and commitment therapy (ACT), which has often been used to decrease EA, may also be useful for adults with ADHD (Munawar et al., 2021).”4
While this research is in its infancy, and further studies would be merited, the initial findings do show that ACT is an effective approach to improving the quality of life for those living with ADHD.
3: Munawar, K., Choudhry, F., & Lee, S., & Siau, C., & Kadri, N. & Sulong, R. (2021). Acceptance and Commitment Therapy for Individuals Having Attention Deficit Hyperactivity Disorder (ADHD): A Scoping Review. Heliyon. 7, 10.
4: Bodalski, E.A., Abu-Ramadan, T.M., Hough, C.E., Lefler, E.K., Meinzer, M.C., & Antshel, K.M. (2023). Low standards yet disappointed: ADHD symptoms and experiential avoidance in college students. Journal of Contextual Behavioral Science, 28, 180-184.