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The impact of attention deficit hyperactivity disorder (ADHD) in adulthood: a qualitative study



Objectives There is limited evidence of the unmet needs and experiences of adults with attention deficit hyperactivity disorder (ADHD). Previous research in this area is predominantly quantitative by nature, few studies employing qualitative approaches. This study seeks to provide a deeper insight into the lived experiences of adults with ADHD within Western Ireland. Methods A qualitative design, consisting of semi-structured face-to-face interviews with a clinical sample in the Sligo/Leitrim area. Participants were eligible for this study if they screened positive for symptoms of ADHD, and diagnosed with ADHD with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV. In total, 11 participants completed this research. The interviews were open ended and exploratory, adopting a phenomenological approach. Results Thematic analysis was used to explore three main themes; The Burden of symptoms of ADHD, Perceived Positive and Negative Effects of ADHD and Challenge of Accessing Services, each with several subthemes. Conclusion This research highlights the experiences of adults with ADHD. It is important for practitioners to be aware of the perceived positive and negative effects of the disorder, and how it can impact on their patient’s lives. In addition, becoming aware of the stigma associated with ADHD can help clinicians improve upon individual treatment plans to meet their patient’s needs. It is important to note that this sample experienced co-morbid diagnoses and so this may limit the interpretation of the findings. Further research in this area could explore patient’s attitudes towards receiving a formal diagnosis of ADHD.
The impact of attention decit hyperactivity
disorder (ADHD) in adulthood: a qualitative study
C. Watters
, D. Adamis
*, F. McNicholas
and B. Gavin
Psychology Services, Markievicz House, HSE, Sligo, Ireland
Mental Health Services, HSE, Sligo, Ireland
Child and Adolescent Psychiatry, School of Medicine, UCD, Dublin, Ireland
Objectives. There is limited evidence of the unmet needs and experiences of adults with attention decit hyperactivity
disorder (ADHD). Previous research in this area is predominantly quantitative by nature, few studies employing
qualitative approaches. This study seeks to provide a deeper insight into the lived experiences of adults with ADHD
within Western Ireland.
Methods. A qualitative design, consisting of semi-structured face-to-face interviews with a clinical sample in the Sligo/
Leitrim area. Participants were eligible for this study if they screened positive for symptoms of ADHD, and diagnosed
with ADHD with the ConnersAdult ADHD Diagnostic Interview for DSM-IV. In total, 11 participants completed this
research. The interviews were open ended and exploratory, adopting a phenomenological approach.
Results. Thematic analysis was used to explore three main themes; The Burden of symptoms of ADHD, Perceived
Positive and Negative Effects of ADHD and Challenge of Accessing Services, each with several subthemes.
Conclusion. This research highlights the experiences of adults with ADHD. It is important for practitioners to be aware of
the perceived positive and negative effects of the disorder, and how it can impact on their patients lives. In addition,
becoming aware of the stigma associated with ADHD can help clinicians improve upon individual treatment plans to
meet their patients needs. It is important to note that this sample experienced co-morbid diagnoses and so this may limit
the interpretation of the ndings. Further research in this area could explore patients attitudes towards receiving a formal
diagnosis of ADHD.
Received 12 September 2016; Revised 14 April 2017; Accepted 15 May 2017
Key words: ADHD, adult, attention decit hyperactivity disorder, qualitative research.
Attention decit hyperactivity disorder (ADHD) is a
neurodevelopmental disorder, which many recognise
as a childhood disorder (Rosler et al. 2010). However,
a review of the literature as well as longitudinal studies
of individuals with ADHD reveals that symptoms
of ADHD can persist into adulthood (Faraone et al.
2006; Davidson, 2008). Regardless of this literature,
there is limited evidence of the unmet needs and
experiences of adults with ADHD (Matheson et al.
2013). It is common among adults with ADHD to
experience high rates of co-morbidities; three in four
patients have at least one or more co-morbid psychia-
tric disorder (Faraone & Biederman, 1998). In some
cases, these other psychiatric disorders can dominate
the picture, causing symptoms of ADHD to be over-
looked or even undiagnosed. Therefore, individuals
with ADHD can be under-treated and may fail to
receive a diagnosis of ADHD and sufcient treatment
which can result in life-long challenges and difculties.
Research has shown that adults with ADHD often
complain of psychological and psychosocial difculties
which can impair functioning, well-being, and health-
related quality of life in adulthood (Nigg et al. 2002;
Murphy & Adler, 2004; Adler et al. 2006; Weiss et al.
2010). Compared with adults without ADHD, adults
with ADHD have a higher risk of developing depres-
sion, anxiety, substance abuse, anti-social behaviours,
lowered socio-economic status due to work-related
stress (Faraone et al. 2000; Schubiner et al. 2000; Barkley
et al. 2004; Wilens & Dodson, 2004), social skills de-
ciencies due to difculties in affect recognition (Rapport
et al. 2002), increased anger expression (Richards et al.
2006), are more likely to commit anti-social acts and
be arrested (Barkley et al. 2004), and an increased risk
for motor vehicle accidents (Swensen et al. 2003).
ADHD can have a negative impact on nances, career
opportunities, income, retirement funds (due to
impulsive spending), friendships groups, families and
co-workers (Brod et al. 2012). As a result, there is often a
substantial psychological and psychosocial burden
* Address for correspondence: Dr D. Adamis, Mental Health
Services, HSE, Sligo, Ireland.
Irish Journal of Psychological Medicine (2017), page 1 of 7. © College of Psychiatrists of Ireland 2017 ORIGINAL RESEARCH
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associated with undiagnosed and untreated ADHD
(Able et al. 2007). Without treatment, these impairments
can have detrimental effects on quality of life.
Stigma is an underlining difculty faced by many
people suffering from mental illness, ADHD in parti-
cular. Previous research has noted some individuals
demonstrate hesitance and reluctance to engage and
interact socially with their fellow peers experiencing
the disorder. One such study was carried out in an
American University. This study consisted of under-
graduate students rating the likelihood that they would
rather interact with a peer described as having ADHD,
a peer with general medical problem, or a peer with an
ambiguous aw such as perfectionism (Canu et al.
2008). Peers described as having ADHD were rated less
socially desirable than peers with the other two
descriptions. It is unclear as to whether stigma stems
from a lack of awareness of ADHD or popular myths
about the illness in that it is only restricted to childhood.
As reasons remain unclear, researchers have requested
for further research to examine the stigma associated
with adults with ADHD (Lebowitz, 2013).
A signicant amount of the available literature on
adults with ADHD has used samples from the United
States and the United Kingdom, and researchers have
requested further research with various methodologies
to shed light on the experience of ADHD in adulthood
(Lebowitz, 2013). Therefore, this research seeks to
explore the experiences of adults with ADHD from a
clinical sample in Western Ireland. The rationale of
this study is simple; understanding the impairments
associated with ADHD in adulthood and the stigma
attached to this illness can help practitioners be more
aware of the difculties faced by individuals accessing
support services and possible barriers that may affect
treatment adherence, particularly within a Western
Irish context. Previous research among individuals
with ADHD have mostly employed quantitative
approaches (Young, 2005; McCarthy et al. 2013). How-
ever, qualitative approaches are more appropriate at
providing an in-depth insight into patientsexperiences
(Pope & Mays, 1995). Like any illness or disability, early
intervention can improve quality of life, self-esteem,
overall functioning, outcome and long-term prognosis
(Agarwal et al. 2012; Shaw et al. 2012; Harpin et al. 2013;
Matheson et al. 2013). Therefore, this research is
essential to ensuring timely and early support is
available to those who require it. There is very little
understanding of the perspectives of adults with
ADHD reported in the scientic literature (Young et al.
2008; Henry & Hill Jones, 2011), particularly regarding
those with untreated ADHD. Therefore, it is hoped that
this research study will contribute to the literature by
informing clinicians of the lived experiences of adults
with ADHD.
Aims of the study
The aims of the study were twofold: to examine the
functional impairments of ADHD and to investigate
perceived attitudes and stigma.
Methodological approach
A qualitative approach using semi-structured inter-
views was used as it aims to elicit a detailed and in-
depth description of the participantsexperiences and
views. A literature review was carried out to establish
topics to guide the interview in order to elicit com-
mentary in several areas, including daily life, social,
psychological, and physical functioning, negative
effects of ADHD, positive effects of ADHD, experiences
accessing support services/treatment centres and
attitudes towards ADHD. Demographic information of
each participant was recorded in order to generate
descriptive statistics.
The recruited sample was a sub-sample of a larger
epidemiological study (Adamis et al. 2016). Consecutive
patients attending any Adult Mental Health Services
out-patient clinics of Sligo/Leitrim were invited to
participate. Participants completed the Adult ADHD
Self-Report Scale and the Wender Utah Rating Scale.
Exclusion criteria applied were as follows: age less than
18 or above 65, illiterate, non-English speaking patients.
Those who scored positive in both scales were further
assessed (second stage of the initial study) with the
ConnersAdult ADHD Diagnostic Interview for DSM-IV
(CAADID) and the Mini International Neuropsychiatric
Interview (M.I.N.I.) (Sheehan et al. 1998) for diagnosis of
co-morbid disorders. Consequently participants who
completed the CAADID and who were considered to
have an ADHD diagnosis were invited to complete this
research; a qualitative interview in 2016. The rst 17 who
have been diagnosed with ADHD according to CAADID
were contacted by telephone or post to take part in this
Study setting
The interviews took place in an out-patient clinic or
mental health service participants were familiar with. The
interviews were conversational and semi-structured
based on previous literature and following a guide that
was reviewed by an expert in qualitative research.
With the participants consent, interviews were audio
recorded and transcribed in order to be analysed.
On average, the interviews lasted ~40 minutes each.
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Areective journal was kept to increase the validity and
reliability of the research.
Demographic information provided quantitative data
that was entered and analysed using SPSS. As data
were only collected for descriptive purposes, only
descriptive statistics were performed. Qualitative
analysis consisted of using a thematic approach in
order to determine similarities across transcripts as well
as highlighting the differences between them. Analysis
consisted of six phases: (1) familiarisation with data,
(2) generating initial codes, (3) sarching for themes
among codes, (4) reviewing themes, (5) dening and
naming themes, (6) producing the nal report. The end
result was a full coding system that was descriptive
of the collective experience of ADHD in adulthood.
A phenomenological approach was adopted which
emphasises the participants perceptions, feelings and
experiences as the paramount object of the study. This
approach encourages participants to discuss the topic
in their own words, focusing on the human experience
In total, 17 out-patients were approached to participate.
Two individuals declined to participate and four
individuals were unable to be contacted, resulting in 11
participants completing the semi-structured individual
interviews; nine male and two female with an age range
of 2054 years (mean age 37.64 years, SD =11.83).
Eight of the participants were currently employed, and
three were unemployed. Four participants were single,
four were married and one was cohabiting. One
participant had obtained an I.T. degree, one had a
University degree, seven had completed education as
far as the Leaving Certicate, one only had Junior
Certicate education and one had a Post-Graduate
degree. Co-morbidity was diagnosed based on use
of the M.I.N.I. Each participant had more than
one diagnoses with the majority being mood dis-
orders (n=8; 72%) following by generalised anxiety
disorder (n=5; 45.5%) and panic disorders and/or
phobias (n=5; 45.5%).
Three main themes were found: The Burden of
symptoms of ADHD, Perceived Positive and Negative
Effects of ADHD and Challenge of Accessing Services.
Each main theme contained a few subthemes which
are described in greater detail below. Quotes from
interviews are provided, followed by the number
in parenthesis (x) attributed to the interviewee.
Ellipses () mark parts omitted from the quote and
words within brackets are clarications made by the
The burden of symptoms of ADHD
Inattention and poor concentration
The impairment associated with poor concentration,
distractibility and inattention were described the extent
and the burden of experiencing symptoms of ADHD in
adulthood. Inattention and lack of concentration resulted
in signicantly difculties with basic tasks such as
reading, watching television, writing a letter, forgetting
things (in terms of relationships), multi-tasking and
getting side tracked by something else(2). Often in
adulthood, demands become more complex and
individuals are expected to function more responsibly
and independently, yet poor abilities to maintain
concentration exacerbate the burden of living with
ADHD. The majority of participants often compare their
concentration levels with others and are aware of the
impact this has on their lives. Itrywatchingandlearning
new things, but I just dont have the concentration for it
like others would(10), My concentration levels delay me
from completing a task so yeah it would probably
take me longer to complete a task than the average
person(5), Ijustwouldnothavebeenabletohave
focused for nearly as long as everyone else It denitely
puts me behind in college(6).
Hyperactivity and impulsivity
Participants reported difculties related to hyperactivity
and impulsivity noting a tendency to blurt things out
without sufcientthoughtintermsofsayingthings
uncontrollably, not completing tasks, negative future
consequences and more subtly through relationships.
It affects my work in that I just cantgetthingsdone
there are a lot of little jobs where I do 80% of it and then
I leave the other 20%, and kind of avoid it and go and
do something else(3), IwouldsaythatIdonthavea
lter on what I say never aggressively, but theres
just no lter I just sit on my hands and try not to say
anything(8), Say I have 20 in my pocket for shopping
and I bumped into someone on the street and they asked
all my shopping money and have no food then for the
week likeIlostalotofweightthelasttwomonths
just from being impulsive with money I have set aside for
food and stuff(4), I just think itsagreatideaatthetime
but then I realise maybe itsnotagreatidealetssay
Im painting the garden fence and Ive a lot of that to do
and thatsne and instead of nishing the fence, I go
over and start painting the shed(5). One participant
described having a hyperactive mind rather than
displaying hyperactive behaviour: Iwouldntoutwardly
by hyperactive, but I might nd it very hard to be
concentrating on a single clear thought. My mind would
be racing and tumbling after itself(9).
The impact of ADHD in adulthood 3
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Limited possibilities
Limited possibilities was identied as an emerging theme,
in that participants explained how their symptoms and
difculties elicited a sense of lost potential. It would stop
me doing courses or jobs where I would have to retain the
information because I get nervous about it then because
stopped me. You know I would have loved to have gone
on and maybe go back to college or do something but
that kept me away(2), I could never hold a job down.
I would always lose focus of the job or I just wouldntbe
bothered just doing the same stuff over and over again
and I always found it very mundane. Ive had so many
jobs since I was 16 its ridiculous(4). Participants descri-
bed how they felt like they failed to full their potential,
yet knowing they are capable of doing more: Imnot
doing the work as well as I should be because I know that
I can work very well. If I dont, Im automatically seen
by other people as poor performance so then I would
be putting myself under more pressure to get the
work done denitely procrastination is a big thing
for me(9). Again, participants reected upon their
childhood and how undiagnosed symptoms may have
limited their educational opportunities from an early age:
I spent half of my time in the corridor, outside of the
classroom. One half in the corridor and the other half in
the principalsofce(4), I would have to really really
learn things and then they were gone. And that used to
upset me and I couldntunderstand.Thingswouldgoin
when I learned it and then that night it was gone
I suppose things just got harder, to retain all of the
Perceived positive and negative effects of ADHD
Every cloud has a silver lining
Some participants noted the benets of some of the
symptoms experienced. I kind of like being like that at the
same time as well. Doing things on impulse is always
better rather than stuff that you plan out, it never works
(4). ADHD could perhaps contribute to a fullled and
exciting life kind of denes me as a person I suppose
just the impulsiveness to go and do something that
somebody else wouldnthavedone(4). One participant
noted the advantages of having an overactive mind,
looking to the bright side of being easily distracted.
I suppose sometimes it is useful (being easily distracted),
if Im stuck in my own head a bit too much and Imjust
over thinking things and stuff like that, itsdenitely a
good thing to be able to let your mind wander a bit, not
to think about anything too heavy(6). It was suggested
that being impulsive and unpredictable can make a person
more likeable. Maybe the spontaneous aspect, people
seem to enjoy that(8).
Low self-condence and self-esteem
A lot of participants reported psychosocial effects of
symptoms of ADHD. For example, some participants
reported lack of self-condence and self-esteem pre-
vented them from taking part in new experiences: I get
frustrated a lot of how I lack in college work, I would
just be very easily distracted and then just lower self-
esteem. Like it can happen before I go to do something
and then getting frustrated during. Before I start
something I think whats the point, I cant do that
anyways(6). Negative comparisons to others affected
making new friends: I suppose I would have been
a little less inclined to get to know people I felt
like everybody was way ahead of me anyways(6).
Condence appeared to limit possibilities in terms of
employment prospects: I never stuck at anything
then I guess I have no condence either. I never thought
I would be able to do it I wouldnt go for a job or
I would never try for things(3), and functioning at
work I know I should be doing it quicker and I can do it
quicker(5). Low self-condence and self-esteem had
several consequences during childhood, causing frus-
tration and embarrassment compared with peers: I get
frustrated because everyone else can do it and I cant
and I get frustrated out of that(11), It made me a bit
nervous, I realised that they were remembering and
I wasnt(2).
A sense of disorganisation was evident throughout
the interviews which was considered debilitating and
draining. I get distracted with work or that and just
getting frustrated and feeling like I cant do it and I get
down on myself that Im not good enough so its just
like being distracted and also just feeling like I cantdo
it anymore, getting frustrated and giving up. So I de-
nitely struggle with that kind of thing(6), I do pro-
crastinate, again that would be quite typical because
jobs often seem very big and overwhelming(7). The
impression from interviews was that daily tasks, such
as household chores, clothes washing, packing a bag,
making breakfast can appear impossible and over-
whelming. When I wake up in the morning, just the
thought of having to do all of that, I mightnt bother
doing that because that time in the morning when
Im just after waking up, any series of tasks like that
complicated would be insurmountable, I would want
another half an hour just staring there beforehand(9).
Strategies were employed to overcome these chal-
lenges. One trick that I try to teach myself in general
was what Ive learned from mental health tools is to try
and do the next little thing and not think of all
the things that I have to do. Thats a little bit more
manageable in terms of thinking Im trying to
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train myself to just think about the next little step(7).
Participants described how they learned to cope with
forgetfulness by immediately writing things done or
asking different people instead of the same person all
the time to avoid being labelled as forgetful. Coping
with symptoms of ADHD in adulthood was described
as something you just had to accept. You just manage,
its like someone with a limp, you just manage to walk.
I suppose you just kind of brush it to the side and learn
to get on with things(5).
Challenge of accessing services
Perceived stigma towards mental health in general was
discussed as an issue for both the person experiencing
mental health difculties and their families. Going to
hospital and attending the psychiatric services were
considered the most severe and unwanted forms of
treatment. Well I would say I had a huge resistance to
Psychiatry because to me that was another downhill
step as long as I didnt go to a Psychiatrist that meant
I was ok. And then at that point, it was as long as
I havent been institutionalised(7), They (my family)
cant really handle mental health issues. Like if I had
cancer, it would be ok(7). The majority of participants
discussed what they thought ADHD was and con-
fessed that they believed it to be restricted to childhood.
When I heard of ADHD I used to always think it
was hyperness I thought it was just a childhood
thing(2), I often heard about it (ADHD) in kids really
more so than adults. The impression I got is that it
would be kids just throwing tantrums I always
thought it was unruly kids(5), People question is
ADHD made up, is it an excuse for boldness(9).
ADHD is viewed in a negative light, and stigma
attached to the disorder may arise from character
portrayals in the media. the bad character in that had
ADHD so its not seen in a positive light. It might not be
a positive thing(8).
ADHD is typically regarded as a childhood disorder
with little attention given to adults with ADHD,
who often go unnoticed and undiagnosed. The scarce
literature that is available employs quantitative
methods; therefore this qualitative methodology
provides further insight into ADHD in adulthood. The
main aim of this research was to the experience of
associated with ADHD in adulthood, as well as the
perceived stigma attached to the disorder. This research
highlights the difculties and challenges faced by an
Irish clinical population who have remained undiag-
nosed until adulthood.
The perceived burden and sense of impairment
associated with ADHD symptoms was highlighted
persistently through the interviews is in-keeping
with previous research in this area, suggesting
that symptoms of ADHD persist into adulthood. The
negative effects of the symptoms were quite dominant
throughout the interviews, however there were some
positive effects associated with symptoms of ADHD.
Some of the participants viewed their impulsivity in a
positive light and felt it made them more likeable to
others, whereas others noted how impulsivity affected
their work, social life and completing daily tasks such
as household chores.
Participants in this research often felt and identied
themselves as different to other people. This difference
was noticed retrospectively in childhood, while in
education, and highlighted when in relationships.
The ndings suggest that symptoms of ADHD such as
inattention, poor concentration, hyperactivity and
impulsivity may have affected the participantsability
to remain focused in school making the earlier years an
unpleasant period which increased the likelihood
of falling behind their peers resulting in reduced self-
esteem and self-condence. This in turn may have
resulted in the feeling of missed opportunities and
failing to full potential.
Stigmatisation was explicitly recognised as an issue
that the general public and clinicians need to be aware
of. There was a huge under awareness of the disorder,
particularly the fact that it can persist into adulthood.
ADHD is viewed in a negative light with one participant
making reference to a popular TV show portraying a
badcharacter with ADHD implying it makes children
uncontrollable. This stigma may have implications during
the diagnostic process. Clinicians need to be aware
of the stigma associated with the disorder and thus can
maintain the appropriate sensitivity. The perceived
stigma can also affect treatment adherence and coopera-
tion with the services. It is clear from the ndings that
participants beneted the most when accessing both
Psychiatry and Psychology services. This is in-keeping
when services work together. Gapsbetween the services
should be addressed with appropriate communication
and cooperation.
The ndings of this research should be interrupted in
light of the following limitations. The sample were
predominantly male and contained only Caucasian
participants. It is important to note that individuals
who are less inclined to access and cooperate with the
mental health services in the Sligo/Leitrim area may
have different experiences and views of ADHD com-
pared with those who voluntarily participated in this
research. Only participants who were considered
as having a clinical diagnosis of ADHD, following
The impact of ADHD in adulthood 5
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completion of CAADID and screening positive for
symptoms of ADHD, were invited to participate in
this research. However, it is important to note that
participants had not yet received a formal diagnosis.
Therefore, this may affect the ndings in that indivi-
duals may not have recognised their symptoms of
ADHD and thus the impact they may have had on their
life. As outlined, all of the participants had at least
one co-morbid psychiatric diagnosis and therefore the
experiences described above could be due to other
diagnoses. In addition, due to preliminary research
with this cohort, researchers were aware of history
and information about other co-morbid psychiatric
disorders and this may have affected the results in that
it may have been difcult to determine the effects of
ADHD versus those of other disorders.
This research highlights the experiences of adults with
ADHD. It is important for clinicians and practitioners
to be aware of the perceived positive and negative
effects of the disorder, and how it can impact on their
patients lives. In addition, becoming aware of the
stigma associated with ADHD can help clinicians
improve upon individual treatment plans to meet
their patients needs. Further research in this area
should explore patients attitudes towards receiving
a formal diagnosis including perspectives linked with
a delayed diagnosis or delayed treatment. Following
their formal diagnosis, a follow-up interview would be
interesting to decipher the experience of receiving a
diagnosis in adulthood.
We would like to thank the participants in this study.
Financial Support
No funding was received to conduct this research.
Conicts of Interest
The authors declare that there are no conicts of interest
to disclose.
Ethical Standards
The authors assert that all procedures contributing
to this work comply with the ethical standards of
the relevant national and institutional committee on
human experimentation with the Helsinki Declaration
of 1975, as revised in 2008. Research ethics was granted
from Sligo General Hospital to conduct this research.
Verbal and written informed consent have been
obtained from all study participants.
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The impact of ADHD in adulthood 7
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... Despite the fact that over the last few years, a growing conversation has arisen linking ADHD and entrepreneurship (e.g., Dimic & Orlov, 2014;Verheul & Rietdijk, 2016, Wiklund, Yu, Tucker, & Marino, 2017 and for decades, researchers have examined well-being of individuals suffering from ADHD (e.g., Harpin, 2005;Kupper, 2012;Watters, 2018), there is limited research on the relationship between ADHD and "entrepreneurial" well-being. Our study reveals a possible paradox that has not yet been explored in existent literature. ...
... ADHD symptoms score: Following previous entrepreneurship research on ADHD (e.g. Kessler, 2006;Watters, 2018;Verheul & Rietdijk, 2016), we measure ADHD symptoms as a continuous variable that reflects the dimensional view of ADHD -that is, individuals differ in degree in their underlying ADHD trait and there may not necessarily be a clear-cut threshold to classify individual as having or having not ADHD (see Yu et al, 2019 for a detailed explanation of ADHD continuous vs. dichotomous view in entrepreneurship research). Specifically, we rely on the established Adult ADHD Self-report Scale (ASRS-v1.1) ...
... ADHD has an estimated prevalence of about 5% in children, and more than 50% of the children diagnosed with ADHD continue to show symptoms as adults [2,3]. Findings from qualitative research indicate that adults with ADHD experience a wide range of consequences related to their diagnosis, such as distractibility, inattentiveness, impulsivity, restlessness, procrastination, and lack of motivation, which further impacts their day-to-day functioning in terms of execution of daily chores, educational goals, finances and occupational performance [4][5][6]. Moreover, ADHD is seen to affect the individual's self-esteem and self-efficacy [7]. ...
... This experience did not seem to be related to the knowledge or discovery that there were others who struggled with similar difficulties, but rather related to the immediate feelings and experiences that emerged when meeting others in the group. Individuals with ADHD are often met with stigma and prejudice, which may induce feelings of shame and lead to an experience of being different to others [5,36]. Hearing about other people's experiences often allows people to feel more part of humankind and thus less alone [37]. ...
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Background: There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. Method: We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. Results: Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - “I am not alone”; The personal cost of participating in the group - “At times it was a hot mess”; and The group supported the learning experience - “We worked with it together”). The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes (Managing ADHD in daily life - “It’s much easier to handle everyday life”, and Personal growth - “Gaining new perspectives”). Conclusion: The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format allowed participants to take away more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.
... We expect that the results of this study will contribute to the growing research on Internet-delivered interventions and that the results will have a major impact on the management of ADHD symptoms in adults. Apart from being influenced by the core symptoms of an ADHD diagnosis -inattention, hyperactivity and impulsivity -ADHD is a clinically heterogeneous disorder were people also often experience emotional problems, procrastination, lack of motivation and low selfesteem which further impacts quality of life and day-to-day functioning (Michielsen et al., 2018;Watters et al., 2018). The MyADHD intervention, focusing on core symptoms of ADHD and their wider consequences for daily functioning, is expected to reduce the severity level of symptoms and increase quality of life for the participants. ...
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Background Attention-deficit/hyperactivity disorder (ADHD) in adulthood, with an estimated prevalence of 2–3%, is associated with several challenges in daily life functioning. The availability of evidence-based psychological interventions for adults with ADHD is still poor. Interventions delivered over the Internet on smartphones or personal computers may help to increase the availability of effective psychological interventions. The primary aim of this randomized controlled trial is to examine the efficacy of a self-guided Internet-delivered intervention on severity levels of ADHD symptomatology and quality of life. Methods We aim to include 118 participants with a self-reported ADHD diagnosis in a randomized controlled trial with two arms: 1) self-guided Internet-delivered intervention for coping with ADHD (N = 59); 2) self-guided online psychoeducation (control group, N = 59). After 3 months, the control group will be given access to the intervention. The primary clinical outcomes are inattention and quality of life. Secondary clinical outcomes are hyperactivity, stress and depression. Measures will be obtained at three time points: before (baseline), immediately after (8 weeks) and 3 months after the intervention. Uptake, usage, adherence and satisfaction will be explored. Discussion This RCT will provide valuable information on the clinical effectiveness of an Internet-delivered intervention for adults with ADHD. This study is, to our knowledge, one of the first randomized control trials that investigates the effects of a self-guided Internet-delivered psychological intervention in a fairly large group of adults with ADHD. Trial registration, Identifier NCT04726813, January 27, 2021.
... Indeed, it has been shown that patients with ADHD report psychological and social difficulties greatly affecting their quality of life. [3][4][5] Additionally, previous research found that more than half of individuals with ADHD also had another mental disorder, 6 drawing attention to the need for further investigations concerning ADHD correlates and comorbidities. ...
Background: Attention deficit hyperactivity disorder (ADHD) has been recognized as a tremendously clinically diverse condition, with one explanation showcasing the elevated rates of comorbidities with other psychiatric conditions. The consequences of social media are gaining much attention worldwide because of its rapidly increased use. A recent article in Lebanon revealed a prevalence of 25% of adolescents that suffer from one psychiatric disorder most commonly anxiety disorders and ADHD. The objective of this research project was to appraise any association between problematic social media use, and ADHD amidst an appropriate sample of the Lebanese people, and detect whether depression and/or anxiety could be considered as mediators of this association. Methods: This study took place between January and May 2019 and adapted a cross-sectional design. Proportionate random sampling techniques were applied on all Lebanese governorates, which channeled the recruitment of 466 community dwelling participants. Adult ADHD was identified using the Adult ADHD Self-Report Scale. Results: Higher problematic social media use (ORa=1.065) was significantly associated with higher odds of ADHD. When adding anxiety as an independent variable, the results showed that higher anxiety (aOR=1.043) was significantly associated with higher odds of ADHD. Anxiety mediated the association between PSMU and ADHD by 26.75%. Conclusion: A clear correlation was demonstrated in this study linking problematic social media use to anxiety and ADHD symptoms. It was interpreted by the constant stimulation provided by the social network sites that decreased significantly the attention. Future studies should evaluate the possible mechanisms and methods for effective awareness especially towards the younger generation.
Sexuality and disability is an important topic in our global society. Dismantling myths about sexuality and disability is considered a final frontier for people with disabilities. Dismantling myths about sexuality and disability is vital to the overall health and well-being of people with disabilities. A major aspect of the dismantling process is to acknowledge that sexuality is a significant quality of life determinant for all human beings. This chapter provides information that will promote a healthier and more accurate view of Sexuality and Disability. Dismantling this last frontier involves providing the readership with relevant historical information; information about psychosocial factors and attitudes that influence sexuality; and information about ethical practice guidelines. Information pertaining to sexuality training, specific provider competencies and how select disabilities and chronic illness impact sexuality is also covered in the chapter.
Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopment disorder that affects individuals across the lifespan. ADHD causes dysfunction when left untreated. Individuals receiving a diagnosis in adulthood have a unique life experience because of their delayed diagnosis. Objectives To identify and methodically review qualitative studies that explored the experiences of receiving a diagnosis of ADHD in adulthood, conduct an interpretive analysis of the identified studies, and produce a qualitative meta-synthesis to provide an understanding of these experiences. Methods Studies with adults diagnosed with ADHD in adulthood, focussed on experiences of receiving a delayed ADHD diagnosis, used qualitative methods, and were cited in PubMed, OVID, and ProQuest databases. Out of 251 studies identified, 7 met inclusion criteria. Results This qualitative meta-synthesis produced 2 main themes: ADHD as an identity and ADHD as a diagnosis, and 5 subthemes: identity before diagnosis, identity after diagnosis, the unnecessary struggle, the diagnosis as a revelation and a burden, and a functional life was finally possible. Conclusion Overall, this study showed that delayed diagnosis of ADHD causes suffering and dysfunction that could be mitigated through earlier diagnosis and treatment.
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Objective: To compare the long-term self-esteem and social function outcomes of individuals with untreated and treated ADHD across childhood, adolescence, and adulthood. Method: A systematic search of 12 databases was performed to identify peer-reviewed, primary research articles, published January 1980 to December 2011, reporting long-term self-esteem and/or social function outcomes (≥2 years; life consequences distinct from symptoms) of individuals with untreated or treated ADHD. Results: Overall, 127 studies reported 150 outcomes. Most outcomes were poorer in individuals with untreated ADHD versus non-ADHD controls (57% [13/23] for self-esteem; 73% [52/71] for social function). A beneficial response to treatment (pharmacological, nonpharmacological, and multimodal treatments) was reported for the majority of self-esteem (89% [8/9]) and social function (77% [17/22]) outcomes. Conclusion: Untreated ADHD was associated with poorer long-term self-esteem and social function outcomes compared with non-ADHD controls. Treatment for ADHD was associated with improvement in outcomes; however, further long-term outcome studies are needed. (J. of Att. Dis. 2013; XX(X) 1-XX).
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Background There is limited evidence of the unmet needs and experiences of adults with Attention Deficit Hyperactivity Disorder (ADHD) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients diagnosed during adulthood and childhood. Methods In this qualitative study, 30 adults with ADHD were recruited through an ADHD charity (n = 17) and two hospital outpatient clinics for adults with ADHD in England (n = 13). Half of the participants were diagnosed with ADHD during childhood or adolescence and the remainder during adulthood. Semi-structured interviews were conducted and data was analysed using a thematic approach based on Grounded Theory principles. Results Analysis revealed five core themes: ‘An uphill struggle’: the challenge of accessing services, ‘Accumulated Psychosocial Burden and the Impact of ADHD’, ‘Weighing up Costs vs. Benefits of ADHD Pharmacological Treatment’, ‘Value of Non-pharmacological Treatment’ and ‘Barriers to Treatment Adherence’. Accessing services and the challenges associated with securing a definitive diagnosis of ADHD in adulthood was an ‘uphill struggle’, often due to sceptical and negative attitudes towards ADHD by healthcare professionals. ADHD-related impairment had an overwhelmingly chaotic impact on every aspect of patients’ lives and many felt ill equipped to cope. A persistent sense of failure and missed potential from living with the impact of ADHD impairment had led to an accumulated psychosocial burden, especially among those diagnosed from late adolescence onwards. In contrast, positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many felt strongly that by itself, it was inadequate. Additional support in the form of psychological therapies or psycho-education was strongly desired. However, few patients had access to non-pharmacological treatment. In some, medication use was often inadequately monitored with little or no follow-up by healthcare professionals, leading to poor adherence and a sense of abandonment from the healthcare system. Conclusion The findings suggest that the unmet needs of adults with ADHD are substantial and that there is a wide gap between policy and current practice in England.
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Background: Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood. Methods: Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs.GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics. Results: Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed. Conclusion: This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made.
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Background In childhood, attention deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate levels of inattentiveness/disorganization, hyperactivity/impulsiveness, or a combination thereof. Although the criteria for ADHD are well defined, the long-term consequences in adults and children need to be more comprehensively understood and quantified. We conducted a systematic review evaluating the long-term outcomes (defined as 2 years or more) of ADHD with the goal of identifying long-term outcomes and the impact that any treatment (pharmacological, non-pharmacological, or multimodal) has on ADHD long-term outcomes. Methods Studies were identified using predefined search criteria and 12 databases. Studies included were peer-reviewed, primary studies of ADHD long-term outcomes published between January 1980 to December 2010. Inclusion was agreed on by two independent researchers on review of abstracts or full text. Published statistical comparison of outcome results were summarized as poorer than, similar to, or improved versus comparators, and quantified as percentage comparisons of these categories. Results Outcomes from 351 studies were grouped into 9 major categories: academic, antisocial behavior, driving, non-medicinal drug use/addictive behavior, obesity, occupation, services use, self-esteem, and social function outcomes. The following broad trends emerged: (1) without treatment, people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD, and (2) treatment for ADHD improved long-term outcomes compared with untreated ADHD, although not usually to normal levels. Only English-language papers were searched and databases may have omitted relevant studies. Conclusions This systematic review provides a synthesis of studies of ADHD long-term outcomes. Current treatments may reduce the negative impact that untreated ADHD has on life functioning, but does not usually 'normalize' the recipients.
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Across all medical specialties, quality of life has become an important measure of outcomes in both research and clinical settings. However, to date, there has not been a systematic review of the research relevant to quality of life in populations with adult attention deficit hyperactivity disorder. We approach quality of life in adult attention deficit hyperactivity disorder by answering the following questions: 1) What specific metrics are used to assess quality of life in adult attention deficit hyperactivity disorder? 2) What is the impact of adult attention deficit hyperactivity disorder on quality of life? 3) What effects do attention deficit hyperactivity disorder treatments have on quality of life? Searches of major electronic databases were conducted, and reference lists from the identified articles were searched for additional studies, with a focus on studies that utilized quality of life measures. Thirty-six relevant studies are included in our review. There are multiple unique measures currently used to measure quality of life in adult attention deficit hyperactivity disorder, ranging from general quality of life scales to those specifically designed for use in attention deficit hyperactivity disorder. Attention deficit hyperactivity disorder was found to significantly worsen the quality of life in adults. Treatment with atomoxetine and mixed amphetamine salts has shown beneficial effects on quality of life even in cases without symptomatology improvement. Pharmacological treatment and early diagnosis have a positive impact on outcomes, longterm prognosis, and quality of life in adults with attention deficit hyperactivity disorder. Having multiple unique measures of quality of life have limited the direct comparison of different classes of attention deficit hyperactivity disorder medication treatments and future research should be aimed to address this.
Introduction The prevalence of ADHD in adult population has been estimated at 2.5%. Higher rates (23.9%) have been reported among adult mental health service (AMHS) users. Aims To estimate the prevalence of ADHD among adult MH users in west county Ireland. Methods All consecutive patients attending any of 5 Sligo/Leitrim AMHS were invited to participate. Participants completed the Adult ADHD Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS). Clinical notes were reviewed to identify those with preexisting ADHD diagnosis. Exclusion criteria applied were: age: less 18 or above 65, illiterate, non-English speaking patients. Results From 792 attending the clinics, n = 59 (47 aged above 65, 10 severe learning difficulties and 2 non-English speaking) were excluded. Ninety-three (11.7%) decline to participate, giving a total of n = 640 (87% eligible response rate). Mean age was 41.27 (SD: 12.8), and 336 (52.5%) were females. Three had diagnosis of ADHD. Two hundred and thirteen (33.8%) met criteria on the WURS for childhood onset ADHD and 238 (37.5%) participants met caseness on the ASRS. Applying more stringent criteria of scoring on both scales, suggested 125 (19.5%) with unrecognised ADHD. Conclusions While recall bias (WURS) and the possibility of overlapping symptoms with other major psychiatric disorders in adulthood need to be considered, the use of both screening reduces these confounders and suggests a very high rate of ADHD. Given the low number previously identified, this becomes a clinical priority, both to offset the negative trajectories associated with untreated ADHD, but also to effect optimal treatments in comorbid conditions.
Objective: In recent years, the stigmatization faced by people with mental disorders has received considerable attention in the empirical literature. However, individuals with different disorders are subject to distinct types of negative attitudes, necessitating examinations of stigma that treat specific disorders individually. Method: This article reviews recent empirical literature concerning the stigmatization of ADHD. Further specificity is achieved by taking a developmental perspective, reviewing studies of stigmatizing attitudes as a function of the age of the target and perceiver. Results: Findings from nationally representative data sets, experimental investigations, surveys, and qualitative studies indicate that individuals of all ages who exhibit symptoms of ADHD are the recipients of substantial stigmatization. Conclusion: Although the stigmatizing attitudes of children and adolescents appear to differ in some ways from those of adults, negative perceptions toward people with ADHD appear to generally be present at all stages of development. (J. of Att. Dis. 2013; XX(X) 1-XX).
Examined the prevalence of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder among adults admitted to 2 chemical dependency treatment centers. It was hypothesized that ADHD alone or in combination with conduct disorder would be overrepresented in a population of patients with psychoactive substance use disorders. 201 Ss were selected randomly from 2 chemical dependency treatment centers. 48 (24%) of the Ss were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95). 79 participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse. Ss with conduct disorder were younger, had a greater number of jobs as adults, and were more likely to repeat a grade in school, have a learning disability, be suspended or expelled from school, have an earlier age at onset of alcohol dependence, and have had a greater number of treatments for drug abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)