source: additudemag.com

Signs of ADHD aren’t as easy to spot in adults as in children. Adult ADHD can be more subtle and misinterpreted as another mental health condition, complicating its diagnosis.

Whether or not ADHD was diagnosed during childhood, it can pose different challenges during adulthood. Symptoms affect more aspects of your life, such as personal relationships, work, and emotions.

Without treatment and support, ADHD can cause people to struggle with career goals, memory, prioritizing, and daily tasks at work and home.

Recognizing signs of ADHD is the first step toward real change. Knowing the facts empowers you to seek the professional help you may need to overcome challenges and thrive.

Read on to discover some of the main signs and symptoms of ADHD in adults.

While many people will experience these issues at some point, ADHD means a persistent pattern (at least six months) of behavior that interferes with your ability to function. 

1. Difficulty Focusing

People with ADHD may lack control over what they focus on and have difficulty concentrating.

You may notice the following: [1]

  • Easily distracted
  • Daydreaming
  • Zoning out during conversations
  • Overlooking instructions and details
  • Unable to finish projects or tasks on time

Another symptom of ADHD is a tendency to hyperfocus on projects you find exciting and interesting. In this state, you may be unable to turn your attention toward other important tasks or people in your life.[2]

2. Misplacing Items

Storing, organizing, or keeping track of belongings can be troublesome for those with ADHD.

This can involve:

  • Misplacing everyday items (i.e., car keys or wallet) while the brain is on autopilot
  • Losing track of where an item is placed after a moment of inattention
  • Constantly retracing steps to find lost items
  • Storing things in the wrong places (i.e., work papers in your car, dirty dishes in the bedroom).

3. Always Running Late

Due to poor time management, adults with ADHD often run late for meetings, appointments, or social plans.

Reasons include:

  • Unable to find required items (car keys, wallet, meeting notes, etc.)
  • Forgetting dates and times
  • Underestimating time needed to complete tasks
  • Getting distracted while preparing for an appointment or event

4. Risky Behaviors

Research shows that adults with ADHD are more likely to engage in risk-taking behavior (RTB).[3] These behaviors may involve the following:

  • Starting arguments or fights
  • Overspending
  • Reckless driving
  • Substance use (alcohol or drugs)
  • Risky sex-related decisions (i.e., unprotected sex)
  • Gambling
  • Impulsive eating

By seeking help and support, you can proactively reduce your chances of involvement in these activities.

5. Lack of Listening

Social interactions may feel like a challenge if you have ADHD. You may struggle with: [1]

  • Waiting for your turn to speak
  • Staying on topic
  • Keeping track of the conversation
  • Using non-verbal cues to show active listening
  • Talking too fast
  • Speaking too much
  • Blurting out words that make others uncomfortable
  • Unable to read other people’s body language

6. Prioritization Perils

Adults with ADHD are almost always occupied. However, deciding which task to prioritize can be a challenge.

You may struggle with prioritization for any of the following reasons:

  • Feeling like you have too much to do (which can overwhelm you, even get you into a state of ADHD paralysis)
  • All tasks feel equally important
  • Difficulty thinking ahead – you underestimate deadlines
  • Seeking novelty over familiar tasks that may be more significant and relevant

Adults with ADHD also tend to procrastinate on tasks that require more focus and attention, leading to missed deadlines and workplace issues.

7. Relationship Roadblocks

Problems in relationships with friends, colleagues, family, or partners is another common issue for adults with ADHD.

There are several reasons why symptoms of ADHD can cause tension, anger, and frustration.

Some ADHD traits that may lead to relationship strains include:

  • Speaking over the other person
  • Not actively listening to the other person
  • Forgetting important events and dates (like birthdays)
  • Blurting out hurtful statements
  • Failing to fulfill responsibilities, commitments, or promises
  • Trouble regulating emotions

Despite these challenges, adults with ADHD can have happy relationships and fulfilling marriages. Seeking professional counseling and support is one of the best ways to work toward this.

8. Nervous Energy

Another sign of ADHD in adults is restlessness. This may present in a variety of ways:

  • Flight of thoughts
  • Constant fidgeting
  • Tics and impulsive behaviors
  • Overthinking and catastrophizing
  • Trouble sitting still

Fidgeting is often misinterpreted as inattention in adults with ADHD. However, fidgeting and stimming can signify attempts to stay focused when a task isn’t providing enough stimulation for the brain.

Interestingly, fidgeting may help increase the ability to focus and concentrate in adults.[4]

9. Memory Issues

ADHD may impact two different kinds of memory.

Working memory is your brain’s short-term storage space, and it’s where adults with ADHD are more likely to experience problems.[5]

Here are some examples of how ADHD can impact working memory:

  • Forgetting things on grocery lists
  • Leaving essential items at home
  • Losing track of belongings
  • Difficulty following instructions to complete tasks
  • Re-reading sections of text due to not retaining information

ADHD’s impact on long-term memory isn’t well understood. Some research shows that adults with ADHD may experience problems with long-term memory.

The ADHD brain tends to encode information in a disorganized manner, interfering with the storage of new information.[6]

10. Easy to Anger

An estimated 70% of adults with ADHD experience mood swings (emotional dysregulation).[7]

Adults with ADHD may notice the following signs of emotional turbulence:

  • Impatience when under stress
  • Explosive outbursts of anger
  • Persistent irritability
  • Surges of anger when met with everyday obstacles
  • Frequent and reactive mood changes
  • Unaware of the other party’s feelings

Professional therapy, medications, and self-care can play a vital role in managing ADHD-related anger.

Adult ADHD Symptoms: It’s Not Too Late to Get Them Diagnosed

If you think you’re experiencing some of the signs and symptoms of ADHD, it’s best to take your concerns to a trusted healthcare provider who can address them effectively.

Try to seek a professional specializing in treating and supporting adults with ADHD.

The ADDA adult ADHD test is a great starting point to screen yourself for signs of ADHD.

Check out ADDA’s online resource hub if you’d like to learn more about adult ADHD. Here, you’ll gain access to support groups, communities, and tips on how to live and thrive with ADHD.

How ADHD Ignites Rejection Sensitive Dysphoria

For people with ADHD or ADD, rejection-sensitive dysphoria can mean extreme emotional sensitivity and emotional pain — and it may imitate mood disorders with suicidal ideation and manifest as instantaneous rage at the person responsible for causing the pain. Learn more about ways to manage RSD here.

William Dodson, M.D.

By William Dodson, M.D., LF-APAVerifiedMedically reviewed by Sharon Saline, Psy.D.Reviewed on February 28, 2020

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What is Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria (RSD) is extreme emotional sensitivity and pain triggered by the perception that a person has been rejected or criticized by important people in their life. It may also be triggered by a sense of falling short—failing to meet their own high standards or others’ expectations.

Dysphoria is Greek for “difficult to bear.” It’s not that people with attention deficit disorder (ADHD or ADD) are wimps, or weak; it’s that the emotional response hurts them much more than it does people without the condition. No one likes to be rejected, criticized or fail. For people with RSD, these universal life experiences are much more severe than for neurotypical individuals. They are unbearable, restricting, and highly impairing.

When this emotional response is internalized (and it often is for people with RSD), it can imitate a full, major mood disorder complete with suicidal ideation. The sudden change from feeling perfectly fine to feeling intensely sad that results from RSD is often misdiagnosed as rapid cycling mood disorder.

It can take a long time for physicians to recognize that these symptoms are caused by the sudden emotional changes associated with ADHD and rejection sensitivity, while all other aspects of relating to others seem typical. RSD is, in fact, a common ADHD trait, particularly in adults.

When this emotional response is externalized, it looks like an impressive, instantaneous rage at the person or situation responsible for causing the pain.

[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

RSD can make adults with ADHD anticipate rejection — even when it is anything but certain. This can make them vigilant about avoiding it, which can be misdiagnosed as social phobia. Social phobia is an intense anticipatory fear that you will embarrass or humiliate yourself in public, or that you will be scrutinized harshly by the outside world.

Rejection sensitivity is hard to tease apart. Often, people can’t find the words to describe its pain. They say it’s intense, awful, terrible, overwhelming. It is always triggered by the perceived or real loss of approval, love, or respect.

People with ADHD cope with this huge emotional elephant in two main ways, which are not mutually exclusive.

1. They become people pleasers. They scan every person they meet to figure out what that person admires and praises. Then they present that false self to others. Often this becomes such a dominating goal that they forget what they actually wanted from their own lives. They are too busy making sure other people aren’t displeased with them.

[ADHD, Women, and the Danger of Emotional Withdrawal]

2. They stop trying. If there is the slightest possibility that a person might try something new and fail or fall short in front of anyone else, it becomes too painful or too risky to make the effort. These bright, capable people avoid any activities that are anxiety-provoking and end up giving up things like dating, applying for jobs, or speaking up in public (both socially and professionally).

Some people use the pain of RSD to find adaptations and overachieve. They constantly work to be the best at what they do and strive for idealized perfection. Sometimes they are driven to be above reproach. They lead admirable lives, but at what cost?

How do I get over RSD?

Rejection sensitivity is part of ADHD. It’s neurologic and genetic. Early childhood trauma makes anything worse, but it does not cause RSD. Often, patients are comforted just to know there is a name for this feeling. It makes a difference knowing what it is, that they are not alone, and that almost 100% of people with ADHD experience rejection sensitivity. After hearing this diagnosis, they’re relieved to know it’s not their fault and that they are not damaged.

Psychotherapy does not particularly help patients with RSD because the emotions hit suddenly and completely overwhelm the mind and senses. It takes a while for someone with RSD to get back on his feet after an episode.

There are two possible medication solutions for RSD.

The simplest solution is to prescribe an alpha agonist like guanfacine or clonidine. These were originally designed as blood pressure medications. The optimal dose varies from half a milligram up to seven milligrams for guanfacine, and from a tenth of a milligram to five-tenths of a milligram for clonidine. Within that dosage range, about one in three people feel relief from RSD. When that happens, the change is life-altering. Sometimes this treatment can make an even greater impact than a stimulant does to treat ADHD, although the stimulant can be just as effective for some people.

These two medications seem to work equally well, but for different groups of people. If the first medication does not work, it should be stopped, and the other one tried. They should not be used at the same time, just one or the other.

The second treatment is prescribing monoamine oxidase inhibitors (MAOI) off-label. This has traditionally been the treatment of choice for RSD among experienced clinicians. It can be dramatically effective for both the attention/impulsivity component of ADHD and the emotional component. Parnate (tranylcypromine) often works best, with the fewest side effects. Common side effects are low blood pressure, agitation, sedation, and confusion.

MAOIs were found to be as effective for ADHD as methylphenidate in one head-to-head trial conducted in the 1960s. They also produce very few side effects with true once-a-day dosing, are not a controlled substance (no abuse potential), come in inexpensive, high-quality generic versions, and are FDA-approved for both mood and anxiety disorders. The disadvantage is that patients must avoid foods that are aged instead of cooked, as well as first-line ADHD stimulant medications, all antidepressant medications, OTC cold, sinus, and hay fever medications, OTC cough remedies. Some forms of anesthesia can’t be administered.

Rejection Sensitive Dysphoria: Next Steps

Dr. William Dodson

Dr. William Dodson is a member of ADDitude’s ADHD Medical Review Panel.

Rejection-sensitive-dysphoria (RSD) is a condition that causes severe emotional pain in response to perceived or actual rejection or criticism. People with RSD may experience symptoms such as:

  • Being easily embarrassed or ashamed
  • Having an emotional outburst and getting angry when they feel rejected
  • Setting impossibly high standards for themselves
  • Experiencing low self-esteem

RSD is often associated with ADHD, but it can affect anyone and may be present alongside other mental health conditions, like depression. Doctors and therapists often use the term when they notice exaggerated reactions connected to an official behavioral condition like ADHD.

RSD is not a formal diagnosis, but rather one of the most common and disruptive manifestations of emotional dysregulation. A mental health professional may help you create a plan that addresses the cause of your symptoms and how you experience them.

References

[1] Targum, S. D., & Adler, L. A. (2014). Our current understanding of adult ADHD. Innovations in clinical neuroscience, 11(11-12), 30–35.

[2] Ashinoff, B. K., & Abu-Akel, A. (2020). Hyperfocus: the forgotten frontier of attention. Psychological Research, 85(1), 1-19. https://doi.org/10.1007/s00426-019-01245-8

[3] Pollak, Yehuda, Dekkers, Tycho J., Shoham, Rachel, Huizenga, Hilde M. (2019).Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): a Review of Potential Underlying Mechanisms and of Interventions. Curr Psychiatry Rep 21, 33 (2019). https://doi.org/10.1007/s11920-019-1019-y

[4] Farley, J., Risko, E. F., & Kingstone, A. (2013). Everyday attention and lecture retention: the effects of time, fidgeting, and mind wandering. Frontiers in Psychology, 4. https://doi.org/10.3389/fpsyg.2013.00619

[5] Kofler, M. J., Singh, L. J., Soto, E. F., Chan, E., Miller, C. E., Harmon, S. L., & Spiegel, J. A. (2020). Working memory and short-term memory deficits in ADHD: A bifactor modeling approach. Neuropsychology, 34(6), 686–698. https://doi.org/10.1037/neu0000641

[6] Skodzik, T., Holling, H., & Pedersen, A. (2017). Long-Term Memory Performance in Adult ADHD. Journal of attention disorders, 21(4), 267–283. https://doi.org/10.1177/1087054713510561

[7] Beheshti, A., Chavanon, M. L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry, 20(1), 120. https://doi.org/10.1186/s12888-020-2442-7
ADHD & Symptom Tests

REJECTION SENSITIVE DYSPHORIA

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