Making Sense

A Guide to Living with

Adult ADHD

Alinda Gillott
 Published by Crocodile House Ltd
First edition 2013

Copyright © Nottinghamshire Healthcare NHS Trust 2013

ISBN 978-0-9570165-1-4

Author
Dr Alinda Gillott
Consultant Clinical Psychologist

Acknowledgements
Thank you to Professor Chris Hollis and Dr Barbara Houghton for editorial comments

For contributions about their ADHD, thank you to:

John, Joe, Bev, Vicky, Scott and Paul

Design and photography - Crocodile House

Any profit made from the sale of this product

will be used to benefit the local service
About ADHD

What is ADHD?
Attention Deficit Hyperactivity The symptoms of ADHD include:
Disorder (ADHD) is a common
• Inattention – difficulty concentrating for very long or finishing
neurodevelopmental condition, which
tasks, disorganised, easily distracted, forgetful, unable to listen
typically starts in childhood and, for
when people are talking
most people, continues into adult life.
• Hyperactivity – fidgety, unable to sit still, talking excessively,
always on the go, feeling of inner restlessness
• Impulsivity – acting quickly without thinking about the
consequences, interrupting other people, difficulty waiting turn

Most people can have these sorts of

difficulties at times, but for individuals
with ADHD, the symptoms are there
most of the time and can seriously
affect their everyday life.

Not everyone has the same pattern

of ADHD symptoms. Whilst many
individuals with ADHD have
difficulties in all three areas of
inattention, hyperactivity and
impulsivity (called ‘ADHD combined
type’), some individuals mainly
have difficulties with inattention
(sometimes described as ‘ADD’ or
‘ADHD inattentive type’). Because
ADHD is a developmental condition,
symptoms can change over time.
Adults often describe inner
restlessness and feeling fidgety rather
than being hyperactive and unable to
stay in their seat.

Page 3
How ADHD impacts on
day-to-day life

Impact in childhood Impact in adult life

• Difficulty concentrating on • Difficulty keeping attention on
schoolwork daily tasks and with finishing
tasks
• Difficulty remembering
things needed for school • Frequent job changes or job
losses
• Frequently losing things
• Difficulty managing personal
• Disruptive in the classroom
relationships
• Difficulty keeping friends
• Unsafe driving – accidents;
• Frequent accidents and speeding Is it real?
injuries Yes! For many years people doubted
• Difficulty managing money ADHD was a real condition, and felt it
• Difficulty with organisation was just an excuse for bad behaviour
and time management or poor parenting. Research has now
shown that ADHD is a real condition,
which can be helped through
treatment and support1.

How many people have ADHD?

Research has shown that around 2-5% of children have ADHD2. As children
develop, symptoms can change, and some children ‘grow out’ of ADHD, or
seem to be less affected by it. Most children with ADHD continue to have
symptoms as adults3, which means around 2% of the adult population.

1. Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E, & Doyle AE (2000). Attention-
deficit/hyperactivity disorder in adults: an overview. Biological Psychiatry, Jul 1;48 (1):9-20
2. Simon V, Czobor P, Balint S, Meszaros A, & Bitter I (2009). Prevalence and correlates of adult attention-
deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry, 194(3):204-211
3. Faraone SV, Biederman J, & Mick E (2006). The age-dependent decline of attention deficit hyperactivity
disorder: a meta-analysis of follow-up studies. Psychological Medicine, 36(2):159-165

Page 4
What causes ADHD?
The exact cause of ADHD is not fully understood. We do know that ADHD tends
to run in families, so there is likely a genetic link. Research has shown that
having a family member with ADHD increases the likelihood of other family
members having the same condition4. Frequently adults think about whether
they might have ADHD when their child is diagnosed as they notice the same
symptoms in themselves.

Chemicals in the brain (called ‘neurotransmitters’) also seem to be affected

in individuals with ADHD, particularly dopamine and norepinephrine. These
neurotransmitters affect how messages to the brain connect, or switch on and
switch off, impacting behaviours such as focusing attention and controlling
impulses.

There also appear to be differences in the parts of the brain that control activity
and attention in individuals with ADHD. The frontal lobes, which act as the brain’s
‘brakes’ and control executive functioning, appear to be affected in ADHD.

Executive functioning
The executive functions relate to mental tasks such as paying attention,
planning activities, short-term memory, solving problems, controlling
actions (inhibition), thinking flexibly, getting started on tasks, doing more
than one task at once, and tracking progress on tasks. The ability to
control emotions is also affected. Difficulties in executive functioning are
frequently seen in ADHD and can impact on daily life.

Additional issues
Frequently adults with ADHD can experience other difficulties (called
‘co-morbidities’) such as mental health problems, personality disorder,
sleep problems, substance misuse and offending behaviours. Other
neurodevelopmental conditions may also be present, such as Tourette
syndrome (and other tic disorders), autism spectrum conditions, dyslexia, and
developmental co-ordination disorder (dyspraxia).

Often adults with ADHD find it difficult to manage their emotions. They can
experience frequent mood changes, find it difficult to cope with stress, and can
be quick tempered.

4. Thapar A, Holmes J, Poulton K & Harrington R (1999). Genetic basis of attention deficit and
hyperactivity. British Journal of Psychiatry, 174, 105–111

Page 5
Being assessed for ADHD

If you think you might have ADHD, ask yourself these questions:
Do you have difficulty concentrating, even on something you enjoy?

Do you leave important tasks until the last minute?

Are you easily distracted?

Do you do things without thinking (impulsive)?

Do you have difficulty organising yourself?

Are you often late even though you try to be on time?

Do you often find it difficult to sit still or feel restless inside?

Are you often busy doing things, but never seem to get anything finished?

Do you often find it difficult to wait your turn in conversation or in a queue?

Do you often find that you lose track of a conversation?

Do you often find yourself forgetting to do things?

Do you find it difficult to manage your emotions?

There may be lots of reasons you find these things difficult, but these are all also symptoms of ADHD

Page 6
How do I get assessed for What will happen
ADHD? during the diagnostic
Being assessed for ADHD is an assessment?
important part of understanding Different clinics may have slightly
your difficulties and getting the different ways of carrying out an
support you need. It is important to assessment. Elements may include:
be assessed by someone who knows
about ADHD such as a Psychiatrist, • Screening questionnaires –
Clinical Psychologist or Nurse you might be asked to fill in
Specialist, who has been trained in the questionnaires about your ADHD
assessment of ADHD. type symptoms and how these
symptoms affect your daily life
Assessment for ADHD must include • A developmental interview -
assessment of other difficulties that questions about what you were like
may better explain your symptoms as a child as well as difficulties you
such as mental health problems or experience now
other developmental conditions.

Tip: bringing old school reports to the

assessment can be useful and help to remind you
of what you were like when you were younger

• Interview or information from

a parent or partner – it can be
really useful to ask a parent or
partner about their experience of
the difficulties you are reporting
• Psychological assessment –
you may be asked to meet with
a psychologist for assessment.
They can look in more detail at
difficulties such as attention,
memory, planning and organising

Page 7
Okay, so I’ve got ADHD, what now?

“It made me understand why I am

the way I am”
Bev, diagnosed at age 34 years

This booklet will help you to better It might also be useful for you Getting a diagnosis of ADHD may
understand and manage your ADHD. to show this booklet to other provoke mixed feelings: it may be
Understanding your condition can important people in your life such a relief to finally feel understood.
help you feel more positive and as your partner, parents, friends, However, there may also be feelings
develop new ways to overcome the and work colleagues. Helping them of sadness, anger or regret for not
difficulties. to understand your ADHD will help being diagnosed earlier and mourning
reduce any misunderstanding or for lost opportunities or feeling you
frustration they may have about your have not fulfilled your potential.
difficulties, and develop some ways of
getting the most out of life with you.

“Without sounding cheesy,

getting a diagnosis has changed
my life because now I am getting
the right help”
Joe, diagnosed at age 18 years

It is important to recognise that these

sorts of feelings are common after
diagnosis and you may need some
support to manage the feelings.
Getting diagnosed with ADHD might
feel like the end of a long journey, but
is actually only the start of getting the
help and support available to achieve
the things you want to do.

Page 8
Growing up with ADHD Looking back, you may feel you
Life can be challenging growing didn’t get on as well as you could “I was always hyperactive
up with ADHD. You may have been have done at school. Often children [as a child], wouldn’t accept
diagnosed during childhood, or with ADHD experience difficulties things, wouldn’t listen”
perhaps you didn’t receive your with their schoolwork, and don’t do John, age 24 years
diagnosis until you were an adult. as well in exams as they are expected
Either way, if you have ADHD, you to do. Behaviours in the classroom
have always had these symptoms. such as daydreaming, blurting out
answers, and interrupting other
children, can result in lots of negative
attention from teachers. At home “my mum and dad always
your behaviour may have also been used to say to me – will you
frustrating to family members. Friends slow down Paul, will you sit
may have found your energy and down for a minute”
distractibility difficult to cope with, Paul, diagnosed with ADHD
and may not always have wanted to at age 37 years
play with you.

Understanding that these things were

due to ADHD and not bad behaviour
or poor parenting is an important step
forward. As adults we have better
ability to understand and have more
control over our lives.

Page 9
Making the transition A brief word for partners
Sometimes being in a relationship “[Scott is] very forgetful,
to being an adult with very disorganised…I am
with a person with ADHD can be
ADHD challenging. Difficulties starting starting to accept it’s
If you were diagnosed with ADHD as and completing tasks, mismanaging ADHD... it’s hard to remain
a child it is likely that you had to go household finances, and difficulties angry for too long when
for regular medical appointments and with communicating can put stress you know these things have
may have been encouraged to take on a relationship. Don’t despair – a good reason”
ADHD medication. Some children do there are ways to overcome these Sonia, wife of Scott
appear to ‘grow out’ of their ADHD, challenges! Learning about ADHD
whilst for others symptoms continue and understanding your partner’s
throughout their lives. Because it is difficulties are the first steps
a developmental condition, often towards making a difference in your
ADHD symptoms change over time. As relationship. Developing strategies
children with ADHD grow, behaviours together to overcome some of those
such as hyperactivity and impulsivity difficulties will also help to get the
can settle for some individuals. most out of the time you spend
together. Remember – adults with
Often adolescence is a time when you ADHD can be energetic, fun and
start to develop your own identity and creative – just some of the reasons
want to become more independent. you were attracted to them in the first
You may rebel against having place!
ADHD and decide to stop taking the
medication. For some young people
this is okay, and they can carry on
their lives without ongoing treatment.
Some young people find over time
that they are having difficulty
progressing with the things they want
to do, such as university or work. If Being a parent with ADHD
this sounds familiar, you may want Being a parent can be tough for anyone, and can be even more challenging
to think about support options as an when you have ADHD! You may also have a child who has ADHD or another
adult living with ADHD. neurodevelopmental condition such as autism.

It can be difficult trying to organise and manage a family when you have
difficulty organising and managing your own life. Developing strategies to
overcome your own difficulties will have a positive effect on your parenting
and family life. You may also want to seek additional advice and support
around parenting.

Page 10
Getting help for adult ADHD

Medication to build up in the body and need to

[ADHD medication] “It’s as The National Institute of Clinical be taken every day. Non-stimulant
though someone is putting Excellence (NICE) recommends medication is often recommended
the brakes on and slowing medication as the first form of when the individual has another
me down” treatment for adults with ADHD. condition, such as autism, or substance
Paul, age 39 years misuse.
The most common medicines
used to treat ADHD are known as Your doctor will talk to you about the
‘stimulants’ and the most commonly best type of treatment for you and
used stimulant is methylphenidate. will work with you to get the dose
Methylphenidate is available as short right. This can take time, individuals
acting tablets which are usually taken vary in the amount of medication they
2-3 times daily, or as long acting need. Your doctor will also want to
tablets taken once daily. Because monitor your physical health while
stimulants are in your body for a short taking medication, including your
period of time, it is possible to be sleep, appetite, weight, pulse and
flexible about when you take them. blood pressure.
Although most people find that when
medication is effective they want its
benefits all the time, some adults
do not want to use medication all
of the time and may take breaks at
weekends or for longer periods.

Where stimulants are not suitable,

or not wanted, different types of
medication (‘non-stimulants’), such
as atomoxetine, are also used. These
are usually taken once daily. Unlike
stimulants, non-stimulants take time

Page 11
Substance misuse If you misuse substances it will
Many young people and adults be important for your doctor to “It [alcohol] slowed me
with ADHD, particularly when they understand some of the factors down and put me at ease.
are not diagnosed or not receiving related to your substance use such What would normally set my
treatment, misuse substances. as significant life events, daily emotions off quickly, it would
Common substances used or misused stressors, and social relationships. really dampen me down”
in ADHD include nicotine, alcohol, Understanding and treating your Paul, diagnosed with ADHD
cannabis, amphetamines, cocaine, substance use will be important to age 37 years
and prescription drugs. Often consider alongside any medication
individuals with ADHD report that you receive to treat your ADHD. You
these substances help to ‘dampen’ may find that you no longer want
symptoms of ADHD and they feel or need to use these substances
calmer. For others it’s about risk taking once you get the right treatment
and sensation seeking. Sometimes for ADHD. Your doctor may have a
a contradictory effect is observed concern that if stimulant medications
to that expected with a drug. For are prescribed you may be at risk of
example, rather than feeling hyped up misusing these, or passing them on to
on amphetamines, some individuals others. Other medications do not carry
with ADHD notice that it helps them these risks and may be more suitable
to focus and concentrate. for your treatment.

Offending behaviour
As a result of difficulties controlling ADHD symptoms, particularly hyperactive-
impulsive symptoms, some individuals with ADHD end up in trouble with the
authorities or police due to their behaviour. Some children with ADHD receive
a diagnosis of conduct disorder or oppositional defiance disorder. Truancy,
shoplifting, vandalism and fighting can be common early behaviours. For some
this can lead on to further offending, resulting in involvement with the criminal
justice system.

Frequently criminal behaviour is not planned, but as a result of impulsive acts

such as aggressive outbursts, opportunistic theft, and damage to property.
Difficulties controlling impulses and thinking of alternatives (problem solving)
can increase these sorts of behaviours. Peer pressure can also be a factor.

Getting diagnosed with ADHD and engaging in treatment can help to reduce
these sorts of behaviours, and help you to access the support you need.

Page 12
Strategies to manage your ADHD

Whether or not you take ADHD medication, you may

want to develop different strategies to overcome
difficulties you experience due to ADHD. These
strategies can help you to feel more in control and
progress with the things you want to do.

“It’s not that I don’t have

ideas or have thoughts, the
problem is that I have too
many”
Scott, age 42 years

Managing daily tasks

Because of your ADHD you may never
have developed skills in organising
yourself. As a child your parents may
have needed to do this for you and as
an adult, a partner may have taken
over many of these tasks. Difficulties
in organising yourself, remembering
things, and being on time, isn’t about
being lazy or stupid. It’s about having
ADHD, and you can develop strategies
to manage these tasks better for
yourself.

Page 13
 It is important to develop daily routines so
the strategies become habit:
1. Use a diary and/or wall calendar - write appointments on it
as soon as you make them. Make a habit of looking in your diary
every morning to see what you have planned to do that day.
2. Make a task list - just keep one list. Keep it small and
manageable. Tick off items when you have done them so you can
track your progress. Include reminders about paying bills, making
phone calls, and buying food.
3. Create a home filing system - use folders or dividers to
store different types of paperwork such as bills, receipts, bank
statements, and medical letters. Use labels and different coloured
folders so you can find what you need easily. Have a regular clear
out of papers you no longer need to keep.
4. Develop a ‘10-minute tidy’ routine - rather than feeling
overwhelmed at all the tasks you need to do, just spend 10
minutes each day on tasks such as sorting the post, filing
paperwork, picking up laundry or pots. This might not sort all
of the things you need to do, but it will help you feel more in
control – and it’s only 10 minutes!
5. Become more aware of the time - minutes can feel like hours,
hours can feel like minutes – always make sure you have a watch
or clock nearby and keep checking it regularly so that you haven’t
become distracted or late for an appointment. Tip: Smart phones can be
6. Set reminders - use visual reminders such as coloured post-it useful for keeping track of
notes on the fridge or front door, or the alarm on your mobile your appointments and task
phone to remind you of tasks to do that day. list - but always keep a back
up in case you lose it!
7. Keep important things in set places - always leave your keys,
phone, wallet and other important things in the same place every
day so you don’t waste time looking for them.
8. Deal with it now - as soon as you get a letter, email, or phone
message – respond to it now, rather than saying you will do it
later and then forgetting to do it (if you can’t do it now, put it on
your daily task list or calendar).

Page 14
Managing friendships
“[I said to my girlfriend]
and relationships if we start going out, I’m
Many individuals with ADHD
warning you that it’s going
have successful friendships and
to be a rollercoaster!”
relationships. Like all relationships,
John, age 24 years
there can be difficulties at times.

Common social difficulties for adults

with ADHD can include difficulty
paying attention during conversation,
difficulty taking turns, blurting
things out, and changing the subject.
Forgetting to meet up, forgetting Strategies to
special occasions such as anniversaries
and birthdays, and being late to meet
manage your
can also be a frustration for friends emotions:
and partners. Within a relationship Managing emotions • Take a breath – stop
it can be difficult to manage Often individuals with ADHD notice yourself from impulsively
responsibilities such as running their moods can change quickly. You reacting
the home and paying bills. It is not may notice that you become angry
unusual for a partner to feel a bit like or tearful quickly. You may not know • Walk away – come back
a parent in the relationship, having why your mood has changed, or later to the situation when you
to take responsibility for finances, feel it has been an overreaction to the feel calmer
planning, and organisation of the situation. This may lead to feelings
• Take your mind off it –
household. of embarrassment or guilt, or feeling
do something else such
that you are not in control of how you
as making a drink or
It is possible to improve social skills by feel.
watching TV
learning conversational and listening
strategies. Using an electronic diary or Some of the difficulties you have • When you feel calmer,
calendar can help you to remember experienced may be due to struggling think through what has
social occasions and using an alarm with ADHD symptoms without happened, and how you
can help you meet up on time. realising you have the condition. You can deal with it
may have developed some reactive
Within relationships it can help to responses to situations you haven’t
work out your different strengths, known how to understand or cope
and divide up tasks based on these. with. Being diagnosed with ADHD You may also find it useful to see a
Strategies such as using time planners, can be a huge relief and a new way counsellor or psychologist to help you
task lists, having weekly planning forward for understanding and to better understand and manage
meetings, or daily ‘catch-up’ sessions managing your difficulties. Getting your emotions – you can talk to your
can be really helpful. the right medication can be one part doctor about getting a referral for this
of managing your emotions. type of support.

Page 15
Managing sleep
Sleep can be a real difficulty for many Strategies to sleep better
adults with ADHD. You may find that
• Keep a regular bedtime - this will allow your body to get used to
you have lots of energy through the
the routine of sleep
day but when it’s time to lie down
and go to sleep – you can’t! You might • Avoid taking naps during the day
find that you just lie in bed thinking
• Try not to be too active before bed - activities such as exercising
about anything and everything. Once
can help you sleep and burn off energy, but try to stop these a
asleep, waking up the next day can
couple of hours before you go to bed
also be a real difficulty.
• Try to avoid a big meal or lots of drinks before bed - this can make
it more difficult for you to settle or may cause you to wake in the
Tip: alcohol is a stimulant night
and may actually keep you • Try to avoid stimulants before bed such as caffeine (coffee, tea,
awake! Having a warm milky cola, chocolate), nicotine, and alcohol
drink will be more likely to
help you settle to sleep • Winding down activities such as listening to music or the radio
quietly, or reading a magazine or book where you are not too
engaged in the story, can help with settling
• If your thoughts are keeping you awake, distract them by
repeating a boring word in your head (such as ‘the’ or ‘and’)
• If you can’t settle to sleep - get up! Go to another room and relax
until you feel tired and ready for sleep again

Managing money
Tip: Try internet banking Money management requires
- organising your money budgeting, planning, and
online means you can access organisation, which for many adults
your account day or night, with ADHD can be a real challenge.
with less paperwork to keep
track of Keep track of your every expense, no
matter how small, for a month. Write
it in a small notebook you can keep
in your bag or pocket. This will help
you to look at areas where you may
be wasting money (such as meals out
or take-aways when you could cook
at home more cheaply) and highlight
unnecessary impulsive purchases.

Page 16
 Parenting
“Every time I go into a shop It can be difficult trying to organise
I buy something that’s not and manage a family when you have
needed and most of the time difficulty organising and managing
I come out without the thing your own life due to ADHD. Here are
that I went in for” some steps you can take to help you
Vicky, age 36 years feel more in control:

Set up a daily routine - All children

respond well to routine, and this
Strategies to manage will help you too. A daily plan helps
impulse shopping to structure the day and provides
Impulsivity in ADHD and shopping can predictability. Put a wall calendar up
be a dangerous combination! This where everyone can see it and use it,
can lead to unnecessary spending and such as on the fridge.
debts. These strategies can help to
manage shopping differently: Organise your home - Use drawers
and storage boxes around the house.
• Shop with cash only - leave your Clear them out regularly so clutter
bank cards at home doesn’t build up, especially when the
• Have only one bank card to keep children have grown out of clothes or
track of toys. Make it clear that when things
are used, they must go back into their
• When you go shopping, take a list proper place when finished with.
of what you need and stick to it
• Keep a running total whilst
shopping (you can use the
calculator on your mobile phone) “Being a parent with ADHD
you have wacky ideas, you
• Stay away from places where you
decide to drive all the way to
know you’re likely to spend too
Birmingham for a McDonalds,
much money
you drive to Skegness for a
• Throw away catalogues that come pair of sunglasses”
in the post as soon as they arrive so Vicky, age 36 years
they are not a temptation
“Pound shops are the worst.
• Delete ‘junk’ emails trying to sell I’ve worked out on average
you products you don’t need I spend £9 when I go in for
one bottle of pop”
Vicky, age 36 years

Page 17
 Finally… remember there
“school routine was
are lots of positives to Bev’s top 5 things
disastrous, always late, never
on time, never organised, my having ADHD about living with
house was a tip” As a person with ADHD you can liven ADHD:
Vicky, age 36 years things up due to your energy and
1. spontaneous
enthusiasm, kindness and sympathy,
creativity and unique problem solving 2. child like energy
Get Support - You don’t have to do skills. These can also be important
3. creative
this on your own! There may be a qualities to bring to the workplace.
partner or family members around It is important to focus on the things 4. fast paced mind
who can help you. It may also be you can do as much as the things
that challenge you. Now you know 5. sensitive to other people
helpful to access additional support
through health, education and social you have ADHD, you can learn to
care agencies. Meeting other parents overcome challenges, develop new
who have ADHD or who have a skills and relationships.
child with ADHD can also be helpful “you have wacky ideas”
to share experiences and tips and Scott, age 42 years
provide emotional support.

Look after yourself - For any parent

it is important to look after yourself. If
you are on ADHD medication, taking
it regularly will help you to keep on “I’m a funny guy, I make
top of tasks and feel more in control. people laugh”
Allowing time to eat a balanced diet, Joe, age 20 years
get plenty of rest, and take regular
exercise, will increase your sense of
wellbeing and ability to cope.

“being spontaneous – I love

that about me”
Bev, age 34 years

Page 18
Useful books and resources

Resources
Addiss (national attention deficit disorder information and support service)
www.addiss.co.uk

Adders (online information service)

www.adders.org

NICE guideline
http://guidance.nice.org.uk/CG72/NICEGuidance/pdf/English

Books
Barkley, R (2010)
Taking Charge of Adult ADHD
Guilford Press

Kelly, K & Ramundo, P (2006)

You mean I’m not Lazy, Stupid or Crazy:
A Self-Help Book for Adults with ADD
Simon & Schuster

Laver-Bradbuy, et al. (2010)

Step by Step Help for Children with ADHD:
A Self-help Manual for Parents
Jessica Kingsley

Pera, G (2008)
Is it you, me, or adult ADD? Stopping the Roller Coaster When Someone
You Love Has Attention Deficit Disorder
1201 Alarm Press

Tuckman, A (2009)
More Attention, Less Deficit: Success Strategies for Adults with ADHD
Specialty Press

Page 19
Nottinghamshire Healthcare NHS Foundation Trust
Specialist Services Directorate
Intellectual and Developmental Disabilities Service

www.nottinghamshirehealthcare.nhs.uk