ADHD in adults – recognising it late

The stereotype is a boy who cannot sit still. That is one presentation. The inattentive pattern — disorganised, forgetful, drifting, unable to start things — produces no classroom disruption, so it is routinely missed, particularly in girls and in anyone academically capable enough to get by.

ADHD does not begin in adulthood; the symptoms were present in childhood even if nobody named them. A great many adults reach assessment only after recognising themselves during their own child's evaluation.

• Chronic disorganisation, lateness, lost items and missed deadlines.
• Starting many things and finishing few.
• Extreme difficulty beginning boring tasks, alongside hyperfocus on interesting ones — the inconsistency is characteristic.
• Restlessness that in adults is often internal rather than visible.
• Impulsive decisions: spending, job changes, saying things before thinking.
• Emotional intensity and difficulty regulating frustration.
• Exhaustion from the effort of compensating, which is what usually brings people in.

Several conditions produce similar difficulties and need distinguishing rather than assuming: depression, anxiety, sleep apnoea and chronic sleep deprivation, thyroid problems, substance use, and the aftermath of trauma. Many co-exist with ADHD rather than replacing it as the explanation.

Treatment is usually a combination: medication, practical strategies, and treating anything co-existing. Medication is prescribed by a psychiatrist or an appropriately experienced doctor, and stimulants are controlled substances in South Africa with the prescribing rules that implies.

• Stimulants work quickly and are effective for most people; the dose is titrated rather than fixed at the start.
• Blood pressure and heart rate are monitored, and a cardiac history matters.
• Non-stimulant options exist for those who cannot take stimulants or prefer not to.
• Medication improves attention and impulse control; it does not install systems. The strategies still have to be built.

1. 1Externalise everything. If it is not written down or in a calendar with an alarm, it does not exist.
2. 2Break tasks into steps small enough that starting is trivial. The barrier is initiation, not capability.
3. 3Use timers, and work in short defined bursts.
4. 4Reduce decisions: same place for keys, wallet and phone; routines rather than choices.
5. 5Do the hard thing when medication and energy are at their best, and protect that window.
6. 6Body doubling — working alongside someone, in person or on a call — helps far more than it should.
7. 7Sleep and exercise both have direct measurable effects on symptoms.