ADHD in Men: Understanding and Managing Symptoms

Spread the love

Studies of ADHD that have examined the presence of impairing symptoms of the disorder have all been prospective in nature, still the issue of whether or not children “outgrow” ADHD is best addressed with longitudinal designs. There are currently no adult-onset ADHD cases in which the symptoms appeared de novo in adulthood and there are few adolescents with new onset of ADHD symptoms during adolescence, supporting the validity of the current DSM-IV criteria for the disorder. Despite the chronic nature of ADHD, there are still some individuals who were misdiagnosed with the disorder during childhood or are no longer impaired from the symptoms of the disorder, who no longer have the disorder. This diagnosis shifting can occur due to the high rate of comorbidities and symptom overlap between ADHD and other disorders as well as high levels of overt symptoms of ADHD displayed by normal children.

The prevalence of ADHD in adults ranges from 3% to 5%. Although the diagnosis of ADHD is more reliable for individuals with moderate to severe symptoms, studies have shown that most individuals who met DSM-IV criteria in childhood still have impairing symptoms of the disorder even though they no longer meet full diagnostic criteria. For example, a four-year prospective study of ADHD children with an 81% follow-up rate found that 60% continued to meet full DSM-IV criteria for the duration of the study and 35% had impairing symptoms that no longer met full DSM-IV criteria. This suggests that ADHD is a chronic disorder for a substantial portion of children who are diagnosed with the disorder. Symptoms that cause impairment, the most stringent criterion for the diagnosis of ADHD, are usually present for most of the individual’s life.

Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder that is characterized by a pattern of inattention, impulsivity, and/or hyperactivity that interferes with development and functioning of at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Gender Differences in ADHD

Adhd is a neurobiological disorder that affects both children and adults. It has been diagnosed twice as frequently in boys as in girls, although this ratio appears to even out in clinical samples. Research on the reasons for gender differences in rates of diagnosis of adhd has focused on three primary areas: referral biases, differences in symptom expression, and the possibility that adhd may present differently in males and females. A study by DuPaul et al. (1993) found that clinicians were more likely to diagnose boys with adhd than girls, even when they presented with the same functional impairment. Referral biases may occur because boys are more likely to exhibit behavioural difficulties, have externalizing disorders, and engage in aggressive and anti-social behaviour. These are the symptoms of adhd that are most disruptive to teachers and parents, thus it may be the case that the behaviour of girls with adhd is overlooked. It has been suggested that because boys’ behaviour may attract more attention, it leads to greater identification of the disorder. This is not to say that only boys display disruptive behavioural symptoms; boys and girls can and do present with similar levels of disruptive behaviours, although this more severe form of adhd is more common in boys. It appears that successful identification of adhd is related to the extent of functional impairment, rather than symptom presentation or severity. This is supported by studies showing that gender differences in prevalence rates decrease when impairment criteria are used to define adhd, as opposed to the presence of symptoms alone (DuPaul et al., 2001). Overall, the evidence is consistent with the notion that referral and identification of adhd is stronger for males than females, largely due to differences in behavioural symptoms. An alternative explanation for gender differences in rates of adhd diagnosis is that the disorder may actually be less prevalent in girls than boys. Although it is established that adhd is more common in males than females, the extent of this difference is unclear. Some researchers have suggested that the male preponderance seen in clinical samples is due to sampling errors, whilst others propose that adhd in females is under-identified because the symptoms can differ and they may not present with disruptive behaviours. This leads to the issue of differences in symptom expression, which may affect the identification and diagnosis of adhd in males and females.

Common Symptoms of ADHD in Men

Symptoms of ADHD, or attention deficit hyperactivity disorder, are often divided into two categories: inattention and hyperactivity and impulsivity. Adult ADHD is often marked by chronic problems with disorganization, time management, indecisiveness, and other executive functioning challenges. And the fact that most adults with ADHD have struggled with these problems since childhood is often overlooked. On the other hand, you may have a problem with hyperactivity only in certain situations where you are required to remain relaxed or still or where you are bored. Some adults with ADHD are not hyperactive or impulsive and may only have problems with inattentiveness. In any case, it takes effort to overcome the problems. Because of the way ADHD is portrayed in popular media, many people are led to believe that it is a disorder suffered mainly by children, and boys are more often diagnosed than girls. This has led many to believe that ADHD is overdiagnosed in children, but studies have shown no significant difference in prevalence between genders. ADHD is often missed in girls and boys of all races if they do not display the more disruptive and controversial externalized symptoms.

Inattention and Hyperactivity

Some boys with ADHD are not overly active, but because they are inattentive, they don’t do well in school and other places. Still, the inattention and disorganization can be as troublesome as the overactivity. It is not an easy task to pin down the nature of ADHD. It is one thing to list down the symptoms of ADHD, but it still looks very different in any person in whom it is present. ADHD occurs at various degrees of severity. Also, the person with ADHD will change over time and environment. It is a neurobiological condition which is chronic in nature. Symptoms sometimes diminish with aging. This often occurs when the person has learned to compensate for the areas of weakness; often times adults are misdiagnosed because the symptoms diminish while the person has learned or at least adapted. Inattention is a major issue for those with ADHD. When one thinks of attention, one would perhaps think of someone who is able to sit at a desk and do schoolwork for several hours. Yet attention is more than this. We all have things which we can pay attention to and things which we cannot. Those with ADHD have great difficulty in paying attention to things which are uninteresting to them. This is a key diagnostic feature of ADHD. It is not that the person cannot pay attention, more that they cannot regulate their attention, i.e. they are able to hyperfocus on things that are of great interest to them.

Impulsivity and Restlessness

Men with ADHD frequently experience symptoms of impulsive behavior and restless over-activity. Impulsivity can manifest as hasty actions, acting without forethought, making decisions too quickly, or being unable to delay gratification. This issue of impulsive behavior often leads to difficulty in work and social functioning as impulsive individuals may have a lesser tolerance for frustration, be irritated by minor hassles, and so blame others for their oversights or mishaps. They may have a preference for immediate rewards and an inability to consider the long-term consequences of their actions. Impulsive behaviors in ADHD are also a serious risk factor for substance abuse and accidental injuries. Restlessness in ADHD is characterized by the inability to relax or be still, the presence of agitated movements, an inner feeling of jitteriness, and an inability to initiate or persist in tasks requiring cognitive effort. This restlessness can instead manifest as a pattern of risk taking and a seeking of new and exciting activities, often with little regard for personal safety or the safety of others. This combination of impulsivity and restlessness can result in chronic over-activity, a lifestyle that is more likely to be chaotic and with frequent crises.

Executive Functioning Challenges

Because there are many tasks in life and work that require different types of executive function, the range and extent to which an individual with ADHD may be impaired can vary drastically depending on the task.

It is important to note that executive function challenges are not symptoms of their own; rather, they are a byproduct of ADHD and therefore can vary in degree and nature from one individual to the next. Because they are secondary symptoms, they often go untreated or, in some cases, are misdiagnosed as depression, anxiety, or a specific learning disability.

ADHD is a disorder most commonly associated with inattention and/or hyperactivity. However, many adults, particularly those that were not diagnosed with ADHD until later in life, experience executive functioning challenges as the most impairing aspect of their condition. The term executive function is a big umbrella term for a variety of complex cognitive processes that allow a person to engage in independent, goal-directed, self-regulating behavior. An individual with executive function challenges may have difficulty with analyzing, planning, organizing, scheduling, and completing tasks at all or within a given time frame. He or she may have trouble identifying what steps are needed to reach a particular goal and seeing the entire process through. They may have issues with short-term working memory and the recall of information that is no longer in front of them. They may have difficulty internalizing language or what is often referred to as talking to oneself in order to regulate one’s behavior. They may have difficulty with task persistence and motivation (Russell Barkley, Taking Charge of Adult ADHD). These are characteristic challenges that the person with ADHD faces on a daily basis.

Impact of ADHD on Men’s Lives

Adults with ADHD are likely to have problems in maintaining stable, satisfying personal relationships. An impulsive and low-frustration tolerance may lead to domestic violence. The lifelong impairments resulting from their symptoms make it difficult for individuals with ADHD to attain and maintain a high social and economic status, and this places a greater demand upon health and social services. ADHD adults are particularly vulnerable to develop a negative self-image and low self-esteem, which will render them even more ineffective in terms of obtaining a proper quality of life and may lead to further psychiatric morbidity.

Men are particularly susceptible to the adverse effects of ADHD, and the resulting social impairments are having a serious impact on the lives of those men ADHD affects. ADHD can disrupt an individual’s personal, social, and occupational life. Symptoms of ADHD may affect adults at home, in the community, and at work. On the job, adults with ADHD may lose or change jobs frequently. In the community, their patterns of behavior may lead to their being labeled antisocial or aggressive, and there is a high incidence of antisocial behavior among those with ADHD. Last but not least, high levels of energy, impulsiveness, and strong motivation, combined with impaired judgment, should be cited as risk factors for substance abuse.

Academic and Professional Challenges

“My boss told me that I am the best worker he ever had for not getting anything done,” writes Thomas Brown, noting the frustration of many individuals with ADHD who feel that their abilities and intelligence are judged on the basis of their performance in a traditional, structured setting such as work or school, which do not take into account their strengths. Preschoolers and elementary school students with ADHD are significantly more likely to be suspended or expelled from school than are children without ADHD. High school students with ADHD are more likely to fail a grade, get lower grades, and drop out than are high school students without ADHD. They are also less likely to go on to college. Adolescents and adults with ADHD are more likely to have occupational problems, which can be partially explained by impairment of executive functioning. Failure to complete and turn in tasks, difficulty in organizing or setting schedules, and impulsive acts can contribute to work loss and the beginning and ending of many jobs. This can lead to a lower socioeconomic status and difficulty in maintaining a household, which can affect the individual and family’s quality of life and self-esteem. Around half of all individuals diagnosed with ADHD at some point in their life were or are currently involved in some form of substance abuse, which can further complicate life at work and home. This is in large part secondary to increased rates of cigarette smoking in adults with ADHD. Cigarette smoking has been shown to increase metabolism of stimulant medications and thus lead to increased likelihood of medication misuse or self-medication with other stimulant drugs. In order to avoid further legal problems, patients with ADHD must sometimes choose between improving symptoms and attaining a state of productivity and wellness. This is seen in the case of professional athletes or individuals seeking employment with the armed forces who are classes ineligible for participation if medication is used to attain performance results, despite proof of symptom improvement.

Relationships and Social Interactions

During dating and early adulthood, similar impulsivity and difficulties with planning ahead can lead to his romantic partner feeling that he is disorganized, uncaring, or irresponsible. Resistance to suggestions and perceived criticism, often leading to angry outbursts, can at times be a strain on intimate relationships. Though not included in diagnostic criteria, many women notice a common pattern that their ADHD partner becomes less attentive and affectionate after marriage. This is likely due to the fact that the effort of maintaining his best behavior has become unnecessary as the goal of secure partnership has been obtained. At this point, he will often perceive that his partner is no longer in love with or proud of him and that his partner is overly critical. Hindered by the internal restlessness of ADHD, these men may not be able to resist the emotional pain and seek a new relationship to provide the emotional intimacy and affirmation often sought.

In adulthood, making and maintaining friendships can be tough. People with ADHD often have difficulty with things like taking turns and listening to others, which can make it tough to build rapport with someone. Another common problem is blurting things out. A friend may ask this person if they like their new outfit, and they may blurt out that it is terrible. This can cause hurt feelings or anger, leaving the person with ADHD confused and defensive. They may not be conscious of the fact that their response was socially inappropriate. Attraction to high-risk behavior increases. Risk-taking increases in adolescence as peer relations take on a stronger significance in exploring identity and social status. This form of risk-taking often has negative consequences in the realm of social adjustment as impulsive actions can lead to alienation or loss of friendships. In research involving young adults, men with ADHD were found to have higher rates of traffic citations, accidents, and speeding tickets than men without ADHD.

Men with ADHD often experience problems with social adjustment. Communication and behavior can be inappropriate. They have difficulty reading social cues and can be perceived as intrusive, selfish, or uncaring. For instance, he may invite himself over to a friend’s house when the friend is not ready to have visitors. Often, the friend will not directly tell him that it is not a good time but then feel resentful when he shows up. The man with ADHD may perceive this as the friend being inhospitable or in some way unfriendly. These small, yet consistent misunderstandings often build a pattern in which the man with ADHD feels consistently rejected or as though his peers do not value his friendship.

Emotional Well-being and Mental Health

Emotional well-being and mental health: Historically, boys have been diagnosed with ADHD over girls by a ratio of 3:1. The implications of having ADHD predispose its male sufferers to a higher risk of anti-social behavior and ultimately an increased risk of depression and dysthymia. ADHD is a mental condition that pervades throughout a sufferer’s everyday life; it is not just about being physically hyperactive or inattentive. Essentially, this means that it can have a massive impact on the social and emotional well-being of an individual. The symptoms of ADHD can create a lot of internal conflict and frustration. It is a general misconception that sufferers of ADHD have a lack of emotional concern for others. This is not true; it is more a case that they have difficulty in controlling their emotions and behavior. This can often lead to feelings of guilt and self-blame. Emotional instability and a quickness to anger can make ADHD sufferers hard to live with. This can result in a lot of negative feedback from those around them and, in some cases, result in violence and aggression. A particularly adverse kind of environment can often be created by the emotionally charged, negative, distorted interpretation of situations and comments, which can characterize those with combined type ADHD. The aforementioned negative experiences can lead to a distorted view of self and feelings of low self-esteem. The chronic underachievement resulting from ADHD symptoms can lead to a huge sense of failure and, in some cases, clinically significant depression. For example, many with ADHD go through their lives being told that they are not working to their full potential. If this is not explained in the context of their condition, it can lead to feelings of inadequacy and failure. Adults diagnosed with ADHD have a higher lifetime occurrence of major depression and injury than those without ADHD. It is not hard to see how, in severe cases, ADHD can lead to suicide. Another study based on self-report concluded that ADHD was associated with an increased likelihood of attempted suicide in both male and female subjects, and that subjects with ADHD are at risk for a variety of suicidal behaviors independent of co-morbid psychiatric conditions. It is clear from the evidence that when compared to the mental health of those without ADHD, the outlook is much poorer for those with the condition.

Substance Abuse and Addiction

The severity of attention deficit/hyperactivity disorder (ADHD) can widely differ in a given person, and from one situation to another, depending on the person’s self-management abilities. There are many possible negative outcomes due to impulsive and poor decision-making results. An adolescent or adult with ADHD may fall into a pattern of failure. An inability to delay gratification may lead to getting into debt, for example, making purchases that they cannot afford. The inability to inhibit can be intrusive and a soft addiction which may foster bad habits, such as frequent use of drugs or alcohol. A person with ADHD may start projects or get involved in relationships that are not healthy for them. Because of these kinds of experiences, ADHD adults are more prone to depression. This depression can lead to alienation and further depression. Since the person was already prone to the potential of substance abuse, the depression can further make the situation worse. Another potential consequence of depression is that it can discourage the patient from further using effective treatments for ADHD.

Strategies for Managing ADHD in Men

Medication in some form is often a first step for adults, and a crucial part of an overall management program. However, like anyone with ADHD, many men have a history of failure on medication, or of only partial response. The reasons for this are several, and the rate of non-response is probably no higher than among children or women, but the net result is that many men will have relatively severe ADHD at a time when taking medication is either unacceptable, or not an option due to side-effects and risk to physical health. Clearly the medication prescribing doctor must take the individual’s life course into account, and it is not uncommon for men to be “postponing” medication for current mild but impairing ADHD to a time when they can be more intensively focused on the condition. Up to 45% of adults with ADHD also have an anxiety disorder, a high co-morbidity rate compared with the general population. Stimulant medication can exacerbate anxiety, or be ruled out as an option due to a pre-existing anxiety disorder, and in these cases it may be more difficult to treat symptoms using medication. An increasing use of non-stimulant medications has broadened the range of medication options for adults, though at this stage there is little evidence that men and women do not respond best to the same medications as used for children. Cognitive behavioural therapy has been shown to be an effective treatment for ADHD in adults, though as yet there are too few trained CBT therapists with experience in this specific area. The day to day function of an adult will be influenced much more by organisational and time management skills than by academic performance per se. Changes may need to be made not only at the individual level, but at a family level if the man has been in the habit of relying on his partner for organisation. Education about the condition will often lead to a realisation that many difficulties in marriage and employment have been secondary to ADHD, and to a decision of whether to try and improve current functioning, or to affirm an approach in which compensation is provided by others. Issues of self-esteem and the question of what is best considered as evolution or cure of an integral personality pattern are complex and beyond the scope of this article.

Medication and Therapy Options

Medication therapy is the first line of treatment for ADHD and is highly effective in 80% of patients. Stimulant medications are the most effective in controlling symptoms. These medicines include methylphenidate, dextroamphetamine, and mixtures of these and amphetamine salts. Methylphenidate is available in short and long acting formulas. Non-stimulant medications are also effective, and include atomoxetine, and antidepressants such as bupropion, tricyclics, and SSRIs. Stimulant medications may be less effective in adults with ADHD comorbid with SUD, anxiety, or depression. In these patients, one of the non-stimulant medications is often tried next. Prices of ADHD medications are quite variable, and it may be helpful to prescribe a patient a medication that is available as a low-cost generic preparation. This can be essential for patients without prescription drug coverage.

Lifestyle Modifications and Self-Care

Getting enough good sleep is important for reducing symptoms of ADHD. Poor sleep can make symptoms worse, so having a good sleep routine and creating a relaxing environment for sleep is essential. A relaxing bedtime routine can include activities such as reading, having a bath, or listening to calming music. Avoid looking at computer or phone screens for at least an hour before going to bed. This is due to the blue light from screens, which can promote wakefulness. Meditation and relaxation exercises can also help people with ADHD to relax in everyday life and improve symptoms.

Step one for a healthier diet is reducing the amount of junk food and increasing the intake of high-quality protein and low GI foods. Consider seeing a dietician to develop nutritional plans if unsure of what to eat.

This section focuses on valuable lifestyle changes that can help alleviate the symptoms of ADHD in men. Exercise and diet are important aspects of a healthy lifestyle that can improve symptoms of ADHD. Some men may find it hard to start an exercise program, so having a fitness buddy may increase motivation and help with sticking to an exercise program. Any form of exercise is helpful, but the best one is the one that is interesting and fun for the individual. Some people may get bored with one activity, so it is best to alternate between activities to maintain interest.

Developing Coping Mechanisms and Support Systems

The ability to cope with symptoms of ADHD can affect many aspects of a person’s life. Studies of children with the disorder have shown that those who can develop effective coping strategies tend to have better outcomes compared to similarly affected children. Coping strategies can be learned in behavior therapy, in which patients are trained to plan out tasks and develop routines. Specific timely instructions and direct orders are given, and practice with these tasks and role-play also occur. This is done in a highly structured environment, with one task or skill being the focus of each behavior therapy session. Despite its benefits in teaching the skills of daily living, behavior therapy has not been shown to increase the overall functioning of the ADHD child. Cognitive-behavior therapy goes one step further with teaching the skills of daily living. It works to change a person’s feelings and attitudes by changing the way he thinks about or perceives a given event. This in turn leads to changed behaviors. In a recent controlled study, 79 adults with ADHD were assigned to either supportive group therapy or cognitive-behavior therapy. The cognitive-behavior therapy was more successful in changing the target symptoms. This suggests it is a viable option for adults wishing to improve their ADHD symptoms. Despite the benefits of psychotherapy and behavior therapy techniques, many patients do not have the patience required for learning these strategies and some insurance carriers do not provide coverage. The use of medication does not have an outright impact on the learning of skills taught in therapy, but it can improve the attentiveness span required to practice these skills. So an alternative or additional method of teaching coping skills is through direct education from a physician. This can be done in conjunction with monitoring the progress of the patient, and the physician can give feedback on how the skills are being practiced and implemented in the patient’s life.