Understanding Adult ADHD Treatment Options: A Patient Guide

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, impulsivity, and/or hyperactivity that interfere with daily functioning. Although often diagnosed in childhood, ADHD frequently continues into adulthood, affecting relationships, employment, self-esteem, and mental health.

ADHD is estimated to affect approximately 2.5–4% of adults worldwide (Simon et al., 2009; Fayyad et al., 2007).

Core Symptoms of Adult ADHD:

• Difficulty sustaining attention on tasks

• Poor organisational skills

• Impulsivity (interrupting, risk-taking)

• Restlessness or internal hyperactivity

• Forgetfulness in daily activities

• Difficulty completing tasks

ADHD in adults often presents differently than in children. Hyperactivity may lessen with age, while executive function challenges (e.g. planning, prioritising, emotional regulation) become more prominent.

Types of ADHD

According to DSM-5 criteria (American Psychiatric Association, 2013), ADHD is categorised into three presentations:

1. Predominantly Inattentive Presentation

   • Difficulty sustaining attention

   • Easily distracted

   • Often disorganised or forgetful

     
     

2. Predominantly Hyperactive-Impulsive Presentation

   • Restlessness or fidgeting

   • Talking excessively

   • Acting without thinking

     
     

3. Combined Presentation

   • Features of both inattention and hyperactivity-impulsivity

     
     

The presentation can change over time. A full clinical assessment, often including structured interviews (e.g. DIVA-5), is required for diagnosis.

Women and ADHD

Treatment Options for Adults with ADHD

ADHD treatment is multimodal—usually combining medication with psychological interventions, lifestyle changes, and support.

NICE Guidelines (NG87, 2018) recommend:

• Medication as first-line treatment for adults with moderate to severe impairment

• Cognitive Behavioural Therapy (CBT) for adults who decline or cannot tolerate medication

• Psychoeducation to promote understanding and self-management

Benefits of ADHD Medication

ADHD medication is clinically proven to reduce core symptoms and improve functioning. Studies show that medication can lead to:

• Improved attention and focus

• Reduced impulsivity and emotional reactivity

• Better task initiation and completion

• Improved quality of life

Response rates are high, with around 70% of adults responding to stimulants and 50–60% to non-stimulants (Bolea-Alamañac et al., 2014).

How ADHD Medications Work

ADHD is associated with altered dopamine and norepinephrine signalling, especially in the prefrontal cortex—an area linked to attention, motivation, and decision-making.

Medications improve symptoms by increasing the availability of these neurotransmitters, enhancing signal transmission in brain regions involved in executive function and self-regulation.

Types of ADHD Medication

ADHD medications are divided into two main categories:

1. Stimulants (First-Line Treatment)

Stimulants are fast-acting and have the strongest evidence base.

• Methylphenidate-based: Ritalin®, Concerta XL®, Medikinet XL®

• Lisdexamfetamine (Elvanse®)

• Dexamfetamine

Stimulants increase dopamine and norepinephrine by inhibiting reuptake and stimulating release. They are usually well-tolerated and available in short- and long-acting formulations.

2. Non-Stimulants

These may be used when stimulants are not tolerated or contraindicated.

• Atomoxetine (Strattera®): a selective norepinephrine reuptake inhibitor

• Guanfacine: occasionally used off-label in adults

• Certain antidepressants (e.g. bupropion, venlafaxine) may be used off-label in some cases

Non-stimulants may take 2–6 weeks to reach full effect and tend to have a more gradual onset.

What to Expect When Taking ADHD Medication

Titration Phase

• Begins with a low dose

• Gradually increased over weeks to find the most effective dose with the fewest side effects

• Monitoring of blood pressure, heart rate, sleep, appetite, and mood is essential

Maintenance Phase

• Regular reviews (every 6–12 months)

• Dose adjustments may be needed if symptoms return or circumstances change

Monitoring Requirements

According to NICE NG87:

• Baseline cardiovascular assessment (BP, pulse, history)

• Ongoing monitoring of weight, mood, and adverse effects

• Specialist review annually (minimum)

Common Side Effects

Side effects vary by individual and medication but can include:

Side Effect	Notes
Loss of appetite	Often dose-related; monitor weight
Insomnia	May resolve; consider dosing time
Headache	Usually transient
Dry mouth	Common but manageable
Irritability or anxiety	May need dose adjustment or medication change
Increased heart rate/BP	Requires regular monitoring

Most side effects improve over time, but persistent issues should be discussed with your prescriber.

Medication Breaks: Are They Necessary?

Some adults choose to take planned breaks (e.g. weekends or holidays) from stimulant medication. This may be considered when:

• Appetite or sleep issues are significant

• Assessing whether medication is still needed

• Reducing side effects or building tolerance

However, medication breaks are not recommended routinely in adults. Many people find their symptoms return quickly. Discuss any break with your prescribing clinician to ensure it’s safe and appropriate.

Other Support Options

While medication is often central, non-pharmacological interventions are also key:

• Cognitive Behavioural Therapy (CBT) for ADHD

• Executive functioning coaching or occupational therapy

• Sleep and time-management strategies

• Psychoeducation for individuals and families

• Peer support groups (e.g. ADHD UK, ADDISS)

Combining medication with psychological support often leads to the best long-term outcomes.

Conclusion

ADHD in adults is a common, treatable condition. Medication can significantly improve quality of life, focus, and emotional regulation. With the right combination of treatment and support, many adults with ADHD thrive in their careers, relationships, and personal goals.

If you suspect you may have ADHD, or if you’re looking to explore treatment, speak to your GP or a qualified clinician.

Key References:

• National Institute for Health and Care Excellence (NICE). (2018). Attention deficit hyperactivity disorder: diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87

• Bolea-Alamañac B et al. (2014). Evidence-based guidelines for the pharmacological management of adult ADHD. J Child Psychol Psychiatry, 55(1):3-15.

• Simon V et al. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder. JAMA, 301(2), 201–214.

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.)

• Fayyad J et al. (2007). Cross-national prevalence and correlates of adult ADHD. Br J Psychiatry, 190:402–409