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A client of mine has been working in his company for 15 years.  All along, he related well with his colleagues and had normal job performance.  However, after being promoted to a middle management position, he started to have problems in organizing and managing his work.  He also had difficulties to meet deadlines and manage his subordinates.  His boss was very dissatisfied with his performance and gave him warning recently.  He felt stressed and worried that he might lose his job if he did not find strategies to improve his performance.  What problems this client of mine actually encountered?  In fact, after thorough assessment, it is concluded that he suffers from adult ADHD.  He was surprised that he had this problem as he mentioned that he was able to focus for a long time in gaming every weekend.  If this is the case, what is adult ADHD?

People with adult ADHD struggle with complex skills related the executive functions of our brain.  Executive functions, such as focused attention, planning and organisation, are located in the prefrontal cortex in our brain.  In fact, neurotransmitters, dopamine and norepinephrine, are not enough produced or efficiently used in the brain of people with adult ADHD.  Dopamine is important for us to achieve our goals and have a feeling of reward.  Norepinephrine helps us to stay away from distractions while we are working on some tasks.  The inability to utilize these neurotransmitters in the brain of adult ADHD actually causes them to have difficulty to stay focus and persistently execute plans.

One of the hallmark of adult ADHD is the inability to filter out distraction for one to sustain focus in important tasks.  As a result, people with adult ADHD cannot stay focus in tasks they consider boring and are easily lost in their own thoughts and daydreams.  They are also easily distracted when there are activities happened around them.  Another problem in executive functions deficit in these people is their inability to organise and plan.  They find that organizing tasks and activities is very difficult.  In fact, they frequently forget appointments and deadlines.  Without good planning and orgainisation, they may also have problems in procrastination. 

Due to their dysfunction in the prefrontal cortex in the brain, people with adult ADHD also have impulse control problem.  They tend to interrupt others in conversation very frequently.  They also switch activities or tasks abruptly in the middle of them.  With impulse control problem, they may make impulsive decision or choices in their lives.  Related to ones’ impulse control problem, people with adult ADHD also have difficulty to regulate or control ones’ emotions and responses to emotions.  In fact, they may be irritated and frustrated easily.  They may also tend to have frequent temper outbursts.  They suffer from unstable emotions constantly.

Apart from the above, people with adult ADHD also have deficit in cognitive flexibility.  This means that they have difficulties to come up with multiple options in any given situations.  For them, it is easy to repeat mistakes without the ability to act in a new way to approach the same problem.  They are also having difficulty to reflect on their own thoughts or impulses.  In fact, changing opinions or perspectives are difficult for them.  They cannot take others perspective in many situations. 

It is important to note that not all people with adult ADHD have all of the above deficits.  Everyone with adult ADHD is unique and has his or her own combinations of problems.  If you or your friends or relatives have some of the above problems, it is important for you or them to seek help for an assessment.  Since our brain can still develop with neuroplasticity, it is hopeful for people with adult ADHD to obtain treatment or coaching in order for them to improve their executive functions.