Thirty years ago, medical and psychological experts believed attention deficit hyperactivity disorder (ADHD) was a childhood disease. Clinicians reassured parents that their child would outgrow the condition by puberty.

Fast-forward to today, and experts realize that ADHD can be a lifelong condition, with research suggesting that impairing symptoms persist in more than 60% of people who had ADHD in childhood. 

“Now that we are aware that ADHD must be properly diagnosed and treated in adults, a new problem has arisen,” says Betsy Busch, M75, a developmental-behavioral pediatrician and associate clinical professor at Tufts University School of Medicine. “Many medical professionals who treat adults—internal medicine and family physicians, advanced practice nurses and physician assistants—have received little training in this area.” 

For adults, common problems include inattention, impulsivity, an inability to regulate emotions, and a lack of executive functioning skills, she says. Untreated, these symptoms can make it difficult for adults to function at work, school, and in their relationships with others. They can limit job prospects, educational attainment, and one’s self-perception. Untreated, adult ADHD is associated with increased risks of anxiety, depression, substance abuse, unsafe driving, and antisocial behavior.

The Centers for Disease Control and Prevention (CDC) estimates that ADHD in adults is rising, and as many as 6% of adults in the U.S.—15.5 million people—may have the condition. The average age of diagnosis of adult ADHD is now about 28.

In response, the American Professional Society for ADHD and Related Disorders (APSARD), the pre-eminent professional organization for those interested in ADHD, is writing the first-ever U.S. Clinical Practice Guidelines for the diagnosis and treatment of adults with ADHD. About 30 experts are involved in the U.S. Adult ADHD Guidelines Task Force, divided into three subcommittees: one to examine how best to diagnose ADHD in adults; a second to look at pharmacological treatments; and the third to look at nonpharmacological treatments, including cognitive behavior therapy, and teaching time management, emotion regulation and organizational skills. Busch is part of the expert panel addressing pharmacological treatments. The Task Force’s recommendations are expected later this year.

Adults Seeking Diagnosis on the Rise

In recent years, both information and misinformation about ADHD on social media has caused a rise in adults seeking a diagnosis and treatment for ADHD. In addition, “telehealth for ADHD emerged during the pandemic and definitely made it more convenient for individuals with ADHD to get care, especially for those who live in rural areas,” where there are fewer health care providers who treat ADHD, Busch says. 

But telehealth has been a mixed bag and, unfortunately, there have been notable abuses. “One online company encouraged their clinicians to prescribe stimulant medication to 95% of those seen, after only a single, 30-minute visit,” she says. “Another had 50,000 patients taking prescription stimulants for ADHD, without thorough diagnostic assessments. The owners were arrested, and the platform was shut down.”

Both the increased recognition of adults with ADHD and the online abuses have driven a surge in ADHD diagnoses and increased demand for ADHD medications. 

Because the most effective drugs available for treating ADHD—stimulant medications, such as methylphenidate and amphetamine—have addictive potential if not used as prescribed, the Drug Enforcement Administration (DEA) has always placed quotas on how much of these prescription medications can be manufactured by drug companies for sale in the U.S. Unfortunately, these quotas mean that, if the demand for stimulant medications increases, as they did during the past few years, the system is poorly equipped to react quickly. 

These factors contributed to the recent lack of availability of ADHD medications, Busch says. The shortage of stimulants is finally easing, as some stimulant medication production quotas were increased by the DEA in 2024.

A Public Health Problem

“Adult ADHD is really a public health problem that we need to address,” emphasizes Busch, who is also a Tufts University Trustee Emerita and a member of the Board of Advisors for the Jonathan M. Tisch College of Civic Life.

She says those with the condition experience more frequent job changes, more workplace injuries, four times the rate of motor vehicle accidents, higher divorce rates, more legal problems, are more likely to be incarcerated, are more likely to partake in risky sexual behaviors, are exposed to more sexual violence, and have twice the rate of premature death via accidents, suicide, overdose or other means. 

It's estimated that 15-25% of people with ADHD have a substance abuse disorder, as compared to 5.6% of those without ADHD. “If you treat the ADHD, patients may remain in treatment for their substance abuse disorder for a longer time and may significantly reduce their substance use,” says Busch.

Treatment More Complicated in Adults

According to a recent report from the CDC, 36.5% of adults with ADHD were not receiving any treatment, while 39.3% of adults with ADHD reported taking medication to treat their ADHD during the previous 12 months.

We can do better, Busch says.

“Getting a diagnosis as an adult so you can receive appropriate treatment can be challenging,” she adds. Although the diagnosis can be made using only the patient's self-report and memory of their childhood symptoms, it is recommended that information from another person who knows the adult well, and confirmation of prior symptoms in childhood be obtained from parents or others when possible. 

“For children, it’s much easier to have collateral informants, as their ADHD symptoms affect their behavior in school and at home, and it can be documented by teachers and parents,” Busch says. “But what adult is going to ask their boss to fill out an ADHD Rating Scale, to document that the employee has difficulty getting tasks done, paying attention, or interacting appropriately in the workplace? And parents may be unavailable or unwilling to discuss issues they have observed in their now-adult offspring, either growing up or in the present.”

“Also, some adults with ADHD have high IQs. They are CEOs, doctors, have college and graduate degrees. How do you measure impairment in high-performing adults?” Busch says. “It’s the CEO who needs two assistants and a vice president to execute their ideas. The professional who always works late and can never get their work done until the last minute. Their ADHD takes a toll on their families, their professional colleagues, and on their own physical and mental well-being.” 

Due to the limited training about adult ADHD, some doctors admit they are not comfortable treating patients for ADHD, Busch notes. One study showed only 28% of psychiatrists and 8% of primary care physicians feel extremely confident diagnosing ADHD in adults, she adds.

“Canada, Britain, and Australia already have guidelines for treating ADHD across the lifespan, but those documents are not easily accessed from the U.S.,” she notes. “In addition, the U.S. also has medications that are not available in other countries. There are over 30 different FDA-approved stimulant and non-stimulant medicine formulations in the U.S. that can be used to treat ADHD in adults.” 

While medications help with focus and attention, they are less effective at improving higher-level executive functioning skills required as an adult. Coaching and cognitive-behavioral therapy can be helpful for learning some adaptive skills to compensate for executive function deficits.

Medication Challenges Different for Adults

Appropriate treatment of ADHD in adults can be more complicated than in children, she says. “Some ADHD medications can increase blood pressure; this may cause hypertension in adults—more often than in children—and the adult's high blood pressure may need to be treated,” she says. Adults also need medication coverage throughout their 16-hour days, for both work and home duties, and many ADHD medications are shorter-acting than that. 

“Extended-release medications have helped caregivers provide treatment over the entire day,” Busch says. “Combinations of stimulant and nonstimulant medications also work well, for many patients. We have many treatment options, so we can tailor treatment to what a person’s day is like.”

“It is important to take your medication as it is prescribed, and work with your doctor to find the right medication and the right dose,” explains Busch. In general, patients do best when they take their medications all day, every day. This allows them to perform well for studying, work, driving, and even playing sports.

Because ADHD medications enhance the effects of alcohol and marijuana and can increase the heart rate, people taking prescription drugs should limit alcohol consumption, and Busch discourages the use of other recreational drugs. 

Misuse of stimulants can occur when people being legitimately treated with the ADHD medications use more than prescribed or share their medications with a friend (this is called diversion and is illegal). “Taking someone else's prescription stimulants is most common in college students, although studies have shown that stimulants do not improve grades in those who don't have ADHD. And sharing your stimulant medication could seriously harm another person,” Busch says. 

“If a person with ADHD is misusing prescription stimulant medication, or using stimulants with alcohol or other recreational drugs, their path to addiction is faster than the person who does not have ADHD. But anyone who mixes prescription stimulant medication with drugs or alcohol is at high risk for addiction. These are issues that keep physicians who work with young adult ADHD patients up at night.” 

Standardized Care Could Save Lives, Money

“We need evidence-based guidelines, combined with the experience of our best clinical experts in the field to address this challenging condition,” Busch says. “Clinicians need to know how to assess and treat adults with ADHD based on our current knowledge, so they don’t overtreat or undertreat. We need Clinical Practice Guidelines for teaching new generations of clinicians—and existing generations—how to treat ADHD in adults.”

Busch hopes the U.S. Adult ADHD Clinical Practice Guidelines will yield standards of care that can influence insurers to cover more medication options, with fewer restrictions. It has been shown that drug treatment of ADHD has the potential to save insurers money over the long term. 

One study shows it reduces the risk of serious injuries, in general. Another shows that regularly using ADHD medication decreases automobile crash risks by 40% and an estimated 22% of crashes involving people with ADHD could be prevented if those with the condition take their medications consistently. A third study conducted a review of teens' Medicaid records and demonstrated that medication reduces the probability of teens with ADHD contracting a sexually transmitted disease by 3.6%, while the probability of having a substance abuse disorder declined by 7.3%, and injuries overall decreased 2.3%.

Busch also hopes the process will yield standards that help the DEA to know when prescriptions are being issued responsibly, so they will adjust drug production quotas as needed as more adults with ADHD are recognized and treated. 

“Physicians also must be aware that many medications for ADHD have potential for abuse, and we must ensure that we use abuse-resistant medications, educate our patients, and do our part to prevent stimulant misuse, diversion, and overdoses,” Busch observes.

Despite the many challenges of ADHD in adults, Busch believes the U.S. Adult ADHD Guidelines will lead to greater understanding, diagnosis and better treatment. “We can do more to help those with ADHD, who are at risk for so many adverse life consequences, live healthier, happier lives.”