By Matt Tilley, Curtin University and Clinical Psychologist, West Leederville
ADHD has rightly gained much attention in recent years, with around one in 20 Australians receiving a diagnosis. Presentation is marked by a persistent pattern of hyperactivity/impulsivity and/or inattention negatively impacting the persons executive function and day-to-day experiences.
In adults, disruptions and difficulties are typically seen with the person’s personal relationships and work experiences.
There are three types of ADHD – hyperactive/impulsive type, inattentive type, and combined type (a mixture of both).
Impact ranges from mild to severe. Although research is inconclusive with no absolutes, men seem to be more likely to exhibit externalising symptoms and be diagnosed with the hyperactive/impulsive type, and women seem to be more likely to exhibit internalising symptoms and be diagnosed with the inattentive type.
Research into transgender and non-binary people is even less clear.
Typically, the hyperactive/impulsive type is characterised by constant fidgeting, restlessness, a tendency to talk excessively, and impulsive behaviours like interrupting and acting on thoughts or feelings without consideration. These symptoms are often more noticeable, making diagnosis easier.
RELATED: Guide to the subtleties of ADHD
While women are more likely to be diagnosed with the inattentive type, men can also experience these difficulties. This ADHD type is characterised by disruptions with cognitive focus and attention (distractibility), listening skills, and difficulties with organisation.
The combined type is most prevalent, characterised by a mixture of the symptoms discussed above, a combination of hyperactivity and impulsivity symptoms plus inattention and distractibility.
Although ADHD is usually associated with hyperactive behaviour, an adult can still have ADHD without being hyperactive.
Typical ADHD experiences
As ADHD is a childhood-onset disorder, people would have had symptoms when they were younger, even if not diagnosed or realising it. Consequently, it’s common for men to report feelings of shame, embarrassment, and inadequacy which can foster beliefs about their abilities as adults which may not be true.
These feelings and experiences may be further intensified if he was undiagnosed.
For example, we know that children with ADHD can experience disruption in attention and impulsivity. The impact on their schooling can be significant; commonly represented by disorganisation and forgetfulness, poor academic achievements, and experiences of behavioural misconduct.
These experiences are often met with negative attention from both parents and schools, for example frustration, scolding, messages of inadequacy, and even punishment.
It is not uncommon for people with ADHD to report beliefs about themselves representing an internalisation of these experiences, thus shaping their adult beliefs and experiences.
Men with ADHD are more likely to experience low frustration tolerance or irritability; frequent mood fluctuations/dysregulation; forgetfulness/often losing things; heightened distractibility; time management difficulties; often ‘on the go’ acting as if ‘driven by a motor’; excessive talking and interrupting; stimming behaviours (dopamine seeking); masking (acting in socially expected ways to fit in); rejection sensitivity dysphoria; negative self-image; hyper-focus; object constancy; sleep disruptions; and fatigue.
In addition to well documented issues with relationship disruption and work or career stress, research indicates that compared to the general population men living with ADHD may be more likely to experience a higher number of sexual partners; more STI diagnoses; potentially risky hyper-sexual activities like sexual compulsivity and addiction; increased experiences of online risk behaviours; premature ejaculation; and Male Hypoactive Sexual Desire Disorder.
Of course it’s not all negative, and it’s important to remember that there are also some common ADHD ‘superpowers’ like being empathetic, enthusiastic, spontaneous, creative, intuitive, imaginative, innovative, problem solvers, adventurous, and hyper focus on interests.
What helps?
Despite these reported difficulties, many men with ADHD thrive and learning about their ADHD can be positively life changing. Having ADHD does not define the person’s intelligence, strengths, capabilities, nor achievements.
Diagnosis, treatment, and support for men with ADHD can assist them to manage their symptoms, build and maintain healthy relationships, and achieve their work and career goals.
RELATED: GP ADHD training to be delivered ‘as soon as possible’
A multimodal approach is the most effective way to manage everyday life and behaviours associated with ADHD, with an aim to improve the management and experiences of the core symptoms, improve functioning, and increase wellbeing.
Therefore, consider a combination of psychoeducation, psychotherapy, and pharmacotherapy.
Psychoeducation assists to increase understanding of ADHD symptoms and experiences, and improve communication skills and time management, for example.
Evidence based psychological therapies like Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, and potentially EMDR, can assist men to process their experiences of living with ADHD.
There are several types of pharmacotherapies used to help manage ADHD symptoms. Stimulants are the most widely used and can work quickly but have side effects and finding the most effective regimen can be trial and error.
Although a good option for many, medication does not necessarily address all ADHD symptoms, and not everyone responds well to them.
Key messages
- An adult can still have ADHD even if they’re not hyperactive
- Not everyone with ADHD was diagnosed as a child, and a late ADHD diagnosis can be positively life changing
- There are many symptoms that can highlight an undiagnosed ADHD presentation; the ASRS-v1.1 psychometric test (free online) can offer clarity.
Author competing interests – nil
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