The impact of adult ADHD in the quality of life profile

ADHD has been thought to affect mainly during childhood and adolescence. However, there is increasing consensus in the fact that ADHD evolves throughout the patient’s lifespan rather than ceasing in adulthood. Overall, some ADHD core symptoms tend to decline over time, and they may manifest in different forms as patients adjust their social and personal environment to the symptomatology. In any case, ADHD will affect—to a greater or lesser extent—many aspects of the adult’s life regardless of the degree of symptoms remission. Authors studying the impact of ADHD throughout the patient’s lifespan observed a long-term persistence of the poor interpersonal skills, which resulted not only in fewer close friendships in the adulthood but also in a greater number of remarriages than control subjects. Likewise, the reduced academic performance of ADHD patients, also characterized by increased disciplinary actions at school, results in a lower educational attainment, limiting their access to qualified job positions. In the occupational area, ADHD patients have also shown greater chances to change jobs, either because they leave or they are dismissed.

In addition to the multiple developmental pathways of ADHD patients, ADHD diagnosis and treatment during childhood influences the course of patients’ life, leading to a broad diversity of clinical profiles in adult patients. In some cases, patients succeed in coping with ADHD core symptoms, mostly by developing alternative behaviors, which results in a compensated psychological and cognitive function. However, the most common scenario is ADHD core symptoms persisting—more or less pervasively—during adulthood. Some of these patients followed an adaptive pathway, having a high rate of syndromic and symptomatic remission and a partially restored functioning. By contrast, others have to deal with a remarkable number of severe ADHD symptoms, which in most cases result in the emergence of comorbidities related to mood, anxiety, bipolar disorders, personality disorders, antisocial behavior, and substance abuse disorders, particularly common in adult ADHD patients, with a prevalence that may reach up to 60%. In these patients, comorbidities are more likely to be the actual therapeutic target, and the symptoms associated with the patient’s comorbidity burden may even mask the inattention and hyperactivity symptoms, thus overlooking ADHD diagnosis and treatment.