Is It Possible to Flourish With Adult ADHD?

Recently published research, drawn from a large population study of the mental health of Canadians using online and in-person interviews, examined an interesting question: To what degree can adults with ADHD achieve complete mental health?¹ This designation is defined as the absence of mental illness, substance addiction, and suicidality; endorsement of happiness or life satisfaction; and social and psychological well-being. Thus, complete mental health is not only the absence of co-morbid conditions but also robust inner and outer well-being. Of the 21,099 adult participants, 480 self-reported a diagnosed history of ADHD—a little more than 2 percent of the sample, which is in the ballpark of typical prevalence rates for adults.

Adults With ADHD Do Quite Well, Sometimes

Curious about the good and bad of ADHD? See the evidence for both here.

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Within the adult ADHD group, 42 percent achieved complete mental health whereas 73.8 percent of the non-ADHD community group achieved this status (at least within the month before the survey). On the other side of the coin, significantly more adults with ADHD than community controls fell into the “not in complete mental health” category with the main factor being a co-existing psychiatric condition (mood, anxiety) within the past year.

These findings are relevant to some of the discussions in the “ADHD world” about whether there are strengths or gifts associated with ADHD, while at the same time ADHD numbers among the neurodevelopmental disorders remain associated with many life impairments. This reflects what Dr. Thomas E. Brown calls the “fundamental paradox” of ADHD. Brown typically uses the phrase to point out the common, cross-situational variability in functioning among adults with ADHD: In the right circumstances, they can perform roles and duties quite well, if not above average; in many other contexts, though, the results are frustratingly worse than hoped for.

Variables Associated With Flourishing

The variables associated with complete mental health in the adult ADHD group were being male, married, regular physical activity, and endorsing the role of religion or spirituality in their lives. Participants in the community sample with complete mental health were split pretty evenly by reported sex; of the total ADHD group, 64.3 percent was male, consistent with the 2:1 or 1.5:1 male-to-female ratio seen in adults.

Women with ADHD are more likely to experience anxiety and depression, oftentimes being treated for these issues before their ADHD is recognized, which likely contributes to the sex difference in complete mental health. While it is difficult to ascribe causality to the other variables associated with well-being among adults with ADHD, physical activity and other health-promoting factors are commonly recommended coping skills. Moreover, stable relationships and a sense of transcendence offer important feelings of belongingness, support, and frameworks for managing uncertainty, all of which are especially important for adults with ADHD.

And Those That Are Not

The particular issues that lowered the likelihood of achieving complete mental health in the study were co-existing psychiatric diagnosis (most often a history of depression or anxiety), significant chronic pain, and a history of childhood physical abuse. The chronic pain finding, including the fact that 25 percent of the whole adult ADHD sample endorsed this, was initially a surprise. However, as mentioned in a previous post, fatigue is increasingly reported by adults with ADHD. What’s more, a history of ADHD is associated with many physical or medical maladies and accidents and makes tending to one’s overall physical well-being a worthy treatment target. In this study, the influence of pain seemed associated with the history of depression and anxiety, which emphasizes the relevance of such co-existing factors in the treatment of adult ADHD.

Riding the Wave of Coping

ADHD is still a conundrum. On one hand, this study confirms the ongoing difficulties faced by many adults with ADHD inasmuch as adults with ADHD were more than twice as likely as controls to face ongoing mental health struggles. On the flip side, more than one-third of adults with ADHD achieved complete mental health at the time of the study. A heartening fact: Treatments for adult ADHD often promote the types of coping behaviors consistent with achieving well-being. Consistency of coping is the issue, as both the coping strengths of adults with ADHD and the challenges they face often unfold in an undulating course of peaks and valleys but hopefully averaging more time in the former and less time and less depth in the latter.