Content uploaded by Merete Bjerrum
Author content
All content in this area was uploaded by Merete Bjerrum on Sep 24, 2018
Content may be subject to copyright.
Living with symptoms of attention deficit hyperactivity
disorder in adulthood: a systematic review
of qualitative evidence
Merete B. Bjerrum
1,3
Preben U. Pedersen
2,3
Palle Larsen
2,3
1
Department of Public Health, Section for Nursing Science, Aarhus University, Aarhus, Denmark,
2
Danish Centre of Clinical
Guidelines, and
3
Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Medicine
and Technology, University of Aalborg, Aalborg, Denmark
EXECUTIVE SUMMARY
Background
Attention deficit hyperactivity disorder (ADHD) relates to four dimensions of behavior: inattentiveness, restlessness,
impulsiveness and hyperactivity. Symptoms affect multiple areas of daily life such as academic performance and
social functioning. Despite the negative effects of ADHD, people diagnosed with ADHD do not necessarily regard
themselves as being impaired. However, it is unclear how adults with ADHD experience and manage their symptoms.
Objectives
To identify and synthesize the best available evidence on how adults experience living with ADHD.
Inclusion criteria
Types of participants
Adults with confirmed ADHD diagnosis.
Phenomena of interest
How adults with ADHD experience and manage the symptoms of ADHD and links between protective factors
provided by relatives, friends, fellow students, mentors and colleagues.
Types of studies
Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory,
content analysis or ethnography.
Search strategy
A three-step search strategy identified published and unpublished qualitative studies from 1990 to July 2015.
Methodological quality
Studies meeting the inclusion criteria were independently assessed by two reviewers using the standardized critical
appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).
Data extraction
Data were extracted from 10 included studies using the JBI-QARI.
Data synthesis
Qualitative research findings were synthesized using the JBI-QARI.
Results
A total of 103 findings from 10 studies were aggregated into 16 categories that were meta-synthesized into four
synthesized findings: ‘‘Adults are aware of being different from others and strive to be an integrated, accepted part of
the community;’’ ‘‘Adults with ADHD are creative and inventive;’’ ‘‘Adults with ADHD develop coping strategies in
striving for a healthy balance in life’’ and ‘‘For adults with ADHD, accomplishing and organizing tasks in everyday life is
a challenge but it can also be rewarding.’’
Conclusion
Adults with ADHD have problems stemming from ADHD symptoms in relation to interacting in social relationships,
academic functioning and being part of the community at the workplace and performing work tasks; they work
harder to perform tasks and strive to be accepted and to be equal members of the community.
Correspondence: Merete B. Bjerrum, mb@ph.au.dk
There is no conflict of interest in this project.
DOI: 10.11124/JBISRIR-2017-003357
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1080
SYSTEMATIC REVIEW
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Protective factors thatsupport their ability to manage daily life with ADHD are personal strategiessuch as reminders and
performing tasks within a given structure. Others close to them can assist by coaching, reminding them of appoint-
ments and so on. Superiors can assist by structuring the work tasks and setting up clear rules and limits for the tasks.
Medication hasproven to be very useful as it leads to less hyperactivity and enhances ability to stayfocused and be more
organized. Finally, insight into ADHD has a positive impact on the ability to manage the consequences of ADHD.
Health professionals should, when advising adults with ADHD, fundamentally see them as persons who have a
problem and not as problem persons, emphasize strategies adults themselves can apply such as structuring everyday
tasks and informing them about positive effects and possible side effects of medication. Policy-makers could launch
campaigns targeted at employers with information about the competencies adults with ADHD possess and how
employers can benefit from these by structuring work tasks. When promoting employees with ADHD, it should be to
positions with more advanced hands-on functions and not positions with administrative duties.
Keywords ADHD; adult ADHD; coping strategies; managing daily living
JBI Database System Rev Implement Rep 2017; 15(4):1080 –1153.
ConQual summary of findings
Systematic review title: Living with the symptoms of attention deficit hyperactivity disorder (ADHD)
in adulthood: a systematic review of qualitative evidence
Population: Adults with a confirmed ADHD diagnosis
Phenomena of interest: How adults with ADHD experience and manage living with ADHD
Context: Social, work-related and educational environments
Synthesized finding
Type of
research Dependability Credibility
ConQual
score Comments
Adults with ADHD
are aware of being
different from
others and strive to
be an integrated,
accepted part of the
community
Qualitative No change No change
High
The two studies
assessed as credible
were plausible
Adults with ADHD
are creative and
inventive
Qualitative No change Downgrade
one level
Moderate
Downgraded one
level due to equiv-
ocal findings
Adults with ADHD
develop coping
strategies in striving
for a healthy bal-
ance in life
Qualitative No change No change
High Only two findings
were assessed as
credible as they
were based on an
open-ended
questionnaire
For adults with
ADHD, accomplish-
ing and organizing
tasks in everyday
life is a challenge
but it can also be
rewarding
Qualitative Downgrade
one level
Downgrade
one level
Low
Downgraded one
level due to
dependability of
primary studies;
Downgraded one
level due to
equivocal findings
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1081
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Background
Attention deficit-hyperactivity disorder (ADHD)
is diagnosed according to the DSM-IV (Diag-
nostic and Statistical Manual of Mental Disorders
by the American Psychiatric Association)
1
and the
IDC-10 (International Classification of Diseases) of
the World Health Organization (WHO)
2
when the
following criteria related to behavior are present:
inattentiveness, restlessness, impulsiveness and
hyperactivity.
3
The onset of the disease occurs in
childhood. Some children grow out of their ADHD
symptoms during adolescence, but it is estimated
that 80% of those diagnosed with ADHD in child-
hood continue to have symptoms throughout life
4-6
;
the global prevalence of adult ADHD is currently
estimated at 4.4%.
7
Attention deficit hyperactivity disorder is associ-
ated with psychiatric comorbidity and psychosocial
problems; some children are at risk of developing
relatively severe psychiatric syndromes in adulthood
such as anti-social personality disorder.
8-11
For
people diagnosed with ADHD in childhood or you-
ng adulthood, the symptoms affect multiple areas of
daily life such as school adjustment, impaired aca-
demic performance and social functioning, and chil-
dren with ADHD often have difficulties in social
relationships.
12,13
Primary research has mainly focused on the nega-
tive effects of ADHD, possibly because individuals
with ADHD display some level of behavioral charac-
teristics such as inattention, distractibility and
impulsiveness; low frustration tolerance; frequently
shifting activities; difficulties in organizing and often
daydreaming,
14
and all of these characteristics can
be troublesome and hamper daily life. Attention
deficit hyperactivity disorder symptoms affect the
individual’s quality of life, so living with ADHD
becomes ‘‘a way of life’’.
15
Studies have shown that people with ADHD have
difficulties in forming strong friendships, although
they are able to manage inter-personal relationships
and have social acquaintances and friendships, they
have fewer close friends and have trouble with keep-
ing friends compared to controls.
15
It is reported that
people with ADHD have a negative perception of
marital and family life in terms of communication
involvement, roles, problem solving and so on.
15
Adult individuals with ADHD also have a higher
incidence of separation and divorce.
16-18
Educational and academic performance is
affected as many experience difficulties with aca-
demic achievement, such as reading disabilities,
attending special educational services, repeat grades
and failure to finish high school or obtain low
grades, which impact negatively on access to higher
education and employment opportunities.
12,13,16
The individual’s occupational functioning is also
affected, as adults with ADHD are often unable to
maintain stable employment as they have more fre-
quent employment changes, perform poorly, quit or
are fired from their jobs.
5,6,14
Employers rate the
work performance of ADHD employees lower com-
pared to controls.
12,16-18
It has also been demon-
strated that individuals with ADHD generally have
lower self-esteem and fewer friends than control
groups.
12
Although the majority of studies show that
ADHD symptoms hamper daily life for people
affected and they have difficulties in coping with
the disease, they are able to some degree to change
situations and re-frame problems.
19
Furthermore,
people diagnosed with ADHD do not necessarily
regard themselves as being impaired; they report
that their self-image does not reflect the degree of
severity or pervasiveness of maladjustment.
13
According to the literature, there are different
perspectives on how ADHD symptoms influence
daily living for people with ADHD.
14,15
It is there-
fore relevant to focus on the subject from the
perspective of people with ADHD. To support
people with ADHD in managing their daily-life
skills, it is necessary for healthcare staff to acquire
knowledge of how people with ADHD experience
and manage their symptoms. It is also important to
know which protective factors in the milieu support
their ability to manage daily life. This is necessary to
develop strategies to help people with ADHD select
careers matching their strengths and weaknesses in
terms of managing social relations, completing edu-
cation programs and sustaining employment. Devel-
oping such strategies is important as individuals with
ADHD strive to take control of the chaos caused by
ADHD symptoms.
20
An initial search in the PubMed, CINAHL, the
JBI Database of Systematic Reviews and Imple-
mentation Reports, DARE, PROSPERO, Cochrane
Library and PsycINFO databases indicated that no
systematic review on this topic was available or
currently underway. This systematic review aimed
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1082
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
to identify the evidence on which to base care for
adults with ADHD to develop strategies to help
people with ADHD to manage daily life.
21
Objectives
The objective of this systematic review was to
identify and synthesize the best available evidence
on how adults experience living with ADHD.
More specifically, the review questions were:
How are adults diagnosed with ADHD charac-
terized in relation to social relations, educational
and work relations, and behavior and coping
styles?
What is the experience of adults living with
symptoms of ADHD?
Which protective factors in the milieu do adults
living with ADHD find important in managing
daily life as described by adults diagnosed
with ADHD?
Inclusion criteria
Types of participants
The current review considered studies that included
adults diagnosed with ADHD in any context. For the
purposes of this review, adults were defined as both
men and women aged 16 years and older.
For the purposes of this review, a clinical diag-
nosis of ADHD was based on the criteria below:
ADHD: ICD-10: F90 (Diagnostic and Statistical
Manual of Mental Disorders, by The WHO)
2
DSM-IV-TR: 314 (Diagnostic and Statistical
Manual of Mental Disorders, by The American
Psychiatric Association)
1
Phenomena of interest
The current review considered studies investigating
the experiences of how adults with ADHD experi-
ence and manage life with symptoms of ADHD and
links between any protective factors provided by
relatives, friends, fellow students, mentors and
colleagues.
Context
The current review considered studies from any
setting, including the community, home setting,
work or education setting.
Types of studies
The current review considered studies with a focus
on qualitative data including, but not limited to,
designs such as phenomenology, grounded theory
and content analysis.
Search strategy
The aim of the search strategy (Appendix I) was to
identify published and unpublished studies. A three-
step search strategy was used in this review.
An initial limited search of PubMed, Embase,
CINAHL and PsycINFO was undertaken followed
by an analysis of the text words contained in the title
and abstract, and of the index terms used to describe
an article.
A second search using all identified keywords and
index terms was then undertaken across all included
databases.
In the third search, the reference lists of all ident-
ified reports and articles were searched for
additional studies. Studies published in Danish, Eng-
lish, German, Norwegian and Swedish were con-
sidered for inclusion in this review. Databases were
searched from 1990 to 2015, as prior to 1990,
ADHD was primarily considered to be a childhood
illness.
22
The databases searched included:
PubMed
Embase
PsycINFO
CINAHL
SveMedþ
ProQuest Dissertations and Thesis Global
Web of Science
WorldCat
TRIP
Bibliotek.dk
ProQuest Dissertations and Database.
The search for unpublished studies included Med-
Nar, ProQuest Dissertations and Theses
The following websites were searched:
www.adhdnorge.no (The Norwegian ADHD
Society)
www.attention-riks.se (The Swedish ADHD
Society)
www.ADHD.dk (The Danish ADHD Society)
www.adhdeurope.net (ADHD Europe)
www.chadd.org (Children and Adults with Atten-
tions Deficit/Hyperactivity Disorder)
www.psych.org (The American Psychiatric Associ-
ation)
www.europsy.net (The European Psychiatric Associ-
ation)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1083
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
www.adhdaustralia.org.au (Australian and New
Zealand ADHD Support Groups)
The reference lists of all included studies were
searched for additional studies.
A full detailed list of search strategies for indi-
vidual databases is provided in Appendix I.
Review method
Assessment of methodological quality
The methodological validity of the studies was
assessed prior to being including in the review using
the standardized critical appraisal tool from the
Joanna Briggs Institute Qualitative Assessment and
Review Instrument (JBI-QARI) (Appendix II). The
10 questions in the critical appraisal tool were
answered for each of the studies with a ‘‘yes,’’
‘‘no’’ or ‘‘unclear’’ response. The first and second
reviewer independently assessed the studies. Any
disagreements between the reviewers were resolved
through discussions.
Data extraction
Data from the included studies were extracted
using the JBI-QARI Data Extraction Form for
Interpretative and Critical Research (Appendix
III). These data included specific details about
the population, study methods and phenomenon
of interest of significance to the review question
and specific objectives. We considered a finding to
be the authors’ original statement or text identified
as themes, sub-themes or text below themes or
sub-themes. From all 10 studies, a corresponding
illustration related to each finding was extracted, if
possible, to illustrate the participants’ voices. Find-
ings were graded into three levels: those that
cannot be challenged (unequivocal), those that
can be challenged (credible) and those that are
not supported by data (unsupported). The level
of credibility of each finding was based on con-
sensus between the first and second reviewer’s
perception of the extent to which an illustration
was related to the finding. Unsupported findings
were not extracted.
Data synthesis
Qualitative research findings were identified and
arranged according to the three research questions:
(1) how are adults diagnosed with ADHD charac-
terized in relation to social relations, educational
andworkrelationsandinrelationtobehaviorand
coping styles?, (2) what is the experience of
adults living with symptoms of ADHD? and (3)
which protective factors in the milieu do adults
living with ADHD find important in managing
daily life as described by adults diagnosed with
ADHD?
The derived research findings were pooled using
JBI-QARI. This inductive analytical process
involved the synthesis of research findings to gen-
erate a set of statements that represent that synthesis,
through assembling the findings (level 1 findings)
rated according to their quality and categorizing
these findings on the basis of similarity in meaning
(level 2 findings). These categories were then sub-
jected to a meta-synthesis (level 3 findings) that
aggregated a single comprehensive set of synthesized
findings that can be used as a basis for evidence-
based practice. The first and second reviewer con-
tinually read back and forth between findings,
categories and synthesis to ensure similarity
in meaning.
Results
A total of 2976 potentially relevant studies were
identified by the literature searches across data-
bases (Appendix I); 241 duplicates were removed
(Figure1).Ahandsearchresultedin11potentially
relevant studies. A total of 2746 studies were
screened by title and abstract against the inclusion
criteria; 48 studies were retrieved for full-text
assessment for eligibility (Appendix IV), of these
37 were excluded for reasons of incongruence with
the review and study design (Appendix V). Eleven
studies (Appendix VI) were assessed for methodo-
logical validity prior to being included in the
review using the standardized critical appraisal
tool from JBI-QARI (Appendix II). One relevant
study
23
was excluded due to the lack of trans-
parency in relation to how the findings were
derived from the empirical data and because it
was not possible to systematically extract findings
from the results as these were presented as long
narratives where the author’s interpretations and
quotes from the data were integrated as an integral
whole, consequently the interpretations and the
quotes could not be separated without destroying
the meaning. But there was concordance between
the stated findings in the excluded study and find-
ings identified and included in the present review
as they also pointed out impairments in relation to
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1084
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
organizational skills, social relationships and aca-
demic and work performance.
Description of studies
The 10 studies included in the present review were
conducted between 2005 and 2013. The studies
reported findings based on 159 informants (88
men and 71 women aged 18–91 years) with con-
firmed ADHD diagnoses from the United States of
America,
24-31
England
32
and Sweden,
33
representing
predominantly Caucasians, and very few were either
African Americans or Hispanics living in Western
Records idenfied through
database searches
(n = 2,976)
Screening
Included Idenficaon
Addional records idenfied
through other sources
(n = 11)
Records aer duplicates removed
(n = 2,746)
Records screened
(n = 2,746)
Records excluded
(n = 2,698)
Full-text arcles
assessed for eligibility
(n = 48)
Full-text arcles
excluded, with reasons
(n = 37)
Studies critically
appraised
(n = 11)
Eligibility
Studies excluded aer
crical appraisal
(n = 1)
Studies included in the
qualitave synthesis
(n = 10)
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for
Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097.
Figure 1: Flowchart of study selection process
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1085
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
countries. Almost all were college students. The
studies described in various ways experiences
related to life with and management of ADHD in
daily living. All participants were aware of being
different from others due to their ADHD charac-
teristics; the descriptions were fundamentally the
same regardless of their context; participants
from psychiatric clinics, nursing homes and college
students provided the same impression: perfection-
ism, concentration difficulties, forgetfulness and
not completing a task or changing jobs unless the
task is within a particular field of interest. Forgetful-
ness is handled by to-do lists and by setting up
routines.
All included studies used the qualitative method-
ology except one
26
that was based on qualitative
analysis of open-ended questions from a question-
naire. Five studies
25,27,28,32,33
were based on individ-
ual interviews, one was based on both individual
and focus group interviews
34
and three studies
were based on information from therapeutic inter-
views.
29-31
Six studies used semi-structured inter-
views.
24,25,27,28,32,33
One study derived data from
college students,
26
in two studies the participants
came from a university setting,
27,28
in three from a
psychiatric clinic,
29-31
in two from a neuropsychiatric
clinic,
24,33
in one from a psychiatric hospital
32
and in
one from a nursing home.
25
Five studies were analyzed
inductively,
24,26-28,33
one study used phenomenolog-
ical analysis,
32
three were case studies
29-31
and one
used the ecological approach.
25
Eight studies were
conducted in the United States of America,
24-31
one
in England
32
and one in Sweden.
33
A description of the
studies is presented in Appendix VII.
Methodological quality
The 10 included studies were generally of good
quality as they all met most of the methodological
requirements stipulated in the JBI-QARI critical
appraisal checklist (Table 1). Four of the stud-
ies
24,26,28,32
had stated congruity between the stated
philosophical perspective and the research method.
Congruity between the research methodology and
the research objective methods used to collect and
analyze data and the interpretation of data was of
high quality in all studies except one,
29
which did not
clearly state how data were collected and analyzed.
The participants’ voices were adequately
represented, either as citations or rich descriptions
in all studies except one,
26
where the content of the
participants’ responses were grouped in categories
calculated in percentages. In all studies, the con-
clusions drawn in the research report arose from
the analysis or interpretation of the data. All studies
fulfilled ethical criteria. Thus, the included studies
provided suitable and credible findings based on
relevant and transparent methodology.
However, the included studies also had some
methodological weaknesses. In six studies, the stated
philosophical perspectives were either unclear
30,31,33
Table 1: Critical appraisal results
Reference Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10
Brod et al.
24
YYYYYUUYYY
Meaux et al.
28
YYYYYUNYYY
Henry and Jones
25
YYYYYNNYYY
Kaminski et al.
26
YYYYYNNUYY
Ramsay and Rostain
29
NYNNYNNYYY
Young et al.
32
YYYYYYYYYY
Meaux et al.
27
NYYYYYYYYY
Ramsay
30
UYYYYYUYYY
Rosenfield et al.
31
UYYYYYUYYY
Ek and Isaksson
33
UYYYYYYYYY
% 50 100 90 90 100 50 30 90 100 100
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1086
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
or not stated.
25,27,29
Half of the studies were either
unclear about
24,28
or did not
25,26,29
state the
researchers’ cultural or theoretical position. Only
three studies
24,32,33
addressed the researchers’ influ-
ence on the research and vice versa. In three stud-
ies,
24,30,31
this issue was unclear, and three did not
include any statements
26,28,29
on this.
Results of meta-synthesis of qualitative
research findings
The following synthesized findings were derived
from 103 study findings (level 1) using JBI-QARI.
The study findings are listed in Appendix VIII. The
103 study findings were examined and categorized
based on similarity in meaning to produce level 2
findings. The findings were subsequently aggregated
into 16 categories (level 2), each with a minimum of
two findings. These categories were then subjected to
a meta-synthesis that produced four synthesized
findings (level 3). The synthesized findings and the
categories and study findings on which they are
based are shown in Table 2.
The analysis shows that adults with ADHD have
problems stemming from ADHD symptoms in
relation to interacting in social relationships, aca-
demic functioning and being part of the community
at the workplace and performing work tasks; they
work harder to perform tasks and strive to be accepted
and to be equal members of the community.
The analysis also shows that protective factors
that support their ability to manage daily life with
ADHD are personal strategies such as reminders and
performing tasks within a given structure. Others
close to them can assist by coaching, reminding them
of appointments and so on. Superiors can assist by
structuring the work tasks and setting up clear rules
and limits for the tasks. Medication has proven to be
very useful as it reduces hyperactivity and enhances
the ability to stay focused and be more organized.
Finally, insights into ADHD have a positive impact
on the ability to manage the consequences of ADHD.
Meta-synthesized findings
1. Adults with attention deficit hyperactivity
disorder are aware of being different from
others and strive to be an integrated, accepted
part of the community
Adults with ADHD are aware of being different and
have the feeling of not belonging in the social context.
This emotion results from the feeling of being out of
control, the inability to ‘‘read’’ social codes and the
feeling of being misunderstood and rejected,leading to
low self-esteem. Such situations are typically caused by
the ADHD symptoms, for example talking before
thinking, having difficulty following rules and so
on. They often feel stupid when they cannot concen-
trate and cannot follow a lesson orconversation. They
strive to be needed and wanted byother people, and to
fit in and hope that this magically will happen when
they just find the right job, take medication and so on.
2. Adults with attention deficit hyperactivity
disorder are creative and inventive
Attention deficit hyperactivity disorder symptoms
have positive aspects. Attention deficit hyperactivity
disorder can enhance the sense of creativity. Adults
with ADHD are often successful in maintaining jobs
within the arts and computer technology.
3. Adults with attention deficit hyperactivity
disorder develop coping strategies in striving for
a healthy balance in life
Adults with ADHD are aware of the deficits caused
by the disorder and strive to overcome these deficits
by developing coping strategies to maintain a bal-
ance between duties and leisure time. To overcome
forgetfulness, they set alarms and make packing lists,
action lists, to-do lists and so on. Coaching and
mentoring by family, friends and colleagues is
another strategy to overcome the negative con-
sequences of ADHD. They greatly appreciate it
when colleagues pay attention and take time to make
them familiar with new job functions (hands-on
experience) and when teachers support them in ful-
filling academic challenges, for example by taking
time to explain how things interact.
They also highly value friends and family remind-
ing them of assignments and providing social support.
It makes it easier for them to manage job requirements
when employers provide structure and clear rules and
limits for the job they are expected to perform.
Receiving the diagnosis of and getting insights into
ADHD are important in coping with the condition. It
makes them understand why it is hard to fit in and
why they have to work harder to fulfil their tasks.
Medication is also part of the coping strategy.
Medication improves the ability to concentrate and
focus and thus make people with ADHD feel that
they can function in everyday life. Medication
improves their inter-personal skills and their ability
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1087
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
to organize. In this way, they feel that they are able to
reach their potential due to medication, which also
makes them feel more positive about the future.
However, some medication also has side effects such
as a feeling of being drugged, fatigue, irritability and
emotional instability.
4. For adults with attention deficit hyperactivity
disorder, accomplishing and organizing tasks in
everyday life is a challenge but it can also be
rewarding
In everyday life, poor time management and hyper-
focusing can both be rewarding and challenging.
It is rewarding when tasks fall within their field of
interest and they forget time and place and stay
focused until the task is completed.
It is challenging when tasks imply distractibility,
disorganization and difficulties in prioritizing,
resulting in poor motivation, poor reading skills,
forgetfulness, procrastination and difficulties in
completing work tasks at home and at work. When
the task does not seem meaningful or is uninterest-
ing, it requires a lot of energy to complete it; it also
results in exhaustion.
Categories
The inability to navigate is frustrating: Adults with
ADHD find it difficult to handle ADHD symptoms
in everyday life, for example being and feeling out of
control when completing tasks or participating in
social relations.
Awareness of being different: Participants are aware
that, due to the effects of ADHD symptoms, they are
different from others, for example inability to follow
rules, lacking a sense of propriety, impulsiveness and
pursuing own ends.
Challenges for self-esteem: Frustrations in relation to
being different lead to low self-esteem and low
expectations for the future.
Stigma attached to ADHD: They feel that others
label them as ‘‘problem-persons.’’
Ways of ‘‘togetherness’’: Sharing everyday activities
provides a feeling of being needed, which is satis-
factory and creates opportunities for social inter-
action.
Being highly creative and inventive: Creativity is a
positive aspect of ADHD.
Coaching, mentoring and facilitating as support:
Mentoring is supportive as it provides guidance
and hands-on experience. It is helpful when families
and friends gently nudge and remind them about
assignments.
Conscious use of medication as a healthy strategy to
cope with ADHD: Medication has a positive effect
as it enables people with ADHD to function and
thereby ‘‘feel normal.’’ It also improves their ability
to organize. But on the negative side, medication can
for some cause feelings of being drugged or feeling
‘‘somber.’’
Insight into ADHD provides the possibility of cop-
ing with the condition: Learning about ADHD
symptoms provides explanations for their way of
acting and provides the ability to cope with the
symptoms. However, it also leads to feelings of
sadness that they have wasted a lot of years.
Keeping up with and managing to have several balls
in the air: It is demanding to shoulder both work and
family responsibilities. It can lead to frustration as
they want both to do their jobs properly and to take
part in duties in the home.
Removing distractions and making reminders are a
means to stay focused: Removing distractions such
as sounds, working in private rooms and avoiding
distraction from others are necessary to stay focused.
Making to-do lists and setting alarms days or weeks
in advance of an assignment help them to
stay organized.
Structure and clear working rules support a balanced
work effort: It is supportive when the workplace
facilitates by setting clear rules and structures.
Accomplishing tasks is challenging but can be
rewarding: Poor organizational skills and inability
to prioritize combined with hyper-focusing is a
challenge in relation to completing work; when
managed, it can be rewarding as they continue
until the job is finished.
Being distractible and disorganized is a challenge: It
is challenging to compete with being distractible and
disorganized, with poor time management and dif-
ficulty in staying focused. It affects both academic
and work performance, but can be managed by
structuring and delegating work.
Living with ADHD is energy-intensive: It is difficult
to complete work as it is energy-intensive to cope
with being distractible and disorganized, being a
poor time manager and having a tendency
to procrastinate.
Tasks must ideally be of interest: People with
ADHD stay focused on tasks when these are
meaningful.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1088
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2: Synthesized findings
Finding Category Synthesized finding
Facilitating support was described as important by both
those who lived in their own apartments and those living in
a community apartment with staff-personnel. Support could
include help in organizing housework, from talking about
what they should start to clean up through how they would
continue. It was also difficult for some participants to realize
when the house was dirty and therefore they needed support
to observe that. Even though they had the structure and
followed a schedule to perform activities, they could require
support from another person to pay attention to and remind
them when they should, for example clean or eat. Their need
for facilitating support to get engaged in and perform
everyday activities meant that living conditions that included
supporting personnel were important for their development
of self-confidence. Through social support they felt that they
could try to perform activities they had earlier been insecure
about (286) (U)
The inability
to navigate
is frustrating
Adults with ADHD are aware of being
different from others and strive to be an
integrated, accepted part of the community
Adults with ADHD are aware of being
different and have the feeling of not
belonging in the social context. This
emotion results from the feeling of being
out of control, the inability to ‘‘read’’
social codes, and the feeling of being
misunderstood and rejected, leading to low
self-esteem. Such situations are typically
caused by the ADHD symptoms e.g. talk-
ing before thinking and having difficulty
following rules etc. They often feel stupid
when they cannot concentrate and cannot
follow a lesson or conversation. They strive
to be needed and wanted by other people,
and to fit in and hope that this will
magically happen when they just find the
right job, medication etc.
In terms of psychological health, almost all of the ADHD
adults interviewed reported general feelings of being over-
whelmed and out of control. Some of the anxiety inspired by
adults related to concerns about their ability to navigate
through their days ‘‘successfully.’’ This anxiety was coupled
with frustration arising from the inability to keep everyday
aspects of life on track. Self-esteem issues and feelings of
depression and isolation were common (61) (C)
It soon became apparent that Ralph also avoided stress by
engaging in magical thinking, coupled with externalizing
thoughts in the form of using the diagnosis of ADHD to
disproportionality emphasize the need for external accommo-
dations. These cognitive distortions served to deflect focus
away from the adaptive changes he could make to his coping
repertoire (480) (U)
Blurting out comments at the wrong time or impulsive acts
resulted in others (both at work and at home) being annoyed
with them or considering them rude. As a result, participants
reported difficulty in keeping friends or meeting new people
(U)
Awareness
of being
different
Feeling different (252) (U)
He bemoaned the fact that his wife felt embarrassed to
socialize with other couples because of his numerous social
‘‘blunders’’. The cumulative effect of these various experi-
ences was that Ralph was left feeling incompetent and
pessimistic about his ability to make changes in his life,
though he desperately clung to the notion that things could
magically work out for the best if he found the ‘‘right’’ job
and the ‘‘right’’ medication (474) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1089
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Ralph tended to respond to superiors’ corrective feedback by
becoming defensive, making excuses. And blurting out
convoluted explanations that ranged from blame to angry
outbursts. Such behaviors invariably led to reprimands,
strained interactions and ultimately, termination of employ-
ment. His conflicts at work were compounded by his
inability to follow rules, misreading social cues, and stub-
bornness with supervisors. These interactions resulted in him
being labeled as ‘‘high maintenance’’ (476) (U)
Cont’d:
Awareness
of being
different
Cont’d:
Adults with ADHD are aware of being
different from others and strive to be an
integrated, accepted part of the community
You felt you had to catch up in the reading to be able to
attend the next class because if you didn’t you would run the
risk of appearing stupid, to use your own words. And even if
you knew you wouldn’t be called on, it sounds like it would
be frustrating to sit in a lecture that you didn’t understand
and thinking, ‘‘I don’t belong here’’ (337–8) (U)
Peer rejection (252) (U) Challenges
for self-
esteem
Ralph’s case conceptualization seemed to be organized
around three principal maladaptive schema: failure, defec-
tiveness/shame and entitlement (479) (U)
Seven out of nine reported experiences of peer rejection of
feeling isolated, alone or different (253) (U)
This frustration and confusion often led to low self-esteem,
feelings of low self-worth and poor expectations of what
they may achieve (496) (U)
Participants hoped that in the future the stigma of ADHD
would gradually diminish and they believed this would occur
in much the same way as it had with dyslexia (498) (U)
Stigma
attached to
ADHD
Participants reported that they sensed a certain degree of
stigma attached to ADHD and this had influenced the
disclosure of their diagnosis to other people. Most partici-
pants had only informed people whom they knew very well,
that is, close friends and family. This sense of stigma
appeared to stem from the fact that they felt others may see
ADHD as a convenient excuse for their behavioral problems
and they may be labeled as a ‘‘problem person’’ rather than
a person who has a problem (498) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1090
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Feeling togetherness with other people and sharing everyday
activities was described as engaging. Through meeting others,
finding common interests and doing activities together, the
participants come to be engaged in a variety of activities. For
example, one activity that was describes as social and
engaging was roleplaying. Role-playing required the partici-
pants to be creative and forced them to find new solutions to
problems. Other activities described as being engaging
through togetherness with others were hanging out with
friends, going shopping, participating in or attending sports
events and holiday travelling. Feelings of togetherness and
engagement could also be achieved through talking to friends
on the phone or through using online social media like
Facebook. The Internet also created the opportunity for
social interaction through playing games. Taking part in
various online data games satisfied their social need for
sharing activities (287) (U)
Ways of
‘‘together-
ness’’
Cont’d:
Adults with ADHD are aware of being
different from others and strive to be an
integrated, accepted part of the community
Furthermore, feelings of togetherness and being needed and
appreciated by others resulted in the performance of several
activities, like shoveling snow, walking the dog, repairing
broken items, babysitting or walking small children to
school. The appreciation they received after managing to
perform an activity that made them feel needed encouraged
the participants to engage in and perform such activities even
when they found them uninteresting (287) (C)
To have employment was also of importance as it was an
opportunity to find and share everyday activities with others.
Through their work they met people and established
togetherness around common work tasks that they were
engaged enough to start and to stay focused on without
losing concentration. Even when they were asked to do
several different tasks they found it easier and more engaging
to perform the activity when they shared it with others (287)
(U)
Among the few college courses he found to be less of a
struggle for him were those involving the creative arts, which
eventually became his major field of study. After completing
his undergraduate degree, he sought a master’s degree in an
art program focused on the use of creative arts in business/
advertising. Although he continued to enjoy studying the arts
and the use of various computer software programs, he
struggled with business classes and with keeping up with
assignments and project (52) (C)
Being highly
creative and
inventive
Adults with ADHD are creative and
inventive
ADHD symptoms have positive aspects.
ADHD can enhance the sense of creativity.
Adults with ADHD are often successful
in maintaining jobs within the arts and
computer technology
In addition to the negative outcome the participants reported
positive aspects associated with the disorder. For example,
participants were almost unanimous in feeling that ADHD
has enhanced their sense of creativity and, when channeled
appropriately, allowed for success in work and home
environments. Although adults with ADHD reported having
difficulty maintaining focus they reported periods with
extreme focus (that is hyper-focus) when they were able to
be highly productive. Unfortunately, they were not able to
predict or bring about this state and, as one adult reported
‘‘it feels like a short wave radio that most of the time can’t
find the right frequency’’ (62) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1091
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Academic support or disability services were also an import-
ant source of support for six of the participants. Students
who used these services were eligible for note takers in class,
extra time on exams, tutors or other individualized academic
accommodations. Participants who were receiving disability
services also indicated that if they stated having trouble with
academics they had somewhere to go to get help (253–4) (U)
Coaching,
mentoring
and facilitat-
ing as
support
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in
life
Adults with ADHD are aware of the
deficits caused by the disorder and strive to
overcome these deficits by developing cop-
ing strategies to maintain a balance
between duties and leisure time. To over-
come forgetfulness they set alarms and
make packing lists, actions lists, to-do lists
etc. Coaching and mentoring by family,
friends and colleagues is another strategy
to overcome the negative consequences of
ADHD. They greatly appreciate it when
colleagues pay attention and take time to
make them familiar with new job functions
(hands-on experience) and when teachers
support them in fulfilling academic chal-
lenges, e.g. by taking time to explain how
things interact.
They also highly value friends and family
reminding them of assignments and provid-
ing with social support. It makes it easier
for them to manage job requirements when
employers provide structure and clear rules
and limits for the job they are expected to
perform. Receiving the diagnosis of and
getting insights into ADHD are important
in coping with the condition. It makes
them understand why it is hard to fit in,
and why they have to work harder in
fulfilling their tasks. Medication is also
part of the coping strategy. Medication
improves the ability to concentrate and
focus and thus makes people with ADHD
feel that they can function in everyday life.
Medication improves their interpersonal
skills and their ability to organize. In this
way they feel that they are able to reach
their potential due to medication, which
also makes them feel more positive about
the future. However, some medication also
has side effects such as a feeling of being
drugged, fatigue, irritability and emotional
instability
After completing his degree, Brian soon found a job working
for a midsize retrial clothing company, in its advertising
department, allowing him to put his training to good use. He
is in an entry-level position and described his experience as
being akin an ‘‘apprentice’’ having the opportunity to be
mentored by the senior-level creative director. Brian found
this arrangement helpful insofar as he was able to learn by
observing his boss demonstrate various tasks and responsi-
bilities and then gained ‘‘hands-on’’ experience executing
these tasks under the supervisor of his boss (52) (U)
Brian was eventually promoted to creative director when his
mentor/boss left the company, and he has been in the
position since then. Brian struggled in his position as director
because, rather being able to rely on his mentor for guidance,
he now was expected to work independently and, in fact, to
provide guidance and directions to his staff (52) (U)
Emotional support (67) (C)
Factors that help them to cope with their ADHD in college:
The most commonly described coping methods mentioned
were using some types of social support (52%). Students
wrote and talked about how their parents, dating partners,
roommates, friends and professors helped them manage their
ADHD (67) (C)
Friends were also an important source of social support (U)
Having someone who pushed them to get started was
important because the participants often experienced lack of
energy and thereby found it difficult to be engaged in and
perform activities, especially those they found boring and
repetitive. Performing different activities often required a lot
of concentration, and it was easier to stay focused and
concentrated when they had the support of a person who
pointed out what they were doing and should do so they
could concentrate on the performance and nothing else. The
SSW (Community Care Workers) personnel were described
as ‘‘starters’’ to begin the activity. To start an activity was
the most difficult part for the participants; continuing and
completing the activity was easier. To enable their perform-
ance of activities, a partner or a friend could also give social
support (286) (U)
Parents developed creative strategies to help their children,
such as setting up daily email reminders. One participant felt
like his parents ‘‘keep him on a tight leash’’. When asked
whether he felt like he had less independence than others his
age he said (253) (U)
Participants described positive relationships with their
parents and indicated that the continuous presence, support
and reinforcement form their parents helped them to get
college (253) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1092
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Unfortunately most participants did not take advantage of
these services because ‘‘they didn’t want to be thought of as
different’’ (254) (U)
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
While parents were the main source of support prior to
college, participants began to utilize their friends as a main
support once they moved away from home. Friends helped
them to stay on track by reminding them of assignments and
due dates, studying with them and even making sure they
got to class on time (253) (U)
Although all of the participants who were initially started on
stimulant medication (n¼13) in early elementary school
had stopped taking them regularly by high school, most (n¼
62%) started taking stimulant medications again in college.
The participants cited the ‘‘need to study and get stuff done’’
as the reason for taking stimulant medications. Many of the
participants who started taking stimulant medications again
in college stated that they only took the medication ‘‘when
they need them.’’ When asked by the investigator ‘‘How do
you know when you need stimulant medications?’’ The
response was typically, more likely to take their stimulant
medications at night than during the day (221) (U)
Conscious
use of medi-
cation as a
healthy
strategy to
cope with
ADHD
Another participant, a soccer player, noticed that taking
ADHD medication improved his ability to stay focused
during games (252) (U)
Both male and female participants used similar words to
describe the medications as making them feel ‘‘somber’’ or
‘‘mellow’’ (219) (U)
Eight of the participants smoked cigarettes and believed that
nicotine helped their ADHD symptoms (253) (U)
Even without specific achievements in mind participants felt
generally more positive about the future (498) (U)
Every participant reported some emotional liability and
anger associated with stimulant medications, particularly
with Adderall (220) (U)
Four participants (31%) stated that they were never ‘‘off’’
medication, but that they did not take them regularly in high
school. ‘‘I would always forget it, so yeah, I mean half the
time, I never took it. And uh, on the weekends, you don’t
want to feel like that’’ two of the 13 continued to take
stimulant medications during high school, but discontinued
once they got to college (218) (U)
Furthermore, participants had always believed that they were
unable to achieve their potential, yet following treatment
with medication, participants believed that reaching their
potential was now possible. This contributed to a more
positive and hopeful outlook on the future (498) (U)
General social effects described by participants were some-
what unexpected. While the literature supports the use of
stimulant medications to reduce impulsiveness and improve
social skills, several of the participants felt like the medi-
cations made them less sociable (219) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1093
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
In addition, when the effect of medication wore off, the
rapid reemergence of symptoms made participants realize
that there is no miracle cure for their symptoms and that
medication alone did not solve all their problems. This
also prompted participants to constructively acknowledge
that they could do something to change their behavior
(498) (U)
Cont’d:
Conscious
use of medi-
cation as a
healthy
strategy to
cope with
ADHD
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
In other words, medication enabled participants to feel that
they could function in the same way as ‘‘normal’’ people
who do not have ADHD (497) (U)
Indeed, the reoccurrence of the symptoms following the
effects of medication wearing off provided participants with
the opportunity to distinguish between the problems that
were strongly associated with their symptoms and those that
were less influenced by the presence of symptoms (498) (U)
Medication also had a positive impact on their ability to
function more successfully in their everyday lives, particu-
larly in terms of interpersonal skills. For example, the
medication improved their interactions with people, which
had previously been hampered by their ADHD symptoms
(497) (U)
Medication also improved their motivation and their ability
to organize and stay focused on everyday tasks (497) (U)
Most participants did not think that stimulant medication
affected their grades, but that the medication’s did affect
how hard they had to work to get those grades (220) (U)
Nevertheless, despite the many advantages of stimulant
medication, participants reported that as soon as the effects
of the medication wore off, they experienced a rapid
reoccurrence of symptoms (498) (U)
One girl remembered that as a 2nd grader, ‘‘It made me feel
like I didn’t have friends. I didn’t ever really play that much.
I’d just; it just felt like you were going very slow.’’ This was
one area in which the participants who were diagnosed with
ADHD later and started on stimulant medication later
differed from those who were diagnosed in earlier elementary
school. Those who were diagnosed later were more positive
and insightful in their perception of general social effects
(220) (U)
One male described the ‘‘cycle’’ of medication effects (220)
(U)
Only the two participants (one male and one female) who
were diagnosed with ADHD in junior high school continued
to take stimulant medications regularly throughout high
school (219) (U)
Others also began to notice the participants’ symptoms again
and expressed negative feedback regarding their behavior
and attitude. However, for those participants who would
have previously ruminated about this feedback and sub-
sequently experienced a low mood they now appeared to be
more accepting of this feedback and thought about it in a
constructive way, for example, by thinking about what they
could do to change their behavior (498) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1094
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Participants described the factor of taking/using CNS stimu-
lants, as helpful. Central nervous system stimulants include
prescription ADHD medication such as Ritalin, Adderall or
Concerta, as well as non-prescription sources such as
nicotine. Ten of the participants were taking prescription
ADHD medication, although only three took it on a regular
basis. Most said it was helpful for studying, completing
course work or for especially long classes. Prescription
ADHD medication was also described as useful for improv-
ing concentration and decision making while driving (252)
(U)
Cont’d:
Conscious
use of medi-
cation as a
healthy
strategy to
cope with
ADHD
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
Participants reported the positive influence that medication
had brought into their life. It appeared that medication had
dissolved the previous sense of ‘feeling different from others
and was replaced by a ‘‘sense of normality’’ (497) (U)
The factor’s benefits included the positive effects of stimulant
medications that were consistent with existing literature.
Participants were unanimous in confirming that stimulant
medications improved concentration and focus. The biggest
benefits cited by participants were being able to study longer,
completing more schoolwork, and improving reading com-
prehension (220) (U)
The factor’s side effects evoked quite a bit emotion from
most participants. All described negative physiological and
psychological side effects from stimulant medications. Phys-
iological effects included nausea, anorexia, increased thirst,
insomnia, shakiness, fatigue and dry mouth. Psychological
side effects included irritability, emotional liability, anger,
anxiety, restlessness and depression. Several of the partici-
pants described themselves ‘‘feeling drugged’’ or ‘‘zoned out’’
(220) (U)
The limitations of medication were often considered together
with the limitations of being diagnosed, that is diagnosis and
treatment with medication were not sufficient to overcome
one’s difficulties (498) (U)
This increased awareness and acceptance of problems that
are directly attributable to their ADHD symptoms and those
that arise from factors associated with them meant that
participants could recognize and adopt greater personal
responsibility for their self-generated behavior. This, in turn,
meant that they were motivated to engage in a process of
change especially with respect to symptoms and/or problems
that they perceived to be resistant to treatment with
medication (498) (U)
When asked ‘‘Other than school work, how does prescrip-
tion stimulant medication help you?’’ several participants
described improved driving concentration (221) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1095
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Acceptance also marked the end of ruminations that had
previously been experienced in relation to the diagnosis.
Another participant also appeared to have stopped ruminat-
ing over the diagnosis (497) (U)
Insights into
ADHD pro-
vide possib-
ility to cope
with the
condition
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
All the participants were diagnosed with ADHD prior to
high school, and most described learning about ADHD
primarily through own experiences. They described how
ADHD was simply a ‘‘part of who I am’’ and that through
trial and error they had learned what worked and what did
not work. About half of the participants indicated that they
really did not want or need to learn any more over and
above what experience had taught them (250) (U)
For some participants, this anger lead to sadness as they felt
they had wasted many years living under the illusion that
they were destined to fail (497) (U)
However, this relief and elation was short-lived and was
quickly followed by feelings of turmoil and confusion as they
looked back and reframed their past experiences in the light
of their diagnosis and a new understanding of themselves
(496– 7) (U)
Immediately after their diagnosis, participants described an
initial sense of relief and elation that their lifelong quest for
an explanation for their difficulties had finally come to an
end (496) (U)
In addition to their newfound self-acceptance, it was import-
ant to several women that they share their experience and
knowledge with others (257) (U)
More specifically, the participants experienced relief and
optimism as the years of frustration and confusion at not
knowing the cause of their problems were now over. Another
participant described a similar sense of joy (496) (U)
Reframing their past experiences led participants to feel
angry that they had not been diagnosed earlier and life had
consequently been an unnecessary struggle (497) (U)
The final stage of adjustment process occurred when the
participants accepted that ADHD is part of their life and
who they are (497) (U)
The next stage of the adjustment process began with
realization of the long-term implications of ADHD as a
chronic disorder. This realization was accompanied by
anxiety as participants worried about having a ‘‘disease for
life’’ which would negatively affect their future (497) (U)
The third factor that helped participants gain insight about
ADHD acknowledging. One female participant who had
been diagnosed with ADHD in elementary school finally had
the opportunity to read her records just prior to entering
college. She described the relief she felt when she finally
understood why she had to work so hard at certain things
(250) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1096
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
These findings show that with group therapy the women
were able to develop a sense of self-acceptance and aware-
ness. They finally had an explanation for many of the actions
they had been exhibiting throughout their lives. They were
also taught skills to control their impulses and anger and
remain calm in ways they were unable to before (257) (U)
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
This relief and elation also stemmed from the fact that the
diagnosis provided an opportunity for them to relocate
blame for their previous difficulties and failures. It enabled
them to shift from an internal attribution that they were
solely responsible for their problems to an external attribu-
tion whereby ADHD was an explanation for their difficulties
(496) (U)
As Brian added the role of father to his life, he found it
increasingly difficult to strike a healthy balance among his
many responsibilities. As a result of innovations in advertis-
ing (e.g. social media) as well as the marketplace becoming
more competitive due to sluggish economy, Brian had more
projects to manage with fewer resources, resulting in even
greater demands on him at work. His wife became increas-
ingly frustrated with him because she felt that Brian was not
helping out enough with child rearing and general household
management. She also complained that he ‘‘was not present’’
when at home and did not listen to her when they had time
to talk with each other (53) (U)
Keeping up
with and
managing to
have several
balls in the
air
As he had throughout his educational life Brian soldiered on
in his work, getting things done on time by regularly staying
up late (often 1:00 or 2:00 a.m.) but recognizing he was
underperforming (53) (U)
Brian enjoyed the creative aspects of his work but struggled
with managing organizational demands of his job (e.g.
financial budgets, project deadlines), social demands (e.g.
delegating responsibilities, paying attention in meetings) and
maintaining a healthy balance between work and home life
(50–51) (U)
Brian’s case could be considered as a mid-to-moderate case
of ADHD with relatively circumscribed symptoms and
impairment. That is, although struggling at work, he was
completing projects, and his employment status was not at
risk. Similarly, although struggling to keep up with the
demands of his home life, his marriage and household
situation were generally stable. That being said, Brian was
spending very long hours to keep up with the demands on
him at work and less time attending to his family. He
experienced emotional distress and frustration, and his
difficulties were apparent to observers, namely, his employer
and his spouse (54) (U)
He took on more administrative and supervisory duties,
which required organization and follow through, and less
time doing ‘‘hands-on’’ work on specific projects. Brian
found himself staying at the office late to catch up on work
and devoting increasing amounts of time working at home to
keep up with his job (52) (C)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1097
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Removing distractions was another factor that was com-
monly described by participants. Rather than simply turning
off the computer or video game, participants actually
psychically removed them so that they could not use them
all. Studying in a sound proof room in the library, closing
blinds so as not to observe people walking by and even
paying extra for a private room were measures were taken
specifically to remove environmental distraction (253) (U)
Removing
distractions
and making
reminders
are a means
to stay
focused
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
The factor, setting alarms and reminders, was cited by all
participants as most important in daily life for getting up in
the morning, being on time, completing assignments on time
and staying organized. Participants most often used their cell
phones to remind themselves of important events and dates.
They set alarms to ring at several intervals to avoid
procrastination. Participants also set multiple alarms to get
themselves up in the mornings. One participant described
alternating between using the alarm on his cell phone and
the ‘‘annoying alarm clock,’’ because one he got accustomed
to an alarm, it would no longer wake him up. Another
strategy was to play the alarm across the room so that they
would have to get up to turn it off (252) (U)
The participants could also be engaged in and perform
activities, through facilitating supports that included adap-
tions of activities or adjustment of the environment, e.g. a
dish-washer facilitated the handling of dishes, and taking a
taxi facilitated opportunities to run errands without having
to make transport arrangements or check the bus schedule.
Further having time aid to remind them to perform the
activity. Another adaption they had experienced was the
handheld computer. It reminded them of everyday activities
that have had to undertake and was seen as a good support
to help them become more independent in their everyday
activities, they used the handheld computer to keep track of
all the activities that they had to do, as they felt that their
schedule was difficult to remember (286) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1098
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Another aspect facilitating support to engage in and perform
everyday activities included that activity’s structure. The
participants explained that structure in their everyday life
increased their capacity to perform various activities. The
structure included carrying out tasks in a certain order and
having routines. For example one participant folded her
clothes by color after doing the laundry to stay fully focused
on the task without losing concentration. To perform an
activity in a certain way with a given structure meant that
the participants could be engaged for an extended time
without losing concentration. Using a schedule was another
way to structure their everyday activities. One of the
participants had learned that written lists of everything that
she needed to do were a facilitator (286) (U)
Structure
and clear
working
rules
support a
balanced
work effort
Cont’d:
Adults with ADHD develop coping strat-
egies in striving for a healthy balance in life
The participants also expressed how their workplace gave
them facilitating support through demands and structure,
and that made them more engaged in activities at work.
They explained that they were more engaged in performing
activities at work since these activities were adapted to meet
their capacity, for example through the number of hours
they worked every day. There were also clear rules and limits
about what activities they should perform, and that made it
easier for them to perform an activity, be fully focused, and
succeed with it. Through facilitating support at work, they
could handle their job requirements to stay focused and be
engaged. Work was experienced as important for the
participants; it was also important that their work was
adapted to their conditions (287) (U)
Factors that help them to cope with their ADHD in college:
The most commonly described coping methods mentioned
were working harder and longer than other students (78%)
(67) (C)
Accomplish-
ing tasks is
challenging
but can be
rewarding
For adults with ADHD, accomplishing and
organizing tasks in everyday life is a
challenge but it can also be rewarding
In everyday life, poor time management
and hyper-focusing can both be rewarding
and challenging.
It is rewarding when tasks fall within their
field of interest and they forget time and
place and stay focused until the task is
completed. It is challenging when tasks
imply distractibility, disorganization and
difficulties in prioritizing, resulting in poor
motivation, poor reading skills, forgetful-
ness, procrastination and difficulties in
completing work tasks at home and at
work. When the task does not seem mean-
ingful or is uninteresting, it requires a lot
of energy to complete it; this also results in
exhaustion
It should also be noted that Brian evidenced many personal
strengths, he has a strong work ethic, doing what needs to
be done to finish a project by a deadline, although he might
not work efficiently or be satisfied with the finished product
(54) (C)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1099
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Ralph’s entrance to the ‘‘real world’’ of the workplace was a
rude awakening for him. The rigidity of schedules, lack of
individualized guidance supervision, emphasis on personal
organization, time management, planning and personal
accountability for performance resulted in repeated poor
performance evaluations. There was also no end of the
semester to provide an opportunity to start over with a
‘‘clean slate’’ (476) (C)
Cont’d:
For adults with ADHD, accomplishing and
organizing tasks in everyday life is a chal-
lenge but it can also be rewarding
About one third (N¼24) identified one or more factors that
were obstacles to their academic success (67) (C)
Being
distractible
and disorga-
nized is a
challenge
Additionally, being disorganized or distracted often created
tension in personal relationships, with partners feeling
neglected or unimportant. Adults with ADHD describe
themselves as ‘‘jugglers who can only keep one ball in the air
at the time,’’ and the ‘‘relationship ball’’ was frequently not
the one in play 61 (U)
All of the participants continued to struggle with persistent
symptoms of ADHD – inattention, impulsiveness and hyper-
activity. The symptoms created challenges to academic
success because of poor time management and organizational
skills, difficulty staying focused, failure to complete work on
time, poor motivation, poor reading and study skills and
difficulty sleeping and getting up in the morning. Several
received failing marks simply because of repeating absences.
One participant had to repeat an entire course because he
failed to show up for the final exam. Outside of the
academic context persistent symptoms of ADHD included
intention, impulsiveness and hyperactivity and these pre-
sented different challenges. Female participants in particular
reported that impulsiveness posed challenges in their social
relationships. They described themselves as blunt and indi-
cated that they often blurted hurtful comments to others.
Four of the participants indicated that being easily distracted
affected their driving skills (251) (U)
All participants reported difficulties in at least one activity of
daily living and most reported multiple impairments. For
example, difficulty organizing meant that bills were often
late and checks often did not get deposited or cashed in a
timely manner. The ADHD symptom of distraction meant
that shopping for groceries, even with a shopping list usually
resulted in missed items (61) (U)
Edna, age 62, ran her own tax business; explained needing
to take many small breaks from her work (256) (U)
Even preparing healthy meals or washing dishes was proble-
matic (61) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1100
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Following the flow of lectures was difficult and she noticed
herself frequently checking the notes of the students around
her to get information she had missed. Amanda also reported
difficulty in managing the volume of required reading in her
class. She reserved large blocks of study time for reading but
had difficulty focusing attention on the material and would
eventually stop studying altogether. Other areas of her life
also suffered because of her disorganization. She spent
inordinate amounts of time locating books and notes,
mismanaged her bank account and was remiss in attending
to her own health needs (332) (C)
Cont’d:
Being
distractible
and disorga-
nized is a
challenge
Cont’d:
For adults with ADHD, accomplishing and
organizing tasks in everyday life is a chal-
lenge but it can also be rewarding
For those who worked for pay, it was frequently difficult to
complete work on time due to being disorganized and/or
becoming distracted easily, as well as feeling fatigued from
the amount of energy required to initiate and sustain work
tasks. This difficulty appeared more pronounced when tasks
required attention to detail and/or were interpreted as being
boring. For example, participants spoke of expense reports
that were often not completed or were done inaccurately. In
addition, several participants commented on how they were
successful in the work environment until they were promoted
or transferred to a new job that required more detailed work
(61) (U)
June and Ralph’s first marital rift arose when Ralph was
fired from his first job during their first year of marriage.
His occupational problems over the years were compounded
by escalating marital conflicts stemming from Ralph forget-
ting to pay bills, not following through on chores and
‘‘getting stuck’’ on topics in conversations, all leading to his
wife’s perception that he was insensitive to her (476) (U)
Obstacles to success: inability to use organization, time-
management and study skills (67) (C)
On average, participants had 1.6 different careers throughout
their lives, although they switched jobs within careers several
times. These women described resourceful ways of working
in a variety of positions. Peggy, age 91, convinced one
company manager to hire her even though she did not
qualify for the position. She worked there for many years
and wrote the office training manual (256) (U)
Six male participants described problems with video gaming
in which they became so absorbed and focused on the games
that they often played into the early morning hours at the
expense of everything else. While these same participants
described difficulties with studying and staying on task, they
could describe every character and nuance of the games and
often played for hours at a time, sometimes forgetting to eat
or even sleep (251–2) (U)
To compound matters, Ralph learned that he could immedi-
ately reduce his distress by engaging in various forms of
avoidance, be it cognitive, emotional or behavioral (479) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1101
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Table 2. (Continued)
Finding Category Synthesized finding
Brian graduated with his class from high school and enrolled
in college. He required an extra semester to complete
graduation requirements in small part due to needing an
extra class related to a change in his major, he also had to
enroll in two other classes he needed to retake after with-
drawing from them after falling woefully behind in his work
because of disorganization and procrastination (52) (U)
Living with
ADHD is
energy
intensive
Cont’d:
For adults with ADHD, accomplishing and
organizing tasks in everyday life is a chal-
lenge but it can also be rewarding
Even when participants reported that they were able to
remain focused or organized, these activities required sub-
stantial energy resulting in later exhaustion. The additional
effort required of adults with ADHD was characterized by
one participant as ‘‘running in mud alongside a road rather
than on the pavement’’ (62) (U)
He struggled with procrastination and had difficulties prior-
itizing his work and often had to take an incomplete for a
class to complete the required work during breaks between
semesters (52) (C)
The major impact on psychical health was a feeling of being
tired or not having enough energy. Symptoms of poor time
management, procrastination, distraction and disorganization
resulted in days which never seemed ‘‘to end’’ and the belief
that everything in life required more effort than to individ-
uals without ADHD (61–62) (C)
There were several reasons why the participants found
certain activities fun, demanding, and inspiring. One was
when they did something they associated with meaning – for
example hobbies like pearl jewelry making, stone cutting,
embroidery or sewing cloth for the ‘‘live group’’ of which
the participant was a member. These activities made it
possible for them to create something on their own without
losing concentration. Activities that were creative awakened
their engagement, interest and desire to learn something new
and activities that provided an opportunity and challenge to
learn something new inspired them and made them engaged.
Activities that involved multiple tasks were demanding and
inspired them to be engaged. Through performing several
tasks at the same time, they could keep their focus on the
activity and avoid distraction (285) (U)
Tasks must
ideally be of
interest
Through their own interest in activities, they became mean-
ingful, which also facilitated the performance of various
activities. Activities they found inspiring were, for example
cooking, reading, playing computer games, training through
sports or learning a new language (285) (U)
When they felt that an activity was fun, they also experi-
enced that the activity was almost ‘‘performed by itself,’’
since they did not have to prepare themselves before the
event. For example, activities that required using a computer
were perceived as a pleasure and easy to perform; therefore
the participants were not distracted and did not lose their
focus, which were common problems otherwise. Activities
they found to be creative and enthusiastic inspired them
(285) (U)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1102
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Discussion
The aim of the systematic review was to synthesize
the best available evidence related to how adults
experience and manage symptoms of ADHD and
links between factors provided by relatives, friends,
fellow students, mentors and colleagues. The
majority of the 10 included studies were of high
quality and despite some weaknesses, the 10 studies
provided useful and credible findings based on the
research methodology, research objectives and the
methods used for data extraction and data analysis.
The 10 studies encompassed 159 informants, 88 men
and 71 women between 18 and 91 years with a
confirmed ADHD diagnosis. The gender distribution
reflects the female-to-male ratio of 3 –5%, based on
the American Psychiatric Association’s Diagnostic
and Statistical Manual of Mental disorders IV
(DSM-IV) criteria.
35-37
It is a strength that the
participants in all the included studies had a con-
firmed ADHD diagnosis and thereby consisted of a
well-defined group because to support people with
ADHD requires that healthcare staff or other
decision makers understand the problem from the
perspective of people with ADHD, as even though
ADHD on the surface has similarities with learning
disabilities (LD), ADHD is distinct from LD.
38
The four synthesized findings in the present meta-
synthesis demonstrate the complexity in living with
ADHD. Above all, it is overridingly energy-intensive
to live with and manage ADHD in all aspects of daily
living. For adults with ADHD, it can be difficult and
frustrating to manage and navigate everyday life as,
due to ADHD symptoms, they typically lack a sense
of propriety, pursue their own ends, have difficulty
following rules, are forgetful, distractible, have poor
time management and are not concentrated and
organized, all of which in many situations imply a
feeling of being out of control. Another aspect of
fundamental importance is that tasks perceived as
boring or not within their field of interest require a
lot of energy to fulfil.
For some people with ADHD, these character-
istics result in a negative life story with a higher
mortality and risky behaviors such as involvement in
traffic accidents, alcohol and substance use,
criminality and weakened school attachment.
39-41
Therefore, it is important to look into the problem
from the perspective of these people to get an insight-
ful perspective to develop strategies that meet their
needs and thereby hopefully reduce the negative
effects of ADHD characteristics. However, an
important finding in this review is that ADHD does
not unequivocally impact negatively on their lives.
Importantly, there are positive aspects attached to
ADHD symptoms. The overarching findings in the
present review are that ADHD symptoms might be
undervalued resources, which may be very useful if
handled properly, for example characteristics such
as persistence and perfectionism can be of value in
both education and the workplace as such efforts
often lead to better achievements. In line with this,
Atkins
42
found that people with ADHD stressed that
living with ADHD was not solely negative; on the
contrary, ADHD symptoms also had positive
aspects, for example they had an increased ability
to be creative and thereby to make quick connections
or move quickly from one thought to another and
creatively make connections others may not see,
and grasp a gestalt more quickly than peers
without ADHD.
Another important finding in the present review
is that people with ADHD are aware of being
different from others and strive to fit in and be
accepted in their various communities including
social life in general, college and the workplace.
The findings also suggest that the ADHD symptoms
give rise to problems in everyday life. It is a general
finding that people with ADHD are aware that they
are different, they acknowledge being forgetful,
distractible, lacking in concentration resulting in,
for example missed appointments, and bills not
being paid, and that they are impulsive, leading to
conflicts. The participants from the included studies
were also aware that their behavior sometimes
might be embarrassing. This is in line with other
studies that have found that people with ADHD, due
to deficits of executive functioning.
43,44
Studies
have also found that people with ADHD often are
socially impaired and always have felt wrong and
that their lives are disrupted, that they are different
from others and perceive themselvesasbeingless
connected to others because they are frequently in
conflict with others, are impulsively blurting inap-
propriate comments and they often feel misinter-
preted by others.
42,45,46
It is described as a source of frustration and a
challenge for their self-esteem when they know and
are aware that their conduct is inappropriate and feel
that other people label them as ‘‘problem-persons.’’
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1103
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
They are conscious that they often act before they
think and that their impulsive acts or blurting out
comments at the wrong time both at home or at the
work create a negative impression and elicit a nega-
tive response from others. From other studies, it also
appears that being different can entail that people
with ADHD in general experience lower levels of
self-esteem
47
and a lower quality of life
5
with nega-
tive self-perceptions, and they are aware that their
academic, inter-personal and work life is impaired
by their symptoms. However, despite of these nega-
tive feelings, they are also fully aware that they are
not ‘‘lazy,’’ ‘‘crazy’’ or ‘‘stupid’’.
42,47,48
Fundamen-
tally, they do not want others to see them as
‘‘ADHDs’’ and due to their behavioral problems
be labeled as ‘‘problem-persons;’’ this is consistent
with Bartlett et al.
45
who emphasize that people with
ADHD find it helpful when others do not focus on
their problems but accept them as they are and find
ways to help them to learn and adapt.
Nonetheless, from the studies, it is clear that
people with ADHD strive to be seen and accepted
as people who have a problem and endeavor to be
needed and appreciated by other people and to be
part of and needed in their various communities.
They struggle to be like others – to fit in – but they
are confused and some are pessimistic in relation to
their ability to be like others and how to fit in. The
findings stress that adults with ADHD appreciate
when others close to them assist them to manage the
problems related to ADHD. It can be in the form of
emotional support from friends, colleagues and fam-
ily members. People with ADHD appreciate it when
others listen to them, give advice and encourage
them. Parents especially play a very useful role for
young adults with ADHD when they initiate creative
strategies to help them gain an independent college
life, for example by sending daily e-mails with
reminders. This is in line with Kubik
49
who showed
the positive effects of coaching.
From the findings, it appears that people with
ADHD use several strategies to overcome problems
related to ADHD. Structure and routine in everyday
life increase their capacity to perform various activi-
ties, for example by performing activities in certain
ways within a given structure where they can be
engaged for an extended time without losing con-
centration. For example, one of the included studies
reported that a participant folded her clothes by
color after doing the laundry to stay fully focused
on the task without losing concentration. Making to-
do lists is another way of overcoming distractibility
and forgetfulness. Problems with organizational
skills can also be dealt with by taking medication,
as it is shown that it improves their ability to
organize and stay focused on everyday tasks and
that they are more likely to do things they have
decided or promised to do.
Medication is another strategy, as many adults in
the included studies describe conscious use of medi-
cation as a healthy strategy to manage ADHD. Being
on stimulant medication enables them to function in
the same way as ‘‘normal’’ people and alleviate the
sense of ‘‘feeling different from others’’ and gives
them an idea of what the average person has. Medi-
cation helps them overcome their problems as it
makes them less hyperactive; this has been shown
to have a positive impact on social life, particularly
in terms of inter-personal skills, as it improve their
interactions with people; they interrupt less and are
able to actually listen to other people and let others
have their say. Without medication, it does not
matter what other people say; to the person with
ADHD, it is only him or her who is important. Being
on medication also improves their ability to meet
criticism and negative feedback regarding their
behavior and attitude. Previously, they would nor-
mally react with a low mood; when on medication,
they would think more constructively about what
they can do to change their behavior. This is in line
with studies that have shown that medication
improves the overall quality of life for people with
ADHD.
52-55
Importantly, medication provides a more positive
view of the future, not that they expect drastic
changes, but they are able to feel better about things
and look on the positive side. Prior to taking medi-
cation, they usually cannot see beyond their noses
and are focused mainly only on negative aspects.
Although they are aware that a change in behavior
does not occur automatically, it is something they
have to work on. But medication is not the sole
solution to all problems, and it is not a miracle cure.
Despite the positive effects, there is also a negative
side to medication in the form of physiological and
psychological side effects. Physiological side effects
include nausea, anorexia, increased thirst, insomnia,
shivering, fatigue and dry mouth. Psychological side
effects are experiences like feeling drugged, ‘‘som-
ber’’ or ‘‘mellow’’, changed personality, irritability,
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1104
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
emotional lability, anger, anxiety, restlessness and
depression.
Insights into ADHD are a third way to relieve
everyday life with ADHD. The findings revealed that
for adults with ADHD, getting the diagnosis and
thereby insights into ADHD gave them the tools to
deal with the condition. On the one hand, it is a relief
to learn about ADHD symptoms as it provides
explanations for their way of acting and, not least,
provides a foundation from which to handle the
symptoms. Understanding the syndrome allows
them to understand why they have had to work so
hard to achieve so many things. On the other hand,
insight into ADHD also leads to feelings of sadness
and having wasted many years being frustrated.
The same is seen in other studies, that getting the
diagnosis is a relief as it gives them new information
and an opportunity to self-reflect and also see
positive aspects,
42
and that delayed ADHD diagno-
sis can lead to an accumulated psychosocial
burden due to a chronic sense of failure and missed
potential.
46,56
The findings illustrate that getting insights into
ADHD is a three-step process, from immediate
relief, to frustration, to self-acceptance. The first
step is an immediate relief directly after the diag-
nosis; they experience an initial sense of relief and
optimism because they now know the cause of their
problems that have given rise to difficulties, frustra-
tions and confusions. The explanation causes them
to understand that the difficulties are not their fault,
they become aware that blurting out comments at
the wrong time, not being able to complete home-
work or other tasks on time are not products of
conscious decisions, but part of the ADHD disease.
The next step is frustration, because recalling their
past experiences makes them feel angry that they
have not been diagnosed earlier because this means
that they have wasted many years living with the
feeling that they have been a failure, and their life
consequently has been an unnecessary struggle.
Insight causes worry about having a chronic dis-
order, ‘‘a disease for life,’’ which will negatively
affect their future. The final step is self-acceptance
when they accept that ADHD is part of their life and
who they are, that there is a reason for their inap-
propriate acts and decisions. This is supported by in
a review about career development, where it is
emphasized that information about ADHD is an
effective means to manage the disorder.
38
From the included studies, it is also apparent that
ADHD symptoms have a negative impact on edu-
cational performance. At college, poor time manage-
ment and organizational skills, lack of concentration
and procrastination are challenges for people with
ADHD, preventing them from achieving academic
success, and they feel that they have to work harder
and longer than others to attain goals. Lack of
concentration means that it is difficult to follow
lectures because of daydreaming, and being disor-
ganized means that they cannot keep up with their
homework. This is in line with knowledge on the
field showing that students with ADHD are at risk
for poor academic achievements and not being able
to complete a college education,
57,58
comprising
achieving lower grades.
59,60
The findings show that
these situations are managed in several ways. One
way is to study in soundproof rooms in the library or
behind closed doors so they cannot observe people
walking by. Another typical strategy to handle for-
getfulness and being disorganized is to use their cell
phone to set alarms and reminders so they can get up
in the morning and be on time – a strategy in that
regard is to place the alarm across the room so they
have to get up to turn it off. They try to stay
organized and keep up with assignments by setting
reminders days or weeks before schedule. It is also
noticeable that friends are also an important source
of support by reminding them of assignments, offer-
ing to study with them and not least by making sure
that they get to class on time. College students highly
value teachers giving support and accommodating
their needs, for example, giving them extra time to
complete assignments, taking more time to explain
certain concepts, or giving them tips on how to stay
motivated and focused.
Furthermore, medication is an effective remedy to
help them fulfil their academic capacity, as the
findings reported that medication is helpful for their
capability to study, because it improves their ability
to concentrate and focus. However, often many
college students with ADHD do not take prescrip-
tion ADHD medicine every day; commonly they
only take it when they have a lot of work to do.
Clearly, the biggest benefit is that when on medi-
cation they are able to study longer, complete more
schoolwork and improve reading comprehension. It
is described as being easier to sit down and focus;
they still have to read a page several times but they
do not have to read it 20 or 30 times to get it all of
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1105
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
what’s in the book and they still have to study that
amount of information twice, but not five or six
times. In spite of the described benefits, college
students who take stimulant medication do not think
that it affects their grades, but rather that the medi-
cation affects how hard they have to work to get
those grades. The fact that many young people with
ADHD who had stopped taking medication in high
school started again in college substantiates the
applicability of medication for reading skills.
In addition, it is also shown to be a problem for
college students with ADHD that they sometimes stay
up all night because they are absorbed with, for
example, playing computer games, video gaming
and so on, and as a result have difficulties getting
up in the morning and therefore skip lessons at col-
lege, which is in line with the study of Yen et al.
61
Findings from the included studies highlight that a
personal strategy to handle this is that they have to
actually physically remove video games so they can-
not use them at all.
The findings suggest that being disorganized and
distractible at work makes it difficult for adults with
ADHD to complete tasks on time. Other problems
such as the inability to follow rules, stubbornness, that
a no is not taken for a no and misreading social cues
often lead to problematic situations. This is similar to
findings in a study that proves that adults with ADHD
are aware that these are obstacles to success in work,
such as fatigue, inability to begin or prioritize, anxiety,
being disorganized, being forgetful, procrastination,
impulsive talk and having problems with authorities,
and that it requires significant coping skills and sup-
port. The same has been found inother studies.
46,62,63
The findings prove that people with ADHD often
have strong work ethics; they commonly keep on
working until the job is finished and, not least, they
do not stop until they are satisfied with the product.
It is described that although they have difficulties
maintaining focus, there are also periods with
extreme focus (hyper-focus) where they are able to
be highly productive and are so absorbed that they
sometimes even forget to eat and sleep. Unfortu-
nately for some, these periods are unpredictable.
Another important finding is that work tasks
ideally have to be meaningful or fall within their
field of interest; if so, they can continue for hours. It
is reported that when they feel that tasks are inspir-
ing or fun, they experience that the activity is almost
performed ‘‘by itself.’’ Activities requiring creativity
and or the use of computers are typically perceived as
a pleasure and easy to perform; thus, when perform-
ing such tasks, they do not feel distracted or lose
focus. So tasks involving creativity and computers
seem to be fields where people with ADHD can
expand their competencies.
The findings indicate that at the workplace, the
employer or a superior can support employees with
ADHD. One way is to set structures and clear rules
and limits about activities the employee should per-
form as it makes it easier for them to perform an
activity by being fully focused. Different kinds of
mentoring are seen to be helpful. When starting a
new job, being mentored by a senior colleague is seen
as supportive as it gives them the possibility to gain
‘‘hands-on’’ experience under supervision. When
necessary, tailoring of work tasks is helpful so they
meet the employee’s expectations.
From the findings, it is clear that medication is a
remedy to handle both the problems of being disor-
ganized and distractible and to improve decision mak-
ing, thereby helping them to participate more
constructively in their work, as instead of excessive
talking they are able to pay attention and focus. Being
less distracted and more focused through medication
means things come easier to them, which in turn
increasestheir motivation. It is also reported that being
on medication both improves their ability to see and
achieve the potential hampered by ADHD symptoms
and contribute to a more realistic view of their poten-
tial. This is in line with other studies that have shown
that medication reduces ADHD symptoms.
50,51
Importantly, the findings emphasize that for
adults with ADHD, it is demanding to shoulder both
work duties and family responsibilities. It can lead to
frustration, as due to their high work ethic they want
to do the work properly and also play their part at
home. It can be a challenge to be promoted to an
executive position. Hence, it is reported how adults
with ADHD feel successful in work until promoted
or transferred to a new position that involves more
administrative and supervisory duties, which also
requires the ability to see and handle the big picture.
This demands organizational skills, which is exactly
one of the skills they lack. To fill such a position
often implies staying at the office late to complete
work and also devote increased amount of time to
working at home. Such situations give rise to
emotional distress and frustration and thereby make
it difficult to keep a healthy work-life balance.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1106
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finally, the findings also elucidate that ADHD
symptoms do not solely impact negatively on their
lives; ADHD characteristics also have a positive side
as some of these make them more creative and
inventive than others. This is in line with another
study
34
where it was found that people with ADHD
identify positive aspects such as creativity, enthusi-
asm, awareness of the multiplicity of things and not
least the ability to hyper-focus and multitask when
interested in a given topic. So understandably, there
are varying opinions as to whether or not ADHD is a
problem. The same ambivalence was found in a
study by Brod et al.,
34
in which a group of people
with ADHD were asked whether or not they would
have their ADHD instantly ‘‘cured’’ or ‘‘taken
away’’ if it was possible; many of them regarded
ADHD an important part of their personality,
including both positive and negative qualities, and
of the 108 participants, 28% agreed to have ADHD
removed, 35% did not agree, 16% were ambivalent
and 21% did not respond.
34
Limitation of the review
Adults in the 10 included studies were mainly
Caucasian college students from Western countries.
This is important in relation to representativeness
as the possibilities for handling problems related
to ADHD symptoms may be different in other
countries.
Conclusion
It can be concluded that adults with ADHD are
aware of the problems caused by symptoms of
ADHD in relation to social interactions, academic
functioning and being part of the community, at the
workplace and performing work tasks. Adults with
ADHD work hard to perform at college and at work.
Furthermore, they strive to be accepted and be part
of social life and academic and work communities.
Above all, they do not want to be seen as ‘‘ADHDs’’
but as people who have a problem.
The findings also point out protective factors that
are supportive in relation to the ability to manage
daily life with ADHD. To keep up with appoint-
ments and complete study and work tasks, they
develop personal strategies such as various
reminders and performing tasks using a given struc-
ture. It is welcomed when others close to them help
them, for example by coaching and reminding them
of appointments. Superiors can assist by structuring
their work tasks, setting up clear rules and limits for
the tasks. Medication has proven to be very useful as
it leads to them being are less hyperactive, which
enhances their ability to stay focused and to be
more organized.
Finally, it has become clear that insights into
ADHD have a positive impact on their ability to
manage its consequences, as it provides an expla-
nation for why they react as they do. However,
coming to terms with the condition is a process,
and ADHD is something they have to not only cope
with but also live with.
Implications for practice
It is important that health professionals when advis-
ing adults with ADHD understand that they are
dealing with a person who has a problem and not
a problem person. They should emphasize the strat-
egies the adults themselves can apply in various
aspects of daily living, such as structuring their
everyday tasks and the use of to-do lists to maintain
an overview of the tasks so that these are clear and
foreseeable. Medication should not be underesti-
mated as a remedy to overcome the consequences
of the ADHD symptoms, and of course information
on both the positive effects and the possible side
effects must be provided.
Policy-makers could launch a campaign targeted
at employers with information about the competen-
cies many adults with ADHD possess and how they
can benefit from these by structuring and limiting
work tasks as well as rewarding and promoting their
employees with ADHD to positions with more
advanced hands-on functions while avoiding pos-
itions that include administrative duties (Grade B).
Implications for research
The lack of qualitative studies indicates that research
on this topic is needed. Future research could
examine how successful people with ADHD are in
fulfilling their professional roles, which jobs they
perform and how they complete their work tasks.
Research could also consider how adults from non-
Western countries experience and manage living
with ADHD.
References
1. American Psychiatric Association. Diagnostic and statistical
manual of mental disorders DSM-IV-TR. Washington, DC:
American Psychiatric Association; 2011; 85– 93.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1107
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
2. World Health Organization. International statistical classifi-
cation of disease and related health problems. 10th ed.
Geneva: World Health Organization; 1992; 378.
3. Retz J, Sobanski E, Alm B, Retz W, Ro
¨sler M. Age and gender
specific characteristics in attention deficit/hyperactivity def-
icit. Der Nervenartz 2008;79(7):809 –19.
4. Mannuzza S, Klein RG, Bessler A, Malloy P, LaPadula M. Adult
outcome of hyperactive boys. Educational achievement,
occupational rank, and psychiatric status. Arch Gen Psy-
chiatry 1993;50(7):565–76.
5. Grenwald-Mayes G. Relationship between current quality of
life and family of origin dynamics for college students with
attention-deficit/hyperactivity disorder. J Atten Disord
2002;5(4):211–22.
6. Mannuzza S, Klein RG, Bessler A, Malloy P, Hynes ME.
Educational and occupational outcome of hyperactive boys
grown up. J Am Acad Child Adolesc Psychiatry 1997;36(9):
1222–7.
7. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK,
Demler O, et al. The prevalence and correlates of adult
ADHD in the United States: results from the National
Comorbidity Survey Replication. Am J Psychiatry
2006;163(4):716–23.
8. Young S, Gudjonsson GH. Growing out of ADHD: the
relationship between functioning and symptoms. J Atten
Disord 2008;12(2):162–9.
9. Taylor E, Chadwick O, Heptinstall E, Danckaerts M. Hyper-
activity and conduct problems as risk factors for adolescent
development. J Am Acad Child Adolesc Psychiatry
1996;35(9):1213–26.
10. Young S, Gudjonsson G, Ball S, Lam J. Attention deficit
hyperactivity disorder (ADHD) in personality disordered
offenders and the association with disruptive behavioural
problems. J Forensic Psychiatry Psychol 2003;14(3):491–505.
11. Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH.
Conduct problems, gender and adult psychiatric outcome
of children with attention-deficit hyperactivity disorder. Br J
Psychiatry 2002;181:416– 21.
12. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult
outcome of hyperactive children: adaptive functioning in
major life activities. J Am Acad Child Adolesc Psychiatry
2006;45(2):192–202.
13. Barkley RA, Anastopoulos AD, Guevremont DC, Fletcher KE.
Adolescents with ADHD: patterns of behavioral adjustment,
academic functioning, and treatment utilization. J Am Acad
Child Adolesc Psychiatry 1991;30(5):752– 61.
14. Biederman J, Faraone SV, Spencer T, Wilens T, Norman D,
Lapey KA, et al. Patterns of psychiatric comorbidity, cogni-
tion, and psychosocial functioning in adults with attention
deficit hyperactivity disorder. Am J Psychiatry 1993;150(2):
1792–8.
15. Eakin L, Minde K, Hechtman L, Ochs E, Krane E, Bouffard R,
et al. The marital and family functioning of adults with
ADHD and their spouses. J Atten Disord 2004;8(1):1– 10.
16. Murphy K, Barkley RA. Attention deficit hyperactivity dis-
order adults: comorbidities and adaptive impairments.
Compr Psychiatry 1996;37(6):393– 401.
17. Kessler RC, Adler L, Ames M, Barkley RA, Birnbaum H,
Greenberg P, et al. The prevalence and effects of adult
attention deficit/hyperactivity disorder on work perform-
ance in a nationally representative sample of workers. J
Occup Environ Med 2005;47(6):565–72.
18. Barkley RA, Murphy K, Kwasnik D. Psychological adjustment
and adaptive impairments in young adults with ADHD. J
Atten Disord 1996;1(1):41–54.
19. Young S. Coping strategies used by adults with ADHD.
Person Indiv Diff 2005;38(4):809–16.
20. Toner M, O’Donoghue T, Houghton S. Living in chaos and
striving for control: how adults with attention deficit hyper-
activity disorder deal with their disorder. Int J Disabil Dev
Educ 2006;53(2):247–61.
21. BjerrumM,LarsenP,PedersenU.Livingwithsymptomsof
attention deficit hyperactivity disorder (ADHD) in adult-
hood: a systematic review protocol of qualitative evi-
dence. JBI Database System Rev Implement Rep
2013;11(3):319– 31.
22. Lange KW, Reichl S, Lange KM, Tucha L, Tucha O. The history
of attention deficit hyperactivity disorder. Atten Defic
Hyperact Disord 2010;2(4):241–55.
23. Wright SA. Functional impairments of college students with
attention deficit/hyperactivity disorder and necessary
modifications for higher education. West Virginia: College
of Human Resources and Education at West Virginia Uni-
versity, University of West Virginia; 2011.
24. Brod M, Perwien, Adler L, Spencer T, Johnston J. Concep-
tualization and assessment of quality of life for adults with
attention-deficit/hyperactivity disorder. Prim Psychiatry
2005;12(6):58–64.
25. Henry E, Jones SH. Experiences of older adult women
diagnosed with attention deficit hyperactivity disorder. J
Women Aging 2011;23(3):246–62.
26. Kaminski P, Turnock P, Rose
´n L, Laster S. Predictors of
academic success among college students with attention
disorders. J Coll Counsel 2006;9(1):60–71.
27. Meaux JB, Hester C, Smith B, Shoptaw A. Stimulant medi-
cations: a trade-off? The lived experience of adolescents
with ADHD. J Spec Pediatr Nurs 2006;11(4):214–26.
28. Meaux JB, Green A, Broussard L. ADHD in the college
student: a block in the road. J Psychiatr Ment Health Nurs
2009;16(3):248–56.
29. Ramsay RJ, Rostain AL. Girl repeatedly interrupted: the case
of a young adult woman with ADHD. Clin Case Stud
2005;4(4):329–46.
30. Ramsay JR. ‘‘Without a net’’: CBT without medications for an
adult with ADHD. Clin Case Stud 2012;11(1):48 –65.
31. Rosenfield BM, Ramsay JR, Rostain AL. Extreme makeover:
the case of a young adult man with severe ADHD. Clin Case
Stud 2008;7(6):471–90.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1108
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
32. Young S, Bramham J, Gray K, Rose E. The experience of
receiving a diagnosis and treatment of ADHD in adulthood:
a qualitative study of clinically referred patients using
interpretative phenomenological analysis. J Atten Disord
2008;11(4):493–503.
33. Ek A, Isaksson G. How adults with ADHD get engaged in and
perform everyday activities. Scand J Occup Ther 2013;20(4):
282– 91.
34. Brod M, Schmitt E, Goodwin M, Hodgkins P, Niebler G. ADHD
burden of illness in older adults: a life course perspective.
Qual Life Res 2012;21(5):795–9.
35. Yallop L, Brownell M, Chateau D, et al. Lifetime prevalence of
attention-deficit hyperactivity disorder in young adults:
examining variations in the socioeconomic gradient. Can
J Psychiatry 2015;60(10):432– 40.
36. Faraone SV, Sergeant J, Gillberg C, Biederman J. The world-
wide prevalence of ADHD: is it an American condition?
World Psychiatry 2003;2(2):104– 13.
37. Simon V, Czobor P, Balint S, Meszaros A, Bitter I. Prevalence
and correlates of adult attention-deficit hyperactivity dis-
order: meta-analysis. Br J Psychiatry 2009;194(3):204–11.
38. Dipeolu AO. College students with ADHD: prescription
concepts for best practices in career development. J Career
Dev 2011;38:408–11.
39. Madsen AG, Dalsgaard S. Prevalence of smoking, alcohol
and substance use among adolescents with attention-
deficit/hyperactivity disorder in Denmark compared with
the general population. Nord J Psychiatry 2014;68(1):
53– 59.
40. Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB,
Pedersen MG. Mortality in children, adolescents, and adults
with attention deficit hyperactivity disorder: a nationwide
cohort study. Lancet 2015;385(9983):2190 –6.
41. Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH.
Long-term criminal outcome of children with attention
deficit hyperactivity disorder. Crim Behav Ment Health
2013;23(2):86–98.
42. Atkins SC. The experience of attention-deficit/hyperactivity
disorder in adulthood: living with a cluttered mind. Massa-
chusetts: Massachusetts School of Professional Psychology;
1996; 171.
43. Biederman J, Petty C, Fried R, Fontanella J, Doyle AE,
Seidman LJ, et al. Impact of psychometrically defined
deficits of executive functioning in adults with attention
deficit hyperactivity disorder. Am J Psychiatry 2006;163(10):
1730– 8.
44. In de Braek D, Dijkstra JB, Jolles J. Cognitive complaints and
neuropsychological functioning in adults with and without
attention-deficit hyperactivity disorder referred for multi-
disciplinary assessment. Appl Neuropsychol 2011;18(2):
127– 35.
45. Bartlett R, Rowe TS, Shattell MM. Perspectives of college
students on their childhood ADHD. MCN Am J Matern Child
Nurs 2010;35(4):226–31.
46. Matheson L, Asherson P, Wong IC, Hodgkins P, Setyawan J,
Sasane R, et al. Adult ADHD patient experiences of impair-
ment, service provision and clinical management in Eng-
land: a qualitative study. BMC Health Serv Res 2013;13:
184.
47. Shaw-Zirt B, Popali-Lehane L, Chaplin W, Bergman A.
Adjustment, social skills, and self-esteem in college stu-
dents with symptoms of ADHD. J Atten Disord 2005;8(3):
109– 20.
48. Dooling-Litfin JK, Rosen LA. Self-esteem in college students
with a childhood history of attention deficit hyperactivity
disorder. J Coll Stud Psychother 1997;11(4):69–82.
49. Kubik JA. Efficacy of ADHD coaching for adults with ADHD. J
Atten Disord 2010;13(5):442–53.
50. Wender PH, Reimherr FW, Marchant BK, Sanford ME,
Czajkowski LA, Tomb DA. A one year trial of methylphe-
nidate in the treatment of ADHD. J Atten Disord
2011;15(1):36– 45.
51. Peterson K, McDonagh MS, Fu R. Comparative benefits and
harms of competing medications for adults with attention-
deficit hyperactivity disorder: a systematic review and indi-
rect comparison meta-analysis. Psychopharmacology (Berl)
2008;197(1):1–11.
52. Brams M, Giblin J, Gasior M, Gao J, Wigal T. Effects of open-
label lisdexamfetamine dimesylate on self-reported quality
of life in adults with ADHD. Postgrad Med 2011;123(3):
99– 108.
53. Spencer TJ, Landgraf JM, Adler LA, Weisler RH, Anderson CS,
Youcha SH. Attention-deficit/hyperactivity disorder-specific
quality of life with triple-bead mixed amphetamine salts
(SPD465) in adults: results of a randomized, double-blind,
placebo-controlled study. J Clin Psychiatry 2008;69(11):
1766– 75.
54. Matza LS, Johnston JA, Faries DE, Malley KG, Brod M.
Responsiveness of the Adult Attention-Deficit/Hyperactivity
Disorder Quality of Life Scale (AAQoL). Qual life Res
2007;16(9):1511– 20.
55. Adler LA, Sutton VK, Moore RJ, Dietrich AP, Reimherr FW,
Sangal RB, et al. Quality of life assessment in adult patients
with attention-deficit/hyperactivity disorder treated with
atomoxetine. J Clin Psychopharmacol 2006;26(6):648– 52.
56. Waite R, Ivey N. Unveiling the mystery about adult ADHD:
one woman’s journey. Issues Ment Health Nurs 2009;30(9):
547– 53.
57. DuPaul GJ, Weyandt LL, O’Dell SM, Varejo M. College stu-
dents with ADHD: current status and future directions. J
Atten Disord 2009;13(3):234–50.
58. Gropper RJ, Tannock R. A pilot study of working memory
and academic achievement in college students with ADHD.
J Atten Disord 2009;12(6):574–81.
59. Heiligenstein E, Guenther G, Levy A, Savino F, Fulwiler J.
Psychological and academic functioning in college students
with attention deficit hyperactivity disorder. J Am Coll
Health 1999;47(4):181–5.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1109
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
60. Waite R, Ivey N. Promoting culturally sensitive ADHD serv-
ices for women: an individual example and a call to action. J
Psychosoc Nurs Ment Health Serv 2009;47(4):26–33.
61. Yen JY, Yen CF, Chen CS, Tang TC, Ko CH. The association
between adult ADHD symptoms and internet addiction
among college students: the gender difference. Cyberpsy-
chol Behav 2009;12(2):187–91.
62. Brod M, Pohlman B, Lasser R, Hodgkins P. Comparison of the
burden of illness for adults with ADHD across seven
countries: a qualitative study. Health Qual Life Outcomes
2012;10:47.
63. Nadeau KG. Career choices and workplace challenges
for individuals with ADHD. J Clin Psychol 2005;61(5):
549– 63.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1110
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix I: Search strategy
PubMed:
(Quality of life OR Family OR Social Support OR Adaption OR Education OR daily life skills OR life
impairment OR social life skills OR academic functioning OR Social Adjustment OR Interpersonal Relations
OR Family Health OR Attitude) AND Attention Deficit Hyperactivity Disorder) not child
Limits:
Publication date: from 1990/01/01;
Adult: 19þyears; adult: 19–44 years; young adult: 19 –24 years; middle aged þaged: 45þyears; middle
aged: 45–64 years; aged: 65þyears; 80 and over 80þyears
Embase:
Attention deficit disorder AND daily life skills OR life impairment OR ‘‘academic functioning OR family
OR quality of life OR social support OR adaptive behavior OR education OR social life skills OR social
adaption OR human relation OR family relation OR attitude NOT (child OR child) AND ([adult]/
limOR[aged]/lim) AND [1990–2015/py
PsycINFO:
(Family OR Social Support OR Quality of Life OR Coping Behavior OR Education OR daily life skills OR
life impairment OR academic functioning OR Social Adjustment OR Interpersonal Relationships OR
interpersonal relations OR attitude OR family Health OR social life skills) AND Attention Deficit Disorder
with Hyperactivity) not child
CINAHL:
Attention Deficit Hyperactivity Disorder AND Quality of LifeþOR FamilyþOR social support OR Adaption
PsychologicalþOR EducationþOR daily life skills OR life impairment OR social life skills OR academic
functioning OR Social Adjustment OR interpersonal relation OR Family Health OR AttitudeþNOT child
Limits:
published date: 1990/01/01
Age groups:
Adult: 19–44 years, middle aged: 45– 64 years, aged: 65þyears, aged: 80 and over, all adults
Svemedþ
Attention deficit disorder with hyperactivity AND quality of life OR family OR social support OR adaption,
psychological OR education OR daily life skills OR life impairment OR social life skills OR 10 academic
functioning OR social adjustment OR interpersonal relations OR family health OR attitude
Limits:
Year: 1990–2015
ProQuest Dissertations and Theses Global
Attention deficit disorder with hyperactivity AND (quality of life OR family OR social support OR adaption
OR psychological OR education OR daily life skills OR life impairment OR social life skills OR academic
functioning OR social adjustment OR interpersonal relations OR family health OR attitude
Limits:
01/01/1990–12/31/2015
Web of Science
Attention deficit disorder with hyperactivity AND quality of life, family OR social support OR adaption
psychological OR education OR daily life skills OR life impairment
Limits:
1990–2015
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1111
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix II: Appraisal instruments
QARI appraisal instrument
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1112
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix III: Data extraction instruments
QARI data extraction instrument
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1113
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1114
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix IV: Studies retrieved for full text assessment for eligibility
Atkins SA. The experience of attention-deficit/hyperactivity disorder in adulthood: living with a cluttered
mind [Doctor of Psychology]. United States: Psychological Department Massachusetts School of Professional
Psychology; 1996.
Babinski DE, Pelham WE, Molina BSG, Gnagy E, Waschbusch DA, Yu J, et al. Late adolescent and young
adult outcomes of girls diagnosed with ADHD in childhood: an explorative investigation. J Atten Disord
2011;15(3):204-14.
Bartlett R, Rowe TS, Shattell MM. Perspectives of college students on their childhood ADHD. MCN Am J
Matern Child Nurs 2010;35(4):226-31.
Bradshaw M, Salzer JS. The nursing student with attention deficit hyperactive disorder. Nurse Educ
2003;28(4):161-65.
Brock LB. Teachers with ADHD: perceptions of support and strategies [PhD thesis]. United States: North
Carolina State University; 2009.
Brod M, Perwien A, Adler L, Spencer T, Johnston J. Conceptualization and assessment of quality of life for
adults with attention-deficit/hyperactivity disorder. Prim Psychiatry 2005;12(6):58-64.
Brod M, Pohlman B, Lasser R, Hodgkins P. Comparison of the burden of illness for adults with ADHD
across seven countries: a qualitative study. Health Qual Life Outcomes 2012;10:47. doi: http://dx.doi.org/
10.1186/1477-7525-10-47.
Brod M, Schmitt E, Goodwin M, Hodgkins P, Gwendolyn N. ADHD burden of illness in older adults: a life
course perspective. Qual Life Res 2012;21(5):795-99.
Bussing R, Koro-Ljungberg M, Noguchi K, Mason D, Mayerson G, Garvan CW. Willingness to use ADHD
treatments: a mixed methods study of perceptions by adolescents, parents, health professionals and teachers.
Soc Sci Med 2012;74(1):92-100.
Coon HL. Community college students with attention-deficit/hyperactivity disorder (AD/HD): a student
perspective [PhD thesis]. United States: Capella University; 2011.
Dipeolu AO. College students with ADHD: prescriptive concepts for best practice in career development. J
Career Deve 2011;38(5):408-27.
DuPaul GJ, Weyandt LL, O’Dell SM, Varejao M. College students with ADHD: current status and future
directions. J Atten Disord 2009;13(3):234-50.
Eakin L, Minde K, Hechtman E, Ochs E, Krane E, Bouffard R, et al. The marital and family functioning of
adults with ADHD and their spouses. J Atten Disord 2004;(1):1-16.
Ek AI, Isaksson G. How adults with ADHD get engaged in and perform everyday activities. Scand J Occup
Ther 2013;20(4):282-91.
Fleischmann A, Fleischmann RH. Advantages of an ADHD diagnosis in adulthood: evidence from online
narratives. Qual Health Res 2012;22(11):1486-96.
Fleischmann A, Miller EC. Online narratives by adults with ADHD who were diagnosed in adulthood. Learn
Disabil Q 2013;36(1):47-60.
Gallo MP. College students diagnosed with ADHD: insights into their experiences [PhD thesis]. United
States: University of North Dakota; 2007.
Gillig PM, Gentile JP, Atiq R. Attention-deficit/hyperactivity disorder in adulthood Case Study and
Commentary. J Clin Outcomes Manag 2004;11(1):51-9.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1115
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Goodman, DW. The consequences of attention-deficit/hyperactivity disorder in adults. J Psychiatr Pract
2007;13(5):318-27.
Heiligenstein E, Guenther G, Levy A, Savino F, FulWiler J. Psychological and academic functioning in college
students with attention deficit hyperactive disorder. J Am Coll Health 1999;47(4):181-85.
Henry E, Jones SH. Experiences of older adult women diagnosed with attention deficit hyperactivity
disorder. J Women Aging 2011;23:246-62.
Jadin B, Looby A, Earleywine M. Characteristics of college students with attention deficit hyperactive
disorder symptoms who misuse their medication. J Am Coll Health 2013;59(5):373-7.
Kaminski PL, Turnock PM, Rose
´n LA, Laster SA. Predictors of academic success among college students
with attention disorders. J Coll Couns 2006;9(1):60-71.
Liebrenz M, Frei A, Fisher CE, Gamma A, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder
and nicotine use: a qualitative study of patient perceptions. BMC Psychiatry 2014;14:141.
Loe M, Cuttino L. Grappling with the medicated self: the case of ADHD college students. Symbolic Interact
2008;31(3):303-23.
Matheson L, Asherson P, Wong ICK, Hodgkins P, Setyawan J, Sasane R, et al. Adult ADHD patient
experiences of impairment, service provision and clinical management in England: a qualitative study. BMC
Health Serv Res 2013;13:184.
Mao A, Brams M, Babcock T, Madhoo M. A physician’s guide to helping patients with ADHD. Postgrad
Med 2011;123(5):60-70.
Matthies S, Philipsen A, Svaldi J. Risky decision making in adult with ADHD. J Behav Ther Exp Psychiatry
2012;43:938-46.
Meaux JB, Hester C, Smith B, Shoptaw A. Stimulant medications: a trade-off? The lived experience of
adolescents with ADHD. J Soc Pediatr Nurs 2006;11(4):214-26.
Meaux JB, Green A, Broussard L. ADHD in the college student: a block in the road. J Psychiatr Ment Health
Nurs 2009;16(3):248-56.
Moldavsky M, Sayal K. Knowledge and attitudes about attention-deficit/hyperactivity disorder (ADHD) and
its treatment: the views of children, adolescents, parents, teachers and healthcare professionals. Curr
Psychiatr Rep 2013;15(8):376.
Parker DR, Hoffman SF, Sawilowsky S, Roland L. Self-control in postsecondary settings: students’
perception of ADHD college coaching. J Atten Disord 2013;17(3):215-32.
Palmer CG. College student-athletes’ experience of living with attention deficit hyperactivity disorder
(ADHD): a phenomenological analysis [EdD]. United States: University of Montana; 2002.
Prevatt F, Lampropoulos GK, Bowles V, Garrett L. The use of between session assignments in ADHD
coaching with college students. J Atten Disord 2011;15(1):18-27.
Reaser AL. ADHD coaching and college students [PhD thesis]. United States: Florida State University; 2008.
Ramsay JR, Rostain AL. Girl, repeatedly interrupted: the case of a young adult woman with ADHD. Clin
Case Stud 2005;4(4):329-46.
Ramsay JR. ‘‘Without a Net’’: CBT without medications for an adult with ADHD. Clin Case Stud
2012;11(1):48-65.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1116
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Rosenfield BM, Ramsay JR, Rostain AL. Extreme makeover: the case of a young adult man with severe
ADHD. Clin Case Stud 2008;7(6):471-90.
Shaw-Zirt B, Popali-Lehane L, Chaplin W, Bergman A. Adjustment, social skills, and self-esteem in college
students with symptoms of ADHD. J Atten Disord 2005;8(3):109-20.
Young S, Bramham J, Gray K, Rose E. The experience of receiving a diagnosis and treatment of ADHD in
adulthood: a qualitative study of clinically referred patients using interpretative phenomenological analysis. J
Atten Disord 2008;11(4):493-503.
Young, EWD. Understanding the psycho-social and cultural factors that influence the experience of
attention-deficit/hyperactivity disorder (ADHD) in Chinese American college students: a systems approach
[Doctor of Education]. , United States: University of Southern California; 2012
Waite R, Ramsay R. Cultural proficiency: a Hispanic woman with ADHD – a case example. J Atten Disord
2009;13(4):424-32.
Waite R, Tran M. ADHD among a cohort of ethnic minority women. Women Health 2010;50(1):71-87.
Waite R. Promoting culturally sensitive ADHD services for women. an individual example and call to action.
J Psychosoc Nurs 2009;47(4):26-33.
Waite R. Unveiling the mystery about adult ADHD: one woman’s journey. Issues Ment Health Nurs
2009;30(9):547-53.
Waite R, Tran, M. Explanatory models and help-seeking behavior for attention-deficit/hyperactivity
disorder among a cohort of postsecondary students. Arch Psychiatr Nurs 2010;24(4):247-59.
Wolf L, Simkowitz P, Carlson H. College students with attention deficit/hyperactivity disorder. Curr
Psychiatry Rep 2009;11(5):415-21.
Wright SA. Functional impairments of college students with attention deficit/ hyperactivity disorder and
necessary modifications for higher education [EdD]. United States: University of West Virginia; 2011.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1117
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix V: Excluded studies and reasons for exclusion
Atkins SA. The experience of attention-deficit/hyperactivity disorder in adulthood: living with a cluttered
mind [Doctor of Psychology]. United States: Psychological Department Massachusetts School of Professional
Psychology; 1996.
Reason for exclusion: It is unclear how the participants had been diagnosed. Focus on how adults with
ADHD adapt to stressors resulting from ADHD.
Babinski DE, Pelham WE, Molina BSG, Gnagy E, Waschbusch DA, Yu J, et al. Late adolescent and young
adult outcomes of girls diagnosed with ADHD in childhood: an explorative investigation. J Atten
Disord.2011; 15 (3): 204-214.
Reason for exclusion: Quantitative design and retrospective study where girls looked back to their childhood
experiences when growing up with ADHD.
Bartlett R, Rowe TS, Shattell MM. Perspectives of college students on their childhood ADHD. MCN Am J
Matern Child Nurs.2010; 35 (4): 226-231.
Reason for exclusion: The study looks back on childhood experiences. Focus on support.
Bradshaw M, Salzer JS. The nursing student with attention deficit hyperactive disorder. Nurse Educ.2003; 28
(4): 161-165.
Reason for exclusion: Kind of expert guideline unclear how it was conducted. Focus on symptoms
and treatment.
Brock LB. Teachers with ADHD: perceptions of support and strategies [PhD thesis]. United States: North
Carolina State University; 2009.
Reason for exclusion: Unclear how the participants had been diagnosed. Focus on strategies in relation to
organization, time-management, memory and personal support.
Brod M, Pohlman B, Lasser R, Hodgkins P. Comparison of the burden of illness for adults with ADHD
across seven countries: a qualitative study. Health Qual Life Outcomes.2012; 10: 47. doi: http://dx.doi.org/
10.1186/1477-7525-10-47.
Reason for exclusion: Self-reported ADHD. The findings suggest that symptoms associated with ADHD
affect individuals similarly in different countries.
Brod M, Schmitt E, Goodwin M, Hodgkins P, Gwendolyn N. ADHD burden of illness in older adults: a life
course perspective. Qual Life Res.2012; 21 (5): 795-799.
Reason for exclusion: Quantitative. Focus on lifetime burden of ADHD.
Bussing R, Koro-Ljungberg M, Noguchi K, Mason D, Mayerson G, Garvan CW. Willingness to use ADHD
treatments: a mixed methods study of perceptions by adolescents, parents, health professionals and teachers.
Soc Sci Med.2012; 74 (1): 92-100.
Reason for exclusion: Focus on willingness to use treatments.
Coon HL. Community college students with attention-deficit/hyperactivity disorder (AD/HD): a student
perspective [PhD thesis]. United States: Capella University; 2011.
Reason for exclusion: Impossible to make out whether the results are related to learning disabilities or
ADHD symptoms. Focus on learning disabilities.
Dipeolu AO. College students with ADHD: prescriptive concepts for best practice in career development. J
Career Deve.2011; 38 (5): 408-427.
Reason for exclusion: Not based on a scientific study. It is a description of ‘‘best practice.’’
DuPaul GJ, Weyandt LL, O’Dell SM, Varejao M. College students with ADHD: current status and future
directions. J Atten Disord.2009; 13 (3): 234-250.
Reason for exclusion: Kind of overview not conducted a basis of a critical appraisal.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1118
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Eakin L, Minde K, Hechtman E, Ochs E, Krane E, Bouffard R, et al.. The marital and family functioning of
adults with ADHD and their spouses. J Atten Disord.2004; 8 (1): 1-16.
Reason for exclusion: Mainly quantitative and qualitative descriptions from spouses focuses on
family functioning.
Fleischmann A, Fleischmann RH. Advantages of an ADHD diagnosis in adulthood: evidence from online
narratives. Qual Health Res.2012; 22 (11): 1486-1496.
Reason for exclusion: Self-reported ADHD-diagnosis. Focus on adults’ perception of getting the diagnosis
issues in relation to being diagnosed with ADHD.
Fleischmann A, Miller EC. Online narratives by adults with ADHD who were diagnosed in adulthood. Learn
Disabil Q 2013; 36 (1): 47-60.
Reason for exclusion: The information conducted through on-line life-stories – that is not necessary a
validated diagnosis focus on self-understanding after getting the diagnosis.
Gallo MP. College students diagnosed with ADHD: insights into their experiences [PhD thesis]. United
States: University of North Dakota; 2007
Reason for exclusion: Doesn’t meet the inclusion criteria. Not possible to separate what is related to learning
disabilities and ADHD symptoms. Focus: a look back at childhood experiences.
Gillig PM, Gentile JP, Atiq R. Attention-deficit/hyperactivity disorder in adulthood Case Study and
Commentary. J Clin Outcomes Manag.2004; 11 (1): 51-59.
Reason for exclusion: Literature review with focus on diagnosing ADHD
Goodman, DW. The consequences of attention-deficit/hyperactivity disorder in adults. J Psychiatr
Pract.2007; 13 (5): 318-327.
Reason for exclusion: Kind of overview unclear how it was conducted.
Heiligenstein E, Guenther G, Levy A, Savino F, FulWiler J. Psychological and academic functioning in college
students with attention deficit hyperactive disorder. J Am Coll Health.1999; 47 (4): 181-185.
Reason for exclusion: Quantitative. Focus on academic functioning.
Jadin B, Looby A, Earleywine M. Characteristics of college students with attention deficit hyperactive
disorder symptoms who misuse their medication. J Am Coll Health.2013; 59 (5): 373-377.
Reason for exclusion: Quantitative focus on misuse of elicit substances.
Liebrenz M, Frei A, Fisher CE, Gamma A, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder
and nicotine use: a qualitative study of patient perceptions. BMC Psychiatry.2014; 14: 141.
Reason for exclusion: Focus solely on smoking and self-medication.
Loe M, Cuttino L. Grappling with the medicated self: the case of ADHD college students. Symbolic
Interact.2008; 31 (3): 303-323.
Reason for exclusion: Focus on attitude towards medication.
Matheson L, Asherson P, Wong ICK, Hodgkins P, Setyawan J, Sasane R, et al. Adult ADHD patient
experiences of impairment, service provision and clinical management in England: a qualitative study. BMC
Health Serv Res 2013; 13: 184. doi: http://dx.doi.org/10.1186/1472-6963-13-184.
Reason for exclusion: Self-reported ADHD. Focus on the challenging process of assessing adequate ADHD
diagnosis and treatment service. Findings indicate social burden in adult ADHD.
Mao A, Brams M, Babcock T, Madhoo M. A physician’s guide to helping patients with ADHD. Postgrad
Med.2011; 123 (5): 60-70.
Reason for exclusion: Overview. Not conducted on basis of a critical appraisal. Focus on impairment in
relation to workplace, diagnosis, assessment and treatment.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1119
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Matthies S, Philipsen A, Svaldi J. Risky decision making in adult with ADHD. J Behav Ther Exp
Psychiatry.2012; 43: 938-946.
Reason for exclusion: Quantitative. Focus on risky behavior.
Moldavsky M, Sayal K. Knowledge and attitudes about attention-deficit/hyperactivity disorder (ADHD) and
its treatment: the views of children, adolescents, parents, teachers and healthcare professionals. Curr
Psychiatr Rep.2013; 15 (8): 376.
Reason for exclusion: Kind of an overview focusing how to improve the knowledge about ADHD.
Parker DR, Hoffman SF, Sawilowsky S, Roland L. Self-control in postsecondary settings: students’
perception of ADHD college coaching. J Atten Disord.2013; 17 (3): 215-232.
Reason for exclusion: Unclear if the participants meet the DSV-IV or ICD-10 criteria. The study report, that
ADHD coaching helped the ADHD students to become more self-regulated, leading to positive academic
experiences and outcomes.
Palmer CG. College student-athletes’ experience of living with attention deficit hyperactivity disorder
(ADHD): a phenomenological analysis [EdD]. United States: University of Montana; 2002.
Reason for exclusion: It is unclear how the participants had been diagnosed. Focus on how student-athletes
with ADHD maintain eligibility to compete and navigate through complex athletic and social environment at
the same times.
Prevatt F, Lampropoulos GK, Bowles V, Garrett L. The use of between session assignments in ADHD
coaching with college students. J Atten Disord.2011; 15 (1): 18-27.
Reason for exclusion: Quantitative focus on coaching.
Reaser AL. ADHD coaching and college students [PhD thesis]. United States: Florida State University; 2008.
Reason for exclusion: It is unclear how the participants had been diagnosed. Focus on coaching.
Shaw-Zirt B, Popali-Lehane L, Chaplin W, Bergman A. Adjustment, social skills, and self-esteem in college
students with symptoms of ADHD. J Atten Disord.2005; 8 (3): 109-120.
Reason for exclusion: Quantitative. Focus on social functioning. Students with ADHD show decreased
functioning in several areas of college adjustment as well as lower levels of self-reported social skills and self-
esteem.
Young, EWD. Understanding the psycho-social and cultural factors that influence the experience of
attention-deficit/hyperactivity disorder (ADHD) in Chinese American college students: a systems approach
[Doctor of Education]. United States: University of Southern California; 2012.
Reason for exclusion: Doesn’t meet the inclusion criteria (as ADHD is self-reported). Focus on how
psychosocial factors cultural factors influence the experience of ADHD in Chinese American college student
and coping strategies used to be effective learners.
Waite R, Ramsay R. Cultural proficiency: a Hispanic woman with ADHD – a case example. J Atten
Disord.2009; 13 (4):424-432.
Reason for exclusion: Not described how the study was conducted. Focus on childhood reflections and life
after the diagnosis.
Waite R, Tran M. ADHD among a cohort of ethnic minority women. Women Health.2010; 50 (1): 71-87.
Reason for exclusion: Not confirmed ICD-10 or DSM-IV diagnosis according to the author. Focus on
internal chaos, self-understanding.
Waite R. Promoting culturally sensitive ADHD services for women. An individual example and call to
action. J Psychosoc Nurs.2009; 47 (4): 26-33.
Reason for exclusion: Doesn’t meet the inclusion criteria. The presentation mainly based on quotations.
Focus on ADHD symptoms impact on living with ADHD.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1120
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Waite R. Unveiling the mystery about adult ADHD: one woman’s journey. Issues Ment Health Nurs.2009;
30 (9): 547-553.
Reason for exclusion: Not a confirmed ICD-10/DSM-IV diagnosis.
According to mail-correspondence with the author 060115. Focus on how late diagnosis of ADHD can affect
a persons’ life.
Waite R, Tran, M. Explanatory models and help-seeking behavior for attention-deficit/hyperactivity
disorder among a cohort of postsecondary students. Arch Psychiatr Nurs.2010; 24 (4): 247-259.
Reason for exclusion: Not a confirmed ICD-10/DSM-IV diagnosis.
According to mail-correspondence with the author 060115. Focus on help-seeking behavior among adults
with ADHD.
Wolf L, Simkowitz P, Carlson H. College students with attention deficit/hyperactivity disorder. Curr
Psychiatry Rep.2009; 11 (5): 415-421.
Reason for exclusion: Kind of overview not conducted on basis of a critical appraisal.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1121
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix VI: Critically appraised studies
Brod M, Perwien A, Adler L, Spencer T, Johnston J. Conceptualization and assessment of quality of life for
adults with attention-deficit/hyperactivity disorder. Prim Psychiatry 2005;12(6):58-64.
Ek AI, Isakson G. How adults with ADHD get engaged in and perform everyday activities Scand J Occup
Ther 2013;20(4):282-91.
Henry E, Jones SH. Experiences of older adult women diagnosed with attention deficit hyperactivity
disorder. J Women Aging 2011;23(3):246-62.
Kaminski PL, Turnock PM, Rose
´n LA, Laster SA. Predictors of academic success among college students
with attention disorders. J Coll Couns 2006;9(1):60-71.
Meaux JB, Hester C, Smith B, Shoptaw A. Stimulant medications: a trade-off? The lived experience of
adolescents with ADHD. J Soc Pediatr Nurs 2006;11(4):214-26.
Meaux JB, Green A, Broussard L. ADHD in the college student: a block in the road. J Psychiatr Ment Health
Nurs 2009;16(3):248-56.
Ramsay JR, Rostain AL. Girl, repeatedly interrupted: the case of a young adult woman with ADHD. Clin
Case Stud 2005;4(4):329-46.
Ramsay JR. ‘‘Without a Net’’: CBT without medications for an adult with ADHD. Clin Case Stud
2012;11(1):48-65.
Rosenfield BM, Ramsay JR, Rostain AL. Extreme makeover: the case of a young adult man with severe
ADHD. Clin Case Stud 2008;7(6):471-90.
Young S, Bramham J, Gray K, Rose E. The experience of receiving a diagnosis and treatment of ADHD in
adulthood: a qualitative study of clinically referred patients using interpretative phenomenological analysis. J
Atten Disord 2008;11(4):493-503.
Wright SA. Functional impairments of college students with attention deficit/ hyperactivity disorder and
necessary modifications for higher education [EdD]. United States: University of West Virginia; 2011.
The study focus on how functional impairments impact on academic functioning but is was excluded due to
of methodological transparency and because the results were presented as narratives for each of the
participants in a way that it isn’t possible to systematically extract interpreted and summarized findings.
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1122
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix VII: Description of included studies
Reference Methods Participants Phenomena of Interest Findings Notes
Brod et al.
24
Phase I: Literature
review, semi-struc-
tured interviews
with clinical and
research ADHD
experts and
patients, con-
ducted either via
telephone or in
person each inter-
view lasted one
hour. Focus-group
interviews with
patients lasted
approximately
three hours. Phase
II telephone inter-
views with
patients
Four experts: three
practicing psychia-
trists and one
ADHD coach;
eight adults with
ADHD individu-
ally interviewed
and 21 partici-
pated in three
focus-group inter-
views 65% male
and 35% female,
aged range 18– 69
years
To examine QoL issues for
adults with ADHD by
exploring the links among
symptoms, functional
impairments, and QoL; to
develop a conceptual model
of the impact of adult
ADHD on QoL; and to use
this understanding to
develop a decease-specific
QoL measure for adults with
ADHD that assists clinicians
and researchers on the evalu-
ation of the disorder and the
effects of treatment
A QoL was developed a
disease specific measure
to be used in assenting
the impact of ADHD on
functional impairments
and QoL and, as such,
has important clinical
utility, clinicians who
understand the impact of
ADHD on QoL can
encourage their patients
to assess necessary sup-
port services. As well as
initial initiate appropriate
pharmacologic treatment,
discussion of QoL issues
between patients and
physicians will facilitate
the development of indi-
vidualized treatment
plans that can more accu-
rately target problem
impairments specific to
that patient. A broad
treatment plan, which
addressees QoL issues as
well as symptoms, will
allow adults with ADHD
to manage their disorder
and enhance their every-
day functioning
A methodolo-
gically well
conducted
study. The
main result
was that pro-
ductivity in
everyday life
was impaired
especially in
relation to
organization
Ek et al.
33
Semi-structured
interview-guide –
to gain deeper
understanding
regarding the per-
son’s experiences
and feelings about
the topic. Partici-
pants interviewed
individually in
their homes by the
first author
12 people diag-
nosed with ADHD
– sic men and six
women – aged
21– 38 years
There is a knowledge gab
within occupational therapy
concerning how adults with
ADHD experience everyday
activities, one that raises the
following question: is feeling
engaged in an activity
enough to encourage adults
with ADHD to perform it,
or are there other factors
involved? How do adults
with ADHD take initiative
in an activity? Do they per-
ceive differences among var-
ious activities? How would
they carry out and complete
an activity? The purpose of
this study was to seek
answers to these questions to
understand the experiences
of engagements in and
describe how adults with
ADHD perform everyday
activities
The study provide some
answers on how adults
with ADHD get engaged
in and perform everyday
activities dependent on
their inspiration, facilitat-
ing support and feelings
of togetherness with ot-
her people. The results
show how adults with
ADHD can find the strat-
egies they need to
become more indepen-
dent in their performance
of everyday activities.
The study furthermore
provides some ways in
which occupational
therapists can increase
opportunities for adults
with ADHD to be
engaged in different
activities, make choice
and find meaning in
everyday activities
The study
focus on how
occupational
therapists can
support adults
with ADHD in
conducting
everyday
activities
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1123
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
(Continued)
Reference Methods Participants Phenomena of Interest Findings Notes
Henry
et al.
25
Semi structured in-
depth interview?
Semi-structured
question guide
consisted of open-
ended questions
9 women diag-
nosed with ADHD
after the age of 60
(62– 91 years) had
been diagnosed
with ADHD for
1– 2 years, had
been part of
weekly group
therapy focus-sing
specifically on liv-
ing with ADHD,
Caucasian (78%),
Hispanic (33%),
widowed and mar-
ried once, edu-
cation ranging
from fourth grade
to some college
What does ADHD look like
in older adult women? The
experiences of older adult
women with ADHD across
their lifespan, how the met
the challenges of living with
undiagnosed ADHD, and
how they experienced being
diagnosed with and treated
for the disorder
Participants reported
experiencing peer rejec-
tion, feeling different, ad
a tendency to become
advocates for others.
Although they reported
difficulties in work and
relationships, they also
described finding creativ-
ity solutions to their
attention problems. Diag-
nosis and treatment
appears to have assisted
with self-acceptance and
appreciation of the
strengths of having
ADHD. The themes that
emerged indicate that
participants had experi-
enced many of the chal-
lenges discussed in the
literature for girls and
young adult women with
ADHD, suggesting that
these issues, left
untreated, may carry over
into late adulthood.
ADHD manifests
throughout the lifespan
to create a unique set of
situations and conflict for
women who are unknow-
ingly suffering form and
coping with this disorder,
the findings of this study
exhibit the power of the
human spirit, as well as
the need for therapeutic
intervention many
women interviewed were
able to lead successful
lives, have families, com-
plete their education and
have careers, all while
living with undiagnosed
ADHD. Their stories
reflect resilience and
creativity ad well as
struggle, hardship and
loneliness
The emerged
themes indicate
that partici-
pants had
experienced
many of the
challenges dis-
cussed in the
literature for
girls and young
adult women
with ADHD. If
untreated these
issues may
carry over into
late adulthood.
ADHD mani-
fest throughout
the lifespan
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1124
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
(Continued)
Reference Methods Participants Phenomena of Interest Findings Notes
Kaminski
et al.
26
Information
regarding number
and severity of
current ADHD
symptoms col-
lected using Adult
Behavioral Rating
Scale-Self Report
of Current Beha-
vior (ABRS-IV
Self, 1998), this
symptoms check-
list is based on
DSM-IV. Aca-
demic success
based on grade
point average.
Coping Resources
Inventory for
Stress (CRIS).
Demographic
questionnaires
were used to
gather information
about gender, age
and socio-
economic status.
Open-Forum
Questionnaire
(OFQ), design
specifically for the
present study to
collect qualitative
data: students was
asked to write
about: (a) factors
that helped them
to cope with their
ADHD in college,
(b) obstacles to
success and (c)
sources of motiv-
ations
68 students. Diag-
nosed with ADHD
(DSM-IV) students
with comorbid
learning disabil-
ities or psychiatric
disorders were
screened out of
the study. 32.3%
had been diag-
nosed primary
inattentive, 16.2%
primarily hyperac-
tive-impulsive and
51.5% combined.
42% reported that
they were cur-
rently taking
medication for
ADHD. The age
of participants
ranged from 18 to
23 years (M ¼
20.23, SD ¼
1.30). 25.7%
seniors in college,
28.6% were
juniors, 28.6%
were sophomores
and 17.1% were
freshmen. 64 ¼
Caucasian, 4 ¼
African-American,
39 ¼male and 29
¼female
To identify factors associated
with academic success
among a sample of college
students with ADHD. Of
particular interest were stu-
dents? resources for coping
with stress and their descrip-
tions of strategies used to
manage their ADHD symp-
toms. To identify coping
resources that differentiates
academically high-achieving
ADHD college students from
their less academically suc-
cessful ADHD peers. If beha-
vioral factors affecting
academic adjustment could
be isolated, the possibility
exists of teaching compensa-
tory behavioral strategies to
academically lower achieving
ADHD individuals to
improve their scholastic per-
formance. A second objec-
tive was to use qualitative
methods to initiate an inves-
tigation of other possible
predictors of academic suc-
cess among college students
with ADHD
Among 68 students with
ADHD, academic success
was positively correlated
with time management
skills and freedom from
financial stress as a
group, students with
higher grade point
averages reported fewer
coping resources than did
academically lower
achieving students, less
academically successful
students likely spend
more time using coping
mechanisms and there-
fore may have less time
to study
Despite the
results mainly
are based on
quantitative
data some
relevant quali-
tative derived
data regarding
coping with
the ADHD-
symptoms
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1125
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
(Continued)
Reference Methods Participants Phenomena of Interest Findings Notes
Meaux
et al.
27
In-depth semi
structured qualita-
tive interviews.
Initial interview
with the 15
included students,
lasted 60– 90 min
based upon an
interview guide
developed by the
research team
took place in pri-
vate location on
the college-cam-
pus. Follow-up
interviews with 10
of the participants
lasted 10– 15 min
with the purpose
to clarify previous
comments and
obtain additional
details and vali-
date initial data
clusters and
themes. All inter-
views were audio-
taped and
transcribed verba-
tim. The investi-
gator also
recorded field
notes after each
interview to pro-
vide additional
contextual details
15 included
participants: 9
males and 6
female. Students in
the age between
18 and 21. 13
Caucasian, 1 Afri-
can-American and
1 Hispanic. Stu-
dent status: 6
freshmen, 7
Sophomores, 2
juniors. Inclusion
criteria: (1) aged
18– 21 years, (2)
diagnosis of
ADHD prior to
high school, (3)
scores on the Con-
nor’s Adult
ADHD Rating
Scale indicating
persistent symp-
toms and (4) No
longer living with
parents
To determine factors that
help, as well as hinder, col-
lege students with ADHD, as
they learn to cope with
everyday challenges of life
and academics once they
leave the structure and sup-
port of their parents? Home
In conclusion, the college
students with ADHD
who participated in the
study provided important
new insight into living
with ADHD. Previous
studies relied heavy on
parents on parents and
teachers as informants
and focused solely on
classroom behaviors and
academic outcomes. In
this study the adolescents
themselves described fac-
tors that helped and hin-
dered their transition to
college. The findings can
serve as the basis for
interventions that educate
and empower adolescents
with ADHD. Of particu-
lar importance are inter-
ventions that help
adolescents develop
insight into ADHD and
self-management skills
well in advance on their
transition to college
The studies of
particular
importance are
interventions
that help ado-
lescents
develop insight
into ADHD
and self-man-
agement skills
well in advance
of their tran-
sition to col-
lege
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1126
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
(Continued)
Reference Methods Participants Phenomena of Interest Findings Notes
Meaux
et al.
28
In depth semi-
structured inter-
view. Each lasted
1– 1.5 h audio-
taped and tran-
scribed. Follow-up
interview with 10
out of 15 (5
impossible due to
end of semester).
Each lasted about
15– 30 min. Field
notes to supply
data obtained
from in-depth
interviews. Demo-
graphic rating
form. Adult
ADHD rating
form. Connors?
Adult ADHD Rat-
ing Form-Long
Edition (CAARS)
used to evaluate
the self-reported
diagnosis of
ADHD
15 single college
students (9 men
and 6 women)
87% diagnosed in
elementary school,
and started medi-
cation within a
week after.
Inclusion criteria:
aged 18– 21 years;
had a diagnosis of
ADHD that were
received prior to
high school (self-
reported) and
lived indepen-
dently from their
parents/guardians.
Participants
recruited through
residence halls,
students? Health
services, the coun-
seling center and
the office of dis-
ability services at
a university
The lived experience of col-
lege students with ADHD
related to prescription stimu-
lant medication since their
diagnosis
Current recommen-
dations for the treatment
of ADHD include a mul-
timodal approach of edu-
cation, behavioral
management and pre-
scription stimulant medi-
cations. Findings of this
study suggest that more
work needs to be done to
implement a developmen-
tal approach to ADHD
management that include
on-going education about
stimulant medications.
School nurses, pediatrics
nurse practitioners,
pediatricians, psycholo-
gists and other providers
need to target education
about prescription stimu-
lant medications to age-
specific issues, abilities
and needs. ADHD is a
chronic disability that
affects many areas of life
for children and adoles-
cents; additional research
is needed to identify
interventions that will
improve self-management
and decrease risk beha-
vior in the population.
Furthermore, the advent
of extended-release
stimulant medications
that do not require
repeated doses during the
school day may affect the
lived experience of chil-
dren with ADHD and
warrants further study
Relevant study
focusing on
initiatives
which can
improve the
students ability
to cope with
ADHD-symp-
toms, such as
medication and
counselors
Ramsay
et al.
30
Case-study One 19-year old
woman
Discuss the case of a young
woman, Amanda, who is
first diagnosed with ADHD
after encountering difficulties
during her freshman year of
college
The included patient-case
demonstrates the import-
ance of an accurate diag-
nosis and the benefit of
course of cognitive-beha-
vioral psychotherapy
combined with standard
pharmacotherapy
It is a case
story and the
focus is on
effect of
therapy and
aims to
describe
recommen-
dations for
clinicians. But
are of interest
because it
describe what
it is like to live
with ADHD
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1127
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
(Continued)
Reference Methods Participants Phenomena of Interest Findings Notes
Ramsay and
Rostain
29
Case-study A 40-year old
married Caucasian
man. Master
degree creative
director in adver-
tising department
of midrange retrial
clothing company.
His position
involved designing
and organizing
print and web
advertising for the
company
To discuss the case of Brian,
an adult diagnosed with
ADHD but who could not
be treated with medications
due to cardiac conditions.
The goal of presenting
Brian’s case is to illustrate
the use of CBT to address
the impairments associated
with adult ADHD when
medication management is
not an option
Adult ADHD ranks
among the most under
recognized and under-
treated disorders, which
is particularly disturbing
because there are many
effective treatments. Psy-
chosocial treatments,
namely CBT, ranks
alongside medications as
the primary evidence-sup-
ported interventions for
adult ADHD. CBT for
ADHD may be underuti-
lized by this clinical
population due to the
scarcity of providers who
are familiar with the
unique clinical challenges
involved in treating
ADHD and the modifi-
cations of CBT to
address the executive dys-
functions that define
ADHD and its impair-
ments
A most
relevant study
as it provide
an excellent
insight into the
challenges in
everyday life
which adults
with ADHD
has to cope
with
Rosenfield
et al.
31
Not stated A 30-year old
married Caucasian
man
To discuss the case of a
young man, Ralph, who was
diagnosed with ADHD and
treated with medication in
childhood. However, Ralph
experienced newfound diffi-
culties functioning in adult-
hood when his symptoms
directly led to a number of
life crises affecting his ability
to function at work and in
his marriage
The case illustrates the
degree of impairment
experienced by many
adults with ADHD and
the benefit of multimodal
treatment package
Although the
methodological
weaknesses the
study is
included
because
includes many
relevant infor-
mation about
the review
topic, and case
is described
sufficiently and
the voice of
the participant
is clear
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1128
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
(Continued)
Reference Methods Participants Phenomena of Interest Findings Notes
Young
et al.
32
Semi-structured
and pilot-tested –
interview, in
addition patients
were encouraged
to specify and
exemplify. Each
interview lasted
75– 95 min. Inter-
views audio-taped
and fully tran-
scribed by the
researcher
Eight participants
(4 women and 4
men) between the
age of 21 and 50
years (M age ¼39
years). All patients
had previously
received a diagno-
sis of ADHD,
inclusion criteria
DSM-IV. Length
of time since diag-
nosis ranged from
1 month to 6
years (M length of
time ¼19 month).
4 participants
cohabiting with at
partner, 2 had
partners with
whom they did
not live, 4 had
children (ranging
1– 3 children). 3
were employed, 5
were unemployed.
7 participants
were taking stimu-
lant medication
for ADHD, 1 had
elected to stop
taking medication
invited by letter
on voluntary basis
followed up by
phone call, no
patients declined
to participate. The
first 8 who were
available were
included in the
study
(a) To evaluate the psycho-
logical impact of diagnosis
of ADHD in adulthood and
their treatment with medi-
cation and (b) to examine
how diagnosis and treatment
with medication may change
individuals? Self-perception
and view of the future
Psychological treatment
should begin at the point
of diagnosis. Cognitive
behavioral techniques
will help clients diag-
nosed with ADHD in
adulthood cope with the
adjustment process.
Adults should be taught
skills to anticipate future
hurdles and challenges
and apply appropriate
coping strategies
The study is
relevant as it
describe how
to cope with
ADHD symp-
toms
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1129
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Appendix VIII: List of study findings/conclusions
Conceptualization and assessment of quality of life for adults with attention/hyperactivity disorder
(Adapted from
24
)
Finding 1 Being productive or effective in accomplishing tasks was a challenge, regardless where
they worked
Illustration ...
Finding 2 Productivity in everyday life was impaired due to procrastination, poor time management,
disorganisation, inability to follow through on a task, difficulty learning or remembering
new material and trouble getting to appointments on time. As a result, the participants
repeatedly indicated that they were not able to accomplish as much as they wanted
Illustration ...
Finding 3 All participants reported difficulties in at least one activity of daily living and most
reported multiple impairments. For example, difficulty organizing meant that bills were
often late and checks often did not get deposited or cashed within a timely manner.
The ADHD symptom of distraction meant that shopping for groceries, even with a
shopping list it usually resulted in missed items (61)
Illustration ...
Finding 4 Even preparing healthy meals or washing dishes was problematic (61)
Illustration One participant reported that he had not washed his clothes in over a year and simply bought
new clothes when everything was dirty. These difficulties with everyday tasks were related to
a clear sentiment heard repeatedly from the participants: ‘‘we don’t do boring’’ (61)
Finding 5 For those who worked for pay, it was frequently difficult to complete work on time
due to be disorganized and/or becoming distracted easily, as well as feeling fatigued
from the amount of energy required to initiate and sustain work tasks. This difficulty
appeared more pronounced when tasks required attention to detail and/or were
interpreted as being boring. For example, participants spoke of expense reports that
were often not completed or were done inaccurately. In addition, several participants
commented on how they were successful in the work environment until they were
promoted or transferred to a new job that required more detailed work (61)
Illustration ...
Finding 6 For those who did not work, the reason for unemployment was frequently that they
could not hold down a job because of their ADHD symptoms (61)
Illustration ...
Finding 7 Short-term difficulties associated with maintaining job or being promoted often led to
long-term financial difficulties for many of the adults (61)
Illustration ...
Finding 8 Impulsiveness, social inappropriateness, difficulty following through on tasks, or being
present while interacting with others, resulted in poor social relationships in all facets
of their lives (e.g. with peers, co-workers and in intimate relationships)
Illustration ...
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1130
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 9 Blurting out comments at the wrong time or impulsive acts resulted in others (both at
work and at home) being annoyed with them or considering them rude. As a result,
participants reported difficulty in keeping friends or meeting new people
Illustration Several participants commented that the ADHD slogan is ‘‘Ready, fire, aim’’ when it
comes to verbalizing thoughts or taking action (61)
Finding 10 Additionally being disorganized or distracted often created tension in personal
relationships, with partners feeling neglected or unimportant. Adults with ADHD
describe themselves as ‘‘jugglers who can only keep one ball in the air at the time,’’ and
the ‘‘relationship ball’’ was frequently not the one in play (61)
Illustration ...
Finding 11 The major impact on psychical health was a feeling of being tired or not having enough
energy. Symptoms of poor time management, procrastination, distraction and disorgan-
ization resulted in ‘‘days which never seemed to end’’ and the belief that everything in
life required more effort than to individuals without ADHD (61 – 62)
Illustration ...
Finding 12 Even when participants reported that they were able to remain focused or organized,
these activities required substantial energy resulting in later exhaustion. The additional
effort required of adults with ADHD was characterized by one participant as ‘‘running
in mud alongside a road rather than on the pavement’’ (62)
Illustration ...
Finding 13 Moderating factors that seemed to portend an even poorer outcome and others that
seemed to contribute to successful adaption or coping. Poorer outcomes were most
clearly associated with a reported inaccurate or missed diagnosis in childhood many
reported as being labelled as ‘‘slackers’’ or ‘‘troublemakers,’’ growing up feeling
different, and being criticized for not living up to their potential. Even after being
diagnosed as adults, they continued to struggle with failure and self-image issues. In
comparison participants who had been diagnosed at an early age and/or had
appropriate support services seemed to be more emotionally stable, less critical of
themselves, and better able to function as adults (62)
Illustration ‘‘slackers’’ or ‘‘troublemakers’’ (62)
Finding 14 In addition to the negative outcome the participants reported positive aspects associated
with the disorder. For example, participants were almost unanimous in feeling that
ADHD has enhanced their sense of creativity and, when channeled appropriately,
allowed for success in work and home environments. Although adults with ADHD
reported having difficulty maintaining focus they reported periods with extreme focus
(i.e. hyper-focus) when they were able to be highly productive. Unfortunately, they were
not able to predict or bring about this state and, as one adult reported ‘‘it feels like a
short wave radio that most of the time can’t find the right frequency’’ (62)
Illustration ‘‘It feels like a short wave radio that most of the time can’t find the right frequency’’
(62)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1131
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 15 Most often these positive features failed to translate into meaningful impact on QoL
when left unharnessed (62)
Illustration ...
Finding 16 Several other protective factors emerged e.g. personal coaching mentioned as a valued
tool for improving functioning, especially for impairments in the activities of daily
living domain (62)
Illustration ...
Finding 17 Additionally, participants who seemed more successful at work, appeared to delegate
tasks requiring organisational or detail skills to others or had found jobs that were
more creative in nature (62)
Illustration ...
Finding 18 Exercise was also mentioned as a coping behaviour that reduced levels of anxiety and
managed symptoms of hyperactivity
Illustration ...
Finding 19 In terms of psychological health, almost all of the ADHD adults interviewed reported
general feelings of being overwhelmed and out of control. Some of the anxiety inspired
by adults related to concerns about their ability to navigate through their days
‘‘successfully.’’ This anxiety was coupled with frustration of the inability to keep
everyday aspects of life on track. Self-esteem issues and feelings of depression and
isolation were common (61)
Illustration ...
How adults with ADHD get engaged in and perform everyday activities (Adapted from 33)
Finding 1 When they felt that an activity was fun, they also experienced that the activity was
almost performed ‘‘by itself,’’ since they did not have to prepare themselves before the
event. For example, activities that required using a computer were perceived as a
pleasure and easy to perform; therefore the participants were not distracted and did not
lose their focus, which were common problems otherwise. Activities they found to be
creative and enthusiastic inspired them (285)
Illustration To be interested in an activity makes it easier to perform. For example cleaning and
cooking are really boring and require so much concentration when you don’t have any
interest in them. It is much easier to succeed and keep your focus on activities that 222
more fun. I think it depends a lot on the motivation and that you enjoy it (285)
Finding 2 Through their own interest in activities, they became meaningful, which also facilitated
the performance of various activities. Activities they found inspiring were, for example
cooking, reading, playing computer games, training through sports, or learning a new
language (285)
Illustration One of the participants described how she could be engaged for a whole day in painting
and drawing, but at the same time she had difficulties initiating a brief activity such as
taking out the trash or vacuuming (285)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1132
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 3 The participants became engaged in and performed everyday activities when they
experienced the activity as fun and demanding. Through performing these activities the
experienced energy, joy, and meaning (284)
Illustration ‘‘Dancing is fun and makes me feel good, I have not really understood how much it
influences me, and if I don’t dance, I can feel really bad. It think it is a survival thing, if
I don’t dance it will become difficult to live’’ (284 –5)
Finding 4 There were several reasons why the participants found certain activities fun, demanding,
and inspiring. One was when they did something they associated with meaning for
example hobbies like pearl jewellery making, stone cutting, embroidery, or sewing cloth
for the ‘‘live group’’ of which the participant was a member. These activities made it
possible for them to create something on their own without loosing concentration.
Activities that were creative awakened their engagement, interest, and desire to learn
something new, and activities that provided an opportunity and challenge to learn
something new inspired them and made them engaged. Activities that involved multiple
tasks were demanding and inspired them to be engaged. Through performing several
tasks at the same time, they could keep their focus on the activity and avoid distraction
(285)
Illustration For example, one participant prepared dinner, laid the table and made dessert at the
same time to maintain a focus on cooking rather than jumping to another activity (285)
Finding 5 To set an apparent goal for an activity was also perceived as inspiring for their
engagement on performing everyday activities, as it prompted them to perform new
activities in their everyday life, a goal could include adding a competitive element to the
activity, which created a sense that the activity was meaningful. The competition took
place within the person him- or herself, becoming a challenged that led to results.
Setting a goal for the activity engaged the participants (285)
Illustration ‘‘Yes I have a goal: to learn Japanese. I will be travelling to Japan’’ it’s a goal and I
haven’t given that up. If you have a goal you perform the activity better. E.g. if I’m
going to see my boyfriend, I must take out the trash and clean up and wash
beforehand? (285)
Finding 6 The participants could also be engaged in and perform activities through facilitating
supports that included adaptions of activities or adjustment of the environment. For
example a dishwasher facilitated the handling of dishes, and taking a taxi facilitated
opportunities to run errands without having to make transport arrangements or check
the bus schedule. Further having time aid to remind them that it was time to perform
the activity. Another adaption they had experienced was the handheld computer. It
reminded them of everyday activities that they had had to undertake and was seen as a
good support to help them become more independent on their everyday activities. They
used the handheld computer to keep track of all the activities that they had to do, as
they felt that their schedule was difficult to remember (286)
Illustration ‘‘Earlier I made weekly lists, but now I have one of those hand computers. I can write
everything I realize that I have to do as a reminder, and then I make a list for the next
day. It is like a second brain that remembers things and increases the possibility to
remember things’’ (286)
Finding 7 It was also important for their inspiration that no one else told them what to do; the
goals and engagement had to come from themselves (286)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1133
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Illustration To get me inspired to do anything, I must feel inside me that I have to do things and
that’s that. I cannot do it if someone tells me what to do, it has to come from me,
although it goes really well if I manage to force myself to do things (286)
Finding 8 Having someone who pushed them to get started was important because the
participants often experienced lack of energy and thereby found it difficult to be
engaged in and perform activities, especially those they found boring and repetitive.
Performing different activities often required a lot of concentration, and it was easier to
stay focused and concentrated when they had the support of a person who pointed out
what they were doing and should do so they could concentrate on the performance
nothing else. The SSW [Community Care Workers] personnel were described as
‘‘starters’’ to begin the activity. To start an activity was the most difficult part for the
participants; continuing and completing the activity was easier. To enable their
performance of activities, a partner or a friend could also give social support (286)
Illustration ‘‘I usually ask a friend to remind me if I ought to do something. It works rather well’’
(286)
Finding 9 Facilitating support was described as important by both those who lived in their own
apartments and those living in a community apartment with personnel. Support could
include help in organizing housework, from talking about what they should start to
clean up through how they would continue. It was also difficult for some participants
to realize when the house was dirty and therefore they needed support to observe that.
Even though they had the structure and followed a schedule to perform activities, they
could require support from another person to pay attention to and remind them when
they should, for example clean or eat. Their need for facilitating support to get engaged
in and perform everyday activities meant that living conditions that included supporting
personnel were important for their development of self-confidence. Through social
support they felt that they could try to perform activities they had earlier been insecure
about (286)
Illustration ‘‘They (the personnel) facilitate the part of me that I’m missing because of my disability.
I have the privilege of having a person supporting and helping me in my everyday life
so I can have a perfectly normal life’’ (286)
Finding 10 The participants could also be engaged in and perform activities, through facilitating
sup-ports that included adaptions of activities or adjustment of the environment, e.g. a
dish-washer facilitated the handling of dishes, and taking a taxi facilitated opportunities
to run errands without having to make transport arrangements or check the bus
schedule. Further having time aid to remind them to perform the activity. Another
adaption they had experienced wad the handheld computer, It reminded them of
everyday activities that have had to undertake and was seen as a good support to help
them become more independent on their everyday activities, they used the handheld
computer to keep track of all the activities that they had to do, as they felt that their
schedule was difficult to remember (286)
Illustration Earlier I made weekly lists, but now I have one of those hand computers. I can write
everything I realize that I have to do as a reminder, and them I make a list for the next
day. It is like a second brain that remembers things and increases the possibility to
remember things and increases the possibility to remember (286)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1134
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 11 Another aspect facilitating support to engage in and perform everyday activities
included that activity’s structure. The participants explained that structure in their
everyday life increased their capacity to perform various activities. The structure
included carrying out tasks in a certain order and having routines. For example one
participant folded her clothes by colour after doing the laundry to stay fully focused on
the task without losing concentration. To perform an activity in a certain way with a
given structure meant that the participants could be engaged for an extended time
without losing concentration. Using a schedule was another way to structure their
everyday activities. One of the participants had learned that written lists of everything
that she needed to do comprised a facilitator (286)
Illustration ‘‘I like to cross off the things I’ve done, so I can cover a whole page with a list of what
I should clean up so I can cross it off when it’s done. Then I really can see what I have
accomplished. I do so with everything – packing lists, action-lists, to-do lists, and so on
and I cannot cheat. If it’s not done, I cannot cross it off’’ (286)
Finding 12 The participants also expressed how their workplace gave them facilitating support
through demands and structure, and that made them more engaged in activities at
work. They explained that they were more engaged in performing activities at work
since these activities were adapted to meet their capacity, for example through the
number of hours they worked every day. There were also clear rules and limits about
what activities they should perform, and that made it easier for them to perform an
activity, be fully focused, and succeed with it. Through facilitating support at work,
they could handle their job requirements to stay focused and be engaged. The works
was experienced as important for the participants; it was also important that their work
was adapted to their conditions (287)
Illustration ‘‘Maybe I cannot work full time, but I manage to work half-time, and for me that may
be as important as a full time job for another person who works’’ (287)
Finding 13 Feeling togetherness with other people and sharing everyday activities was described as
engaging. Through meeting others, finding common interests, and doing activities
together, the participants come to be engaged in a variety of activities. For example,
one activity that was describes as social and engaging was roleplaying. Role-playing
required the participants to be creative and forced them to find new solutions to
problems. Other activities described as being engaging through togetherness with others
were hanging out with friends, going shopping, participating in or attending sports
events and holiday travelling. Feeling of togetherness and engagement could also be
achieved through talking to friends on phone or through using online social media like
Facebook. The Internet also created the opportunity for social interaction through
playing games. Taking part in various online data games satisfied their social need for
sharing activities (287)
Illustration ‘‘There is one thing I do at home: I play a lot of online games on my computer. Online,
I meet other people so I have developed or achieved a sort of substitute for a normal
social life’’ (287)
Finding 14 Participating in everyday activities together with others also gave them feelings of being
needed and appreciated by other people. To perform activities to help other people in
their social network gave the participants feelings of happiness and satisfaction (287)
Illustration ...
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1135
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 15 Furthermore, feelings of togetherness and being needed and appreciated by others
resulted in the performance of several activities, like shovelling snow, walking the dog,
repairing broken items, babysitting, or walking small children to school. The
appreciation they received after managing to perform an activity that made them feel
needed encouraged the participants to engage in and perform such activities even when
they found them uninteresting (287)
Illustration ...
Finding 16 To have employment was also of importance as it was an opportunity to find and share
everyday activities with others. Through their work they met people and established
togetherness around common work tasks that they were engaged enough to start and to
stay focused on without losing concentration. Even when they were asked to do several
different tasks they found it easier and more engaging to perform the activity when they
shared it with others (287)
Illustration They explained that it was easier to work with others than on their own; at the same
time they became more inspired to perform more demanding tasks when they had
some-one else with them (287)
At home I can be myself and be private, I also, of course, am myself at work, although
it’s my job, and it’s important for me to be needed and show that I am as worthy ad
everyone else, that I can do this work as well as someone who does have the same
handicap as I do is something I really want to live up to (287)
Experiences of older adult women diagnosed with attention deficit hyperactivity disorder (Adapted from 25)
Finding 1 Peer rejection (252)
Illustration I am a loner. I don’t mix well (252)
Finding 2 Feeling different (252)
Illustration I knew I was different, but now I have a name. Up until now I didn’t know (252)
Finding 3 Seven out of nine reported experiences of peer rejection of feeling isolated, alone, or
different (253)
Illustration Peggy, 91 years old, described herself as always having been a ‘‘loner’’ (253)
Finding 4 On average, participants had 1.6 different careers throughout their lives, although they
switched jobs within careers several times. These women described resourceful ways of
working in a variety of positions. Peggy, age 91, convinced one company manager to
hire her even though she did not qualify for the position. She worked there for many
years and wrote the office training manual (256)
Illustration ‘‘Yeah well there were those things that there were no books got, so I went in blank,
you know they sent me in the business office with nothing, and I didn’t know which
way I was going to jump, so I made some books that kind of helped to tell what to do.
I wrote the orders for what the men would do and what the operators would do’’ (256)
‘‘I had to come up with things to keep it interesting I think a person with ADHD can
always make something interesting’’ (252)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1136
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 5 Edna, age 62, ran her own tax business, explained needing to take many small breaks
from her work (256)
Illustration ‘‘Because I couldn’t think too long. I would do 2 to 3 of them (taxies) and I’d go. I’d
go around talking to people for a while. I would make some small conversation until I
felt my mind cleared up’’ (256)
Finding 6 These findings show that with group therapy the women were able to develop a sense of
self-acceptance and awareness. They finally had an explanation for many of the actions
they had been exhibiting throughout their lives. They were also taught skills to control
their impulses and anger and remain calm in ways they were unable to before (257)
Illustration ‘‘Well, you know, after a lot of thinking, and uh, consideration from Kathy (practitioner’s
pseudonym), I got to the point where all the nice things, I felt like she said, you know,
like ‘theyre creative; they go with the flow a lot easier than other people’. You know, a
lot of things she said, well, it made me feel like how I’m kind of glad I have it [ADHD], it
doesn’t hurt me at all. It’s not a big stamp on my life to hurt me at all?’’ (257)
‘‘It helps me make sense of my life. It explains so much of my life because, uh, I think a
lot of us ADHD’s need to have things explained to us. You know, like why we do certain
things’’ (257)
Finding 7 In addition to their newfound self-acceptance, it was important to several women that
they share their experience and knowledge with others (257)
Illustration It’s not something to be scared of. Don’t use an excuse for what you do. There’s no
excuse for what you do. What you do is made of what you’ve done in the past. Learn
to accept who you are. I think I’ve done a good job working with it (257)
Predictors of academic success among college students with attention disorders (Adapted from 26)
Finding 1 Factors that help them to cope with their ADHD in college: The most commonly
described coping methods mentioned were using some types of social support (52%).
Students wrote and talked about how their parents, dating partners. Roommates,
friends and professors helped them manage their ADHD. (67)
Illustration Social support (N¼35) (66–67)
Finding 2 Factors that help them to cope with their ADHD in college: The most commonly
described coping methods mentioned were working harder and longer than other
students (78%) (67)
Illustration Working longer and harder than others (N¼53) (66– 67)
Finding 3 Specific instrumental support
Illustration Wake-up calls, reminders, taking exams in private (67)
Finding 4 Emotional support (67)
Illustration Listening, advice giving, encouragement (67)
Finding 5 About one third (N¼24) identified one or more factors that were obstacles to their
academic success (67)
Illustration Procrastination (N¼13) (67)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1137
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 6 Obstacles to success: inability to use organisation, time-management and study skills
(67)
Illustration Inability to use organisation, time-management and study-skills (N¼8), peer-pressure
to socialise instead of study (N¼5) lack of time to study (N¼4), being perfectionist
(N¼3), procrastination (N¼3) (67)
ADHD in the college student: a block in the road (Adapted from 28)
Finding 1 Managing life to cope with ADHD it is important to find somebody to be accountable
to was important self-management strategy. Most often friends provided this kind of
help. Tried to schedule classes with friends so that they would have someone to study
with and be accountable to. ... Campus services providing tutors and/or coordinators
that provided additional accountability was considered helpful in managing life (252)
Illustration ...
Finding 2 The factor, setting alarms and reminders, was cited by all participants as most
important in daily life for getting up in the morning, being on time, completing
assignments on time and staying organized. Participants most often used their cell
phones to remind themselves of important events and dates. They set alarms to ring at
several intervals to avoid procrastination. ... Participants also set multiple alarms to get
themselves up in the mornings. One participant described alternating between using the
alarm on his cell phone and ‘‘annoying alarm clock,’’ because one he got accustomed to
an alarm, it would no longer wake him up. Another strategy was to place alarms the
alarm across the room so that they would have to get up to turn it off (252)
Illustration One participant described how he set an alarm to ring to remind himself one week
before an assignment was due, then another reminder 3 days in advance and finally
another, one day in advance. Another described her cell phone as her ‘‘brain’’ and
related that when she forgot her cell phone at home one day she ‘‘lost the entire day’’
(252)
One participant described altering between using the alarm on his cell phone and an
‘‘annoying alarm clock’’ because once he got accustomed to an alarm, it would no
longer wake him up (252)
Another strategy was to place the alarm across the room so that they would have to get
up to turn it off. Even during the course of the interviews participants were observed
reaching for and checking their cell phones multiple times (252)
Finding 3 Self-talking help to modify their behavior (253)
Illustration Well, maybe I might (talk out of turn) once or twice and then I’ll think about it. I’m
like, okay, they’re talking ... no you don’t talk ... so I’m like being my own little
person in my head (253)
Finding 4 Sometimes the self-talk was covert, but at other times participants actually spoke aloud
to them selves
Illustration Don’t even need anyone to actually listen to what I’m saying, but I just need to like
verbally express it to myself (253)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1138
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 5 Removing distractions was another factor that was commonly described by participants.
Rather than simply turning off the computer or video game, participants actually
psychically removed them so that they could not use them all .... Studying in a sound
proof room in the library, closing blinds so as not to observe people walking by and
even paying extra for a private room were measures were taken specifically to remove
environmental distraction (253)
Illustration One participant loaned his video game equipment to a friend so that he would not be
tempted to play. Another delayed getting his computer fixed because he found it so
distracting to his schoolwork (253)
Finding 6 All of the participants continued to struggle with persistent symptoms of ADHD:
inattention, impulsivity and hyperactivity. The symptoms created challenges to academic
success because of poor time management and organisational skills, difficulty staying
focused, failure to complete work on time, poor motivation, poor reading and study
skills and difficulty sleeping and getting up in the morning. Several received failing
marks simply because of repeating absence. One participant had to repeat an entire
course because he failed to show up for the final exam. Outside of academics, persistent
symptoms of ADHD: intention, impulsivity and hyperactivity presented different
challenges. Female participants in particular reported that impulsivity posed challenges
in their social relationships. They described themselves as blunt and indicated that they
often blurted hurtful comments to others. Four of the participants indicated that being
easily distracted affected their driving skills (251)
Illustration ‘‘I’m probably not as careful as I should be. I haven’t really had a lot of wrecks’’ I’ve
had three but only one was really my fault. I do get distracted there’ll be somethin’
over there and then I’ll look over there. You know. I’ve driven and been thinkin’ about
somethin’ or been turned into somethin’ and look and it would be like how’d I get this
far? I don’t even remember goin’ by all that stuff back there’’ (251)
Finding 7 Six male participants described problems with video gaming in which they became so
absorbed and focused on the games that they often played into the early morning hours
at the expense of everything else. While these same participants described difficulties
with studying and staying on task, they could describe every character and nuance of
the games and often played for hours at a time, sometimes forgetting to eat or even
sleep (251–2)
Illustration ‘‘I really enjoy playing videogames and I can go long periods of time. I’ll stay up on my
own and then I’ll look at the clock and it’s like 4:00 in the morning. I’ll say when Halo
Two (video game) came out last November that kinda took over my world for a little
bit – we’re talkin’ like four hour chunks of my day were gone to this game’’ (252)
Finding 8 Alcohol abuse is another addictive behaviour. While binge drinking and partying is
common among college students, these students had experienced repeated consequences
from drinking alcohol
Illustration The campus, um, has a strict alcohol policy. It you get caught on campus you’ll get an
alcohol violation and on your fourth one you get kicked out. Yeah, um I’ve done three.
Um, you know, I came here my freshman year and I was drinkin’ pretty often, you
know, and then I actually got arrested in my third week here. I’m like; no I don’t think
I have a problem or anything like that. Then I got my third alcohol violation and so I
decided to quit drinkin’ for three month? (252)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1139
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 9 All the participants were diagnosed with ADHD prior to high school, and most
described learning about ADHD primarily through own experiences. They described
how ADHD was simply a ‘‘part of who I am’’ and that through trial and error they
had learned what worked and what did not work. About half of the participants
indicated that they really did not want or need to learn any more over and above what
experience had taught them (250)
Illustration ...
Finding 10 The third factor that helped participants gain insight about ADHD acknowledging. One
female participant who had been diagnosed with ADHD in elementary school finally
had the opportunity to read her records just prior to entering college. She described the
relief she felt when she finally understood why she had to work so hard at certain
things (250)
Illustration ‘‘I think it’s been both from reading (about (ADHD) and after reading acknowledging
what’s going on. It (ADHD) always made me feel like it was a block in the road. After
I read my records, it gave me a completely different look. It gave me such an insight.
You have to understand so that you can cope, and you know, work around it’’ (250)
‘‘Reading about ADHD helped me to understand it better. The best thing is being self-
aware so you can learn to live with it’’ (250)
Finding 11 Participants described the factor, taking/using CNS stimulants, as helpful. Central
nervous system stimulants include prescription ADHD medication such as Ritalin,
Adderall or Concerta, as well as non-prescription sources such as nicotine. Ten of the
participants were taking prescription ADHD medication, although only three took it on
regular basis. Most said it was helpful for studying, completing course work or for
especially long classes. Prescription ADHD medication was also described as useful for
improving concentration and decision making while driving (252)
Illustration Most commonly they took prescription ADHD medicine only when they had a lot of
work to do (252)
‘‘When I’m on medication I drive a lot more conservatively. But, when I’m off, it’s
more aggressive’’ (252)
Finding 12 Another participant, a soccer player, noticed that taking ADHD medication improved
his ability to stay focused during games (252)
Illustration ‘‘I play soccer and I noticed a big difference whenever I was on my medicine – I know
what’s goin’ on in the game. Any other time the ball will be passed to me and I might
be lookin’ in the trees or somethin’ and then just everybody jumps down my throat’’
(252–3)
Finding 13 Eight of the participants smoked cigarettes and believed that nicotine helped their
ADHD symptoms (253)
Illustration ‘‘like it helps calm your brains and all that, smoking also helps you concentrate better’’
(253)
Finding 14 Participants described positive relationships with their parents and indicated that the
continuous presence, support and reinforcement form their parents helped them to get
college (253)
Illustration They described their parents as ‘‘never letting up’’ and ‘‘always being there’’ (253)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1140
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 15 Parents developed creative strategies to help their children such as setting up daily email
reminders. One participant felt like his parents’ keep him on a tight leash. When asked
whether he felt like he had less independence than others his age he said (253)
Illustration ‘‘It started off that they had a very tight leash on me as far as things that I could
actually do on my own without their supervision, but as time went on they gave me
more leeway. A little more independence and eventually I was ready for complete
independence when I went to college’’ (253)
Finding 16 While parents were the main source of support prior to college, participants began to
utilize their friends as a main once they move away from home. Friends help them to
stay on track by reminding them of assignments and due dates, studying with them and
even making sure they got to class on time (253)
Illustration ‘‘If you are around the right people, you can overcome it (ADHD) and they can help
you’’ (253)
Finding 17 Friends were also an important source of social support
Illustration My friend Sarah is the one that know that I have ADHD and so she understands. So
she doesn’t mind, she doesn’t make fun of me (253)
Finding 18 Teachers’ support to cope with academic challenges related to ADHD. They like college
professors who knew about their ADHD diagnosis usually went out of their way to
provide necessary accommodations as long as they showed they were willing to do the
work (253/54)
Illustration ...
Finding 19 Academic support or disability services were also an important source of support for
six of the participants. Students who used these services were eligible for note
takers in class, extra time on exams, tutors or other individualised academic
accommodations. Participants who were receiving disability services also indicated
that if they stated having trouble with academics they had somewhere to go to get
help (253–4)
Illustration ‘‘I see my coordinator every day, she reminds me – she helps me – and al that’’ (254)
Finding 20 Unfortunately most participants did not take advantage of these services because ‘‘they
didn’t want to be thought of as different’’ (254)
Illustration ‘‘Didn’t want to be thought of as different’’ (254)
Finding 21 Consequences helped them to stay on task and make better decisions
Illustration Experiencing consequences was often the factor that ‘‘got attention.’’ ‘‘I never had an F
in my life until last semester and uh’ not going to class, not doing the work, you know.
I’m goin’ (thus semester), I’m doin’’ (252)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1141
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Stimulant medication: a trade-off? The lived experience of adolescents with ADHD (Adapted from 27)
Finding 1 Only the two participants (one male and one female) who were diagnosed with ADHD
in junior high school continued to take stimulant medications regularly throughout high
school (219)
Illustration ‘‘The medications helped big time. I wasn’t talking. I was paying attention I wanted to
do work. I was highly motivated, highly driven, and it seemed like things came easier
to me’’ (219)
Finding 2 One girl remembered that as a 2nd grader, ‘‘It made me feel like I didn’t have friends. I
didn’t ever really play that much. I’d just it just felt like you were going very slow.’’
This was one area in which the participants who were diagnosed with ADHD later and
started on stimulant medication later differed from those who were diagnosed in earlier
elementary. Those who were diagnosed later were more positive and insightful in their
perception of general social effects (220)
Illustration ‘‘When I wasn’t on medicine or anything ... I was just so hyperactive and just like my
mind ... I just said anything before I thought about it and I was always interrupting
people ... now I think about things more before I say them .... Starting to take
medicine just didn’t automatically ... you know, but it’s something you have to - you
have to work on, but it helped a tremendous amount’’ (220)
Finding 3 The factor benefits included the positive effects of stimulant medications that were
consistent with existing literature. Participants were unanimous in confirming that
stimulant medications improved concentration and focus. The biggest benefits cited by
participants were being able to study longer, completing more schoolwork, and
improving reading comprehension (220)
Illustration ‘‘It’s easier to sit down and focus. I still have to read a page, like a textbook page,
several times but I don’t have to read it like 20 or 30 times to get all of what’s in the
book, if I took medicine I would only have to study that amount of information once
or twice, but if I didn’t, I might have to study it five or six times. It’s just easier to
comprehend’’ (220)
Finding 4 Most participants did not think that stimulant medications affected their grades, but
that the medication0s did affect how hard they had to work to get those grades (220)
Illustration ‘‘I didn’t notice big improvements in my grades (when I started taking stimulant
medications). I noticed an improvement in the ease of how I got those grades’’ (220)
‘‘My grades didn’t change (when I stopped taking stimulant medication), the amount of
homework I got done changed because I got a little less homework done’’ (220)
Finding 5 Although all of the participants who were initially started on stimulant medication (n¼
13) in early elementary school had stopped taking them regularly by high school, most
(n¼62%) taking stimulant medications again in college. The participants cited the
‘‘need to study and get stuff done’’ as reason for taking stimulant medications. Many of
the participants who started taking stimulant medications again in college stated that
they only took the meds ‘‘when they need them.’’ When asked by the investigator
‘‘How do you know when you need stimulant medications?’’ The response was
typically, more likely to take their stimulant medications at night than during the day
(221)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1142
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Illustration ‘‘I’m like, okay, look, I have 3 hours left to do this paper. I’ll take the medicine and get
it over with. And I will and I’ll be done. I had a huge paper due today – because I
procrastinate about everything – and I took two of ‘em last night. Just so I could work
all night and that helped.’’ (221)
‘‘I don’t take it every day. I take it when I need it. When I have a lot of work to do, I’ll
take it. If I don’t have a lot of work to do, I won’t. I never take it on the weekend. I
probably take it more at night than I do at any time. Most of the people I know take it
more at night because that’s when they have time to do stuff. I’d probably do better in
school, but a lot of the stuff lasts long time. I’m only in class for like two hours ... I
don’t want to feel like that the rest of the day’’ (221 –2)
Finding 6 When asked ‘‘Other than school work, how do prescription stimulant medication help
you?’’ Several participants described improved driving concentration (221)
Illustration ‘‘I noticed a big improvement in driving ... it’s a lot easier to concentrate on driving
and not get distracted or not daydream.’’ ‘‘When I’m on medicine I drive a lot more
conservatively’’ (221)
Finding 7 Medication improved concentration and several described improvement in driving
Illustration ‘‘I noticed an improvement in driving ... it’s a lot easier to concentrate on driving and
not get distracted or not daydream.’’ ‘‘When I’m on medicine I drive a lot more
conservatively’’ (221)
Finding 8 Four participants (31%) stated that they were never ‘‘off’’ medication, but that they did
not take them regularly in high school. ‘‘I would always forget it, so yeah. I mean half
the time, I never took it. And uh, on the weekends, you don’t want to feel like that’’
two of the 13 continued to take stimulant medications during high school, but
discontinued once they got to college (218)
Illustration ‘‘I felt like everything was numbed down. Like you can’t feel really below sorta the
highs. And like it wasn’t really helping me. I just got sick of it and I quit taking it’’
(218–19)
Finding 9 Both male and female participants used similar words to describe the medications as
making them feel ‘‘somber’’ or ‘‘mellow’’ (219)
Illustration ‘‘like everything was in slow motion. It just felt like most of my school I kinda went by
I was kinda like watching it go by while I was sittin’ there’’ (219)
‘‘When I was on it, I was just like real mellow through the day. I paid attention a little
bit better in the class, but I just really could care less’’ (219)
‘‘that everything is just OK all the time. It?’’ never great and it’s never terrible. It’s like
I’m monotone the whole day long (219)
Finding 10 The factor side effects evoked quite a bit emotion from most participants. All described
negative physiologic and psychologic side effects of stimulant medications. Physiological
including nausea, anorexia, increased thirst, insomnia, shakiness, fatigue and dry
mouth. Psychological side effects included irritability, emotional lability, anger, anxiety,
restlessness, and depression. Several of the participants described themselves ‘‘feeling
drugged’’ or ‘‘zoned out’’ (220)
Illustration ‘‘just would zone out. I think my eyes would probably glaze over.’’ ‘‘It killed my
personality. I had no personality, I was dead.’’ ‘‘It changed my mood ... I didn’t care
about anything ... lifeless in a way’’ (220)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1143
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 11 Every participant reported some emotional lability and anger associated with stimulant
medications, particularly with Adderall (220)
Illustration ‘‘Adderall makes you concentrate. It makes you wanna get stuff done and want to do it
fast, then if someone or something tries to bother me, uh, uh. Adderall made me angry.
It would make me snap like that and I’m not really a snappy person’’ (220)
Finding 12 One male described the ‘‘cycle’’ of medication effects (220)
Illustration ‘‘Whenever it’s just startin’ to kick it’s like everything just wonderful, it’s bliss, it seems
like. Nothing – nothing, can get me down, but that goes away, then I’m like a zombie
And then I get grouchy’’ (220)
Finding 13 General social effects described by participants were somewhat unexpected. While the
literature supports the used of stimulant medications to reduce impulsivity and improve
social skills, several of the participants felt like the medications made them less sociable
(219)
Illustration ‘‘It seems like when I’m on Ritalin or one of the other ones that I just, you know. Like
when I’m around other people I just kinda clam up and just get in my own little shell
kinda and just don’t really talk. It was really hard to interact with other people on it’’
(220)
‘‘It made me feel like I didn’t have friends. I didn’t ever really play that much. I’d just
... it felt like you were going slow’’ (220)
Girl, repeatedly interrupted: the case of a young adult woman with ADHD (Adapted from 29)
Finding 1 Following the flow of lectures was difficult and she noticed herself frequently checking
the notes of the students around her to get information she had missed. Amanda also
reported difficulty in managing the volume of required reading in her class. She reserved
large blocks of study time for reading but had difficulty focusing attention on the
material and would eventually stop studying altogether. Other areas of her life also
suffered because of her disorganization. She spent inordinate amounts of time locating
books and notes, mismanaged her bank account, and was remiss in attending to her
own health needs (332)
Illustration ...
Finding 2 Amanda presented for treatment with a belief system clustering around chronic issues
related to inadequacy and social undesirability stemming from her life experiences
Illustration I’ve always been screw-up (336)
I’m different. I don’t fit in (336)
Finding 3 You felt that you had to catch up in the reading to be able to attend the next class
because if you didn’t you wouldn’t run the risk of appearing stupid, to use your own
words. And even if you knew you wouldn’t be called on, it sound like it would be
frustrating to sit in a lecture that she doesn’t understand and thinking, ‘‘I don’t belong
here’’ (337–8)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1144
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Illustration ‘‘I might be expected to answer a question and I would look stupid if I couldn’t. It’s
torture to sit there when you can’t follow the lecture. You just feel stupid, like you
don’t belong there and everyone knows it, too’’ (337)
‘‘Just like usual it was hard to concentrate. I’ve always been a slow reader but, oh my
God, economics is torture. I tried to focus on it, I really did, but it seemed hopeless that
I would ever catch up. Soon after I started, I would take a break and putter around my
room. Before I knew it I was off to find my friends’’ (338)
Without a net: CBT without medications for an adult with ADHD (Adapted from 30)
Finding 1 Brian’s case could be considered as mid-to-moderate case of ADHD relatively
circumscribed symptoms and impairment. That is, although struggling at work, he was
completing projects, and his employment status was not at risk. Similarly, although
struggling to keep up with the demands of his home life, his marriage and household
situation were generally stable. That being said, Brian was spending very long hours to
keep up with the demands on him at work and less time attending to his family. He
experienced emotional distress and frustration, and his difficulties were apparent to
observers, namely, his employer and his spouse (54)
Illustration He reported having to – work hard to hold it together at work – and he tended to ‘‘let
down’’ at home, where his wife witness his frustrations (54 –5)
Finding 2 As he had throughout his educational life Brian soldiered on in his work, getting things
done on time by regularly staying up late (often 1:00 or 2:00 a.m.) but recognizing he
was underperforming (53)
Illustration He noted that he received objective evaluative feedback of his underperformance in the form
of performance reviews that cited many domains of his job that ‘‘need improvement’’ (53)
Finding 3 As Brian added the role of father to his life, he found it increasingly difficult to strike a
healthy balance among his many responsibilities. As innovations in advertising (e.g.
social media) as well as the marketplace becoming more competitive due to his slugging
economy, Brian had more projects to manage with fewer resources, resulting in even
greater demands on him at work. His wife became increasingly frustrated with him
because she felt that Brian was not helping out enough with child rearing and general
household management. She also complained that he ‘‘was not present’’ when at home
and did not listen to her when they had time to talk with each other (53)
Illustration Brian noted that he was easily frustrated with child care duties and did not like to be
interrupted when working at home because he had difficulties refocusing on what he
was doing, which was a central source of conflict with his wife (53)
Finding 4 It should also be noted that Brian evidenced many personal strengths he has a strong
work ethic, doing what needs to be done to finish a project by a deadline, although he
might not work efficiently or be satisfied with the finished product (54)
Illustration
Finding 5 He also is a likable person who gets along well with others. That is, his frustration is
often self-directed and does not manifest as anger directed towards others, which may
have allowed Brian to ‘‘smooth over’’ any negative effects if his inefficiencies at work (54)
Illustration ...
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1145
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 6 Brian enjoyed the creative aspects of his work but struggled with managing
organizational demands of his job (e.g. financial budgets, project deadlines), social
demands (e.g. delegating responsibilities, paying attention in meetings) and maintaining
a healthy balance between work and home life (50–51)
Illustration Brian said that he assumed more responsibilities in his career, he had to work harder to
keep pace, which required him to devote time to working from home to make up for
his inefficiencies at the office. He said that he noticed increased difficulties managing
stress and frustrations at home and at work and felt he was falling behind in both
domains of his life despite working harder than he ever had, particularly since becoming
a farther (51)
Finding 7 Brian was graduated with his class from high school and enrolled in college. He
required an extra semester to complete graduation requirements in small part due to
needing an extra class related to a change in his major he also had to enrol in two
other classes he needed to retake after withdrawing from them after falling woefully
behind in his work because of disorganization and procrastination. (52)
Illustration Although he completed most of his classes, Brian said that he had to continue to work
harder than peers to keep up with his work, to the detriment of his social life (52)
Finding 8 He struggled with procrastination and had difficulties prioritizing his work and often
had to take an incomplete for a class to complete the required work during breaks
between semesters (52)
Illustration Brian described college as a ‘‘struggle’’ and he finished with a ‘‘mediocre’’ grade point
average (52)
Finding 9 Among the few college courses he found to be less of a struggle for him was those
involving the creative arts, which eventually became his major field study. After
completing his undergraduate degree, he sought a master’s degree in an art program
focused on the use of creative arts in business/advertising. Although he continued to
enjoy studying the arts and the use of various computer software programs, he
struggled with business classes and with keeping up with assignments and project
(52)
Illustration ...
Finding 10 – sought a master’s degree in an art program focused on the use of creative arts in
business/advertising. Although he continued to enjoy studying the arts and the use of
various computer software programs, he struggled with business classes and with
keeping up with assignments and project (52)
Illustration ...
Finding 11 Again, review of his graduate transcript reflects a graduate student who earned average
grades and completed the program ‘‘on time’’, although it does not reflect the excessive
them and effort expended to achieve this outcome, including appealing to instructors
for extra time to complete his work (52)
Illustration ...
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1146
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 12 He took on more administrative and supervisory duties, which required organization
and follow through, and less time doing ‘‘hands-on’’ work on specific projects. Brian
found himself staying at the office late to catch up on work and devoting increasing
amounts of time working at home to keep up with his job. (52)
Illustration ...
Finding 13 After completing his degree, Brian soon found a job working for a midsize retrial
clothing company in its advertising department, allowing him to put his training to
good use. He in an entry-level position and described his experience as being akin an
‘‘apprentice’’ having the opportunity to be mentored by the senior-level creative
director. Brian found this arrangement helpful insofar as he was able to learn by
observing his boss demonstrate various tasks and responsibilities and then gained
‘‘hands-on’’ experience executing these tasks under the supervisor of his boss (52)
Illustration ...
Finding 14 Brian was eventually promoted to creative director when mentor/boss left the company,
and he has been in the position since then. Brian struggled in his position as director
because, rather being able to rely on his mentor for guidance, he now was expected to
work independently and, in fact, to provide guidance and directions to his staff (52)
Illustration ...
Extreme makeover: the case of a young man with severe ADHD (Adapted from 31)
Finding 1 Ralph presented as a rather cheerful but admittedly ‘‘social awkward’’ young man
whose manner made him seem considerably younger than his stated age (473)
Illustration ...
Finding 2 He was friendly and cooperative throughout the interview process, but had a tendency
to blurt out answers to questions before the examiner could complete them. Con-
sequently, his answers often missed the mark and periodically spiralled into loosely
related tangents. His eye-contact was minimal and he requested the window blinds be
drawn
Illustration As the light reflections through the blinds is very distracting (473)
Finding 3 Although he reported minimal emotional distress, Ralph’s expectations that he would
‘‘fail’’ in his endeavours, based in no small part on his realistic experiences of being
fired. Spurred brief, though intense feelings of dysphoria and hopelessness
Illustration He said that, when stressed, he distracted himself by becoming engrossed on the
computer or by ‘‘puttering around in the house’’, adopting an attitude that ‘‘everything
is going to work out’’ (474)
Finding 4 He made plans for finding a new job, but did not follow through on steps to achieve
this goal
Illustration He said it bothered him to have been fired from every job he had had in adulthood,
usually because of some combination of recurrent tardiness, inability to follow
directions, forgetting important projects. Inefficiency, procrastination, and clashes with
peers and supervisors (474)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1147
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 5 Ralph effectively avoided short-term distress but was left ‘‘feeling like a failure’’
compounded by resulting financial stress and his wife’s view of him as a ‘‘lazy
underachiever’’ (474)
Illustration ...
Finding 6 Ralph hoped to improve his relationship with his wife but it seemed that the harder he
tried, the more mistakes he would make (474)
Illustration ...
Finding 7 He bemoaned that his wife felt embarrassed to socialize with other couples because of
his numerous social ‘‘blunders’’. The cumulative effect of these various experiences was
that Ralph was left feeling incompetent and pessimistic about his ability to make
changes in his life, though he desperately clung to the notion that things could
magically work out for the best if he found the ‘‘right’’ job and the ‘‘right’’ medication
(474)
Illustration For example, they attended a formal fundraising event for the school district in which
June worked and he told an inappropriate, off-color joke to the superintendent and his
wife. In another instance he reduced a restaurant hostess to teas when he made a joke
about her weight, thinking she was out of earshot (474)
Finding 8 – College was not easy for him. He was somewhat disorganised in the approach to
completing assignments but was proud to graduate with a solid C average (476)
Illustration ...
Finding 9 Ralph’s entrance to the ‘‘real world’’ of the workplace was a rude awakening for him.
The rigidity of schedules, lack of individualized guidance supervision, emphasis on
personal organization, time management, planning, and personal accountability for
performance resulted in repeated poor performance evaluations. There was also no end
of the semester to provide an opportunity to start over with a ‘‘clean slate’’ (476)
Illustration ...
Finding 10 Ralph tended to respond to superiors corrective feedback by becoming defensive,
making excuses. And blurting out convoluted explanations that ranged from blame to
angry outbursts. Such behaviours invariably led to reprimands, strained interactions,
and ultimately, termination of employment. His conflicts at work were compounded by
his inability to follow rules, misreading social cues, and stubbornness with supervisors.
These interactions resulted in him being labelled as ‘‘high maintenance’’ (476)
Illustration For instance, he often arrived early or stayed late to compensate for his admitted
procrastination and inefficiency at work. However, these extra hours raised concerns
because his employers were legally obligated to pay him overtime. Although Ralph
offered to waive his overtime pay, such appeals ended in arguments when Ralph was
unable to accept ‘‘no’’ for an answer (476)
Finding 11 June and Ralph’s first marital rift arose when Ralph was fired from his first job during
their first year of marriage. His occupational problems over the years were compounded
by escalating marital conflicts stemming from Ralph forgetting to pay bills, not
following through on chores and ‘‘getting stuck’’ on topics in conversations, all leading
to his wife’s perception that he was insensitive to her (476)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1148
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Illustration ‘‘My wife says I’m driving her crazy with my irresponsibility (i.e. unemployment) and
social embarrassments’’ (473)
Finding 12 To compound matters, Ralph learned that he could immediately reduce his distress by
engaging in various forms of avoidance, be it cognitive, emotional, or behavioural (479)
Illustration ‘‘I could not stand not being able to concentrate on my reading assignments, so I found
excuses to do everything but reading’’ (480)
Finding 13 Ralph’s case conceptualization seemed to be organized around three principal
maladaptive schema: failure, defectiveness/shame and entitlement (479)
Illustration ‘‘I’ve failed at everything important in life.’’ (Defectiveness/shame) ‘‘I’m a social
embarrassment’’ (Entitlement) ‘‘People should know I have ADHD and accommodate
me because I cannot change’’ (479)
Finding 14 It soon became apparent that Ralph also avoided stress by engaging in magical
thinking, coupled with externalizing thoughts in the form of using the diagnosis of
ADHD to disproportionality emphasize the need for external accommodations. These
cognitive distortions served to deflect focus away from the adaptive changes he could
make to his copings repertoire (480)
Illustration ‘‘It will all work out’’ (480)
‘‘They should cut me a break because I have ADHD’’ (480)
The experience of receiving a diagnosis and treatment of ADHD in adulthood: a qualitative study of
clinically referred patients using interpretative phenomenological analysis (Adapted from 32)
Finding 1 This frustration and confusion often led to low self-esteem, feelings of low self-worth,
and poor expectations of what they may achieve (496)
Illustration ‘‘When you don’t know what the problem is and you’re told you are stupid, it just sort
of sparks something off it makes it worse’’ (496)
‘‘I felt pretty kind of inadequate, I suppose that it is the right word, and frustrated’’ ‘‘I
knew if I went to college no matter how much I tried, that would just bring another
rejection, another failure onto me’’ (496)
Finding 2 However this relief and elation was short-lived and was quickly followed by feelings of
turmoil and confusion as they looked back and reframed their past experiences in light
of their diagnosis and a new understanding of themselves (496–7)
Illustration ‘‘It was unbearable because I felt they’ve diagnosed me, yes they’ve diagnosed me, yes
they’re saying I’ve got medication to take right, and now they’ve left me here right, and
I’ve got all these feelings coming through about my childhood’’ (497)
Finding 3 Reframing their past experiences led participants to feel angry that they had not been
diagnosed earlier and life had consequently been an unnecessary struggle (497)
Illustration ‘‘At first I was pleased in a way that I’d found out what that the problem was, why my
medication hadn’t worked last time and in another way I felt very, very angry and I
thought here I am nearly 50 years old and it didn’t need to be like that’’ (497)
Finding 4 For some participants, this anger lead to sadness as they felt they had wasted many
years living under the illusion that they were destined to fail (497)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1149
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Illustration ‘‘People keep saying to me who I chat to, Oh that’s all behind, leave it behind, you’ve
got this now, now look to the future, and I’m like, ‘Yeah hang on, I’ve just spent 34
years underachieving’. I feel like of my life has been a lie’’ (497)
Finding 5 The next stage of the adjustment process began with realization of the long-term
implications of ADHD as a chronic disorder. This realization was accompanied by
anxiety as participants worried about having a ‘‘disease for life’’ would negatively affect
their future (497)
Illustration ‘‘It’s like a diagnosis of diabetes, it’s like congratulations, you’ve got it, you’ve stuck
with it’’ (497)
‘‘I think one of the things that happened by the time you get into your 30 s you’ve got
all these things you’ve wanted to do, and you’ve got this kind of wreckage of things
behind you, like all the stuff you started and didn’t finish, its like you know, am I going
to start and not finish stuff forever’’ (497)
Finding 6 The final stage of adjustment process occurred when the participants accepted that
ADHD is part of their life and who they are (497)
Illustration ‘‘It’s all part of me and I’m quite happy the way I am’’ (497)
Finding 7 Acceptance also marked the end of ruminations that had previously been experienced in
relation to the diagnosis. Another participant also appeared to have stopped ruminating
over the diagnosis (497)
Illustration ‘‘Acceptance of myself. I accept myself now. I don’t have this, so much of this
frustration inside me. There’s a reason why I do these stupid little things’’ (497)
‘‘I just learn to live with it and accept. I try, well, I don’t think about it. I just take the
medication and let it [life] go on’’ (497)
Finding 8 Participants hoped that in the future the stigma of ADHD would gradually diminish
and they believed this would occur in much the same way as it had with dyslexia (498)
Illustration ‘‘Nowadays dyslexia is fairly understood and if you go to an employer and say, ‘I’ve
got dyslexia, I need a certain amount of accommodation’, nowadays, most people say
‘Oh okay, fair enough we’re aware of dyslexia’. It’s defined now, and I think we need
to get the ADHD to that point as well’’ (498–9)
Finding 9 Participants reported that they sensed a certain degree of stigma attached to ADHD and
this had influenced the disclosure of their diagnosis to other people. Most had only
informed people, whom they knew very well, close friends and family. This sense of
stigma appeared to stem from the fact that they felt that others may see ADHD as a
convenient excuse for their behavioural problems and they may be labelled as a
‘‘Problem person’’ rather than a person who has a problem (498)
Illustration ‘‘I don’t want them to judge me any different; I want them to know me – just for me
without a label. ’’ (498)
Finding 10 Participants hoped that in the future the stigma of ADHD would gradually diminish
and they believed this would occur in much the same way as it had with dyslexia (498)
Illustration ...
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1150
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 11 Immediately after their diagnosis, participants described an initial sense of relief and
elation that their lifelong quest for an explanation of their difficulties had finally come
to an end (496)
Illustration ‘‘The tears were running down my face, cause it was like a road to Damascus moment,
I could put my finger on it, because it was an exact description, I just couldn’t believe
it’’ (496)
Finding 12 More specifically, the participants experienced relief and optimism as the years of
frustration and confusion at not knowing the cause of their problems were now over.
Another participant described a similar sense of joy (496)
Illustration ‘‘It gave me answers and a way forward’’ (496)
‘‘In one part of me I felt elated, it was almost like ‘Oh there’s an actual reason why I
acted like that’’’ (496)
Finding 13 This relief and elation also stemmed from the fact that the diagnosis provided an
opportunity for them to relocate blame for their previous difficulties and failures. It
enabled them to shift from an internal attribution that they were solely responsible for
their problems to an external attribution whereby ADHD was an explanation for their
difficulties (496)
Illustration ‘‘Until I knew about this condition, I assumed that everything was part of my
personality. And I guess one of the things it gives you is an awareness of how many
things that you convince yourself are conscious decisions are in fact nothing of the
kind’’ (496)
Finding 14 Participants reported positive influence that medication had brought into their life. It
appeared that medication had dissolved the previous sense of ‘‘feeling different from
others’’ and was replaced by a ‘‘sense of normality’’ (497)
Illustration ‘‘Yeah the tablet makes me feel human. I say ‘well I feel like you now’’’ (497)
Finding 15 In other words, medication enabled participants to feel that they could function in the
same way as ‘‘normal’’ people who do not have ADHD (497)
Illustration ‘‘Being medicated I think has for the first time given me a sense of what the average
person has’’ (497)
Finding 16 Medication also had a positive impact on their ability to function more successfully in
their everyday lives, particularly in terms of interpersonal skills. For example, the
medication improved their interactions with people, which were previously hampered
by their ADHD symptoms (497)
Illustration ‘‘I can now let them have their say, whereas before it didn’t matter. Now I actually let
them talk, now I listen to them. I’ll let them get their word in’’ (497)
‘‘I’ve got a lot more tolerance, I don’t interrupt much’’ (497)
Finding 17 Medication also improved their motivation and their ability to organize and stay
focused pm everyday tasks (497)
Illustration ‘‘I found it very difficult to start tasks and now I find it less difficult, I am a bit more
directed’’ (497)
‘‘I suppose I’ve got more confidence, simply because I know that if I say something, I’m
more likely to do it. The main benefit is that you get things done’’ (497)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1151
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 18 Furthermore participants had always believed that they were unable to achieve their
potential, yet following treatment with medication, participants believed that reaching
their potential was now possible. This contributed to a more positive and hopeful
outlook of the future (498)
Illustration ‘‘I have – if you like ‘unrealized potential to work, to do even better and produce more
success because I can’ I am much more positive about the future and I can see much
more potential in myself’’ (498)
‘‘Whereas before I was just stumbling through, I can now look and know what I can
and can’t do. I’m more aware of my own capabilities. So now I can do well, and I
know what I can do well in ‘I have direction’.’’ (498)
Finding 19 Even without specific achievements in mind participants felt generally more positive
about the future (498)
Illustration ‘‘I can see a brighter future basically ‘ not anything drastic is going to change. I can
look forward to things even if nothing great is gonna happen but before I couldn’t see
beyond my nose because I didn’t want to ... because I would only see the negative side,
whereas now I tend to look on the more positive side ... it’s sort of like the will to live
basically’ You just feel better about things the ...’’ (498)
Finding 20 Nevertheless, despite the many advantages of stimulant medication, participants
reported that as soon as the effects of the medication wore off, they experienced rapid
reoccurrence of symptoms (498)
Illustration ‘‘Its quite hard to come down off them [the tablets]. What it gives you is your
symptoms back again and you’ve had the whole day without that so here they are’’
(498)
Finding 21 Others also began to notice the participants symptoms again and expressed negative
feedback regarding their behaviour and attitude. However, for those participants who
would have previously ruminated about this feedback and subsequently experienced a
low mood they now appeared to be more accepting, of this feedback and thought about
it in a constructive way, for example, by thinking about what they could do to change
their behavior (498)
Illustration ‘‘I think when I first started taking them [tablets] my partner thought I would stop all
these things altogether but then I realized that a lot of things are habit and I’ve got to
break them’’ (498)
Finding 22 In addition, when the effect of medication wore off, the rapid reemergence of symptoms
made participants realize that there is no miracle cure for their symptoms and that
medication alone did not solve all their problems. This also prompted participants to
constructively acknowledge that they could do something to change their behaviour
(498)
Illustration ‘‘The tablets only help to a certain amount, they don’t help everything’’ (498)
Finding 23 The limitations of medication were often considered together with the limitations of
being diagnosed, that is diagnosis and treatment with medication were not sufficient to
overcome one’s difficulties (498)
Illustration ‘‘Your ADHD doesn’t go away the minute you’re diagnosed or even necessarily that
you went on medication’’ (498)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1152
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
Finding 24 Indeed, the reoccurrence of the symptoms following the effects of medication wearing
off provided participants with the opportunity to distinguish between the problems that
were strongly associated with their symptoms and those that were less influenced by the
presence of symptoms (498)
Illustration ‘‘No tablet will do everything, your brain’s got to do something’’ (498)
Finding 25 This increased awareness and acceptance of problems that are directly attributable to
their ADHD symptoms and those that arise from factors associated with them meant
that participants could recognize and adopt greater personal responsibility for their self-
generated behaviour. This, in turn, meant that they were motivated to engage in a
process of change especially with respect to symptoms and/or problems that they
perceived to be resistant to treatment with medication (498)
Illustration ‘‘There comes a point where you think well, on the one hand, maybe I have this
problem, but on the other hand, if I have this problem and its recognized perhaps I can
get help’’ (498)
SYSTEMATIC REVIEW M.B. Bjerrum et al.
JBI Database of Systematic Reviews and Implementation Reports ß2017 THE JOANNA BRIGGS INSTITUTE 1153
©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
