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Procrastination, risk-taking, impulsivity, difficulty completing tasks, and problems maintaining focus are among the features of Attention Deficit Disorder (ADD) in adults. In children, these symptoms often – though not always – come with noticeable hyperactivity and fidgeting, which are typically associated with Attention Deficit/Hyperactivity Disorder (ADHD).

“In the past 30 to 40 years, what was once considered a fringe condition affecting only children and adolescents has become widely recognised in mainstream medicine as a condition that can affect both children and adults,” says psychiatrist Dr Ulli Meys, who practises at Netcare Akeso Kenilworth and serves as an honorary senior lecturer at the University of Cape Town and the Red Cross Children’s Hospital.

“Children were often thought to ‘grow out of’ ADHD, but we now know that many continue to experience symptoms into adulthood. Adults with this predominantly genetic brain condition may not display obvious hyperactivity and can appear calm or relaxed, but they often struggle with concentration, planning, task completion, procrastination, and varying levels of impulsivity.”

ADHD in children

Children with ADHD may display excessive energy combined with risk-taking behaviours. They are often overly talkative, constantly on the move “like the Duracell Bunny,” climbing to dangerous heights, jumping off roofs, or engaging in other risky activities. In the classroom, they may leave their seats, be disruptive, fail to listen, or be easily distracted. Their impulsivity can increase the risk of broken bones or other accidents beyond typical childhood play.

Impulsivity may also appear as difficulty waiting their turn, blurting out answers, or lashing out easily. By contrast, children with ADD without hyperactivity are often quiet daydreamers, inattentive, and unable to complete their work, which can have significant academic consequences.

Teachers may observe that such children are easily distracted, struggle to follow instructions, and underperform academically despite potential ability. This can affect self-esteem and future prospects if not addressed.

Executive functioning and working memory

“Individuals with ADD or ADHD often struggle with executive functioning, controlled by the brain’s prefrontal cortex,” Dr Meys explains. “This includes planning, organising, problem-solving, time management, and regulating emotions and behaviour. Working memory is also impaired, making it difficult to hold and manipulate information — for example, remembering a list of names and putting them into alphabetical order. Flexible thinking is often compromised as well.”

The impact on adults

Difficulty with impulse control can have serious consequences for adults. “There may be a constant need for instant gratification,” says Dr Meys. “Instead of budgeting for a purchase at the end of the month, the urge to buy immediately can lead to long-term financial problems. Impulsivity can also manifest in gambling, promiscuity, or reckless driving.”

Motivation is another challenge. The condition should not be mistaken for laziness: many adults with ADHD may begin projects with intense focus and enthusiasm but lose momentum before completion, creating frustration for themselves and those around them. Procrastination further compounds these issues, as bills go unpaid and tasks are delayed until the last minute, adding stress to relationships and work.

“In the distant past, impulsivity and risk-taking may have been advantageous for survival,” Dr Meys notes. “But in today’s information-driven, high-demand society, these same traits often make daily functioning more difficult. Someone who managed mild ADHD symptoms 20 years ago may now struggle significantly due to the pace of modern life, necessitating professional support.”

The consequences of untreated ADHD

Without proper diagnosis and treatment, ADHD can have lifelong repercussions. At school, children may be mislabelled as disruptive or lazy, leading to feelings of rejection, low self-worth, and heightened sensitivity. Untreated ADHD in children can be exhausting for parents and teachers, increasing the risk of anxiety, depression, and other mental health conditions later in life.

“Individuals with untreated ADHD are at higher risk of anxiety, depression, and substance use disorders,” Dr Meys cautions. “In fact, research shows that effective treatment with medication significantly reduces the risk of developing substance abuse problems.”

Many individuals with undiagnosed ADHD attempt to self-medicate with drugs or alcohol. Combined with their natural impulsivity, this raises vulnerability to addiction. Other risk-taking behaviours, such as reckless driving or unsafe sexual activity, are also more common.

Treatment and support

“Medication remains the cornerstone of ADHD management,” says Dr Meys. “It is highly effective in improving concentration and impulse control. However, psychotherapy and behavioural strategies are also valuable in creating structure, establishing routines, and improving planning skills. This could be as simple as setting reminders for deadlines or scheduling a fixed date each month to pay bills.”

For those who cannot tolerate medication, psychotherapeutic interventions can be particularly useful. Structured routines, lifestyle adjustments, and coping strategies play an essential role in improving quality of life.

The way forward

“It is vital that we train more teachers, counsellors, and healthcare workers to recognise ADHD,” Dr Meys concludes. “With the right skills and early medical intervention, the condition can be managed effectively within primary healthcare. By improving awareness of the many faces of ADD and ADHD, we can help people lead safer, more stable lives while reducing the strain on health systems by preventing the avoidable complications of untreated ADHD.”

Ends.

About Netcare Akeso
Netcare Akeso operates a network of private inpatient mental health facilities and is part of the Netcare Group. Netcare Akeso provides individual, integrated and family-oriented treatment in specialised inpatient treatment facilities, as well as certain outpatient services, for a range of psychiatric, psychological and substance use conditions. Please visit www.akeso.co.za or contact [email protected] for further information.

In the event of a psychological crisis, call 0861 435 787, 24 hours a day, for emergency support. Psychiatrist consultations can be made through Netcare appointmed™, online at www.netcareappointmed.co.za or by calling 0861 555 565.

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