When you think of ADHD, a hyper kid running around an elementary school classroom may come to mind. But while attention deficit hyperactivity disorder often starts in early childhood, an estimated 4% of adults have the condition—and many of them don't even realize it.

“A lot of people have this vision of ADHD in their minds of Dennis the Menace running amok causing chaos and terror wherever he goes,” says Dale Archer, MD, board-certified psychiatrist and fellow of the American Psychiatric Association and author of The ADHD Advantage. “But the condition is the same whether it’s in children or adults like myself; it’s the symptoms that might be different.”

ADHD is a brain disorder, and in children, symptoms include hyperactivity, lack of attentiveness, or impulsive behavior that interferes with functioning. Among adults with the diagnosis, it can manifest as disorganization and problems prioritizing, poor planning, mood swings, issues following through with tasks, and more. It’s not entirely clear what causes ADHD, but evidence shows it may be linked to genetics, certain environmental factors (such as lead exposure), or both.

The disorder isn’t totally understood yet, Dr. Archer says, “and that lack of understanding ends up causing a lot of misunderstanding.”

Time to clear up confusion: Here, adults living with ADHD offer up some of the truths about coping with the condition.

ADHD can improve by adulthood, but not always

Research has shown that symptoms of ADHD (namely hyperactivity and impulsivity) often do decline after the adolescent years, but an estimated half of people with ADHD bring that symptom with them to adulthood. For some, symptoms worsen with age. 

Britt Bischoff, 29, a digital marketing specialist, remembers parents and teachers dismissing her behavior as a hyper phase she would eventually outgrow.

“My mother always chalked it up to me being a daydreamer,” Bischoff remembers. “One teacher swore that I could hear the lights buzzing or a ticking clock, and that's where my attention would go.”

Today some of Bischoff’s symptoms have gone away, but others linger. “My inattentiveness has also improved significantly. I am more able to control where my attention goes and tune out what's unnecessary,” she says. “However, my hyperactivity and flooding thoughts have increased slightly with age.”

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Dr. Archer says part of the reason many believe ADHD can be outgrown is because most people get better at making lifestyle adjustments to better manage their symptoms.

“As you get older, it’s not like your brain has changed,” he says. “But a couple of things happen: You learn to understand the way your brain works, and modify how you study or how you work.”

Meds aren’t the only way to treat ADHD

With ADHD, the attention center of the brain isn’t working at maximum efficiency at all times, explains Dr. Archer. “That’s why medications are prescribed; they stimulate the brain in a way so that the ADHDer is able to hyper-focus and concentrate.”

But for some, it's possible to manage ADHD without meds, he adds. “One strategy that ADHDers have learned to deploy is setting false or early deadlines and waiting until the last minute to finish projects,” Dr. Archer says. “That little bit of stress or panic that happens by doing so actually helps the brain hyper-focus.”

Extra discipline and a pared-down routine also help with managing symptoms, adds Peter Shankman, 44, creator of the ADHD podcast Faster Than Normal. “I have what I like to call unchangeable life rules that help me not only get through the day, but also help me use my ADHD to my advantage and make me a better person,” he says.

“I wake up at the same time every day. I don’t drink. And I have a ridiculously organized closet,” Shankman says. “If I had a bunch of random belts, pants, sweaters, whatever, I’d be thinking, ‘Oh, I remember that sweater! Laura gave me that sweater! I wonder how Laura is doing!’—then three hours later I haven’t left the house. Routine doesn’t allow me to get off track as easily.”

Dr. Archer also believes many patients would benefit from counseling: "Therapy should always be the first line of treatment—not drugs," he says. "I'm not opposed to medication in worst-case scenarios, but I sure would like to try these other things first before the knee-jerk, 'OK, you need Adderall.'"

ADHD is the inconsistency of focus, not the inability to focus

“I equate ADHD to having 50 pages open on a browser, and you keep jumping among all of them,” says Michelene Wasil, 44, a marriage and family therapist, who was diagnosed with ADHD at age 41. But other times, “I can hyper-focus and tune out the world.”

That makes total sense, says Dr. Archer. “People with ADHD can actually focus extremely well on topics that they find stimulating and interesting,” he says. “It’s when the brain is bored that the mind begins to wander all too easily.”

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People with ADHD aren’t lazy or stupid

Terena Bell was diagnosed with ADHD at age 15. Now at almost 40, she is currently growing her second startup project, called TVrunway, after selling her first entrepreneurial venture, a translation business.

“While I owned my first company, I was appointed to the White House Business Roundtable and took two calls with President,” she shares. “So when I cut the check to pay a bill but forget to mail it, when I start to tell a story in the middle of a conversation, [the people around me] look at these amazing things I'm capable of doing and think surely I must just not be trying,” Bell explains. “But I am. I am trying every day, and I try very hard.”

People with ADHD also have IQs that are just as high as those of people who don’t have the condition. “In fact, it’s been brought out by a multitude of studies that the intelligence of an ADHDer is no different whatsoever than someone that doesn’t have the diagnosis,” Dr. Archer says.

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ADHD can be alienating as an adult, too

For Chris Rither, a professor and author, ADHD typically comes out when he interacts with other people. “I literally have to remind myself to look into their eyes, focus on what they are saying, and give them enough time to express themselves before I move on to the next task bouncing around in my brain,” says Rither, 53.

Like Shankman, Rither also channels his energy by keeping a busy, fast-paced schedule. But it can create friction with others, he says: “To help focus, I try to multitask on these activities over shorter periods of time. Because of this, I have a tendency to not give people my full attention.”

You can also feel very alone, says Will Steward, 25, an entrepreneur with ADHD. “The hardest thing for me personally is the feeling of loneliness ADHD can evoke at times when it seems people don't understand you,” he says. “I find that I often process information in different ways than other people.”

ADHD can be a powerful asset

There are huge advantages to having ADHD, Dr. Archer says, like resilience and an ability to keep cool in a crisis.

One study of college students looked at the psychological resilience of people with ADHD who were not on medication compared to those that didn't have ADHD; they found that the ADHDers were more resilient overall.

“And if you understand the condition of the brain with ADHD, the research makes complete and total sense,” Dr. Archer says. “If you have ADHD and you make it to college and immerse yourself in all its challenges, then you had to do a lot of things and figure out a lot of things on your own.”

Adults with ADHD also tend to be very creative, says Ted Behr, 73, an ADHD coach. “Many artists, musicians, and entrepreneurs have ADHD,” he says. “We’re also good risk takers.”

Empathy and understanding from others is everything

Having personal awareness of your ADHD symptoms is key, says Chris Nealy, a 33-year-old psychotherapist and social worker, “but family and social support is just as important."

“My impulsivity, forgetfulness, and racing thoughts create challenges as a husband and parent,” Nealy continues. “My wife's support allows us to work together to cope.”