Though ADHD was once thought of as a childhood disorder, everyone knows now that many adults also struggle with this condition. While a small percentage of people outgrow most of their symptoms, at least 80% of those diagnosed with ADHD in childhood continue to struggle with attentional issues throughout their lives.
Unfortunately, adults with ADHD have a much higher risk of experiencing misdiagnosis or under-diagnosis than children. Low rates of childhood diagnosis prior to the 1990s and ongoing under-recognition of ADHD in adults have caused many mature ADHD sufferers to fall through the cracks. Studies of adults receiving mental health care reveal that up to 20% of psychiatric patients have undiagnosed ADHD, for example, with women in particular often being misdiagnosed with depression or anxiety when they present with symptoms of ADHD. Many experts also believe that the criteria used to diagnose ADHD in adults are outdated, making the condition difficult to identify in adults from all backgrounds.
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For those adults who aren’t receiving adequate treatment – or who were never diagnosed as children – this has a wide range of socioeconomic implications. Poorly managed adult ADHD is associated with difficulties to maintain stable full-time employment or get advanced in your job and obtain position matching your talents and qualifications. Adult ADHD is also associated with higher rates of divorce, substance abuse, depression, and criminality, among other issues. If you suspect you have ADHD, it’s therefore crucial to seek help rather than minimizing your symptoms.
What Are the Symptoms of ADHD in Adults?
ADHD typically presents differently in adults than it does in children, so many sufferers aren’t even aware they have the condition – they just know they have a great deal of difficulty staying organized, focused, and completing tasks. Adults with ADHD are less likely to display overt hyperactivity, for instance, but more likely to experience comorbid mental health conditions and overall reduced quality of life. However, like children, adults with ADHD typically fall into one of three subtypes: Inattentive, Hyperactive-Impulsive, or Combined, as outlined below:
Inattentive Type
- Prone to making careless mistakes or missing details.
- Poor attention span and/or listening skills. May appear to “tune out” during lengthy conversations or presentations.
- Inability to multitask or staying on one task.
- Difficulty following instructions (particularly verbal instructions).
- Problems with planning and staying organized; frequently forget or misplace items and lack adequate time management skills.
- Tend to avoid tasks that require sustained focus.
Hyperactive-Impulsive Type
- Frequent restlessness, which may manifest as fidgeting or having trouble remaining seated.
- Heightened energy levels that make it difficult to relax; adults may feel as though they can’t “turn off” or experience chronic insomnia.
- A tendency to talk excessively, interrupt others, and/or blurt out answers to questions prematurely.
- Extreme impatience; may rush through tasks and struggle with waiting and taking turns.
- Impulsivity, which may manifest as reckless behaviour or a tendency to be argumentative.
- Poor frustration tolerance and a reduced ability to cope with stress.
Combined Type
- The individual displays a mix of both inattentive and hyperactive-impulsive symptoms.
Of course, many people experience cognitive or behavioural issues occasionally, especially during times of stress or fatigue. To be a good candidate for ADHD testing, you should have a history of multiple symptoms in either the inattentive or hyperactive-impulsive category (or in both categories) going back to at least age 12. In most cases, symptoms will be severe enough to impact the ability to function in day-to-day life, though the degree of disruption will vary from one individual to another. Finally, to qualify for a diagnosis of ADHD, symptoms must be present in at least two areas of your life; e.g., they must affect your ability to perform at work and your relationships or affect your career and your hobbies.
Even if you meet the criteria for ADHD, it’s important to avoid self-diagnosis (such as relying on internet tests to diagnose your condition). Symptoms that appear similar to ADHD can be caused by a wide variety of other medical conditions, including hyperthyroidism, anxiety, bipolar disorder, and various learning disabilities. For this reason, only a qualified mental health professional can accurately diagnose ADHD.
How to Get Tested for ADHD as an Adult
To confirm (or rule out) the presence of ADHD, you may start by visiting your primary health care provider. Your doctor may wish to conduct a physical examination, a blood test, or other medical tests to make sure your symptoms aren’t being caused by a physical condition. If you are found to be in good health, he (or she) will probably refer you to a specialist, such as a psychologist or a psychiatrist, for a complete psychological evaluation.
What to Expect During the ADHD Assessment?
Getting evaluated for ADHD is a lengthy, multistep process. For this reason, you should be wary of any clinician who attempts to diagnose you after a brief interview – particularly if he (or she) tries to prescribe you medication right away. The correct protocol for evaluating ADHD consists of the following components:
1. Clinical Interview
During a clinical interview your care provider will discuss your personal history and, if possible, talk to several of your loved ones to gain a well-rounded picture of your symptoms. Some of the issues you can expect to discuss during your clinical interview include:
- What specific problems led you to seek an evaluation.
- How you’re currently functioning at work (or at school) and within your social and family relationships. Your doctor may ask to speak to your friends and family members during this part of the clinical interview.
- An overview of your interests and hobbies.
- Your living situation.
- Your family background, including your current relationship with your family, any problems your family has had in the past, and your family psychiatric history.
- How you feel about yourself and how you think others see you.
- Your medical history (including any medications you take and any previous mental health assessments you’ve had) and an overview of your lifestyle. Your doctor will ask about your eating habits, your sleeping patterns, and your substance use.
- Your emotional status; e.g., your levels of anxiety, the stability of your moods, and your ability to healthily cope with stress.
- Your academic record. Your doctor may ask to see old report cards and other academic assessments to gauge how you performed at school as a child. This history can be helpful to measure how long you’ve been experiencing ADHD symptoms.
2. Psychometric Testing
If your clinical interview indicates that you might have ADHD, the psychologist will assign appropriate psychometric tests. Depending on the information obtained from the interview, you may be given tests of cognitive functioning (IQ test), tests of attention (CPT, CATA, or TOVA), tests of memory or/ and academic skills. If indicated, your psychologist may also perform a psychoeducational assessment. These tests, which are often used to detect learning disabilities in children, can also be helpful for diagnosing adults whose ADHD is complicated by the presence of other learning or sensory disorders.
3. Assessment with Normed Rating Scales
In addition to testing your care provider should use normed ADHD rating scales to assemble more information about your case. (These include the Barkley, BASC, Brown, Conners, CEFI and/ or BRIEF rating scales.) These tests take the form of questionnaires which the clinician uses to compare observations about your functioning (both self-reported and from family members or your partner) against a standardized ADHD rating scale.
4. Screening for Comorbid Conditions
Because more than two-thirds of adults with ADHD have at least one co-occurring mental health disorder, most clinicians will screen for comorbid conditions as part of an ADHD evaluation. You will be asked about symptoms that might indicate anxiety, depression, or bipolar disorder, among other conditions.
In addition to knowing which tests are useful for evaluating ADHD, it’s good to be aware of which assessment tools are not helpful in diagnosing ADHD. ADHD cannot be detected by genetic testing, neuropsychological testing, or brain imaging scans, so you should be wary of any clinician who advises using these measures.
After your evaluation, you can expect your care provider to follow up by discussing your diagnosis with you and providing a written summary of your condition. He (or she) will talk about the different treatment options available to you, including medication, lifestyle changes, occupational therapy, family or marital therapy, and cognitive-behavioural therapy (CBT).
As a final note, it’s important not to get discouraged if your treatment plan doesn’t yield rapid results. In many cases, patients need to have their medication adjusted several times before finding a dose that minimizes their symptoms without causing unwanted side effects. Similarly, psychological interventions like CBT usually take weeks or months to alter ingrained patterns of behaviour. This is the case because it takes time – and practice – to reprogram how the brain responds to stress, manages impulses, or executes skills.