ADHD Diagnosis in Adults

Don’t Let Them Talk You Out of Your ADHD

Doctors are often hesitant when diagnosing ADHD in adults. Use these tips to ensure that your condition isn’t overlooked.

Older woman with ADHD staring into distance with fist under chin outside
Older woman with ADHD staring into distance with fist under chin outside

A friend of mine is convinced she has ADHD. She has classic symptoms that she can trace back to early childhood. Recently, she visited her doctor (again) only to hear (again) that she doesn’t meet the DSM-V standards for an ADHD diagnosis. Her doctor told her that, at her age, it isn’t worth getting diagnosed with ADHD anyway, since it is too late to do anything about it.

Those are fightin’ words, my friend. No one’s mental health deserves to be dismissed with a wave of the hand and a figurative pat on the head. I thought that we left medical condescension back in the 1970s and ‘80s. Maybe not.

My hunch is that the doctor in question is perfectly competent in other arenas. But adult ADHD, especially in the over-40 crowd, is still something of a mystery. And medical mysteries (translate: those that don’t have enough peer-reviewed published research) are best left alone. Better to fall back on tried-and-true diagnoses like depression. I understand; doctors don’t want to risk diagnostic errors.

[Self-Test: Could You Have Adult ADHD / ADD?]

But this attitude is a dramatic disservice to the midlife and older population. As many as 80 percent of ADHD adults are still undiagnosed; a substantial proportion of those still absent-mindedly bumping into furniture are over age 40. They need to understand that their chronic tardiness or inability of earn a living wage is not a character flaw. They need to have the option of treatment for their ADHD, whether they have 30 years or 30 months to live. No one can or should be allowed to decide whether treatment should be given or withheld based on longevity (an unpredictable target at best).

Certainly, normal aging can look a lot like ADHD. Memory lapses, mental confusion, and distractibility are as much a part of growing older as reading glasses. Layered onto an ADHD brain that already struggles with those challenges, however, normal aging escalates to a higher plateau. I believe that if diagnosis and treatment can ease a single anxious mind, calm one buzzy brain, or relieve one guilt-ridden psyche, it’s worth the effort. Appropriate ADHD treatment can transform a life at any age.

We need to take a stand for accurate and thorough diagnoses without age bias. We can and should ditch doctors who are unwilling to acknowledge not only ADHD after age 40, but the coexisting conditions that further complicate diagnosis. We should expect that our medical professional is a) already current in his or her training about adult ADHD or b) willing to dive into the mountain of data that now exists. Granted, there is a scarcity of research about the intersection of age and ADHD, but for a medical professional to pay attention to the possibilities is a step in the right direction.

I know that this post preaches to the choir of ADHD-savvy docs who peruse the pages of ADDitude magazine. They know their stuff. Find one of them near you, secure in the knowledge that their assessments are based on years of experience with adult ADHD.

[Free Download: Who Can Treat ADHD?]

If there’s no one in your area who fits that criterion, travel to an area where there is one. Seriously, it’s that important. You can get diagnosed in another state or province and be treated back home. Just ask that the testing records be forwarded to your local doctor or psychologist.

Those of us who fight wrinkles as well as deadlines already have spent too many years in mental disarray. It’s time for the medical profession to take our complaints seriously, sort out the messy symptoms, and then treat our ADHD with expediency.

[The Downside of Undiagnosed Adult ADHD]

Updated on September 21, 2018

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  1. I was ignored for years, it was always depression and/or anxiety, but ADD was never recognized or tested for. I would get this “look” and I would be basically told no if I suggest it. I didn’t get an official diagnosis until I turned 39 years old by a good psychologist who did a full computerized/paper assessment on me. Though I still struggle, at least I know why now.

  2. I didn’t get the courage to ask to be assessed until my 50’s. The evaluator pulled out the DSM-V to show me that I didn’t meet the criteria. One criteria is that ADHD had to be apparent in childhood. I pointed out that when I was a child it was called “minimal brain dysfunction”, ADHD wasn’t even a word. So, if you are older and trying to get an accurate diagnosis, know the history of ADHD, and have your facts in order about yourself.

    Yes, I got a diagnosis and am on meds for work and long sit-down events. I pay better attention. But, I wish I had started medication when I was younger so that my brain had gotten retrained to follow stronger listening and attention pathways. Now, even though I have help, I have to fight the old ways. I can still distract myself by spending hours doing what I *want* to do, not what I should do.

  3. I agree with this article completely! I was diagnosed with ADHD 5 months ago at 47. I suspected something is wrong because I haven’t been able to get my act together and it’s out of control. I researched online and found that I met the DSM-V standards for ADHD. I told my Physcians Assistant, I’d had for years, that I suspected I have it. She seemed skeptical and indiscreetly looked, with her eyes darting back and forth, at mine. I realized she was trying to see if I had dilated pupils and thought I was just trying to get drugs. My eyes weren’t dilated, so the PA referred me to a psychologist who diagnoses ADHD. After 3 visits and a series of tests, the psychologist diagnosed me with Inattentive ADHD. The PA then prescribed Adderall XR 10 mg. It didn’t work so she increased it to XR 20 mg. It still wasn’t working so I asked for an increase. The PA agreed to XR 30 mg but said if it didn’t work I’d have to see a mental health professional for medication. I didn’t try the XR 30 mg prescription. At this point, it had been 6 weeks since my diagnosis and I had read A LOT about ADHD. I could tell she doesn’t know much about it. I even emailed her a couple of articles and a link to an ADDitude webinar about managing ADHD meds.

    Already frustrated, I scheduled an appointment with a Nurse Practitioner at a mental health clinic. She thought I needed to try another class of stimulants so she put me on Vyvanse 20 mg for 2 weeks. I couldn’t handle the side effects. On the next visit, the Nurse Practitioner told me that if the drugs weren’t working then maybe I don’t have ADHD. Umm, what? At that time, I’d only tried one stimulant at 2 doses and one dose of another. She then put me on regular Adderall 10 mg. I could tell this Nurse Practitioner doesn’t know much about ADHD or how to properly titrate stimulants either. It’s disturbing that she works at a mental health clinic!

    Frustrated once again, I sought out a general care doctor on my insurance plan to manage all of my meds. I didn’t notice a difference on Adderall 10 mg, unsurprisingly, so he decided to try another class and prescribed Concerta 18 mg. Based on this visit, I could tell he doesn’t understand ADHD either. If the Concerta doesn’t work, I was told once again, that I may not have ADHD. We talked about symptoms and I mentioned Executive Function Disorder and disorganization. He doesn’t know what EFD is or that people with ADHD struggle with organization! And what’s alarming and sad in this case, is that he said his son has ADHD! I’ll stick to him for now to manage my other meds, but not treatment for ADHD!

    Now frustrated with a third clinician and meds that aren’t working within a 4 month period, I searched for an ADHD specialist on my insurance plan and found a Mental Health-Certified Nurse Practitioner. Because I’ve experienced so much skepticism, I asked for a second opinion. He confirmed that I have ADHD. He wasn’t surprised that Concerta 18 mg wasn’t working so he doubled the dose. I had difficulty falling asleep with Concerta so he switched me to regular Adderall 15 mg twice a day. This way I have more control and can choose not to take the second one. He also prescribed Trazadone to help with falling asleep. Time will tell, but so far so good with this practitioner. My well-being is in my hands and I refuse to tolerate ignorance and inadequate care.

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