Just Diagnosed: Next Steps

Late Diagnosis: Was ADHD to Blame All Along?

Misdiagnosed ADHD in adults can create a lifetime of emotional turmoil. Why can’t I keep up? Why is this so hard? Dr. Dodson explains how to spot the signs and (finally!) understand what’s holding you back.

Doctor's laptop and stethoscope, important tools for accurate diagnoses.
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Adult ADHD: A Difficult Diagnosis

The diagnostic criteria for attention deficit disorder were designed to identify ADHD in children — not adults. Criteria like "often runs about or climbs" and "often fails to finish schoolwork" don't help to diagnose ADHD in adults who are bright, hardworking problem-solvers who have found clever ways around their symptoms, like learning to hyperfocus on cue.

Most ADHD diagnoses happen when kids are disruptive, or are being screened for learning disabilities. People who fly under the radar may never get diagnosed. Our expert explains the eight top reasons why.

A doctor consults with a patient about the possibility of adult ADHD.
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Bad Diagnostic Criteria

Believe it or not, most physicians still don't believe that ADHD exists, especially in adults. What’s more, 93% of adult psychiatrists, when asked, report that they've never had any ADHD training, either in their residency or in their continuing medical education, whether in children, adolescents, or adults. Thus, most don't know how to recognize its symptoms in adults. They are stuck with the disruptive little boy archetype, and don't recognize that adults with ADHD experience difficulty sleeping, relationship disappointment, and rejection-sensitive dysphoria, among other symptoms not found in children or included in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5).

An adult with ADHD has a bag over his head, symbolizing the shame that often accompanies ADHD.
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Shame

Adults with ADHD have struggled their entire lives. They've been told over and over that they're not living up to expectations, or that they have "bad brains." Sometimes, rejection-sensitive dysphoria can make adults with ADHD experience the withdrawal of love, approval, or respect in a catastrophically painful way. Often, the only reason adults seek treatment is because a boss or a spouse has said, "Get it under control, or this is over." This buildup of shame can make even walking out the door in the morning an act of courage; seeking medical help may feel impossible.

[Free Download: 15 Ways to Disarm (and Understand) Explosive ADHD Emotions]

Adult ADHD is often misdiagnosed due to overlapping symptoms with other conditions
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Misdiagnosis

Doctors often mistake ADHD symptoms in adults for mood disorders, anxiety, obsessive-compulsive disorder, and other conditions with overlapping symptoms. For adults, hyperactivity can be turned inward. You may think that your racing thoughts stem from anxiety, when they are really caused by over-activity in the brain caused by ADHD. These internal behaviors are more difficult to detect and diagnose. Doctors need time to find and put together the pieces of various ADHD symptoms during a thorough clinical interview, but most doctors only have a 15-minute visit. It's not enough time.

Woman with ADHD is sleepless touching alarm clock while eyes open.
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Sleep + ADHD

Difficulty sleeping isn't recognized as an ADHD trait, but 40% of adults with the condition say it's their biggest impairment. Adults with ADHD describe themselves as night owls who get their best bursts of energy right before bed, and then can't turn off their minds. They toss and turn, fidget, and worry. Another 20% fall asleep easily, only to wake in a couple hours with their minds bouncing around. Especially for women, the overactive component of ADHD arrives after the sun goes down.

Woman with ADHD drawing a lightbulb because People with ADHD nervous systems are usually much brighter and more creative than the average neurotypical person
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High IQ + Coping Skills = Missed Symptoms

People with ADHD nervous systems are usually brighter and more creative than average neurotypical people. Because of this, over time, they find lots of ways to compensate for ADHD symptoms and make their way through life. The diagnosis usually occurs when an adult has a child diagnosed with ADHD, adds a new family member, or takes on more in their career and the extra stress becomes too much to bear.

Pill box for ADHD medication
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Fears About Medication

People with anxiety and mood disorders are often concerned about treating ADHD because they think ADHD medications will exacerbate their symptoms, or interfere with other medications, like SSRIs. However, studies have shown that stimulants do not make anxiety worse when the dose and medication are right. When conditions like arrhythmias, high blood pressure, and other disorders are stabilized and treated, medication is safe. Stimulants don't increase blood pressure unless the dose is too high.

[Your After-Diagnosis Survival Guide]

A person with ADHD runs on a treadmill and it helps their ADHD symptoms.
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Self-Medication

When ADHD goes undiagnosed, it can lead to low self-esteem from a lifetime's build-up of poor job and relationship performance. Many adults self-medicate with alcohol or drugs, which is obviously quite dangerous. However, roughly 20% of individuals with ADHD are able to regulate ADHD with exercise. Every hour of aerobic activity translates into about four hours of relief from symptoms. Others use caffeine, which isn't the best, but works better than nothing to manage symptoms.

Doctor writing prescription for ADHD
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Slow Response to Medication

If you don't have an immediate response to ADHD medication, that doesn't mean you don't have ADHD. The dosage might be off, or another medication might be a better fit. If you've tried amphetamine and it didn't work, methylphenidate might be the answer. Cutting out vitamin C, and taking medication on an empty stomach can help with absorption. Sometimes it takes a few tries to find the right treatment for you. Don’t give up without trying several alternatives.

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  1. Hey Y’all I wrote once for but I’m not sure if I had any replies then I did write a book as I was so excited to find out what is wrong after 35 years of getting back up after another loss I self-medicated with drugs money women and gangs and crime yes a real dopamine fiend I payed a heavy heavy price outta the blue I was diagnosed and put on meds and my life changed but unaware how serious ADHD IS I stopped taking my meds relapsed and found the book Driven 2 Distraction and cried like a baby I had grown to literally hate myself and many times not being alive seemed better than living in all the chaos I felt I had no one to blame but myself never knew there was a reason besides my morals …what can I do to advocate so no other kids have to survive the war untreated ADHD can cause ???

  2. Hi, I was diagnosed last year and before my diagnosis I absolutely knew that I had ADHD as I could see so many similarities between myself and celebrities that I knew had the disorder.

    What I was wondering was has any one hidden their diagnosis like I have so far? Other than my daughter, I have literally not told anyone as I’m really worried that people will be nasty. Growing up I was constantly shouted at for being messy and losing things. Not to mention being called a dreamer at school. I knew from the age of 5 that I had more thoughts than everyone else.

    I am finding it so incredibly difficult to run a house, work and raise my daughter and I honestly believe that if I didn’t have this I would be high-flying. I can’t seem to get the motivation, have poor follow through, even to the point that I can’t manage getting all of the washing in in one go and every day I feel so over whelmed. I thought my diagnosis would be the start of a new chapter in my life but it hasn’t changed a thing.

    1. Hi Kate,
      You sound like me. I was diagnosed back in August and haven’t told anyone yet apart from my wife. I’m not sure about telling others as, like you, I’m worried about the response.
      My doctor has prescribed methylphenidate. I’m currently going through the titration process but haven’t felt much effect from it so far. Have you been prescribed anything?

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