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.
1 of 9

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.
2 of 9

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.
3 of 9

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
4 of 9

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.
5 of 9

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
6 of 9

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
7 of 9

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.
8 of 9

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
9 of 9

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.

10 Related Links

  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?

  3. I was just diagnosed with ADHD inattentive type. The drug process is very scary to me. I dont want to take drugs and I have an appointment to see a doctor who can help me in making a process. Hearing about everyone elses experience on different medication is scary but also gives me hope. My biggest fear is becoming addicted to a medication. If you have any advice it would be greatly appreciated.

  4. I was diagnosed last August, went straight onto Concerta XL 18mg then 36mg and stopped after a week. It felt really false and I hated the comedown and not sleeping. 2 more false starts and now alternating 36mg and 54mg (54 is better). I realised that for me it’s all been about acceptance – when I read this article I identified with every word. My mistake has been taking meds without having an ADHD therapist – for the first time in my life (I’m 61) my brain is working and it’s absolutely amazing – except I need support to learn how to manage it and I don’t have that sort of money. I’m so aware of of my behaviour now, I so wish I could have been diagnosed as a kid – but it didn’t even have a name in the 60’s.
    Sorry if I’ve rambled on guys and gals 👩‍🔧👨🏽‍💼 x

  5. Diagnosed with ADHD in 2002, age: 39 and couldn’t believe it. Was given Ritalin but that made me all wirey and buzzy feeling. It didn’t do anything. After a few years different docs wound prescribe antidepressants that cover a myriad of maladies but it never addressed my ADHD problem. Finally, I broke down and I called them on a weekend cause I’d had it. I was upset because I was not getting the specific help I needed. I was in a conference room crying, telling them I can’t stand it. I want to feel normal and the all purpose meds weren’t cutting it. A doc sitting across from me said he was ADHD and was 42. I was surorised by that. He said my old doctor shouldn’t have given me Ritalin since that’s geared more for kids. He said I should be taking Adderall. So I felt hopeful finally I was getting somewhere. The doc wrote my prescription for Adderall ER/25 mg. So, driving home I stopped to get it filled at a pharmacy and then when I got home I sat down and plopped in a DVD movie and took (1) 💊 Adderall ER.
    People, my goodness!!! I felt 100% better within 5 minutes or less. I could actually focus and enjoy watching a movie. I felt this calmness in my mind and generally all over. It was like night and day. The lightbulb turned on I felt an overwhelming clarity and not trying to do a million things or all those other things. I wasn’t cutting people off in conversation or interrupting not out of rudeness, it’s just I’m overly wound up and it was hard to listen to people telling me something because I was too hyper to pay attention. When I took the medicine you wouldn’t believe the relief I felt. It was amazing. I could enjoy going to the movies and not be figety, distracted by my facing mind thinking of things. It felt good to feel 100% better!….hoping my experience helps someone out who’s frustrated and not getting the help you need so you can enjoy the things you like. Take it easy everyone.

  6. I am a 48 year old man from the UK, I am awaiting an appointment with a Psychiatrist in my District’s Adult Mental Health Team. My appointment is on Friday 15th. I have been reading these forums for a long time, but have never commented or joined as I have not yet received the Diagnosis.

    I have no doubt however that I have ADD, (ADHD?) as everything I’m reading, I’m identifying with. I am a qualified Primary School Teacher and let me tell you, my Open University Degree and PGCE (UK teaching qualification) were the hardest things I have ever done, but gave me a confidence and self satisfaction I never thought I would possess.

    I grew up feeling slow and stupid in a family of (very loving) academics, doing my best to hide my (perceived) inadequacies. Things I struggled with include following directions (street directions mainly), remembering names – no matter how hard I tried (this is embarrassing even now – particularly in Job interviews), I can read a book cover to cover, watch a movie from start to finish and be able to understand complex plots, but could not recount a single character name, or the name of the actor who played a character. I used to think that my brain was filtering it out because it was in some way superficial, but I know that’s not the case because in Job interviews it’s very important to remember people’s names. I can remember the names of a classful of children (eventually).

    When my line manager talks to me, sometimes I can’t recall some or any of the conversation – leading to embarrassment and job instability and the “We discussed this last week” scenario.

    I get in trouble with my wife because I can never remember where the car keys are, or even that they’re still in my pocket. I have tried discussing this with her but she has always just laughed it off. Saying that I’m just ‘hopeless’. But it upsets me because I’m not being deliberately negligent, she thinks I do it on purpose – she just doesn’t get it.

    So I am certain I have ADD and this appointment can’t come soon enough, I am getting very stressed and emotional thinking about it.

Leave a Reply