ADHD Diagnosis in Adults

What Your Doctor Needs to Know About Diagnosing ADHD in Adults

Though the medical and scientific communities now agree that ADHD is not strictly a childhood condition, the most widely used criteria for diagnosing ADHD in adults remain focused on identifying symptoms in children and teens. This means adults may suffer misdiagnosis or no diagnosis at all if their physician doesn’t understand nuances of ADHD and it’s overlapping conditions in adulthood. Learn what to do about it here.

A doctor talks to an adult patient after diagnosing her with ADHD.

How Do They Test for ADHD in Adults?

Not long ago, most doctors believed that children outgrew symptoms of attention hyperactivity deficit disorder (ADHD or ADD) with time. It was considered a pediatric condition. ADHD was traditionally linked to hyperactivity, which fades in early adolescence. We now know that ADHD is a lifelong condition that manifests differently for different patients. Some never display outwardly hyperactive behavior. Because our understanding of diagnosing ADHD in adults has improved so much in the last few decades, many adults are recognizing their symptoms for the first time, and seeking an evaluation late in life.

Recognizing ADHD Symptoms in Adults

Most adults seeking an evaluation have spent a lifetime learning to compensate for ADHD symptoms such as inattention, disorganization, and impulsivity. Because they are bright, creative, and good problem solvers, these undiagnosed individuals find ways to make life work for them — often until mounting family and career responsibilities push them to seek a diagnosis and symptom relief. Dr. William Dodson, a board-certified adult psychiatrist who has specialized in adults with ADHD for the last 23 years, says the average age of diagnosis in his practice is 39.

“[These adults have] been able to find compensations and ways around their ADHD their entire lives,” says Dodson, until their challenges “just overwhelm their ability to cope with their ADHD.” They typically go to the doctor for other conditions they think they may have, like anxiety or a mood disorder.

Common symptoms of ADHD among adults include:

  • Distractibility and inconsistent focus
  • Forgetfulness
  • Disorganization
  • Inability to finish projects
  • Tension or restlessness
  • Inconsistent performance often perceived as being unreliable
  • Motivation not based on importance, but interest and urgency
  • Unable to get enough restful sleep
  • Poor sense of time
  • Intense emotions and sensitivity to criticism
  • Unexplained underachievement (not failing, but not achieving what you feel you should be or could be)
  • Substance abuse and/or dependence

[Self-Test: Could You Have ADHD?]

Diagnosing ADHD in Adults

The standard checklist to determine if a child has ADHD is the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-V). This symptom guide is invalid for adults. The only way to diagnose ADHD in adulthood is through a careful clinical interview to gather a detailed medical history. It’s important to see a clinician who specializes in ADHD, and will take the time required to identify symptoms in adulthood.

Surveys tell us that most general physicians, even most psychiatrists, undergo no training on ADHD. “Ninety-three percent 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,” says Dodson. It’s no wonder so many struggle to get an accurate ADHD diagnosis in adulthood.

The clinical interview may be supplemented with neuropsychological testing, which offers greater insight into strengths and weaknesses, and helps identify co-existing, or comorbid, conditions.

“The part that most family physicians miss out on would be the differential diagnosis,” explains Dr. Michele Novotni, former president and CEO of the national Attention Deficit Disorder Association (ADDA), speaker, best-selling author, psychologist, and coach. “ADHD symptoms can be the result of different mental health issues, such as anxiety or a mood disorder. Any of these conditions can be occurring with ADHD.”

It’s important to see a clinician who also has a thorough understanding of its comorbid conditions. The emotional sensitivity component of ADHD can look like a mood disorder and/or anxiety, particularly in adults who have lived with ADHD all their lives. If your clinician doesn’t understand the nuances of each related condition, and how they can mimic one another, you may endure a frustrating waste of time and money. A clinician trained in just one of these conditions will see only the condition they’re trained to see, and that often leads to a misdiagnosis of a mood disorder and/or anxiety. Of course, an inaccurate diagnosis leads to ineffective (and in some cases, counterproductive) treatment, which often worsens the problem.

“The best way to find a competent clinician,” Dr. Dodson says, “is to start either with the ADDitude’s ADHD Directory, or go to a CHADD or NADDA meeting. These are people who are just a couple of years ahead of you and they can tell you who’s good [for adult ADHD] and who’s not.”

Physicians unfamiliar with making a mental health diagnosis should refer patients to either a psychiatrist or psychologist who is trained to diagnose and treat ADHD and its comorbid conditions.

“You want to see someone who realizes that there’s a lot of talent embedded in the problems,” suggests Dr. Edward Hallowell, a practicing psychiatrist and founder of the Hallowell Center for Cognitive and Emotional Health. “You don’t want to get a diagnosis and walk out feeling like things are all bad, and will be forever.”

[Free Guide: What a Diagnosis Should Look Like]

Treating ADHD in Adults

Dr. Russell Barkley is a clinical professor of psychiatry and pediatrics at the Medical University of South Carolina. When adult patients ask him questions about why they should try medication to manage their ADHD, he begins his reply with two important words: “Medication works,” he says. “When you find the right medicine, you can experience substantial improvements in your ADHD symptoms.”

The same medications used to treat children who have ADHD are also used to treat adults. Stimulants like Ritalin, Concerta, Vyvanse, or Adderall, comprise the first line of treatment, not the last resort, Dodson says.

“About 80 percent of adults with ADHD have some kind of co-occurring condition that complicates the treatment of their ADHD,” says Novotni. She warns that not treating all of the problems leaves the patient struggling and frustrated.

Debra Brooks was a treatment holdout — at first. Upset about her diagnosis, she says, “for about six weeks, I flailed. I resisted starting medication. But then I remembered what the neurologist who diagnosed me had said: ‘Why did you pay me $1,400 if you didn’t want my advice?'”

After starting a medication regimen, every patient should consider working with an experienced psychologist, psychiatrist, or life coach, says CHADD director Meyer. These professionals can help people with ADHD learn behavioral, time-management, and organizational strategies to enhance their quality of life.

“A coach can give you ways to manage your ADHD symptoms,” Novotni says. “If you’re hyperactive, a coach can suggest ways of channeling your energy — for instance, taking a walk during your coffee break. If you’re impulsive, a coach can teach you ways to delay your responses, so you can think about them.”

“Education of the entire family about what ADHD is — its strengths, its weaknesses, and its treatments — is essential,” concludes Dodson. Understanding of how the ADHD brain works is essential to success.

In addition, Meyer offers these tips for the newly diagnosed:

  • Know your legal rights. Having ADHD means you’re protected under two federal laws that apply to individuals with disabilities.
  • Seek support by attending meetings of your local chapter of CHADD, a non-profit advocacy and education organization (click “Find local chapters” on CHADD’s home page).
  • Don’t feel compelled to tell your boss. “There’s more understanding about ADHD now, but that doesn’t mean that supervisors are happy to learn that one of their employees has the condition,” says Meyer. If, however, you think accommodations — closing your office door, taking more breaks — will help you improve your job performance, you may want to discuss these with your employer.

The bottom line: Adults with ADHD should learn as much as possible about how to make the most of their unique brain wiring. This may include individual or couple’s therapy, support groups, and learning new ways to do things.

[Why Is Adult ADHD Missed So Often?]

5 Comments & Reviews

  1. A couple of years ago, my mom’s friend, a rehabilitation specialist, told me that I have ADHD. Since I was in college she was able to write a letter to the Office for Disabilities and I got to take my test in a quiet room with extra time. Not knowing or understanding what ADHD was at the time, when I was in my math and science classes, I used this benefit which did wonders.

    Two years later when I changed my major to HR, I did not use these benefits and wound up failing due to unsubmitted papers. Half a year later, after reading article after article on ADDitude, these life long struggles finally started to make sense to me.

    I am an Iraqi War Marine Veteran that turned 30 this year, but I still wept everytime an ADHD article really hit home.

    Before I changed my major, a few years ago, I went to the VA and a doctor told me that I had an Adjustment Disorder after a 15 minute, yes or no questionnaire. Finally understanding all of the research I put into this myself, I finally went back to the VA to see another doctor, which diagnosed me with the same Adjustment Disorder. I went back for approximately 8 visits of psychotherapy before he released me, and the only focuses of the visits I remember were anxiety and depression.

    It is a very interesting predicament when you are telling someone that you have had such problems all of your life and only now are they kicking your butt.

    Still undiagnosed by a doctor, I understand what I have and know why I do the things I do, but I am still without the proper help to make advancing changes in my life. I never thought I would be working at Starbucks for more than 5 years while trying to finish my degree.

    1. Good day brother, i can relate to a few things you are saying. If possible i would like to communicate with you outside of this setting, could be like a support system. I have been in four and a half years now, i have just been diagnosed at the end of university. It is so weird that i have had this all my life, suffered the symptoms and never knew what was going on. I found ways to deal with it and struggle, i always questioned why am i so inconsistent, disorganized, forgetful, easily distracted, unable to finish assignments ( especially within the due time) doing everything last minute out of urgency. I have always wonder why, why do i start projects, and stop not being able to finish etc. It has been overwhelming processing all these various information about ADHD. It really puts everything into perspective, finally understanding that i am not crazy and all the other self loathing labels we place on ourselves, or was placed on us by others.

  2. It’s important to get properly diagnosed. The focus on this website is “Do my symptoms match those of ADD or ADHD?” The answer could be a resounding “YES,” and yet you still have an excellent chance of being diagnosed with the wrong condition. Why? There’s another condition endemic in our society which has symptoms virtually identical to ADD: Sleep Apnea, and medical professionals who specializew in each condition ARE NOT TALKING TO EACH OTHER.

    Let me share my personal story. At age 49, I was diagnosed (at the VA, after very comprehensive physical and psychological testing) with ADD, and took medicines for 20 years to manage it (mostly Ritalin and Prozac). I was diagnosed again by the VA at age 69 with sleep apnea, and was given a CPAP machine.

    After a month I was doing so well I discontinued all medicine. A VA-provided video, explaining the cause and effects of SA, was a revelation: SA symptoms are virtually identical to those of ADD. Every contact I now have with a health professional now includes the telling of my story, as this parallel-symptom circumstance seems to have gone unrecognized by the medical community. Everyone I tell my story to seems to be hearing it for the first time.

    “Combatting ADD” is now an industry that does not seem interested in hearing my story. I welcome the opportunity to share my story with you in hopes that the medical community/industry, and the suffering public, will become more informed and take appropriate actions.

  3. I’d like to address the bullet items at the end of this essay.

    KNOW YOUR LEGAL RIGHTS. Let’s get out of pollyanna lalaland and talk about how the world truly works. If you are stupid enough to publicly admit that you have this peculiar, embarrassing condition, you will have signed the death warrant on your career. You will have given yourself a label and everyone will assume that you check ALL the boxes of telltale symptoms. Your associates will think that you are a drug user and/or and alcoholic; that you will blurt out something stupid in a customer-facing meeting.

    You will then be the first name on the HR director’s secret layoff list and you will never know the real reason why you got whacked. So, you’re going to file a complaint with the Fair Employment and Housing Commission? Huh? Haven’t you heard? This is the era of minimalist government and all their case workers got laid off. So picture this: here you are trying to feed yourself and pay rent on $400 per week while your ex-employer has $400per hour lawyers ready to squash a piss ant like you.

    DON’T FEEL COMPELLED TO TELL YOUR BOSS. Let’s make a stronger statement than this mealy-mouth bull$#!+ advice and simply say: DO NOT TELL YOUR BOSS. Your boss is not your buddy. By definition he/she is the person who dangles the Sword of Damocles over your career. You don’t legally have to admit this career-endangering condition to your employer, so STFU about it. Once you tell one person, the secret is not a secret anymore.

    Suppose your boss is a rare sympathetic and understanding real Christian and gives you a break. But what about the dude whose desk is 10 paces from yours? What if you have a private office but he sits in a cubicle? What if you have a more prestigious job title? See where I’m going with this? Once you have the ADHD label etched into your nameplate that news will spread like wildfire. You will be a pariah and you will not be invited to have a beer after work with your coworkers. You will sit alone in the cafeteria and no one will help you on any large project.

    Believe me, I know what I’m talking about. I’ve had an honorable 40 year+ career as an engineer in a for-profit company. These companies do not tolerate mistakes, missed deadlines or whiny excuses about mental illness. I have a good reputation as the go-to guy for certain product lines. I am perceived as a somewhat eccentric nerd but to admit to any sort of mental illness would destroy everything I’ve strived so hard for.

    Use common sense and don’t be ****ing stupid. If you need help, get help. And read ADDitude magazine for its valuable advice; they are a friend in your corner.

Leave a Reply