Adults can be diagnosed with attention deficit hyperactivity disorder (ADHD). I have ADHD and I was diagnosed as an adult after having my daughter.
At first, I doubted that I had ADHD. After all, I did well in school, completed a very competitive graduate program, and landed my dream job before graduating. I watched a commercial advertising a medicine for ADHD; however, this particular commercial featured a young mom. I do not remember what medicine they were advertising; however, I distinctly remember resonating with the symptoms she described and thinking “That is me”. As a new mom, I attributed poor concentration to the postpartum period, lack of sleep, and doing everything for my daughter by myself. I was exhausted. However, I realized that there was likely more to it. This led to a conversation with my physician and an evaluation. Yes, I had ADHD.
Can you have adult ADHD if things seemed fine as a child?
Since working with many adults with ADHD, I have found that most describe similar experiences to mine; although each person will have a unique story. I see no reason that I would have been diagnosed as a child. I did well in school and other than talking too much in class, my teachers had no complaints.
I’ll discuss more about the diagnosis of ADHD later in this blog; however, current guidelines state that some symptoms were evident before the age of twelve. Caye and colleagues reported that 17 percent of children with ADHD still had the disorder as young adults. Only 13 percent of young adults who met DSM-5 criteria for ADHD (except age at onset) had the disorder as children. Their findings, published in the Journal of the American Medical Association, do not support the assumption that Adult ADHD is a continuation of childhood ADHD.
A U-K study published around the same time supported their findings. However, we do not grow into ADHD any more than we grow out of it. Adaptability and degree of impairment explain what appears to be new symptoms in adults. Therefore, symptom manifestation may be different throughout life, but childhood and adult ADHD are the same.
Social scaffolding explains the difference between childhood and adult ADHD.
Social scaffolding refers to life situations and relationships in which a person operates.
I had a well-structured routine as a child and adolescent. It took me longer to complete graduate assignments; however, I attributed that to being in a rigorous program. In most cases, adults who think they did not exhibit symptoms as a child were able to thrive despite symptoms through a structured environment. Dr. Manos from the Cleveland Clinic states that when social scaffolding changes, so does the presentation of ADHD symptoms.
The authors of Adult ADHD: Underdiagnosis of a Treatable Condition agree and argue that adults may have experienced subthreshold symptoms for diagnosis of ADHD but were not diagnosed since they did not report impairment. They conclude that intellectual and social scaffolding help youth compensate for ADHD symptoms. However, this leaves them at risk once that scaffolding is removed.
We see this in different scenarios:
- A child performs well in school under parent and teacher supervision. However, they struggle in a college environment with an unstructured routine.
- An individual performs well in a routine 9-5 job. However, they struggle when a schedule changes.
- A mother or father performs well. However, they struggle when staying home after the birth of a child. The chaotic and unstructured day leads to impairment that was otherwise masked.
Before having my daughter, I changed jobs from working in the pediatric intensive care unit to working as the Director of School Nutrition for a neighboring county. I went from having a very busy day rounding with physicians and seeing patients to one where I had much unstructured time and sat in meetings. Despite having more than enough time to complete tasks, I felt behind. This only increased after having my daughter and I stayed home with her.
Receiving the diagnosis of ADHD and getting treatment is life-changing.
We know that adults report an improved quality of life when they receive treatment. For me, treatment brought less anxiety and the ability to be productive. Pawaskar and colleagues studied the differences between adults with diagnosed ADHD who received treatment and those who did not receive treatment. Those receiving treatment reported a higher quality of life. They also reported improvements in work productivity, self-esteem, and functional performance. So, what exactly is ADHD and how can you know if you may have this?
Symptoms of ADHD
ADHD is a disorder associated with an ongoing pattern of inattention, hyperactivity, and/or impulsivity. The symptoms of ADHD can interfere significantly with an individual’s daily activities and relationships. ADHD typically begins in childhood and can continue into the teen years and adulthood. Again, while we often see it begin in childhood, there are many reasons why you may not experience impairment until adulthood.
People with ADHD experience an ongoing pattern of the following types of symptoms:
- Inattention–having difficulty paying attention
- Hyperactivity–having too much energy or moving and talking too much
- Impulsivity–acting without thinking or having difficulty with self-control
Some people with ADHD mainly have symptoms of inattention. Others mostly have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms. Often, individuals with ADHD also experience anxiety and/or depression. When these comorbidities are present, untreated ADHD can either cause them or make them worse.
In an article by the American Psychological Association, Dr. Jaska states, “When ADHD is not diagnosed—when it’s not treated effectively—over time, chronic stress and frustration lead to anxiety. This has a very negative impact on self-esteem. It’s very common to see adults with ADHD grow up with a strong sense of underachievement.” Continually hearing messages like “try harder” or “you should be doing better,” can get internalized and lead to anxiety and/or depression”.
Symptoms of ADHD and diagnosis of ADHD
Diagnosing an adult with attention-deficit/hyperactivity disorder (ADHD) requires at least five symptoms of inattention and/or hyperactivity and impulsivity, per the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
According to the DSM-5, symptoms of ADHD:
- Are present in two or more settings
- Interfere with everyday functioning
- Are not caused by another mental disorder
- Were evident before age 12
Symptoms of inattention:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus or gets side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted.
- Is often forgetful in daily activities.
Symptoms of hyperactivity and impulsivity:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting their turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
Getting a proper ADHD diagnosis
While DSM-5 criteria clinically define adult ADHD, symptoms in adults may not present accordingly. The best way to diagnose adult ADHD is through a thorough evaluation like the one provided at New Hope Counseling and Wellness Center, LLC. A thorough evaluation, such as the one you will receive with New Hope, provides more detailed information than what can be gathered in a time-limited office visit with your physician. A proper evaluation for ADHD includes gathering your medical and mental health history, your family history, and completing several standardized assessments developed to evaluate for ADHD. Family history can give an evaluator information when adults are not sure of their history before the age of twelve. ADHD is a highly heritable disorder, with estimates of about 70% to 80% being heritable. If you feel you may have ADHD, a thorough evaluation can help you determine the best path forward.
