Do I have ADHD as an adult is a simple question, unfortunately there isn’t a simple answer. No matter what you may read or hear, there isn’t a simple test that someone can give you to find out this answer. Complex evaluations are required to know for sure. I am both a psychologist, and an adult who was diagnosed with ADHD in his 40’s, following multiple children being diagnosed. With this, I hear both ends of the process regarding ADHD and thus impacts my desire to help even more.
In this article I will provide education, tools, and self tests that can aide in your journey to finding answers about ADHD. By the end of this article you will not only know important aspects of ADHD, but know what really matters when considering if you have ADHD.
This article will explore a few key points for anyone thinking if you have ADHD or not. A list of the bullet points is noted below; so if a particular topic is more important to you, please just skip ahead.
- What is ADHD?
- What are ADHD symptoms?
- Adult ADHD
- How is ADHD diagnosed?
- What matters when considering ADHD?
What is ADHD?
ADHD is the commonly used abbreviation for attention-deficit/hyperactivity disorder. It can be a mouthful to say, as are many neurological or mental health disorders. Thus, the abbreviated version ADHD or just ADD during previous years. Confusion on the terms continues as many continue to use the term ADD, including many professionals. Officially the name is ADHD regardless of type since 1994 with the revision of the DSM (more on this later).
First and foremost, information about ADHD comes from scientific research and studies. That being said, the scientific community has made many advances over the past few decades. Previously when working with mental disorders, the science wasn’t mature enough for consistent results. Now we have brain imaging, advancements in neuroscience and genetics. To summarize here, we now know tons more information to aide with both understanding and treating this disorder.
So, back to my first thought on “what is ADHD?”. ADHD is considered a neurodevelopmental disorder. In other words, a disorder that manifests in early childhood that shows deficits in what is considered normal development. The deficits seen for ADHD are in the areas of attention, activity levels and impulsivity. Especially important here is the fact that ADHD is considered to be present in childhood regardless of when it is diagnosed. In other words, its a disorder of the brain and is lifelong.
A Common Myth
A common myth associated with ADHD comes around if it is real or not. I often hear opinions like “ADHD is not a real thing” or questions like “is ADHD real thing?” or even “aren’t we all a little ADHD?”. ADHD has been medically documented as early as 1775. Research has shown that if a parent has ADHD, the child has a 57% risk to also have ADHD. Brain imaging studies has shown differences in brain functioning between individuals with ADHD and without. The medical science we now have shows physical differences. This readily collaborates with the long documented history of behaviors and symptoms. Now with these advances and physical evidence, it is much harder to continue to deny the existence of this brain disorder.
What Are ADHD Symptoms?
As the name suggests, ADHD is a disruption in attention, hyperactivity/impulsiveness. Symptoms come on a spectrum with ADHD. Individuals can have impact on one or both of these areas. Thus an individual could have ADHD with symptoms primarily around attention. Alternatively, symptoms can just be hyperactivity/impulsiveness. There can also be differences in number and severity of symptoms.
So, just what are these symptoms and what do they look like? To answer these questions lets first look at the criteria of ADHD. Criteria is what providers look for to diagnosis ADHD.
ADHD Criteria Sources
ADHD criteria comes from one of two sources. These two sources are the DSM (as mentioned above) and the ICD. First, the DSM stands for Diagnostic and Statistical Manual for Mental Disorders. The DSM in in its fifth revision and is by the American Psychiatric Association. Secondly, ICD stands for International Classification of Diseases. ICD is on its 10th edition and is from the World Health Organization, or WHO. I will focus on the DSM in this article.
DSM ADHD Criteria
Psychologists (or a medical provider, more noted below) examine behaviors. We looks at not just the behaviors, but the occurrence of these behaviors since childhood. In other words, you can’t just develop ADHD suddenly as and adult.
Symptoms
In this paragraph, I will discuss some common examples of symptom that occur. Another key point is these symptoms result from the above criteria, hence the reason for listing and reviewing them first. Some of the criteria are easily recognized as symptoms, while others take a bit of diving into.
attention symptoms
- Day dreaming about the big picture, never finishing work towards it
- Being overwhelmed when too much is going on
- taking the trash out and forgetting to put a new bag in (fill in any task others tell you that you only “partially did”)
- searching intently for something and not finding it, when others come in and find it right away
- unable to plan the day
- chronic lateness
- I do my best work under a deadline
- all in on my new hobby
- Instruction manual? who needs that?
- Where is the remote? Where did I put my keys?
- frequent last minute cancellations of plans
- love ones say “I’ve told you this already” frequently or, “how could you forget that?”
- Your workspace looks like this:
Hyperactivity & Impulsivity symptoms
- Pacing while on the phone
- changing positions constantly while seated
- shaking feet, legs or knees often
- fidgeting often
- becomes restless easily and fidgety during meetings or long waits
- becomes a “workaholic”
- constantly finding new tasks to do
- getting frustrated often by all the “slow walkers”
- difficult to wait until someone finishes talking to state your answer
- others just talk too slow
- stepping quickly to aid your child with a task as they are taking too long
- waiting in line seems to wear you out
Sound familiar? If so, ADHD is a consideration. To sum up, these are just some examples of what it may look like to have ADHD.
Adult ADHD
I’m not sure if Tom Cruise was able to help Ricky Bobby put the fire out, but I do know he definitely did not help with stigma for ADHD. Though Tom Cruise made derogatory statements in early 2000’s about ADHD, it has been since the 80’s that unfounded campaigns against medications that treat ADHD were seen in the media. I remember the news around this as well as other view points growing up in the 80’s about ADHD. All in all, misinformation and stigma seem to be a large portion of concerns I hear from others about ADHD.
Brief History of Adult ADHD
Though articles were written about adult equivalents to ADHD in the 60’s and 70’s, it was not until the 90’s that things changed. Not only did the view of ADHD begin to change in the 90’s, but adult ADHD started to be viewed as a legitimate disorder. The outdated opinions that ADHD does not exist in adults, and commonly outgrown by adolescence began to be refuted.
Though recognition of ADHD in adults was beginning to be seen in the 90’s, it was not until further into the 2000’s that more changes and research was seen. The DSM revised the classification and noted differences for adults for ADHD in 2013. ADHD was reclassified from a disorder that was normally diagnosed in childhood, to a neurodevelopmental disorder. Additionally, the internet and support organizations such as chadd.org and add,org, have increased awareness and decreased stigma.
Adult ADHD Facts
Children diagnosed with ADHD and studied into adulthood have been the historical means of research for adults with ADHD. With this in mind, it has been shown that approximately 50% of adults continue to show significant impairment and a range seen from 32-45% continue to meet full criteria for ADHD. These numbers go against the myth that ADHD is outgrown by adolescence
Adult ADHD diagnosis has significantly increased. Despite this, Adult ADHD is still considered to be underdiagnosed. Many adults refer themselves to evaluated for ADHD after their children received the diagnosis. Not to mention, it is estimated that 20% of parents of children with ADHD meet full criteria themselves.
Nearly 80% of individuals with ADHD have a co-occurring mental health disorder. At the present time, mood and anxiety disorders are the most common co-occurring disorders.
How Is ADHD Diagnosed?
First and foremost, a qualified mental health professional or physician can diagnoses ADHD. Furthermore, with adults this is most often done through a psychological evaluations with a psychiatrist or psychologist. Additionally, evaluations have multiple parts with screening for other mental health disorders as an important part of the assessment.
Clinical interviews will be the first portions of any evaluation. During the interview you can expect to review the following:
- reasons for presentation
- goals for evaluation
- family history
- developmental history
- educational history
- occupational history
- social history
- Screening for other mental health disorders
Following the interview, or sometimes accompanying, expect to complete a battery of rating scale, questionnaires and cognitive testing. The testing and questionnaires will vary depending both on who is conducting the interview as well as presenting symptoms. Inventories for adult ADHD, anxiety, and mood are commonly seen.
A parent, close friend or other individual that knows you well will also likely be involved.
Adult ADHD Self-Reported Scale (ASRS)
The ASRS is a common screening tool used during assessments. It is simple to use and is consistent in recognizing adults that need further inquiry about ADHD. Below is a copy of the tool.
Most important is the first 6 items. 4 or more marks in the shaded boxes on the first 6 indicate high changes of ADHD. The other 12 questions help provide additional information and context, especially when working with a professional during assessment.
What Really Matters?
In a word, impact. Impact on life, distress or functioning. For me, the most important aspect of anyone seeking help is to discuss pain points. The reason to seek a diagnosis is to reduce suffering. Ultimately, the entire purpose of evaluations is to find out what is causing pain and give it a name. If pain is frequent it impacts our life greatly, as well as cause many impacts on our mood and ability to function in day to day activities. After all, the reason most people present for therapy or evaluations is because of what is going on in their life. They want the pain to stop.
Impact or the pain in life can be different for everyone. Nonetheless, there is patterns of types of impact seen. Earlier I mentioned a pattern seen with adults seeking evaluations after their children are diagnosed. Another key pattern is referral from family members, as they are often the first to be aware of impact. Also patterns in certain areas are noted and include the following:
- increased risk of injuries
- sleep problems
- academic difficulties
- learning disabilities
- occupational impact
- marriage quality and relationship satisfaction
- money management
- increased alcohol usage
So, what really matters is what you want to be different. Healing from pain and reducing impact on life. Not if its ADHD or not.
In Summary
ADHD identification and understanding has changed immensely over the past few decades. With this, increases in adult presentations and diagnoses have been seen. There has also been increases with treatment enhancements or supports such as ADHD coaching.
I’ve found that many find comfort in having a name to place on the pain. All of a sudden there is an explanation. In addition to a name, there can be hope of change.
Change can be seen with improved relationships, better management of money, accommodations at school or work. Improved mood and self esteem. It can be invaluable to look through the past with the lens of new understanding, and see the reasons for past decisions as ADHD.
I encourage anyone who is reading this to seek help if you relate. Even if ADHD is not the diagnosis for you, I believe seeking evaluations can provide the answers that you need. Talk to your doctor, do some research for local psychologists or psychiatrists. Life doesn’t have to be this hard. https://www.psychologytoday.com/us is a good resource to find local help.
I also provide evaluations throughout North Carolina virtually, and more locally in office at Wilmington NC. Information can be found here.
References and Resources
- Barkley, RA. (2014). Attention-deficit hyperactivity disorder, fourth edition: A handbook for diagnosis and treatment. New York, NY: Guilford Press.
- Chung W, Jiang S, Paksarian D, et al. Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups. JAMA Netw Open. 2019 2(11):e1914344.
- Niel, Ushma. Tom Cruise is Dangerous and Irresponsible. J Clin Invest. 2005 Aug 1; 115(8): 1964–1965
- Centers for Disease Control and Prevention (CDC). Attention-Deficit/Hyperactivity Disorder.
- Kessler, R. C. , Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J. , Jin, R., Scnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization adult ADHD self-report scale (ASRS). Psychological Medicine, 35(2), 245-256.
- Daly, B. P., Nicholls, E., Brown, R.T. (2016). ADHD in Adults. Hogrefe publishing
