Could It Be ADHD? Here’s How Doctors Diagnose ADHD in Adults

There’s no one test to diagnose this mental health disorder.

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Adults who are diagnosed with ADHD have likely lived with the condition for decades. The symptoms of ADHD may not be obvious to them because they’ve simply always had them—they don’t necessarily feel abnormal. For many people, however, everyday life frustrations caused by ADHD may eventually prompt them to investigate. Maybe they feel like they’re falling behind at work, because they can’t hit deadlines or get distracted in meetings. Their friendships might suffer because they blow off plans or show up late. Their family life could be fraught because they have a hard time listening to their partner or taking care of their share of household responsibilities.

“Adults go and seek a diagnosis because they realize they’re not being as effective in their lives as they would like to be, or their relationships are really struggling,” says Jennifer Hartstein, PsyD, psychologist in New York City.

Once someone has made the decision to speak with a doctor about the issues they’ve noticed in their personal and professional lives, doctors will use a few different assessments before diagnosing with ADHD.

The Signs Doctors Look For When Diagnosing ADHD

“Somebody who has ADHD might have symptoms of hyperactivity, impulsivity, and inattention, or might have some combination of those symptoms,” says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.

You’re probably familiar with what hyperactivity looks like in children, but in adults, it manifests a little differently: being constantly on the go, unable to sit still, or multitasking all the time. They may tap or talk constantly or when not appropriate, according to the National Institute of Mental Health (NIMH).

“The impulsivity piece comes in when things are happening that would be somewhat risky,” says Dr. Samuels. For example, splurging on frivolous purchases, eating unhealthy foods, speeding when driving, having unsafe sex, or binge drinking. Or even just interrupting colleagues in meetings or friends over dinner.

Inattention is as it sounds: an extreme difficulty focusing on the task at hand and paying attention. Adults with ADHD may be the daydreamers who always seem a little out to lunch while sitting at their desks. Learn more about inattentive ADHD in adults here.

The Process to Diagnosis ADHD

“For an adult to have a diagnosis of ADHD, they would have a comprehensive evaluation with a mental health professional, and they'd be asked all sorts of questions about hyperactivity, impulsivity, and inattention,” says Dr. Samuels, “and how those things might affect their personal life, their work life, and other parts of their lives.”

And it’s important that the the symptoms affect multiple parts of their lives. Think about it: If your symptoms only appear at work, you may simply not “jive” well with the company or your coworkers, or maybe it’s a hostile or chaotic work environment that brings out unusual behaviors from you. 

But if the symptoms are consistent in multiple arenas, a diagnosis of ADHD is more likely. Spouses, bosses, and other important figures in the person’s life may fill out an evaluation, and the mental health professional will compare the feedback, according to Dr. Hartstein.

Why Childhood May Impact a Diagnosis of ADHD

Being diagnosed as an adult can be insightful and even a relief, but it can also feel overwhelming to have a new medical condition at, say, age 35. You might even wonder “what went wrong” that you ended up with ADHD.

But this thinking is a myth. “It’s not true that adults can be diagnosed with ADHD for the first time [without ever] having symptoms before,” says Dr. Samuels. In many cases, adults simply don’t realize they have ADHD until they are faced with the responsibilities and independence of adulthood. Find out more about the myth of adult-onset ADHD here.

In fact, your experience growing up plays a critical role in your ADHD diagnosis. Doctors look for symptoms of ADHD to be present before the age of 12, according to NIMH.

“You would go back to childhood [and] ask about their schooling and how they functioned in school and how they functioned at home,” says Khadijah Watkins, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. “You would try to put together the pieces to come up with a diagnosis.”

Co-Occurring Disorders with ADHD

People with ADHD are more likely to have other conditions too; they’re officially called “comorbid conditions.”

The most common co-occurring disorder is anxiety disorder. About 53 percent of adults with ADHD have some type of anxiety disorder, according to the National Resource Center on ADHD.  In many cases, these disorders become maladaptive coping mechanisms to deal with the frustrations caused by the ADHD symptoms.

Other common coexisting conditions include oppositional defiant disorder (affecting 40 percent of people with ADHD), substance abuse disorders, depression (affecting 47 percent of adults with ADHD), tics or Tourette Syndrome, bipolar disorder, or sleep disorders. Learn more about the link between sleep disorders and ADHD here.

Knowing your ADHD diagnosis can help these co-occurring disorders; by getting help for ADHD, you are helping to treat a source of anxiety, and you may better understand why certain situations cause problems for you and learn more productive ways to handle them.

Getting an ADHD diagnosis as an adult often is a relief for patients. “It almost appears that the pieces are coming together and [the patients] understand what’s going on with them,” says Dr. Watkins.