There’s no one test to diagnose this mental health disorder.
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.
00:00:00,000 --> 00:00:02,464
00:00:02,464 --> 00:00:05,843
So I think adults go and seek a diagnosis
because they notice that they're not being
00:00:05,843 --> 00:00:08,180
as effective in their lives
as they would like to be.
00:00:08,180 --> 00:00:11,400
Or their relationships
are really struggling because
00:00:11,400 --> 00:00:14,480
their partner's saying hey can
you do these three things, and
00:00:14,480 --> 00:00:17,120
one thing gets done because they
got distracted by something else.
00:00:17,120 --> 00:00:22,828
00:00:22,828 --> 00:00:28,281
Somebody who has ADHD might have
symptoms of hyperactivity compulsivity,
00:00:28,281 --> 00:00:33,610
and inattention, or might have some
combination of those symptoms.
00:00:33,610 --> 00:00:34,950
So with hyperactivity,
00:00:34,950 --> 00:00:39,290
you're gonna people that are constantly
on the go, can't sit still.
00:00:40,510 --> 00:00:44,060
Might be somebody who you notice
is multitasking all the time.
00:00:44,060 --> 00:00:48,820
The impulsivity piece comes in when
things are happening that might be
00:00:48,820 --> 00:00:49,800
00:00:51,390 --> 00:00:56,340
Things that are done without much thought,
and sometimes kinda getting in trouble for
00:00:56,340 --> 00:01:00,300
things being too risky and too impulsive.
00:01:00,300 --> 00:01:04,780
And then the inattention piece is,
as it sounds, a real difficulty with
00:01:04,780 --> 00:01:07,980
focusing and attending to the thing
that's right in front of you.
00:01:07,980 --> 00:01:12,070
So for an adult to have a diagnosis of
ADHD they would have a comprehensive
00:01:12,070 --> 00:01:15,390
evaluation with a mental health
professional and they'd be asked all sorts
00:01:15,390 --> 00:01:19,200
of questions about hyperactivity,
impulsivity, and inattention.
00:01:19,200 --> 00:01:23,760
And how those things might affect their
personal life, their work life, and
00:01:23,760 --> 00:01:26,680
other parts of their life.
It has to be behavior that's seen
00:01:26,680 --> 00:01:27,950
in more than one environment.
00:01:27,950 --> 00:01:32,460
So maybe they're at home, maybe their
partner fills out some sort of measure.
00:01:32,460 --> 00:01:35,253
Their boss could fill out of measure,
the person fills out a measure, and
00:01:35,253 --> 00:01:37,641
we do a little comparison to see
kind of where things fall out and
00:01:37,641 --> 00:01:40,390
how people observe that person,
how the person observes himself.
00:01:40,390 --> 00:01:42,910
It is not true that adults can be
00:01:42,910 --> 00:01:48,700
diagnosed with ADHD for the first time
never having had symptoms before.
00:01:48,700 --> 00:01:52,890
They might get the diagnosis as an adult,
but then they look back and realize that
00:01:52,890 --> 00:01:57,820
they had problems with hyperactivity and
impulsivity, and or inattention when they
00:01:57,820 --> 00:02:01,370
were younger and in elementary school.
You would go back to childhood,
00:02:01,370 --> 00:02:04,180
so you would ask about their schooling and
00:02:04,180 --> 00:02:07,080
how they functioned in school,
how they functioned at home.
00:02:07,080 --> 00:02:09,510
And you would try to put together
00:02:09,510 --> 00:02:12,370
the pieces to come up with
the diagnosis in that way.
00:02:12,370 --> 00:02:17,870
There are many co-occurring disorders that
you'll see with someone who has ADHD.
00:02:17,870 --> 00:02:20,840
The most common one would
be anxiety disorders.
00:02:20,840 --> 00:02:26,280
Another kinda co-occurring diagnosis with
ADHD could be substance use disorders.
00:02:26,280 --> 00:02:30,290
But you'll see people with ADHD and
00:02:30,290 --> 00:02:33,940
Tic disorders, OCD, those are all kind
00:02:33,940 --> 00:02:38,030
of co-occurring diagnoses that
you'll see with someone with ADHD.
00:02:38,030 --> 00:02:43,020
When adults are diagnosed with ADHD,
it is often a sense of like aha.
00:02:43,020 --> 00:02:45,340
This is why school was such a struggle.
00:02:45,340 --> 00:02:48,310
This is why managing my
home is such a struggle.
00:02:48,310 --> 00:02:51,219
This is why I've had so
much trouble with relationships.
00:02:52,240 --> 00:02:55,610
It almost appear that things
are pieces that coming together and
00:02:55,610 --> 00:02:58,600
they have an understanding of
what's going on with them.
00:02:58,600 --> 00:03:00,710
So it appears to be a sense of relief.
00:03:00,710 --> 00:03:06,367
Coexisting conditions. Children and Adults with Attention-Deficit/Hyperactivity Disorder. (Accessed on May 24, 2018 at http://www.chadd.org/understanding-adhd/about-adhd/coexisting-conditions.aspx.)
Could I have attention-deficit/hyperactivity disorder (ADHD)? Bethesda, MD: National Institute of Mental Health. (Accessed on May 24, 2018 at https://www.nimh.nih.gov/health/publications/could-i-have-adhd/index.shtml#pub1.)
Diagnosing ADHD. Children and Adults with Attention-Deficit/Hyperactivity Disorder. (Accessed on May 24, 2018 at http://www.chadd.org/understanding-adhd/about-adhd/diagnosing-adhd.aspx.)
Symptoms and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on May 24, 2018 at https://www.cdc.gov/ncbddd/adhd/diagnosis.html.)