[This article was written by Justin Naylor, a therapist who sees patients in his brick-and-mortar facility in NY and online through Amwell]
Once thought to be a childhood disorder that faded with adulthood, Attention Deficit and Hyperactivity Disorder – better known by its acronym, ADHD – today affects approximately eight million adults in the U.S., and sadly, 80 percent of them remain undiagnosed.
Take for example the case of “Matt” (not his real name), a mid-career businessman in his mid-40's. His superiors and clients often praised him for the quality of his work, but issues such as being late for work, a messy workstation, and missed deadlines hampered his advancement beyond an assistant manager. Eventually, these issues resulted in him losing his job for goals unmet, poor communication, and a poor attitude, which Matt blamed on his superiors, claiming they were, "constantly bothering him about deadlines,” and "micromanaging him."
Upset over losing his job, Matt sought help from a psychologist who listened to his story and asked questions about his history. The therapist uncovered that Matt had similar issues going back to childhood. Despite earning straight-A's, his teachers gave him the nickname, "The Absent-Minded Professor," because of how often be would forget books, homework, hats, and other things. Teachers said he just needed to work on his organizational skills, but they never showed him how to do this.
At the end of the session, the therapist asked Matt one more question, "Has anyone ever suggested to you that you might have ADHD?"
What Is ADHD?
ADHD is a neurodevelopmental disorder, which begins during childhood and involves levels of inattention far greater than normal for the child's age, hyperactivity, impulsivity, or a combination of the three. These focus-diminishing issues occur in approximately 5-10 percent of children and can lead to significant impairments that result in academic deficiencies, and emotional and behavioral problems.
Approximately 50 percent of children with ADHD will go on to meet criteria for ADHD in adulthood. Some adults, however, may experience ADHD even if not diagnosed as children... but ADHD does not spontaneously occur in adulthood.
Dr. Margaret Sibley, a clinical psychologist and researcher at Florida International University, says that adults with no history of ADHD who present with issues consistent with the disorder may have other issues that mimic ADHD symptoms.
“ADHD and depression can both cause concentration, motivation, and memory problems; so can drug abuse and other illnesses,” says Sibley. “Professionals should be cautious with first-time adult ADHD diagnoses. They should consider multiple explanations.”
Sibley also points to studies confirming that adult-onset ADHD diagnoses are often undiagnosed cases of childhood ADHD, and that true adult-onset ADHD is unlikely.
"We found a number of people who looked like they had adult-onset ADHD, but when we looked closely, adult-onset symptoms were traced back to childhood or were better explained by other problems, like the cognitive effects of heavy marijuana use, psychological trauma, or depressive symptoms that affect concentration," says Sibley.
Experts estimate only 20 percent of adults who have ADHD have been diagnosed with it. They attribute this to the psychological community recognizing only in the last 20 years that ADHD does, in most cases, carry over from childhood into adulthood. Further compounding this issue was the failure of previous generations to recognize ADHD symptoms in children. Before the mid-1990s, many children who suffered from ADHD went undiagnosed, and instead, therapists and educators labeled them as “disorganized,” “distracted,” or “behavior problems.”
How Do Doctors Diagnose ADHD in Adults?
With today’s better understanding of ADHD, it is possible to determine if an adult may have ADHD that went undiagnosed in childhood through careful diagnosis by an experienced clinician.
The steps involved in an adult ADHD assessment typically involve:
- Gathering a thorough history from people who knew the person well as a child
- Completion of standardized rating scales
- Health history and consultation with the person’s primary care provider to rule out other mental and physical health issues that could be mimicking symptoms of ADHD, such as anxiety, depression or traumatic brain injury.
There is hope for adults who are just discovering they have dealt with ADHD their entire lives.
Many effective treatments and supports are available for adults with ADHD, including:
- Cognitive Behavioral Therapy (CBT)
- Lifestyle changes such as exercise
- Workplace accommodations
- Self-help approaches
So, do you think you have ADHD as an adult?
The symptoms of ADHD vary from person to person, but experts say the most prevalent ones among adults include:
- Disorganization and problems prioritizing
- Poor time management skills
- Problems focusing on a task
- Trouble multitasking
- Excessive activity or restlessness
- Poor planning
- Low frustration tolerance
- Frequent mood swings
- Problems following through and completing tasks
- Hot temper
- Trouble coping with stress
If you have any combination of these symptoms – even just four or five of them – Amwell providers can help get you started on finding out if you have ADHD, and can walk you through the steps to help you reach your goals.
By the way, Matt did have ADHD. Through a treatment regimen of medication, CBT, exercise, and using tools to assist him with memory and organization, his situation has improved. He’s back to work now and even got a promotion to senior manager.
Living Mentally Well is a blog series about achieving mental health wellness. In each installment, AmWell’s healthcare professionals discuss how specific events, lifestyle issues, and even physical health affect mental health. These entries aim to help create a better understanding of mental health conditions, offer advice to those suffering from mental illnesses, their friends, and family members, and to help improve mental health well-being. AmWell does not intend these entries to replace treatments or meetings with mental health professionals. If you or someone you know needs additional assistance, we encourage readers to follow-up with their mental health provider and/or arrange for an online appointment with an AmWell mental health clinician.