This article was medically reviewed by Dr. Troy Noonan, MD Psychiatry. Dr. Noonan received his M.D. from Finch University at the Chicago Medical School, Psychiatry Residency and fellowship at the University of South Florida (USF) College of Medicine. He is Certified by the American Board of Psychiatry & Neurology.
ADHD in Adults – Symptoms, Diagnosis, and Treatments Demystified
This article explains the most important things about ADHD in Adults and why it sometimes goes undiagnosed. We’ll also clear up the most common confusions about ADHD diagnosis and treatment, in adults and children.
Let’s start with some questions that might sound strangely familiar. Does it feel like you’ve lost your groove, but you’re not sure why? Or maybe you just feel like nothing has come easy for you. Maybe you had to work, or study harder than the other kids when you were in school and it took long study hours to get through college.
At work, you might have excelled by putting in more hours than everyone else. You made it this far in life because you simply outworked everyone else. Now, you have too many responsibilities between kids, your career, and trying to squeeze in a few hours of personal time every week. You’ve lost your edge or your motivation, and you’re not sure why.
If this sounds familiar, you’re about to get some news that could change your life. I described what life is like for adults with ADHD, many of whom don’t even know it. They just know that learning has always been challenging work. They’ve spent their lives watching people breeze through school and work with minimal effort while they have to fight for every inch of progress they make.
Adults newly diagnosed with ADHD are often relieved and even excited to discover that there’s a scientific reason life has seemed so hard for them. First, however, I’d like to clarify the confusion about the various labels used to describe ADD and ADHD.
How Many Types of ADD Are There?
It’s easy to get confused by the various terms: “ADHD,” “ADD,” ADD/ADHD,” “ADD with hyperactivity,” “ADD without hyperactivity,” etc. This confusion comes from the difference in terminology between the DSM-4 and the DSM-5. However, there are only two types:
- Attention Deficit Disorder WITH hyperactivity (ADHD)
- Attention Deficit Disorder WITHOUT hyperactivity (ADD)
This article will use the term ADHD to describe the first type and ADD to describe the second. When referring to both simultaneously, we’ll use the term ADD/ADHD. See the DSM-4 and DSM-5 for more details on how this terminology is used in the diagnostic literature.
The other factor is that both ADD and ADHD exist on a spectrum. In other words, just as there are different degrees of hot and cold, there are different degrees of ADD and ADHD.
While this difference in degree can be intrinsic to the person, certain exterior conditions can cause the challenges of ADD or ADHD to become more noticeable. I’ll give you some examples when we get into details about diagnosis in adults and in children.
Why Adults With ADHD Go Undiagnosed
“There’s no such thing as adult-onset ADD or ADHD."
Unlike depression, PTSD, and other mental health challenges, ADD/ADHD isn’t something you get later in life. If you have it now, you’ve always had it. You’ve simply learned to manage it using raw willpower and, many times, by simply outworking everyone else.
Adults with undiagnosed ADD/ADHD may have suddenly hit a wall in their ability to keep up at work, or in other tasks that require focus and learning new skills or information. Before this point, they have most likely found a way to manage the effects of ADD/ADHD.
Others might simply have not experienced circumstances that would make the effects of ADD/ADHD obvious enough to merit concern. Still others get into careers that make the effects of ADD/ADHD less obvious, or not noticeable at all.
For example, adults with undiagnosed ADD/ADHD often end up in sales, or in the military. The symptoms of ADHD aren’t such an obstacle in these careers and might even give them an advantage. The structured and systematic nature of the military removes a lot of distractions and allows people suffering with ADD/ADHD to focus all their energy and attention on their specialized tasks.
On the other hand, people in sales might excel because of the unstructured nature of their schedule. They can be distracted multiple times during the day, but often develop their own rhythm and end up making or exceeding their sales quota.
Undiagnosed ADD/ADHD might become suddenly noticeable under the right combination of exterior circumstances (time pressures, increase in complexity of tasks or learning, boredom with a specific activity or subject, etc.) For example, they might have children, jobs, families, and other commitments that keep them from managing ADD/ADHD the way they always have. They might even start to struggle in a career or activity at which they used to excel.
This is not because they suddenly developed ADD/ADHD. It’s more a result of exterior pressures making the challenges of ADD/ADHD more apparent, and harder to manage. This is why, when an adult is finally diagnosed with ADD/ADHD, everything suddenly makes sense.
If this sounds familiar, it might be a good time to find out if you have undiagnosed ADD or ADHD. Go to our assessments page and take the ADHD Assessment or schedule an appointment to meet with a psych certified practitioner.
What Everyone Should Know About ADHD in Children
Why are some children diagnosed with ADHD early in life? Imagine the above-mentioned scenario playing out faster. A child starts out as a high-achieving student. Then, they start to fall behind in their grades and develop behavior problems (i.e., problems staying on task and remaining still and quiet).
They might appear to have “sudden” problems with hyperactivity and to struggle with focusing or learning because of it. This hyperactivity may become especially noticeable as the child starts working on subjects that require more focus.
These are examples of why ADD and ADHD are often discovered in children. It’s important to understand the differences in how ADD and ADHD present themselves in children. In the case of ADD, the child might simply have trouble focusing on certain tasks, and their grades might start falling as a result.
This is why ADD often goes undiagnosed, since it is not accompanied by hyperactivity. In some cases, teachers or parents attribute the academic challenges to something else.
In the case of ADHD, the child might simply become hyper when trying to work on tasks that require more concentration. They might be an A or B student otherwise. Other times, this challenge in focusing leads to behavior problems, and decline in academic performance.
The most important distinction is hyperactivity, and the fact that when it is not present (as in the case of ADD), the decline in academic performance is attributed to something else, and the diagnosis keeps getting kicked down the road.
During my interview with Dr. Troy Noonan at Mental Health Management Group in West Florida, he told me that more women have ADD (without hyperactivity) and therefore the diagnosis slips through the cracks.
It’s also important to note that children and adults with ADD/ADHD may only have trouble focusing on tasks or subjects that they don’t like. This is why children and adults with ADHD are sometimes labeled as “lazy” or undisciplined. This misunderstanding is especially easy to make for people who don’t have ADD/ADHD.
In many cases, there is a failure to link the learning challenges of ADD/ADHD with the behavior problems. Especially if there are no behavior problems, and the ADD/ADHD is only “triggered” when working on certain tasks or subjects. Thankfully, a good mental health professional can recognize the cluster of behaviors and challenges because they have seen many, many cases of both ADD and ADHD in children and in adults.
According to a national 2016 parent survey, 6.1 million (9.4%) children in the United States have been diagnosed with ADHD. This includes 388,000 children between ages 2–5, 2.4 million children between ages 6–11, and 3.3 million children between the ages of 12–17. They also tell us that boys are more likely to be diagnosed with ADHD than girls (12.9% compared to 5.6%).
A Popular Myth About ADHD Diagnosis and Treatment
There’s a pervasive myth that people who take Adderall (and ADHD medication) are comparable to users of the street drug methamphetamine. People who spread this rumor are confused about ADHD and about basic chemistry.
First, ADHD medication abuse results from misdiagnosis rather than chemical dependency. People without ADHD are sometimes diagnosed with ADHD, but not for the reason you think. This happens because people without ADHD have a different response to ADHD medications.
Someone with ADHD will likely become calm and focused while on ADHD medications, while someone without ADHD will become energized and alert.
Imagine the pick me up that you get from drinking coffee or Red Bull, only without the jittery side-effects. The subject is less likely to get tired, and the medication often suppresses their appetite. As you can imagine, people in college often find this aroused, alert, and non-munchy state useful.
They get the benefits of caffeine without nervous peripheral effects. Because of this, some college age adults try to “hack” their ADHD diagnosis so they can get the prescriptions. In fact, this is known as prescription fraud, and is illegal in many places.
Obviously, we don’t recommend this, but there’s also a bright side to this as well. It makes diagnosing ADHD in adults and in children much more straightforward. If the patient experiences the energizing effect, they probably don’t have ADHD. If they become calmer and more focused the diagnosis is correct.
Bottom line, someone with ADHD has a different reaction to the medications than someone without it. One response brings a person closer to normal functioning, while the other response is abnormal and behaviorally addictive.
Secondly, those who compare people who take Adderall to street drug users don’t understand the difference between chemistry (an objective science) and the legal category of “Controlled Substance.” Yes, Adderall is legally categorized as a controlled substance. So is oxycodone, Vicodin, LSD, and even cannabis (a natural substance).
This legal category might change how a chemical is administered or made available (or illegal) to members of our society. But it doesn’t change the basic principles of chemistry.
Scientifically speaking, everything is made of chemicals, including food. The important question is how a chemical interacts with the chemical processes in your body. It’s also important to note that even minor differences in chemical compounds can equal major differences from compounds that seem similar.
For example, you might have heard it said that “sugar is one molecule away from cocaine.” Upon first hearing this, it’s easy to assume that sugar and cocaine are nearly identical in their addictive quality. While sugar addiction is most definitely possible, and a problem for many people, this slogan about sugar and cocaine is just clever wordplay.
Table salt is 97% to 99% sodium chloride, and obviously not dangerous to ingest. However, the two elements that combine to create Sodium Chloride are dangerous to ingest by themselves. It would be irresponsible health advice to say, “you know, that stuff you put on your food is made of two elements that are dangerous to ingest!”
But, from a purely linguistic perspective, it sounds like wise advise. A lot of health advice is like this, especially when it comes to rumors about chemical compounds. The truth is, even food is made of chemicals, and different people have different reactions to food. Some people can literally die just from eating peanuts or strawberries.
Likewise, someone with ADD/ADHD will have a completely different experience with Adderall than someone who does not. This difference matters, especially to the person using the medication and the doctor attempting to make a diagnosis and treatment. Some people do not have a medical reason for taking ADD/ADHD medications because they don’t have ADD or ADHD.
Those who do have ADD or ADHD will likely have great experiences. To say that both groups are “abusing’ the medication is logically fallacious and socially irresponsible.
How Adults With ADHD Can Get Their Groove Back
What causes ADD/ADHD in adults? By now you know that this is a trick question. You either have ADD or you don’t have it. Same with ADHD. If you have either now, you’ve always had it. You probably also have relatives who either have ADD/ADHD, or who have it and have not been diagnosed for reasons covered in this article.
This is why adults with ADD or ADHD often report that they have family members who are in sales, in the military, or in some of the other professions mentioned earlier. Again, this is often because these professions are more accommodating for ADHD because of the nature of the work. Others report that they have a niece, nephew, aunt, uncle, sibling, or parent who has ADD or ADHD. Regardless, there are two things you should know about ADHD in adults.
First, if you’ve managed it up to this point in your life, you’ve turned it into a blessing. The fact that it’s forced you to work harder means you’ve developed a habit of self-discipline that is worth its weight in gold. Secondly, the right ADHD treatment can help you put this skill to even better use.
This is not to say that a child with ADHD will be better off if they “tough it out” and learn to manage it the way you did. It’s better to talk with a professional who has seen, diagnosed, and treated dozens of cases in children, and in adults.
Some children with ADHD are overprescribed and become overstimulated, while others become zombie-like because of poor dosage. Others go undiagnosed until they become adults and start experiencing challenges later in life. All are due to misunderstanding about either the differences between ADD and ADHD, and the varying degree to which they present, or which treatment (and dosage) are most appropriate.
If you want to know whether you, or your child, can benefit from ADD/ADHD diagnosis and treatment, contact a board certified psychiatrist or schedule an appointment with the Mental Health Management Group . This concludes our article on ADHD in Adults.
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