Most people think of attention deficit hyperactivity disorder, or ADHD, as a childhood disorder that most kids outgrow. This is not the case. According to an article published in the American Family Physician, up to 50% of children labeled as ADHD continue to have symptoms as adults. In fact, almost 5% of adults in the general population have ADHD, many of whom are undiagnosed. Often times, adult ADHD is simply persistent childhood ADHD. Unfortunately, diagnosing this relatively common problem, especially during adulthood, is challenging.
The Challenge of Diagnosis
Unlike some physical conditions, doctors can’t diagnose adult ADHD with a blood test or an imaging study, although blood tests are important for ruling out medical problems like an overactive thyroid that can mimic symptoms of ADHD. To complicate matters even more, adults with ADHD are more likely to have other psychiatric problems like depression and anxiety that obscures the underlying problem of ADHD.
Another myth that makes diagnosing ADHD challenging is the belief that you can’t have ADHD as an adult if you didn’t have it as a child. ADHD may go unrecognized during childhood, and a child can carry the symptoms into adulthood where it masquerades as other psychiatric problems. In addition, adult ADHD symptoms may be masked by alcoholism or other addictive behaviors. Even kids who sought help for ADHD-like symptoms during childhood may have been misdiagnosed. Even if you were never formally diagnosed with ADHD as a child, it doesn’t mean you can’t have it as an adult because the diagnosis may have been missed during childhood.
The Diagnosis of ADHD in Adults
The symptoms of ADHD in adults are usually more subtle than they are in children. Doctors typically use criteria called DSM-IV Diagnostic Criteria for diagnosing ADHD in kids. To make the diagnosis, a child must have at least six symptoms that point to inattention problems like being easily distracted or forgetful – or six or more symptoms suggestive of hyperactivity or impulsivity such as frequent fidgeting, talking excessively or difficulty waiting their turn. These symptoms must be present for at least six months to exclude the possibility that they’re related to factors like short-term stress.
Some doctors use these criteria for making the diagnosis in adults too, but they may not be sensitive enough. For example, one criterion that points to impulsivity in children is difficulty waiting their turn or blurting out answers to questions in class. This is less relevant to adults where impulsivity may be channeled into reckless behavior, addictions or poor self-control instead. Inattention problems in adults are more likely to manifest as absent-mindedness or carelessness rather than reluctance to do schoolwork. For this reason, doctors who use DSM-IV criteria to make the diagnosis will lead to a number of adult ADHD cases not getting a correct diagnosis.
Because the DSM-IV criteria for diagnosing ADHD aren’t as relevant to adults, another set of criteria called the Utah Criteria has been proposed. According to the Utah Criteria, ADHD symptoms must be present since childhood, at least back to the age of 7, and must include difficulty concentrating and problems with hyperactivity. Adults with it should have at least two of the following symptoms: impulsivity, difficulty completing or organizing tasks, problems coping with stress, an explosive temper or a labile mood. There are several other proposed models for diagnosing ADHD, but none has been accepted as the “gold standard” for diagnosing ADHD.
Distinguishing Between Adult ADHD and Other Psychiatric Problems
Other psychiatric problems have some of the features of ADHD. These include generalized anxiety disorder, major depression, personality disorders, bipolar disorder, and substance abuse disorders. In addition, some medical problems like heavy metal poisoning, nutritional deficiencies, an overactive thyroid, head injury, drug reactions, sleep disturbances and liver disease can cause symptoms of ADHD. That’s why a thorough physical exam, along with a psychiatric assessment, is essential for ruling out other medical problems, especially if the symptoms didn’t appear until adulthood. In some cases, adult ADHD and another mental health condition like anxiety or depression co-exist. It’s not clear whether ADHD predisposes to other psychiatric problems or whether other psychiatric problems predispose to ADHD, but they frequently occur together.
Why is it so important to make the correct diagnosis? Many doctors recommend stimulants to control ADHD symptoms. These medications can increase blood pressure and heart rate. This isn’t healthy for some adults. That’s why a good doctor will take a thorough history, looking for patterns of hyperactivity, impulsivity and difficulties focusing or completing projects that date back to childhood before saying it’s ADHD. If these are present, this strengthens the case since adult ADHD often has its roots in childhood.
A Good History Going Back to Childhood is Important for Making the Diagnosis
When making the diagnosis, it’s important to look for problems with focus, concentration and impulse control as an adult and to delve into school performance and employment history. A pattern of not completing school courses, switching from job to job and problems with decision making and procrastination raises red flags, but other psychiatric problems and personality issues have to be considered too. Most doctors making the diagnosis would like to have input from other family members. When there’s no history of problems during childhood, it’s unlikely the diagnosis is adult ADHD – but it’s important to keep in mind that an adult with childhood ADHD may have gone undiagnosed.
How Childhood and Adult ADHD Differ
Childhood ADHD symptoms are often more obvious than adult ones since adults are more likely to internalize their symptoms while children act them out. The outward signs of impulsivity in childhood ADHD in an adult may be addictive behavior, irritability or mood swings rather than talking out of turn in class. Children with ADHD fidget and have problems sitting still, while adults may be inwardly restless and have problems sticking with projects. That’s why a good doctor will look at all aspects of a person’s social, family and work life dating back to childhood.
The Bottom Line?
Diagnosing ADHD is a challenge since the criteria used to diagnosis ADHD in children, DSM-IV criterion, aren’t as sensitive for diagnosing the problem in adults. That’s why it’s important to get a thorough medical and psychological evaluation and a second opinion, if necessary. The good news? There are treatments available that help to relieve the symptoms of adult ADHD once the diagnosis is made.