ADHD, which stands for attention-deficit hyperactivity disorder, is a neurodevelopmental disorder that’s typically diagnosed in children.
But according to data from the National Center for Health Statistics, more than 15 million American adults say they have ADHD, and about half of them received their diagnoses as adults.
ADHD is not becoming more common in adults, but doctors are seeing more diagnoses because the scientific understanding of ADHD is changing, said Dr. Maire Daugharty, a psychotherapist and anesthesiologist based in Denver who has written about adult ADHD.
“The medical community used to believe that ADHD resolved from childhood through adolescence into adulthood, so in other words, you would get a diagnosis in childhood and the expectation would be that those symptoms would resolve over time,” she said. “Turns out that’s not the case. ADHD is a neurodevelopmental disorder that you are born with and that you carry for the rest of your life, and so adults who were formerly thought to have outgrown the illness now find that that’s not the case and are being diagnosed as adults later in their lives.”
7 questions with Dr. Maire Daugharty
If people are diagnosed with ADHD as adults as a new diagnosis, does that mean that doctors missed the diagnosis when they were younger, or could you develop ADHD later in life?
“ADHD is something that you’re born with and it can be missed in childhood for a number of reasons. Sometimes the child is neglected and nobody thinks to bring them to the doctor to discuss these particular symptoms. Sometimes parents don’t want to hear that there’s something wrong or different with their child, and some pediatricians aren’t particularly attuned to ADHD, so kids can certainly slip through the cracks.”
Does the environment or lifestyle play into how ADHD may manifest itself?
“It can be worse in certain environments and better in other environments, but it is always there. So chaotic circumstances, a child growing up in a household where there isn’t a lot of structure, where maybe the parents are not aware the child has ADHD, because there are particular ways to manage raising a child with ADHD compared to raising a child without ADHD.
“It is really important to understand that your child’s frustration tolerance with ADHD is going to be lower. The ability to sit and concentrate and do homework is going to be lower, so you need to come up with different strategies to navigate that appropriately so that the child can learn that they are capable. They are not ‘lazy’ or ‘aren’t paying attention.’ They have ADHD.”
Do the symptoms of ADHD look different in adults compared to children?
“Childhood ADHD can look very, very different from adult ADHD. The predominant difference that we see is children who are diagnosed with ADHD hyperactive type tend to be more overtly hyperactive, whereas adults it’s things like knee jiggling or a need to interrupt people so they’re not bouncing off the walls like they were in childhood. Adults also learn numerous coping skills so that they look very different in adulthood compared to childhood.”
Are there specific guidelines for diagnosing ADHD in adults that doctors follow or look for?
“People will fill out a screener. [If] they are positive in certain arenas and that suggests that further workup is indicated. A screener is not a diagnosis. It’s just an indicator for further workup. Further workup includes a medical exam to make sure there isn’t a medical issue interfering with what may be happening, and then history and diagnosis is really history oriented.
“In other words, you start to ask open-ended questions around patient symptomatology, their experiences in school, their experiences in relationships, particularly when they were younger, and has that been consistent over time into adulthood. The other thing that’s really important because we’ve all had arenas where we have difficulty focusing or where we hyperfocus, so we’re looking for consistency over time in multiple arenas that rises to the level consistently of distress and impairment.”
How might ADHD affect your personal relationships when you see this in adulthood?
“In terms of relationships, ADHD can have a significant impact really indirectly, because people who are untreated and don’t know they have ADHD feel like there’s something wrong with them, so their self-esteem really suffers and that impacts their social relationships. The other thing that can happen is their behaviors are often, I would say, a turn-off to the people around them if they don’t understand what’s happening.
“For example, a spouse might say, ‘My husband or my wife sits at home doing nothing. They can’t do the laundry. They can’t get anything organized.’ So it does have an impact compared to a spouse who understands my husband or wife has ADHD and this is how it impacts their day, and these are some strategies we can develop to navigate that.”
How could increased awareness contribute to overdiagnosis or self-diagnosis in some cases?
“I think it’s really important for people to be aware, but you don’t look at a YouTube video or an Instagram post and say, ‘I have ADHD.’ You look at those and you say, ‘This resonates with me. Where do I go to get more information about what might be happening for me?’ The other thing that’s really important is to go to clinicians who are well-versed in ADHD. So, for example, those 30-minute online surveys that you fill out, and here’s your diagnosis and here’s your medication are totally inappropriate to diagnose a really nuanced disorder.”
Is the average primary care doctor equipped to treat ADHD in adults?
“Pediatricians are attuned to ADHD and trained to identify or refer out for further information. Primary care doctors for adults [are a] very different scenario. Some primary care doctors do additional training and are very comfortable working with mental health issues, including ADHD. Some are not. And so the recommendation is if you believe your patient might have ADHD, and you’re not somebody who’s comfortable making that diagnosis, you refer to psychiatry for further evaluation or to a psychologist or a neuropsychologist for formal assessments.
“I would say probably the adult physician population is less trained, less immersed than the pediatric physician population just because this is new compared to our understanding of ADHD in childhood.”
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Samantha Raphelson produced and edited this segment for broadcast with Micaela Rodríguez. Raphelson also produced it for the web.
This article was originally published on WBUR.org.
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