Grown-up ADHD - Should I Get Diagnosed?
"I can't get anything done", "I'm always behind", "I can never make it to place on time", "where did my day go?", "holding a job is hard for me". If You find yourself in these loops, you might want to read this. Adult ADHD; the numbers, diagnosis, and effects.
Where did I go? Well, as y'all can see, I haven't posted in a while. I was away on vacation (as part of my zealous self-preservation), saw many friends and family, and talked about life while enjoying fantastic food and beautiful beaches. Many of our conversations naturally turned to ADHD, and what started with discussing our kids, quickly turned into the adults and their struggles.
Working with parents of children with ADHD, I've only met a handful of parents who were actually diagnosed even though we know ADHD is highly hereditary. Most parents report having difficulties in school which they "overcame" as adults. It got me thinking about numbers; how many undiagnosed adults with ADHD are out there? How does it affect their lives?
So this blog is about sharing research about adult ADHD. I offer this with love to all adults who do everything for their kids and overlook their self-preservation. I embedded some references in the text, and share the rest at the end.
Adult ADHD: the numbers
It's hard to find figures for adult ADHD since it's often underdiagnosed/misdiagnosed. Roughly 65% (some research says 50% and some as high as 75%) of children with ADHD experience symptoms into adulthood. However, less than 1/3 of adults are diagnosed with ADHD. This means that adults don't get diagnosed. This can be because of cultural perceptions, diagnostic procedures, lack of knowledge about ADHD, or lack of funds. Some adults feel they have good control of their ADHD; "I'm doing just fine without anybody poking into my brains or taking medication".
Should I get diagnosed for adult ADHD?
While I don't offer ADHD diagnosis in my practice, here are some things I often hear adults say that could suggest they have ADHD: "I can't get anything done", "I'm always behind", "I can never make it to place on time", "my house is a mess and my fridge is empty", "I had a million plans and didn't follow any of them", "where did my day go?", "I was working on my report and three hours later, I'm still on YouTube", "I got stuck without gas, again", "I can't get off the couch to do the laundry. I have piles of laundry", "I pay double for my vacations because I book late", "holding a job is hard for me".
Each of these things on its own doesn't necessarily mean you have ADHD, but if you find yourself looping in these situations for years and frustrated because you KNOW you can do better, you might want to seek a disgnosis especially if you have a family member with ADHD.
So adult ADHD is underdiagnosed. Let's talk diagnosis!
Adult ADHD diagnosis follows the DSM-5 (Diagnostic and Statistical Manual
of Mental Disorders), which was designed to diagnose children with ADHD, and many researchers and practitioners have their issues with it used for adults. This manual lists behaviors for a professional to check and diagnose ADHD, taking into account the on-set age (when the symptoms started), how long they have been present, and the patient's age.
According to the CDC, five or more symptoms of inattention and/or 5 symptoms of hyperactivity/impulsivity (from the DSM 5 list) must have persisted for at least 6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities (https://www.cdc.gov/ncbddd/adhd/diagnosis.html) for an adult to be diagnosed with ADHD.
Who can diagnose adult ADHD?
Primary Care Physician (PCP)– PCPs can offer a diagnosis (not an evaluation of what the impairments are) for ADHD and prescribe medication. Some clinics have PCPs who are trained for ADHD, and some don't. This is probably your shortest route, but it is also a straightforward one that will not offer you a deep understanding of your ADHD and possible treatment. I read a study from 2009 (Adler et al.) stating that 48% of PCPs were not comfortable with diagnosing adult ADHD and I can't blame them.
Psychiatrist/Psychologist with ADHD training – ADHD is neurological and, therefore, should be diagnosed by a brain doctor (simply put). This can be done in private practices or big clinics offering the service. These are the gold standard as far as diagnosis goes. While this diagnosis demands more time, effort, and money, you will do this once, so you might as well do it right. Brain doctors offer a comprehensive diagnostic assessment, including a diagnosis (of ADHD presentation), an assessment (what impairments are involved), and possible treatment and recommendations.
What to expect?
ADHD diagnosis relies on reports. When we diagnose children, we will ask parents and teachers to report or check in questionnaires for behaviors they see.
While the intuitive thing with an adult diagnosis will be to ask them, research says there is a lot of misreporting/misconceptions when we talk about ourselves. A thorough diagnosis will include as many informants as possible reporting about your behavior at work, home, social interactions etc. The more information the doctor has, the better the diagnosis.
A family history background check – was someone in your family diagnosed or exhibited symptoms of ADHD?
An interview – what do you report? Adults with ADHD report an impact on 5 main areas: work, daily activities, relationships, emotional well-being, and physical well-being.
Ruling out anything else – this maybe is one of the most important things a good doctor does. In order to diagnose ADHD, other conditions should be ruled out, and comorbidities should be recognized. The following things need to be discussed: substance abuse, depression, anxiety, sleep apnea, eating disorders, learning disabilities, and more.
If you made it this far… let's talk about NOT getting diagnosed or WHY to get diagnosed.
My personal belief is that you need to name it to own it. A lot of adults suspect they may have ADHD (especially after a child's diagnosis) or simply feel it in their bones. The first step is to name it – Do you have ADHD, and what presentation (Hyperactive/impulsive, inattentive, combined)? What are YOUR impairments (ADHD looks and feels different for different people)? What can you do about it?
Name it to own it.
While many adults with ADHD learn to compensate for their ADHD-related impairments, it can be exhausting. Think of working extra hard at work to finish in 6 hours what other people finish in an hour and then coming home to your partner and kids. People are restless, with mood instability (lashing out at family members) and low self-esteem. Even with excellent compensation mechanisms, adults with ADHD report poor time management, procrastination, disorganization, problems in following through, and distraction.
With all of this, please remember ADHD has its upsides! Adults with ADHD are very intelligent, gifted creative people with tenacity and beautiful ideas that just keep coming. They love different creative things like drawing and telling stories, working with wood to create wonderful things, music, cooking, and other things that leave me in awe of their extraordinary brain! They are creative, fun-loving parents who come up with the best activities and bedtime stories and are incredible partners and friends.
So whatever you choose to do with this information is up to you. I hope it helped some or just got things in place for you to decide your next step.
All my love,
Michal
References:
Asherson, P., Akehurst, R., Kooij, J. J. S., Huss, M., Beusterien, K., Sasané, R., Gholizadeh, S., & Hodgkins, P. (2012). Under Diagnosis of Adult ADHD: Cultural Influences and Societal Burden. Journal of Attention Disorders, 16(5_suppl), 20S-38S. https://doi.org/10.1177/1087054711435360
Adler, L. A., Shaw, D., Sitt, D., Maya, E., & Morrill, M. (2009). Issues in the diagnosis and treatment of adult ADHD by primary care physicians. Primary Psychiatry, 16, 57-63.
McLeod, J. D., Fettes, D. L., Jensen, P. S., Pescosolido, B. A., & Martin, J. K. (2007). Public knowledge, beliefs, and treatment preferences concerning attention-deficit hyperactivity disorder. Psychiatric Services, 58, 626-631.
McLeod, J. D., Fettes, D. L., Jensen, P. S., Pescosolido, B. A., &Martin, J. K. (2007). Public knowledge, beliefs, and treatment preferences concerning attention-deficit hyperactivity disorder.Psychiatric Services, 58, 626-631.
Demuth 2022 https://guilfordjournals.com/doi/10.1521/adhd.2022.30.4.7