Late Diagnosis: Was ADHD to Blame All Along?

The diagnostic criteria for attention deficit disorder were designed to identify ADHD in children — not adults. Criteria like "often runs about or climbs" and "often fails to finish schoolwork" don't help to diagnose ADHD in adults who are bright, hardworking problem-solvers who have found clever ways around their symptoms, like learning to hyperfocus on cue.

Most ADHD diagnoses happen when kids are disruptive, or are being screened for learning disabilities. People who fly under the radar may never get diagnosed. Our expert explains the eight top reasons why.

Believe it or not, most physicians still don't believe that ADHD exists, especially in adults. What’s more, 93% of adult psychiatrists, when asked, report that they've never had any ADHD training, either in their residency or in their continuing medical education, whether in children, adolescents, or adults. Thus, most don't know how to recognize adult ADHD Symptoms. They are stuck with the disruptive little boy archetype and don't recognize that adults with ADHD are night owls and experience difficulty sleeping, relationship disappointment, and rejection sensitive dysphoria, among other symptoms not found in children or included in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5)

Adults with ADHD have struggled their entire lives. They've been told over and over that they're not living up to expectations, or that they have "bad brains." Sometimes, rejection sensitive dysphoria can make adults with ADHD experience the withdrawal of love, approval, or respect in a catastrophically painful way. Often, the only reason adults seek treatment is because a boss or a spouse has said, "Get it under control, or this is over." This buildup of shame can make even walking out the door in the morning an act of courage; seeking medical help may feel impossible.

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Doctors often mistake ADHD symptoms in adults for mood disorders, anxiety, obsessive-compulsive disorder, and other conditions with overlapping symptoms. For adults, hyperactivity can be turned inward. You may think that your racing thoughts stem from anxiety when they are really caused by over-activity in the brain caused by ADHD. These internal behaviors are more difficult to detect and diagnose. Doctors need time to find and put together the pieces of various ADHD symptoms during a thorough clinical interview, but most doctors only have a 15-minute visit. It's not enough time.

Difficulty sleeping isn't recognized as an ADHD trait, but 40% of adults with the condition say it's their biggest impairment. Adults with ADHD describe themselves as night owls who get their best bursts of energy right before bed, and then can't turn off their minds. They toss and turn, fidget, and worry. Another 20% fall asleep easily, only to wake in a couple hours with their minds bouncing around. Especially for women, the overactive component of ADHD arrives after the sun goes down.

People with ADHD nervous systems are usually brighter and more creative than average neurotypical people. Because of this, over time, they find lots of ways to compensate for ADHD symptoms and make their way through life. The diagnosis usually occurs when an adult has a child diagnosed with ADHD, adds a new family member, or takes on more in their career and the extra stress becomes too much to bear.

People with anxiety and mood disorders are often concerned about treating ADHD because they think ADHD medications will exacerbate their symptoms, or interfere with other medications, like SSRIs. However, studies have shown that stimulants do not make anxiety worse when the dose and medication are right. When conditions like arrhythmias, high blood pressure, and other disorders are stabilized and treated, medication is safe. Stimulants don't increase blood pressure unless the dose is too high.

[Your After-Diagnosis Survival Guide]

When ADHD goes undiagnosed, it can lead to low self-esteem from a lifetime's build-up of poor job and relationship performance. Many adults self-medicate with alcohol or drugs, which is obviously quite dangerous. However, roughly 20% of individuals with ADHD are able to regulate ADHD with exercise. Every hour of aerobic activity translates into about four hours of relief from symptoms. Others use caffeine, which isn't the best, but works better than nothing to manage symptoms.

If you don't have an immediate response to ADHD medication, that doesn't mean you don't have ADHD. The dosage might be off, or another medication might be a better fit. If you've tried amphetamine and it didn't work, methylphenidate might be the answer. Cutting out vitamin C, and taking medication on an empty stomach can help with absorption. Sometimes it takes a few tries to find the right treatment for you. Don’t give up without trying several alternatives.