Can ADHD Start in Adulthood?
Over the last few years, I have received an increasing number of inquiries from adults requesting ADHD evaluation. Many of these adults have never had an evaluation before and wonder if they are experiencing symptoms of ADHD.
If you are one of those people who wonders why life has gotten so much harder as an adult, you may also be asking the question: Can ADHD present in adulthood?
What is ADHD?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is the widely used manual to diagnose conditions such as ADHD, Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disorder that causes “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
While this definition can certainly apply to adults, there is a key characteristic of ADHD that we must consider.
The DSM-V clearly states that a diagnosis of ADHD is dependent upon symptoms presenting before age 12.
Why Did I Not Have Symptoms as a Child?
For adults who are just now “feeling” symptoms of ADHD, there can be several explanations for a seeming lack of symptoms in childhood.
High cognitive ability
Individuals with a high cognitive ability (i.e., high IQ), often have the capability to function successfully in school simply because they can get by on their “smarts.” This is especially true in elementary school, where the curriculum is not particularly challenging.
ADHD is “mild”
ADHD is diagnosed with specifiers for level of severity. The three levels as defined in the DSM-V are:
Mild
Moderate
Severe
A “mild” diagnosis is characterized as “symptoms result in no more than minor impairments in social or occupational functioning.” These minor impairments may not be noticeable enough to warrant evaluation or diagnosis in childhood.
Built-in support at home or in school
Kids with ADHD often struggle with executive functions skills, including organization, time management, and task initiation. But some kids naturally receive support in these areas at home and/or in school. Some parents naturally provide appropriate structure at home to enhance executive function skills, while many schools, particularly smaller private schools, can provide adequate individualized support. Consequently, some of these kids’ ADHD symptoms may go unnoticed.
Girls versus boys
While boys tend to present with more overt ADHD symptoms, girls tend to have more understated symptoms. It is not unusual for girls to appear focused and engaged while actually struggling to pay attention underneath.
Other conditions can mask ADHD
ADHD is a commonly co-diagnosed condition with other disorders. Kids who experience anxiety, learning disorders, and autism often end up with a diagnosis of ADHD as well. However, many times, emphasis is placed on the anxiety, learning disorders, and autism while the ADHD goes undiagnosed.
So the answer to our initial question of “Can ADHD present in adulthood,” the short answer is YES!
What do adult ADHD symptoms look like?
Whether or not an individual is diagnosed with ADHD in childhood or not, there are common features associated with adult ADHD. Among these are:
Chronic disorganization
Inconsistent follow-through
Time blindness
Emotional reactivity
Procrastination
Losing track of conversations, tasks, or priorities
In terms of inattention and impulsivity, these can look like:
Inattention
Starting many tasks but finishing few
Forgetting bills, calls, emails, or other daily obligations
Difficulty sustaining focus in meetings or while reading
Losing items such as wallet, keys, and cellphones
Underestimating time and chronically being late
Hyperactivity/impulsivity
Inner restlessness or fidgetiness
Racing thoughts
Talking too fast or interrupting others
Impulse purchases, abrupt decisions, reactive comments
Frequently switching tasks due to boredom
It is important to note here that a diagnosis of ADHD is dependent upon these tendencies happening in multiple areas of life. Just because your job may be boring and you cannot focus while at work does not necessarily mean you have ADHD. These difficulties must also impact you in other areas, such as your home life, in hobbies, or in school.
How do I get evaluated?
If you suspect you may have adult ADHD symptoms, it is important to undergo a thorough evaluation. A comprehensive evaluation for ADHD should include:
1. Extensive interview with a clinician to examine childhood behaviors and tendencies
2. Input from others who may have insight into your emotional and behavioral functioning
3. A full cognitive assessment to identify areas of strength and limitation that are associated with ADHD
4. A specific measure of attention and response control that is often given on computer
5. A self-report measure to confirm or rule out other possible conditions
If you suspect you may experience symptoms of adult ADHD, I encourage you to seek out an evaluation. Even if you were not diagnosed as a child, there are still ample support and treatment options to help manage your symptoms. But the first step is to identify the problem and formulate a specific plan.