But what happens when an adult expresses concerns with his or her ability to remain focused, alert, attentive, or engaged? What about adults who have difficulty keeping track of important items, completing tasks at work, sustaining social relationships, or simply remembering important dates?
I would estimate that about 10% of the clients I work with are over the age 18 and present with these particular challenges. Often, the first questions they ask is, “Is this ADHD?”
Can Adults Have ADHD?
The short answer is “yes.” Adults absolutely can have ADHD. However, the nature of adult ADHD is often much different than the symptoms experienced as a child or adolescent. There are many reasons for these differences, including brain maturation and improved compensatory skills. And some adolescents simply outgrow their ADHD symptoms altogether. However, I personally know many adults who exhibit the same ADHD symptoms they did as youngsters.
How Do I Know if it is ADHD?
One of the most important variables when considering a diagnosis for an adult is the client’s history of symptoms. According to the Diagnostic and Statistical Manual of Mental of Mental Disorder (DSM-V), a diagnosis of ADHD can only be made if the individual has exhibited symptoms prior to age 12.
So, when an adult client contacts me to discuss his or her current situation, my first questions is always, “How long has this been a concern.” If the answer is after age 12, then it is important to dig further to determine if indeed symptoms existed prior to age 12. In many cases, particularly in older adults, it is difficult to recall symptomatic behavior that long ago. Consequently, the adult client may gather information from his or her parents or siblings to get a better picture.
Another important factor according to the DSM-V is that symptoms must present in more than one setting. So, if an individual claims that their ADHD symptoms only affect them at work, then it is possible that their behavior is a function of their environment rather than underlying ADHD. Therefore, it is necessary to determine the full extent of the symptoms and in what particular settings they present.
How to Test for Adult ADHD
When considering a diagnosis of ADHD, one must understand the nature of the condition. ADHD is a neurodevelopmental disorder that presents in childhood. Because it is not a structural or physical condition, it can be very difficult to diagnose it with certainty. For instance, if an individual is suspected of having a broken arm, he or she can simply obtain an x-ray to confirm or rule it out. Unfortunately, a diagnosis of ADHD is not that simple. Instead, I like to think of it as a puzzle. My job it to gather all the pieces and put them together to determine if the symptoms are consistent with ADHD or not.
The assessments I administer for adult ADHD are similar to those for children and adolescents. However, mainly due to the age limitations of particular assessments, there are some specific instruments used for adults that help confirm or rule out ADHD. The entire evaluation process for adult ADHD takes approximately 1.5 hours.
Perhaps the most important part of the adult ADHD evaluation is the consultation with the client. This portion takes approximately 20 minutes, and it is a time to gather all the relevant information.
As mentioned above, there are a few key requirements in order for an individual to meet the criteria for a diagnosis of ADHD. Many of these requirements can be determined during the clinical consultation. I also provide a pretty extensive intake form that asks a lot of important questions, including medical history, family history, and school history.
The main component of an adult ADHD evaluation is the cognitive portion. This is essentially an IQ test. The purpose of administering a cognitive assessment is to establish a baseline ability level. Additionally, a cognitive assessment can help rule out or identify other conditions that may mimic ADHD (i.e., low working memory).
A cognitive assessment also allows me a full hour to observe the client’s behavior in real time. During an hour long, highly intensive assessment, I usually get a good idea of one’s attention, focus, and impulsivity. I mainly administer the Wechsler Adult Intelligence Scale (WAIS-IV).
A comprehensive evaluation for ADHD will almost always include some form of computerized assessment. These tests are typically referred to as continuous performance tests. Although there are a few different ones, they all work the same way. Basically, the client sits in front of a computer for 15 minutes and either clicks the mouse or avoids clicking the mouse when certain visual or auditory stimuli are presented on screen.
The purpose of this task is to measure response time to the visual and auditory stimuli and to measure the number of errors in the responses. Both of these tendencies are highly correlated with attention and focus, so it is a useful tool when confirming or ruling out ADHD. The computerized test I prefer is the IVA-2.
Almost all evaluations should include at least one self-report assessment. These measures give excellent insight into the client’s perception of his or her own behavior. There are dozens of self-report measures that look at adult behavior. Some are more comprehensive than others and include symptoms of personality disorders, depression, anxiety, and other psychiatric disorders. The self-report measure I use specifically for adult ADHD is the ASRS V-1.1. It is easy to fill out and easy to interpret.
Conclusion and Diagnosis
Once I have gathered all the information and administered all the assessments mentioned above, I then analyze the quantitative (results of the assessments) and qualitative (observations) data. During this process I try to determine if the client indeed exhibits signs and symptoms consistent with ADHD. If so, then I match that information up with the client’s reported history. If it all checks out, then it is a relatively simple decision to make.
However, if the information does not line up or if there are discrepancies between the quantitative and qualitative results, then it is a harder decision to make regarding a diagnosis of ADHD. It is not unusual for me to request additional information from the client when considering such circumstances. My main goal in the entire evaluation process is to make the best determination based on input from the client and observations and results of his or her evaluation.
The final part of the evaluation is the written report which compiles all the relevant information and data and makes the final determination on a diagnosis. Additionally, the report will also offer recommendations for the client going forward. In situations in which a diagnosis is warranted, then treatment options are typically discussed. For adult who are still in schooling situations, these may include academic accommodations. For non-students and students alike, treatment options may include counseling, behavior modification, and/or medication.
If you or someone you know may be struggling with attention, focus, or impulsivity, you may benefit from an adult ADHD evaluation. Evaluations are efficient and thorough, and you can schedule either in-person or remotely.