Insights into Adult ADHD: From Recognition to Diagnosis

Throughout my clinical practice spanning the last ten years, I’ve observed a recurring pattern among adults who suspect they may have attention deficit hyperactivity disorder (ADHD), but they did not go further for professional assessments and/or get appropriate treatments. The barriers to not getting the assessment or treatments could include misconceptions about ADHD in adults, hectic schedules, limited availability of ADHD specialists in their regions, potential financial constraints associated with assessments or treatments, and the enduring stigma linked to ADHD diagnoses.

Due to these barriers, it’s common for these individuals to delay seeking assessments and treatments, often enduring years of grappling with challenges stemming from or exacerbated by ADHD conditions. These difficulties may manifest in various aspects of their lives, leading to consequences such as job terminations, school suspensions, relationship breakdowns, declining health, sleep disturbances, and prolonged experiences of anxiety and depression.

Additionally, many adults come for treatment later in life, having been diagnosed decades earlier but never receiving adequate or timely intervention.

According to the American Psychiatric Association, ADHD affects about 8.4% of children and 2.5% of adults. Undiagnosed and/or untreated ADHD can present as biological, psychological and environmental factors that interfere with many aspects of a person’s daily life, including their relationships.

ADULT ADHD Presentations 

The “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” notes three different ADHD presentations:

  • Predominantly Inattentive
  • Predominantly Hyperactive-Impulsive
  • Combined

To receive a diagnosis of ADHD, an adult must exhibit at least five of the symptoms associated with a particular type for at least six months. Adults with combined ADHD exhibit at least five symptoms of each of the other types. In addition, multiple symptoms must have been present before the age of 12 years.

ADHD must also negatively impact multiple areas of a person’s life socially, occupationally, relationally and academically, not just one. Getting a proper diagnosis is the first step to getting treatment. 

The presentations of ADHD symptoms in daily life could include the following:

1) Disorganisation
2) Relationship concerns
3) Time management concerns
4) Lack of focus or hyperfocus
5) Anxiety & restlessness
6) Emotional concerns
7) Forgetfulness
8) Negative self-image and self-esteem
9) Physical health concerns
10) Impulsivity
11) Sleep disturbance
12) Fatigue
13) Lack of motivation
14) Substance misuse

Adult ADHD profiles may look like this:

Billy is a corporate executive with great ideas and communication with his team. Still, he is always late getting reports or interviews done, and he is always forgetful with the deadlines and details.

 Jessie is a stay-at-home mother who is frantically running around all day long. When her husband comes home after work, the house is a mess, and she hasn’t even started her dinner yet.

 Emma is a great teacher in school, but it takes her forever to grade her assignments and test, and she works late every day to get things done. She is mentally drained and feels tired.

 Tom is a husband who has to stay late for work because that’s the time he can focus when everybody leaves the office. His wife complains about him not spending time with the kids, and their marriage starts to deteriorate because he is always at work.

In fact, they are functioning adults, but they have difficulty getting things done. Perfectionism can also be an issue because they want to avoid the shame of not getting things done and letting people down. But this leads to self-doubt and overwhelming feelings, so the vicious cycle continues.

Adult ADHD Assessments At IMC

There’s no one specific test designed to diagnose ADHD in everyone. Instead, we use comprehensive evaluation and multiple screenings necessary to diagnose ADHD. It typically involves at least two detailed clinical interviews with a psychologist in combination with assessment tools to rule out similar conditions. As many as 80% of people with ADHD have at least one coexisting condition, the most common being depression, anxiety, and bipolar disorder.

Your psychologist may also ask to interview close family members or others who know you well. This part of the diagnosis process helps your healthcare practitioner get extra details and corroborate your answers.

Medical Examination

You may be given a medical examination if you haven’t had one recently. This exam can help your healthcare practitioner rule out other conditions that may cause symptoms that mimic ADHD symptoms, such as thyroid problems.

ADHD also can produce different symptoms in different people. If you think you may have ADHD, it’s important to visit a trained healthcare practitioner for a proper diagnosis.

Can I go for self-diagnosing with online surveys?

You can find many online surveys for self-diagnosis of ADHD. However, mental health experts strongly discourage using these surveys to self-diagnose since most tests aren’t scientifically validated. A formal diagnosis can only come from qualified and licensed professionals.

Understanding ADHD and its various presentations is crucial for adults seeking clarity about their mental health. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), defines three distinct ADHD presentations: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined. Diagnosing ADHD is a critical first step toward effective treatment. ADHD assessments also aim to rule out similar conditions and coexisting disorders, recognising that ADHD often coexists with depression and anxiety.

Dr Felice Soo

Clinic Psychologist

Felice has worked as a clinical psychologist at international outpatient clinics in Shanghai (private hospitals and clinics) since 2017 with the expatriate community and local residents. She has been working with patients grappling with various medical conditions, including cancer, pain management, sleep problems and heart issues, alongside addressing a spectrum of psychological disorders, such as psychosomatic disorders, eating disorders, panic disorders, obsessive-compulsive disorders, and bipolar disorder.

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