Adult ADHD: Diagnosis or Mislabel?

Adult Attention-deficit/hyperactivity disorder (ADHD) is a misnomer, as it implies that ADHD can develop in adulthood. Assessment of ADHD in adults has dramatically increased, as many adults have sought evaluation for the development of Adult ADHD. This is primarily due to the "popularizing" of the diagnosis on social media and television. Other times, individuals have presented for assessment because they have been diagnosed by another provider but failed treatment or changed providers. Sometimes, an assessment is requested because a relative has been diagnosed. Other times, it's because they have struggled with difficulties that don't fit previous diagnoses. Individuals then begin to wonder if ADHD is the explanation for struggles with attention, organization, time management, unfinished projects, forgetfulness, irritability, impulsive spending, etc. However, ADHD is a neurodevelopmental disorder, which means it begins in childhood and is present throughout the lifespan. This means that adults can have ADHD symptoms, but also that inattention and impulsivity that suddenly start in adulthood are not due to an ADHD that has spontaneously "developed." Perhaps a more accurate term, then, is ADHD persisting into adulthood. Previously, ADHD was said to be something that children "grew out of." Recently, practitioners have recognized that ADHD changes and grows as the brain does, and adults have developed strategies to manage the symptoms. As such, someone with ADHD does not "grow out of it" but learns to cope. It has also become increasingly recognized that symptoms in adulthood are different than those in childhood. In children, there is excessive fidgeting and movement, difficulty remaining quiet when needed, losing pencils or paperwork, not turning in completed schoolwork, significant difficulty obtaining grades that match their abilities, etc. In adults, essential items are often misplaced, there is a struggle to organize bills and paperwork and appointments, difficulty staying on track when off a routine, etc. Unfortunately, obtaining a diagnosis of ADHD in adulthood is more complicated than in childhood. There is a great deal of overlap between ADHD and other mental health disorders. Diagnoses such as depression, anxiety, bipolar disorder, obsessive-compulsive disorder, borderline personality disorder, autism, traumatic brain injuries, and multiple concussions have significant overlap, and some are more likely to be present in adults, complicating the clinical picture. Additionally, it is necessary to establish that symptoms were present before age 12, which is typically best done through school records. With the greater time that elapses between graduation and evaluation, obtaining school records becomes more difficult. Furthermore, there is much more research on ADHD that has been diagnosed in childhood. However, an accurate diagnosis is essential, as there can be a variety of adverse outcomes from misdiagnosis. For example, a misdiagnosis of ADHD with stimulant treatment when the correct diagnosis is bipolar disorder can induce manic episodes. Misdiagnosis often occurs when relying solely on a screener, which is meant to cast a wide net but has a high rate of false positives. Instead, a comprehensive assessment is the best practice. This assessment includes administration of psychological measures for cognition and mental health, reviewing educational history, performance-based measures, collateral information collection, and a lifespan interview. Psychologists and medical doctors with psychological assessment training are best suited to provide this type of assessment. If you are concerned about the presence of undiagnosed ADHD that persists into adulthood, it is recommended that you discuss concerns with your doctor to decide if a more comprehensive assessment is appropriate. Your doctor can place a referral for you to obtain a comprehensive assessment. Shay McGuire is a psychologist with the Psychiatric Center of Northwest Ohio.