ADHD in adults: A guide to recognising symptoms and getting a diagnosis

While it is an extremely common childhood disorder, ADHD can frequently be overlooked or misdiagnosed in adults. Freiraum Psychotherapie looks at how ADHD presents itself in adults, and how it can be diagnosed by a professional. 

ADHD stands for Attention Deficit Hyperactivity Disorder and is one of the most common mental disorders in children and adolescents. In many cases, it persists throughout someone’s life, but in adulthood it can often be overlooked or misdiagnosed, especially if the individual has learned to live with and compensate for the symptoms. 

This article looks at the symptoms associated with ADHD in adults, and how adults can be diagnosed with the disorder by a professional. 

What is ADHD? 

ADHD is a neurobiological disorder characterised by a combination of symptoms related to attention difficulties, hyperactivity, and impulsivity. The features of ADHD can vary in intensity and affect different aspects of daily life. 

The causes of the disorder are not fully understood, but research suggests it is a combination of biological factors and environmental influences. 

How does ADHD manifest in adults?

Motor hyperactivity, such as fidgeting or moving various body parts, tends to decrease over time, making it a less prominent symptom in adults. Nevertheless, adults with ADHD may still experience difficulties with tasks that require prolonged sitting. 

The following symptoms are all typical of ADHD in adulthood:

• Symptoms of inattention
• Easy distractibility
• Difficulty concentrating on specific tasks or conversations
• Forgetfulness
• Symptoms of impulsivity
• Making decisions without considering consequences
• Difficulty exercising restraint or patience
• Impulsively intervening in conversations or activities of others

The effects of ADHD can impact various areas of a person’s life, including their work, social environments, and personal relationships. It can lead to organisational problems, challenges in time management, and task execution. The person’s emotional regulation is also often affected, resulting in mood swings, irritability, and difficulties in managing stress. 

Why is ADHD sometimes not diagnosed until adulthood? 

ADHD is frequently diagnosed in childhood, but for many individuals, the diagnosis remains unrecognised until adulthood. This can be attributed to a variety of different reasons:

Diverse presentation of symptoms

As hyperactive and impulsive behaviours diminish, ADHD symptoms may not be as obvious in adults, leading to under-recognition. 

Individual strategies

Adults with ADHD often develop a number of strategies to compensate for their symptoms and help them to cope better with daily life. This might include things like establishing set routines or choosing occupations that align with their specific ADHD symptoms. 

Confusion with other conditions

ADHD symptoms may be dismissed as "personality traits" or confused with other mental disorders, such as anxiety disorders or depression. There are also factors that impact childhood diagnoses and, consequently, influence adult diagnostics.

Resources and socioeconomic background

The individual’s environment and access to resources also play a crucial role. Better access to medical care or individual support can help the individual to address the disorder and its consequences early on. Without these resources, ADHD may go undetected and might be diagnosed late or not at all. 

Gender differences

ADHD is diagnosed more frequently in boys than in girls. This discrepancy may be due to the expression of symptoms, as females tend to exhibit more internal and inattentive symptoms, while males often display hyperactive and impulsive symptoms. The societal perception of internal symptoms contributes to this under-recognition and lack of treatment. Even large studies, such as the Updated European Consensus Statement on diagnosis and treatment of adult ADHD, emphasise the need for further research into gender differences. 

Diagnostic procedures for ADHD in adults

When considering whether an ADHD diagnosis is correct for someone or not, a trained professional would take the following steps:

Medical history

For an ADHD diagnosis, medical history plays a crucial role. Psychotherapists will extensively discuss your symptoms, developmental history, and potential family predispositions. It is important to be honest and open about your experiences to enable an accurate diagnosis. 

Structured interview

Usually, the therapists use a structured interview, for example the DIVA, to evaluate your symptoms and see how they align with those typical for someone with ADHD.

Medical history from a third party

Members of your family or close friends will also be interviewed or asked to fill out questionnaires providing an external assessment of your symptoms. Their responses will be put together with your own testimonial and life history to inform the diagnosis.  

Consultation report from a physician

In order to rule out any connection between the symptoms and organic correlates or other conditions, a mental health professional would also ask for a consultation report from a physician.

Questionnaires and self-assessment tests

Questionnaires and self-assessment tests are useful tools to precisely assess ADHD symptoms and their impact. There are questionnaires specifically tailored to ADHD in adults, such as the ADHD Self-Report Scale (ASRS). These instruments help understand your self-perception and daily challenges, providing practitioners with information for potential treatment approaches.

Neuropsychological tests

Neuropsychological tests can offer additional insights into cognitive functions and attention processes. Specific test procedures can be used to examine attention, concentration, memory, and processing speed. However, these tests are not standard and are conducted only under certain circumstances. 

Differential diagnosis

To make an accurate diagnosis, it is crucial to rule out other possible causes for the symptoms. A careful differential diagnosis ensures that no other mental disorders or physical conditions with similar symptoms as ADHD are present. It also verifies that the symptoms are not caused by medication or substance use. 

The importance of consulting a professional

If you suspect that you might have ADHD, or you are concerned about any of your symptoms, it is crucial that you consult a trained specialist, who can navigate the complexities of ADHD symptoms and distinguish them from those caused by other mental health conditions. 

Only a specialist will be able to accurately diagnose ADHD and offer you a tailored treatment plan to help you better manage your symptoms. 

Freiraum Psychotherapy, based in Berlin, offers Testing and Diagnostics for ADHD and ADD in adults, in English. You can make an appointment or get in touch with the team via their website.