U.S. clinicians often lack training in evaluating adult ADHD.
A forthcoming set of national clinical guidelines will finally provide some clarity.
Growing up, Jia Sung struggled in class.
Illustration by Julie Bang for Verywell Health
Those early signs of ADHD were dismissed as laziness or lack of motivation.
Part of me was a little resistant to it.
It took me a couple years of sitting with this possibility to act on it and seek diagnosis.
People with ADHD may refer to themselves as neurodivergent because they think or function differently than most people.
For decades, scientists thought ADHD only affected children, most of whom would outgrow it.
Clinicians now know that the condition often continues into adulthood.
Some 40 countries have adult ADHD diagnostic guidelines, but the U.S. does not.
I didnt get that in med school, so I cant help you.
For one, it wasnt considered a real diagnosis until recently.
“It wasnt until the DSM-IV was published in 1994 that there was mention of ADHD extending into adulthood.
Even then, the criteria werebased on trials that were limited to school-aged children.
Because ADHD is a neurodevelopmental disorder, the current DSM says symptoms must be apparent by age 12.
But Ramsay said that requirement may miss some adolescents.
The way ADHD symptoms appear may changeas an individual matures and their behaviors become ingrained.
Children who were hyperactive in school may become restless and easily bored in work meetings as adults.
Sometimes, mental health professionals get distracted by those other conditions, Jensen said.
There’s a lot of area for misunderstanding, even among healthcare providers.
They might say, How could you have ADHD?
Illustration by Tara Anand and Arif Qazi for Verywell Health
You graduated from law school.
They don’t totally get it, Jensen said.
Thats where the guidelines come in.
Specialists like me cannot treat all of the individuals with adult ADHD.
Its important to get those guidelines right.
Throughout middle school, he had a hard time focusing and often daydreamed more than other kids.
At the time, there was a lot of stigma around ADHD, he added.
Everybody was diagnosing their kids with it.
Doctors were going crazy, giving out Ritalin, or so it seemed.
In his fifth year of college, Solomon was assigned a class project about ADHD medication.
While researching the diagnostic criteria, he realized they described him to a tee.
He then set up a visit with a psychiatrist.
He left that appointment with an Adderall prescription and took his first dose before a two-and-a-half-hour physics lecture.
It was that profound, Solomon said.
Everyone has had a moment where they couldn’t pay attention in class.
That doesn’t necessarily mean that they have ADHD.
ADHD symptoms don’t occur in a vacuum.
They occur in the context of the individual’s life.
For many people, the COVID-19 pandemic forced a life change.
Lockdowns interrupted work and social routines and kept many people at home.
Some students who had always managed to pass their classes started slipping without the routine of going to school.
Some adults who found themselves working at home struggled to remain productive while surrounded by family members and distractions.
The pandemic was a watershed moment, Ramsay said.
With the increased demand for mental health support overall, ADHD specialists became swamped with clients seeking support.
Telehealth companies filled the gap.
Only 11% of the videos were uploaded by healthcare providers.
Videos about first-person experiences got the most likes and views.
Ramsay said that personal story videos tend to be some of the least reliable content.
But theyre attractive to people, he said, because theyre affirming.
Its a connection with somebody, albeit virtually.
Those tests, Ramsay said, give a lot of false positives.
But they also tend to identify many people whodohave ADHD and never before recognized it.
That could lead some people to ask a clinician for a more rigorous diagnostic evaluation.
Why Adult ADHD Guidelines Matter
ADHD has long been understood as a disorder of inattention and hyperactivity.
Ramsay said the diagnostic criteria as it exists now is not wrong, but its incomplete.
One girl is diagnosed with ADHD for every four boys.
In adulthood, the ratio evens out to one to one.
I really thought ADHD was like little boys jumping around.
Theres a backlog of grief around that, Sung said.
A late-in-life diagnosis can conjure mixed emotions about ones sense of identity and relationships.
But theres also something nice about that fluidity and the different lenses of understanding of yourself.
Story edited byDaphne LeeandNicole Kwan.
Art direction by Amelia Manley.
Illustrations by Julie Bang, Tara Anand, and Arif Qazi.
Additional edits bythe anti-bias review boardat Dotdash Meredith.
