“Some people with adult ADHD have a tapestry of difficulties so severe they end relationships and jobs, cause driving difficulties, and lead to legal and financial problems,” explains J. Russell Ramsay, PhD, the codirector of the Adult ADHD Treatment and Research Program and an associate professor of psychology in psychiatry at the University of Pennsylvania in Philadelphia. According to the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), 18 symptoms could indicate that you have ADHD. There are two groups of symptoms: inattention, with nine symptoms; and a combined hyperactive and impulsive group, with six hyperactive and three impulsive behaviors. The 18 symptoms are as follows:
Inattention
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activitiesOften has trouble holding attention on tasks or play activitiesOften does not seem to listen when spoken to directlyOften does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, gets sidetracked)Often has trouble organizing tasks and activitiesOften avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)Is often easily distractedIs often forgetful in daily activities
Hyperactivity and Impulsivity
Often fidgets with or taps hands or feet, or squirms in seatOften leaves seat in situations when remaining seated is expectedOften runs about or climbs in situations when it is not appropriate (adolescents or adults may be limited to feeling restless)Is often unable to play or take part in leisure activities quietlyIs often on the go, acting as if driven by a motorOften talks excessivelyOften blurts out an answer before a question has been completedOften has trouble waiting their turnOften interrupts or intrudes on others (e.g., butts into conversations or games)
Individuals 17 years old or older require five out of nine symptoms in one group and/or the other to confirm a diagnosis of ADHD, says Dr. Adler. In addition, a number of symptoms that go along with ADHD but are not in the diagnostic criteria are also important and can be quite impairing, he adds. “These include executive function deficits and trouble with organization, prioritization, planning, procrastination, and time management,” he explains. There are two types of adult ADHD: adult onset and adult presentation. A minority of people have adult onset ADHD, but it’s not common, says Adler. The majority of cases have some symptoms that go back to childhood. “Most high-functioning adults that come into my office were not diagnosed in childhood. They’ve gotten by, and are bright and found a way to get around symptoms until life became more complex,” he explains. If you have trouble being patient with your kids, feel like you can’t stay on top of everything, can’t seem to get to anything on time, lack the motivation to get things done, have a child with ADHD and see some of your own personality traits in the child, or remember having trouble concentrating and studying in high school or college, these could all be potential consequences of having untreated ADHD, says Adler.
Who You Should Talk To: What Doctors and Specialists Help Diagnose ADHD in Adults
Adler recommends visiting the website ADHD in Adults and taking the six-question ADHD screener. You can bring it to your regular primary care doctor, and they can score it for you. A psychologist, psychiatrist, neurologist, or nurse practitioner could also do it for you, he adds.
How to Talk to Your Doctor About ADHD
Although ADHD cannot be cured, it can be treated. “In most cases, people wait too long to bring their ADHD symptoms up to their physicians," says Ramsay. His suggestion: “Trust yourself enough and err on the side of bringing it up.” People with ADHD symptoms may hesitate to mention their worries about the condition to their doctor because they fear they’ll be labeled a hypochondriac. Ramsay points out that although ADHD is underrecognized in the medical community, he doesn’t deny that the popular claim that ADHD is overdiagnosed has some merit. “The real problem is actually misdiagnosis, not overdiagnosis,” he says. “There’s an overdiagnosis of ADHD in people who want to take medication to enhance their academic performance but an underdiagnosis of ADHD in people who truly have it.” Once you’ve made the decision to discuss your ADHD symptoms with your doctor, it’s good to have a plan for how you will address the issue. Here are some suggestions on how to talk to your doctor about ADHD.
Step 1: Don’t Worry About Your Doctor Labeling You
Put away your fears about being labeled a hypochondriac. Trust your instincts if you think you have the condition or have had it for a long time.
Step 2: Make a Specific Appointment to Discuss Your ADHD Symptoms
State ADHD as your reason for seeing the doctor when you make your appointment. Don’t just bring it up at the end of an appointment for something else. Instead, make an appointment specifically to discuss ADHD.
Step 3: Explain Your Symptoms of ADHD With Real-Life Examples
Discuss your ADHD symptoms with your doctor and give examples of how they interfere with your daily life.
Step 4: Be Honest With Your Doctor If You’ve Tried Someone Else’s ADHD Medication
If you’ve self-diagnosed ADHD and tried medication (such as your child’s ADHD medication), tell your doctor. Although it’s never a good idea to take medication that hasn’t been prescribed to you by your doctor, it’s important to be honest, and it may even be useful for a proper prescription.
Questions to Ask Your Doctor About ADHD
Do You Only Prescribe Adderall for ADHD, or Are There Other Medication Options for Treatment Available?
Once you confirm a diagnosis of ADHD, you can use medicine or one of the psychosocial treatments, mostly cognitive behavioral therapy. “Most commonly for adults, medication plays a role, but cognitive behavioral therapy is quite helpful,” says Adler. Adderall (amphetamine and dextroamphetamine) is only one of the many medications for ADHD, and it should not be the only one used for adults, he notes. Currently for adults, there is one approved nonstimulant, Strattera (atomoxetine), and five approved sustained-release stimulants — two of which are Ritalin-based (methylphenidate) and three that are amphetamine-based (including Adderall). “Treatment plans are made in partnership with your doctor to find the right medications that are the best fit for you,” explains Adler. Healthy lifestyle modifications can also be beneficial. Adler says that people with ADHD can benefit from a balanced, healthy diet; adequate hydration; getting enough sleep; and moderating caffeine if you’re on medication. Some mindfulness therapies can be quite helpful in terms of relaxation techniques, he adds.
How Can I Best Keep Track of My Progress With ADHD?
You can track your ADHD symptoms by scaling the 18-item self-report checklist that is an extension of the ADHD screener. “You can do this before treatment and repeat during your treatment to see where you’re at,” says Adler. If treatment is effective, you would want to see at least a 30 percent improvement in your overall symptoms, he notes.
Can ADHD Get Worse As I Age?
ADHD doesn’t occur in a vacuum, explains Adler, and symptoms will change and flux over time. “For women, menopause can sometimes worsen ADHD,” he says. “Sometimes life changes, such as moving from a more structured to a less structured job, or being promoted and needing to manage others, will have an effect on ADHD symptoms. Or having a child diagnosed with ADHD and recognizing your own symptoms.” For older adults with ADHD, the symptoms and presentation are slightly different, but there’s not a huge amount of literature on the topic, Adler notes. “With retirement, there is less structure, and symptoms may come forward. There is a small amount of literature showing that hyperactive-impulsive behavior may come forward again as people age. But you have to make sure it’s ADHD and not another cognitive disorder.” If you’re not sure whether you have ADHD or another condition, talk to your doctor. “I think if individuals are worried that they have ADHD, they should make an appointment with their doctor and get evaluated,” says Adler. Additional reporting by Jennifer D’Angelo Friedman.
