If you're a newly diagnosed adult with ADHD or suspect you may have ADHD, then you know what a rollercoaster ride it can be. From battling the "myths" to understanding how the diagnosis will affect your life and identity, there is no denying that living with ADHD can be emotionally and mentally exhausting. However difficult, coming to terms with and accepting a late diagnosis of ADHD can be the beginning of a new chapter. In today's blog post, I'll share some tips about dispelling myths regarding adult ADHD while also providing encouragement for anyone making their way down this path of late discovery.
Navigating and coping with an ADHD diagnosis in adulthood can be a wild ride.
Attention-Deficit/Hyperactivity Disorder (ADHD) often conjures up images of school-age children, particularly boys, who can't sit still. But this couldn't be further from the truth. It's a persistent disorder that extends into adulthood, causing significant challenges in daily life (Kessler et al., 2005). So, let's first debunk the myth that ADHD is confined to childhood while exploring the complex journey toward a late diagnosis in adults.
Misconception of ADHD as a Childhood Disorder
Contrary to popular belief, ADHD is not a condition that simply fades away with childhood. Research indicates the global prevalence of adult ADHD ranges between 2.5% to 6.8%, with a slightly higher preponderance in males than in females (Ahmann et al., 2022; Song et al., 2021). Debate persists in the field regarding whether new diagnoses in adults are invariably late-identified childhood-onset ADHD or, in some cases, might be actual adult-onset ADHD (Hartung et al., 2022). Despite all this, there's a societal stereotype labeling ADHD as a childhood disorder. Sadly, this misperception often leaves adults with untreated ADHD symptoms unaware of the root cause behind their struggles.
Symptoms of Adult ADHD
ADHD in adults often appears somewhat differently than it does in children. For example, while inattention symptoms tend to persist into the adult years, physical hyperactivity usually decreases; however, many adults with ADHD report having racing thoughts or mental restlessness, which is sometimes referred to as "cognitive hyperactivity." Other ADHD traits many adults share include difficulty focusing, impulsivity, general restlessness, and challenges with organization and time management (Asherson et al., 2016).
“I have more thoughts before breakfast than most people have all day.” -unknown
In addition to deficits in attentional areas, cognitive markers of adult ADHD may include reduced processing speeds and difficulties with executive functions, verbal memory (i.e., the ability to recall something written or spoken), language (primarily reading), social cognitive, and arithmetic skills (Onandia-Hinchado et al., 2021). It's also worth noting that high intelligence doesn't safeguard against ADHD. In fact, many individuals with ADHD possess high levels of intelligence but often face significant challenges in utilizing executive functions, which can play a crucial role in achieving success in important life domains. Taken together, symptoms of adult ADHD can significantly impact one's work performance, relationships, daily activities, and self-perception, often leading to feelings of inadequacy and masquerading as a personal failure.
The Journey to Late Diagnosis
The path to late diagnosis can be an uphill journey. Adults with ADHD often find themselves navigating through a maze of confusion, misdiagnosis, and, sometimes, incorrect treatment. The complexity of getting a correct diagnosis can be attributed to factors such as a lack of awareness among some providers, symptoms mimicking other conditions, differences in diagnostic criteria and cultural norms, fear of being stigmatized, variations in symptoms based on gender, etc. Also, conditions like depression and anxiety, often co-occurring with ADHD, might be diagnosed first, leaving the root cause—ADHD—unaddressed (Kooij et al., 2005). Further adding to the diagnostic complexity is that the presentation of ADHD symptoms is multifaceted—symptoms differ from person to person and show considerable individual variation in the contexts in which they are expressed. When an incorrect diagnosis is made, it can lead to mismanagement of symptoms, leave individuals feeling frustrated and hopeless, and bring about a host of unique challenges.
Implications of Late Diagnosis
It's important to understand that receiving a diagnosis later in life can spark a whirlwind of emotions. As many adults with ADHD have been living with unexplained or misdiagnosed symptoms for years, a late ADHD diagnosis can be bitter-sweet. On the one hand, it can feel overwhelming, bewildering, and even isolating. There's often a sense of mourning for the years spent misunderstanding oneself. You might ask yourself, "Why didn't I know this before?" or "Why did I struggle for so long?" The chronic stress and frustration that results from years of untreated or misdiagnosed ADHD can have a very negative impact on self-esteem, as many adults grapple with the shame of underachievement and their inability to self-regulate and follow through with goal-directed behavior.
On the other hand, an ADHD diagnosis can provide relief, explaining long-standing difficulties and leading to more effective coping strategies and improved quality of life (Deberdt et al., 2015). Either way, allowing oneself time to process the diagnosis is essential. Acceptance is key to moving forward from this point, and accepting the past can be a difficult but vital part of that process. Partnering with skilled professionals can support you in reframing past experiences and reassessing your identity. Remember that a diagnosis doesn't define you. With the right support and tools, you can thrive and reach your full potential.
Treatment and Management Strategies for Adult ADHD
When it comes to adult ADHD, there are a variety of treatments to choose from, some based on empirical evidence and some without. Numerous studies have demonstrated the effectiveness of stimulant and non-stimulant medications in treating ADHD in adults (De Crescenzo et al., 2017). It is now thought that the most effective treatment is a multimodal approach (Ahmann et al., 2022). Psychosocial approaches (behavioral therapy or behavior modification), including psychoeducation, cognitive behavior therapy (CBT), support groups, and skills training, are thought to provide additional benefits in managing ADHD.
ADHD Coaching
Increasingly, ADHD coaching is gaining recognition as a valuable stand-alone service and an effective component of multimodal support/intervention (Ahmann et al., 2018). Working with a certified, competent ADHD coach can make a world of difference when navigating the ADHD labyrinth and implementing positive behavior change. A qualitative study from the Netherlands reported that adult participants with ADHD highly valued the optimistic, strength-based, future-oriented, solution-focused ADHD coaching approach versus the deficit-based, symptom-centered intervention they had previously experienced. They felt that the coach-client partnership and person-centered approach, which focuses on the uniqueness of the individual, resulted in greater self-awareness and insight into how they approached life. Ultimately, they felt more hopeful (Schrevel et al., 2016).
Importantly, ADHD coaches support clients in managing executive functions (e.g., time management, planning, prioritizing, juggling multiple tasks, etc.) more effectively, achieving meaningful goals, building self-esteem and competencies, and developing a greater sense of self-efficacy (i.e., feeling "confident" in one's abilities; believing that you have the necessary skills and resources to be successful) and agency (the actual ability to deal with a task or situation, influence your own outcomes, effect change, and make choices in and exercise control over your life). With personalized strategies and ongoing support, an ADHD coach can play a significant role in not only transforming your journey with ADHD but in enhancing your overall life and wellbeing.
A Take-Home Message
While the journey to diagnosing adult ADHD may be complex, understanding and managing this condition can lead to profound life improvements and wellbeing. Let’s wave goodbye to outdated ADHD stereotypes and welcome a future of understanding and acceptance. If you find yourself relating to this post, don’t hesitate to seek help. Remember, in the journey of self-discovery and growth, it’s never too late for a fresh start.
Key Points in this Post
ADHD is not just a childhood disorder; it often extends into adulthood, causing significant challenges. The global prevalence of adult ADHD is estimated between 2.5% and 6.8%.
Adult ADHD symptoms can include difficulty focusing, impulsivity, restlessness, and challenges with organization and time management, significantly impacting life domains such as work, relationships, and daily activities.
A late ADHD diagnosis can be complicated due to a variety of factors, including a lack of awareness among healthcare providers and symptoms that mimic other conditions. Misdiagnoses can lead to mismanagement of symptoms and unique challenges.
Late diagnosis can bring mixed emotions; it can feel overwhelming, but it can also provide relief and lead to more effective coping strategies. Acceptance of the diagnosis is a crucial part of the post-diagnosis process.
The most effective treatment for adult ADHD is a multimodal approach, combining medication, psychotherapies, and other supports like ADHD coaching to boost executive function skills, leverage strengths, and build confidence.
References
Ahmann, E., Saviet, M., Springer Institute, & Maryland University of Integrative Health (2022). Attention-Deficit Hyperactivity Disorder (ADHD) coaching engagement: Manualized intervention (adults, 12-weeks). Licensed under Creative Commons Attribution-NonCommercial 4.0 International License. https://springerinstitute.org/adhd-coaching-engagement-manualized-intervention-adults-12-weeks/
Ahmann, E., Saviet, M., & Tuttle, L. J. (2018). ADHD coaching outcomes: What does the research say? [Chapter 5]. In A. Graham (Ed.), The guide to ADHD coaching. Motivational Press.
Asherson, P., Buitelaar, J., Faraone, S. V., & Rohde, L. A. (2016, June). Adult attention-deficit hyperactivity disorder: Key conceptual issues. The Lancet Psychiatry, 3(6), 568–578. https://doi.org/10.1016/s2215-0366(16)30032-3
Deberdt, W., Thome, J., Lebrec, J., Kraemer, S., Fregenal, I., Ramos-Quiroga, J. A., & Arif, M. (2015, October 13). Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe. BMC Psychiatry, 15(1). https://doi.org/10.1186/s12888-015-0624-5
De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L. (2017, January 20). Pharmacological and non-pharmacological treatment of adults with ADHD: A meta-review. BMJ Ment Health, 20(1), 4-11. https://doi.org/10.1136/eb-2016-102415
Hartung, C. M., Shelton, C. R., Abu-Ramadan, T. M., & Canu, W. H. (2022, September). Proposed Terminology to Distinguish Adult-Onset from Late-Identified ADHD: A Preliminary Effort in a Large Survey of Adults Aged 18 to 80. The ADHD Report, 30(6), 1–10. https://doi.org/10.1521/adhd.2022.30.6.1
Kessler, R. C., Adler, L. A., Barkley, R., Biederman, J., Conners, C. K., Faraone, S. V., Greenhill, L. L., Jaeger, S., Secnik, K., Spencer, T., Üstün, T. B., & Zaslavsky, A. M. (2005, June). Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: Results from the National Comorbidity Survey Replication. Biological Psychiatry, 57(11), 1442–1451. https://doi.org/10.1016/j.biopsych.2005.04.001
Kooij, J. J., Buitelaar, J. K., van den Oord, E. J., Furer, J. W., Rijnders, C. A., & Hodiamont, P. P. (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological medicine, 35(6), 817–827. https://doi.org/10.1017/s003329170400337x
Schrevel, S. J., Dedding, C., & Broerse, J. E. (2016, July 1). Why do adults with ADHD choose strength-based coaching over public mental health care? A qualitative case study from the Netherlands. SAGE Open, 6(3). https://doi.org/10.1177/2158244016662498
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11. https://doi.org/10.7189/jogh.11.04009