If a child has ADHD there's better than a 1 in 2 chance that he or she will continue to have the disorder into adulthood. Impulsivity, restlessness and distractibility can all be present in the adult with ADHD. However, these symptoms sometimes look different than they do in children. In this entry, I want to discuss some of the difficulties in making an ADHD diagnosis in adults.
Before we even begin talking about the nuisances of the diagnosis, one key point to remember is that, very often, people with adult ADHD have another psychiatric disorder. Depression, anxiety, and substance abuse disorders are all very common in these adults. This can make it difficult to tell where the symptoms are coming from, particularly with depression. For example, a person may feel depressed and have concentration problems. Sometimes it's hard to tell whether the concentration problems are a direct result of major depressive disorder or attention deficit hyperactivity disorder. Also, a common side effect of several selective serotonin reuptake inhibitors used to treat depression is akathisia. This is often described by patients as an unpleasant, overwhelming urge to move. So if a person is being treated for depression with an SSRI and they look jittery or have a hard time sitting still, it takes some investigating to find out whether they are experiencing a side effect of the medication or exhibiting a symptom of ADHD.
Another complication in diagnosing adult ADHD is that symptoms become less obvious as a person ages. Frank motor symptoms are much less common in late adolescence than in small children. Adults who have had ADHD most of their lives tend to compensate for the disease one way or another, making overt symptoms even more difficult to identify. There's a tendency in people with this disorder to gravitate away from sedentary work or desk jobs that don't allow much spontaneous movement. A chaotic lifestyle of holding multiple jobs is often seen in adults with ADHD.
All this being said, adult ADHD can be diagnosed, but the symptoms have to be fairly significant and impact the adult's life. As a general rule, the person should be able to report a diagnosis of ADHD from childhood. It's unfortunate, but many adults with ADHD did not get treatment or were not appropriately diagnosed in childhood. Since children of people with ADHD are more likely to have the illness than others, it's not unheard of that an adult recognizes symptoms in themselves after their own children start getting treatment for ADHD. Future blogs can discuss some of the interfamily dynamics of ADHD; however, I am interested in answering any questions you may have about the diagnosis and management of the illness.