Adult ADHD (Part 1): Diagnosis

ADHD (attention deficit hyperactivity disorder) is a behavioural disorder characterised by a pattern of symptoms that affect daily function. Although symptoms of ADHD are usually recognised early, some people may not get an ADHD diagnosis until adulthood.

Dr Richard Bowskill is a renowned consultant psychiatrist who specialises in the assessment and treatment of ADHD, and other mental health conditions such as depression. In the first of a two-part series of articles on adult ADHD, Dr Bowskill offers a comprehensive insight into how ADHD affects adults and why ADHD is sometimes diagnosed during adulthood.

What is ADHD? How can it affect adults?

ADHD is a neurodevelopmental condition that primarily affects people’s ability to concentrate and focus.

Sometimes, concentration and focus can become overly fixated (hyper focused), but usually, the difficulty lies with the ability to sustain focus and concentration for long periods of time. People who have ADHD are often very distractable - occasionally, dreamy - and have trouble focusing on their work.

The other group of symptoms that occur with ADHD are hyperactivity and impulsivity. Hyperactivity can lead to restlessness and the inability to switch off at night-time, known as a sleep disturbance. Impulsivity, which refers to not thinking things through before acting upon them, can lead to all types of difficulties.

Thus, there are two broad types of ADHD: one that affects attention and focus, and another one that affects hyperactivity and impulsivity. Mood swings often come along with ADHD, as well.

Evidence with scans and EG tests have shown that the frontal lobes (which are the areas of the brain involved in focus and concentration) seem to be underactive, and that the part of the brain involved in the perception of pleasure also seems to be underactive. As a result, in people who have ADHD, the brain appears to be less reactive to stimulation, which might explain why people who have ADHD sometimes get involved in impulsive and reckless types of behaviour – to get that hit of dopamine (pleasure).

There is also a genetic component with ADHD, and often, the condition presents in childhood. At other times, however, ADHD becomes more apparent when people’s circumstances change. For example, some people who have ADHD can manage when they are at school and there is a lot of structure to their day and to their learning, but can later find it hard to cope when they are at university and are faced with flexible schedules and independent learning. Similarly, some people who have ADHD can notice the signs of the condition when they are at work, where sustained concentration and focus are required.

Why do some people only receive a diagnosis of ADHD in adulthood or later in life?

The main issue is that sometimes ADHD is less apparent in childhood, because a high IQ and the use of compensation learning techniques at school can mask the features of the condition.

The signs of hyperactivity and impulsivity are also less evident in girls and women; it is more the distraction, the dreaminess, the foggy brain, and the lack of focus and concentration that are present and sometimes not identified.

In addition, the presence of coexisting mental health conditions is a factor. About 70 per cent of people who have ADHD also have another mental health condition – often, depression and anxiety – that coexists with ADHD. Sometimes, these conditions end up being the focus and thus, ADHD is missed.

Another common reason why this might occur is if there are other issues happening at the same time. For example, if people are drinking alcohol or taking substances, then this can sometimes mask symptoms and distract from the actual diagnosis of ADHD.

Obviously, awareness is quite important, as well. People who are now in their 50s and 60s were much less aware of ADHD as a condition when they were younger.

Why is an ADHD diagnosis important?

ADHD often underpins other mental health conditions. If people have depression and anxiety that is not responding to standard treatments such as SSRI (selective serotonin reuptake inhibitors), antidepressants or psychological treatment, then sometimes this is because ADHD is present and needs to be treated first to enable the other conditions to be treated after.

Generally, people find it quite relieving to get a diagnosis of ADHD, because in childhood, they might have been branded as misbehaving, distracted, or lazy, which can all affect self-esteem.

Sometimes, there is an associated problem involved with being very sensitive about rejection. People who have ADHD frequently end up being people-pleasers or being very sensitive to rejection, and this can affect relationships as well as functioning in education.

ADHD can have a major impact on people’s self-esteem and abilities to function in social settings like school/university and in the workplace. Successful treatment can greatly improve people's functioning.

Head on over to the second part of this series of articles on adult ADHD to find out about the symptoms and treatment of ADHD in adults.

If you have been living with symptoms of ADHD, do not hesitate to reach out to Dr Bowskill to receive expert assessment and treatment.