An in-depth analysis of Adult ADHD: part 1

ADHD is a condition which is omnipresent in society, although people often associate it with children only. However, ADHD can also affect adults and be diagnosed at any stage of life. In the first article of a two-part series, leading consultant general adult and liaison psychiatrist Dr Nick Walsh explains the condition, including why ADHD may remain undiagnosed until adulthood.

Why might ADHD remain undiagnosed until adulthood?

There are a number of reasons that ADHD might not be diagnosed until adulthood. Firstly, it may not be recognised by the adults around a child. Family members or teachers at school would be the most obvious people who would notice signs of ADHD or arrange for the child to be assessed.

They may not understand ADHD or be aware of it, or the case may be that the symptoms of ADHD in the child are not particularly obvious or don't cause much impact in childhood, and it's not until adulthood that their symptoms become more apparent. That can be for a number of reasons, but generally, as we get older, life becomes more difficult and we have to be more self-reliant, whereas children get a lot of support from teachers and parents.

As you get older as a child, you get less support, you're more independent and so ADHD tends to become more obvious for some people as they get a bit older, including in adulthood. People can be diagnosed with ADHD at any stage of life. Commonly, difficulties occur in higher education or in the transition from education to employment, because these are periods where things get particularly more difficult and people are more reliant on themselves to organise things and get things done.

It can also can happen as people get to more senior positions in their career, as that gets more demanding, or their life in general gets more demanding with family and work. For women, perimenopause, alongside causing worsening of mood and of memory, may also cause anxiety and mood problems, which can actually unmask ADHD that was there but had gone unnoticed.

What are the main features of ADHD profiling adults?

ADHD stands for attention deficit hyperactivity disorder. The core symptoms of ADHD are divided into difficulties with attention and difficulties with hyperactivity or impulsivity.

There are also subtypes of ADHD; either difficulty with attention or difficulty with hyperactivity and impulsivity, or a combined type.

The core difficulties with attention include:

• Struggling to concentrate on things which are not very interesting.
• Getting easily distracted.
• Putting off or delaying boring or repetitive tasks.
• Being forgetful.
• Needing lots of reminders.
• Losing things around the house.
• Leaving things behind in places.
• Being generally messy and disorganised.

The symptoms of hyperactivity and impulsivity are:

• Being restless.
• Being fidgety.
• Being impatient.
• Tending to interrupt people, or interfere with what other people are doing.

These are the core symptoms, however, people with ADHD often have other difficulties, such as disturbed sleep patterns. It is also common for people with ADHD to have anxiety or mood problems.

Furthermore, due to impulsivity, they may have some difficulty in planning things, are more likely to binge on food, alcohol, or drugs and have difficulty managing their finances.

ADHD affects all areas of life and relationships; it’s not just the core difficulties with attention and restlessness.  

How is the condition detected and diagnosed by a professional?

An ADHD assessment is performed by a clinical assessor. This means that you spend time with the professional and they will ask lots of questions, and get as much information as they can. Often people will start by going to talk to their GP (although that isn't always necessary) and following this, they'll be referred to or make their own appointment with a specialist.

At the appointment, the specialist will begin with a detailed general mental health assessment to discover if there is any other physical or mental health condition that might explain the difficulties that the person has. Following this, they will do a specific assessment for ADHD, which involves obtaining information not just from the person, but also from an informant who's known them well in adulthood.

In ideal circumstances, we would also get an informant who has known the person well in childhood, ideally a parent. Information from school reports can also be useful. There are some additional specific tests which can be done, but in general, the process involves a very detailed discussion with a specialist, who will use a structured assessment, to rate the symptoms and gather all the information together.

There are also some validated screening tests, which can indicate whether ADHD is likely. These are short questionnaires that people often complete online, which can indicate whether a full assessment is beneficial.

One of the most commonly used assessments is called ASRS. When we do a screen for ADHD it's also good practice to screen for ASD (autism spectrum disorder) because these two conditions are both types of neurodiversity and they're more commonly found together.

If you are an adult who has or suspects that you have ADHD and would like to discuss this further with Dr Walsh, do not hesitate to book an appointment by visiting his Top Doctors profile today.