Females are more likely than males to have complex presentations of ADHD, potentially leading to delayed diagnosis and treatment, according to new research published in the Journal of Attention Disorders. The study found that females with ADHD are more likely than males to have inattentive ADHD, are diagnosed at older ages, and have higher rates of anxiety and depression diagnoses both before and after their ADHD diagnoses. ¹

The retrospective observational study was conducted using data from four U.S. health databases. The researchers sought to explore the relationship between sex as well as ADHD subtype and diagnosis timing. They also hoped to assess whether receiving an ADHD diagnosis had an impact on pre-existing diagnoses of depression and anxiety in women and girls, who receive treatment for these comorbidities at higher numbers.

Age of ADHD Diagnosis Rates by Sex and Subtype

The study revealed:

• The average age of ADHD diagnosis by gender:
  • Females:16 to 29 years
  • Males: 11 to 23 years
• Across both sexes, the average age of diagnosis by ADHD type:
  • Inattentive Type: 17 years to 27 years
  • Hyperactive impulsive Type: 10 years to 20 years
• Females were substantially more likely than males to be diagnosed with inattentive ADHD

How Mood Disorders Fit Into the Diagnostic Picture

• Females were twice as likely as males to have depression or anxiety diagnoses and treatments in the year before their ADHD diagnosis.
• Females were more likely than males to receive new diagnoses or treatments for depression or anxiety in the year following an ADHD diagnosis.
• The number of females with pre-existing depression or anxiety diagnoses with symptoms that did not continue after their ADHD diagnosis was higher than the number of males. In these cases, ADHD may have been misdiagnosed as anxiety or depression.
• Patients with inattentive ADHD were more likely to receive a prior diagnosis of depression or anxiety:
  • Inattentive ADHD: 13% to 18% (depression) and 17% to 26% (anxiety)
  • Hyperactive impulsive ADHD: 5% to 12% (depression) and 9% to 20% (anxiety)

Repercussions of Delayed Diagnosis

The study’s finding that females are diagnosed five years later than males, on average, together with other key data points lead researchers to conclude that diagnoses in females tend to occur “only once ADHD symptoms become more severe,” and underscores the importance of addressing this gap in health equity.

The consequences of undiagnosed ADHD are dire, especially for women.

“Women who live undiagnosed until adulthood experience significant negative outcomes in the areas of self-esteem, social interaction, and psychosocial wellbeing beginning in childhood and continuing into adulthood,” concluded the authors of a systematic review of research published in March 2023. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD.” ²

A female ADDitude reader explains the lived experience of late diagnosis this way: “I have lived with the misleading belief that I was a loser, lazy, incompetent. What are the long-term impacts of these self-defeating beliefs?”

The Complicating Presence of Mood Disorders

The connection between ADHD and mood disorders, including depression, is well-established. According to a recent study in BMJ Mental Health: ³

• People with ADHD are 9% more likely to have MDD
• An MDD diagnosis increases the risk for ADHD by 76%

These findings are echoed in the responses to a recent ADDitude survey of 6,810 adults, which found that 72% reported having anxiety and 62% having reported depression.

In addition to the over-representation of mood disorders among individuals with ADHD, previous research has documented that women in general are twice as likely as men to suffer from MDD and General Anxiety Disorder (GAD).

While rates of mood disorders are unequivocally higher among women with ADHD than either men with ADHD or women without the condition, the new study lends credence to what many women have reported anecdotally: They are also more likely than men to have ADHD initially misdiagnosed as depression or anxiety.

“Because of stigma and thoughts related to gender role presentations, when females do present with ADHD symptoms, it can be thought that it’s more likely due to anxiety or depression, because those are presentations that people are used to seeing in females early on,” explained Dave Anderson, Ph.D., in the ADDitude webinar “ADHD Then and Now: How Our Understanding Has Evolved.” “So, people say, ‘She’s distracted because she’s anxious or sad,’ not because she has ADHD. That’s something that we’re actively trying to fight, even in clinician bias.”

The new study, and research like it, helps shed light on the unique toll exacted on women by ADHD. More investigation is desperately needed, explains Dawn K. Brown, M.D., in the ADDitude article, We Demand Attention! A Call for Greater Research on Women with ADHD.

“Further research regarding these topics is indeed crucial,” Brown explains. “By conducting in-depth investigations into the gender-specific nuances of ADHD presentation and impact, healthcare professionals, policymakers, and advocates can promote greater awareness, understanding, and tailored support for women with ADHD.”

Read on to learn about the Top 10 research priorities detailed in ADDitude’s groundbreaking, cross-platform initiative : We Demand Attention! A Call to Action for Greater Research on Women with ADHD.

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹  Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241251738

²  Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645-657. https://doi.org/10.1177/10870547231161533

³  Meisinger, C. & Freuer, D., (2023) Understanding the Causal Relationships of Attention Deficit/Hyperactivity Disorder with Mental Disorders and Suicide Attempt: A Network Mendelian Randomisation Study. BMJ Mental Health. doi.org/10.1136/bmjment-2022-300642

By Russell Barkley, Ph.D.

DSM-5 ADHD criteria are flawed for several reasons. “The DSM-5 does not capture ADHD accurately because its criteria do not conceptualize ADHD as a disorder of executive functioning and self-regulation,” says Russell Barkley, Ph.D. “This limitation greatly narrows the concept of ADHD, trivializes its nature as just an attention deficit, and discourages diagnosing clinicians from focusing on the wider range of impairments inherent in ADHD.”

Despite these flaws, Barkley explains, clinicians can ensure more accurate diagnoses by focusing more on the patient’s symptoms of disinhibition and executive dysfunction and less on the age of onset for ADHD symptoms.

Continue reading “How the DSM-5 Fails People with ADHD — and a Better Way to Diagnose”

DSM-5 ADHD Criteria Challenged: Related Resources

• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Read: Why We Need U.S. Guidelines for Adults with ADHD
• Read: What do I need to understand about ADHD that is not fully represented in the DSM?
• Download: How Is ADHD Diagnosed?

2. Deciphering Irritability in Children: Causes and Links to Comorbidities

By William French, M.D., DFAACAP

“Irritability is to mental health providers what fevers are to pediatricians,” says William French, M.D., DFAACAP. “Just as a fever is a core symptom of numerous illnesses and infections, irritability is a core symptom of many mental conditions.” In this guide, French outlines possible causes of irritability and provides a detailed overview of conditions such as DMDD, ODD, ADHD, and bipolar disorder. He analyzes emerging research on treatment approaches and interventions.

Continue reading “Deciphering Irritability in Children: Causes and Links to Comorbidities”

Irritability in Children: Related Resources

• Read: The ADHD-Anger Connection
• Read: Top Emotion Regulation Difficulties for Youth with ADHD
• Self-Test: Could Your Child Have DMDD?
• Read: The Parents’ Guide to Dismantling Oppositional, Defiant Behavior

3. Treatments for Depression and ADHD: New and Forthcoming Approaches

By Nelson M. Handal, M.D., DFAPA

Rising rates of depression — a condition that often accompanies ADHD — have attracted well-deserved concern and attention. Here, Nelson M. Handal, M.D., DFAPA, reviews what we know about major depressive disorder (MDD) and ADHD, combs through the latest treatment options for depression, and touches on alternative approaches for managing depression. “The field of depression treatment is making huge advances,” Handal says, referencing psychedelics, Spravato nasal spray, Zurzuvae (zuranolone), a rapid-acting oral treatment that was approved to treat postpartum depression, and others promising treatments for MDD.

Continue reading “Treatments for Depression and ADHD: New and Forthcoming Approaches”

Treatments for Depression: Related Resources

• Read: The ADHD – Depression Link
• Read: What to Expect When You Start Depression Medication
• Download: The Facts About Major Depressive Disorder in Women
• Read: How Undiagnosed ADHD Triggers Depression and Anxiety

4. Differential Diagnosis of Bipolar and ADHD: Taking a Phenomenological Approach

By David W. Goodman, M.D., LFAPA

A thorough and accurate diagnosis is critical before treating bipolar disorder, ADHD, or the two together. However, high rates of comorbidity and a constellation of overlapping symptoms make the task of distinguishing between bipolar disorder and ADHD especially challenging. David W. Goodman, M.D., LFAPA, explains how clinicians can differentiate between the two conditions.

“To arrive at an accurate differential diagnosis, a clinician must carefully consider family psychiatric history and dial into the patient’s phenomenological experience. The latter focuses on specific symptoms and qualitative nature,” he says. “For example, there is a qualitative difference between a tension headache and a migraine headache, even though both are headaches. The same difference can be seen in sadness vs depression — a qualitative difference in the psychological experience.”

Continue reading “Differential Diagnosis of Bipolar and ADHD: Taking a Phenomenological Approach”

Bipolar Disorder and ADHD: Related Resources

• Download: Solving the Bipolar and ADHD Puzzle
• Read: How to Distinguish ADHD’s Rejection Sensitive Dysphoria (RSD) from Bipolar Disorder
• Read: The Physicians’ Guide for Distinguishing Bipolar Disorder and ADHD
• Self-Test: Bipolar Disorder in Adults

5. Prenatal and Early Life Risk Factors of ADHD: What Research Says — and What Parents Can Do

By Joel Nigg, Ph.D.

Is ADHD caused by birth trauma? Do prenatal complications like maternal obesity or hypertension increase a child’s risk for ADHD? What role do prenatal and postnatal exposures to substances, such as alcohol and smoking, play in the development of ADHD? Joel Nigg, Ph.D., explores the answers to these difficult-to-answer questions and provides an overview of the latest research and steps parents can take to protect their child’s health. “Exposure to risk factors does not guarantee ADHD, and early and effective treatment approaches can often mitigate the effects of previous complications and improve outcomes,” he says.

Continue reading “Prenatal and Early Life Risk Factors of ADHD: What Research Says — and What Parents Can Do”

What Causes ADHD? Related Resources

• Read: Epigenetics and ADHD: The Impacts of Environment, Lifestyle, and Stress
• Download: Free Guide to Hormones & ADHD in Women
• Read: Treating for Two: ADHD Meds in Pregnancy
• Watch: The Unspoken Truths of Postpartum Depression: Help for Women with and Without ADHD

6. The Future of ADHD Research Looks Like This

By Peter Jensen, M.D.

While no one can predict the scientific discoveries that lie ahead, three research areas are especially promising for improving our understanding of ADHD: neuroimaging, genetic research, and non-pharmacologic interventions, like transcranial magnetic stimulation and attention training. Here, Peter Jensen, M.D., describes these key three areas of ADHD research.

“As we discover more specific gene and brain developmental pathways, we should expect to find that different and precise interventions work for different ADHD subtypes, depending on the individual’s particular gene-environment mix and how factors unfold over time,” he says.

Continue reading “The Future of ADHD Research Looks Like This”

ADHD Research Updates: Related Resources

• Download:  Health & Fitness Lifestyle Changes for Adults with ADHD
• Read: The Evolution of ADHD: Examining the Last 25 Years — and the Future
• Watch: ADHD Then and Now: How Our Understanding Has Evolved
• Read: Beyond Genes: Leveraging Sleep, Exercise, and Nutrition to Improve ADHD

7. Sobering Advice: How to Treat ADHD Alongside SUD

By Timothy Wilens, M.D.

ADHD medications — both stimulants and non-stimulants — may be used to treat patients with comorbid substance use disorder and typically improve outcomes for patients with both conditions. “Unfortunately, many patients who have an active SUD (or even a past history of substance use issues) are either not diagnosed with ADHD or, even with a diagnosis, they are denied medication and appropriate treatment for their co-occurring ADHD due to overstated and misplaced fears, bias, and misinformation,” says Timothy Wilens, M.D. “In other words, far too many clinicians discriminate against patients with comorbid ADHD and SUDs.” Here, Wilens examines the role ADHD medications play in SUD treatment and suggests steps to curtail prescription misuse.

Continue reading “Sobering Advice: How to Treat ADHD Alongside SUD”

Substance Use Treatment with ADHD: Related Resources

• Read:  The ADHD & Addiction Link — Addictive Behaviors in Adults Explained
• Read: Does Stimulant Medication Cause Drug Dependence?
• Self-Test: Could You Have a Substance Use Disorder?
• Read: 5 Key Facts About Substance Use Disorders

8. First-Ever Adult ADHD Guidelines Forthcoming

By Carole Fleck

ADHD diagnoses among adults are growing faster than ever in the U.S. despite the absence of formal clinical guidelines for the accurate evaluation and treatment of the condition after childhood. That’s about to change. A task force commissioned by the American Professional Society of ADHD and Related Disorders (APSARD) is developing ADHD diagnosis and treatment guidelines for adults in the U.S., to be published in 2024. In an interview with ADDitude, APSARD President Ann Childress, M.D., discussed the implications of the forthcoming guidelines. “ADHD in adults is not just a minor inconvenience — it is a major public health problem,” Childress says. “Guidelines will help practitioners who previously may have felt uncomfortable evaluating and treating adults with ADHD, and these will improve access to high-quality care.”

Continue reading “First-Ever Adult ADHD Guidelines Forthcoming”

ADHD Treatment & Diagnosis Guidelines: Related Resources

• Read: Adult ADHD Is Real — and Still Heavily Stigmatized
• Read: ADHD in Older Adults: Distinct Diagnostic and Treatment Considerations
• Download: How Common Is ADHD in Adults?
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks

9. How Undiagnosed ADHD Triggers Depression and Anxiety

By Nelson M. Handal, M.D., DFAPA

Depression and anxiety disorders occur with ADHD at significant rates. What explains these high comorbidity rates? “Many factors may explain the overlap, and one of them I can’t stress enough: ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated,” Nelson M. Handal, M.D., DFAPA, says. Here, Handal shares why depression appears to take a more significant toll on women with ADHD and how undiagnosed and/or untreated ADHD manifests in patients with depression.

Continue reading “How Undiagnosed ADHD Triggers Depression and Anxiety”

Untreated ADHD in Adults: Related Resources

• Download: Signs of Depression That May Surprise You
• Self-Test: Depression in Adults
• Read: The Depression Treatment Gap for Teens — And How to Close It
• Read: What’s Behind the “Depression Gap” Impacting Women?

10. “A Daily Nightmare:” One Year into the ADHD Stimulant Shortage

By ADDitude Editors

More than one year into the ADHD stimulant shortage, patients still struggle to fill their prescriptions for Adderall XR and other stimulants like Vyvanse, Concerta, and Focalin.

According to an ADDitude survey of 11,013 caregivers and adults with ADHD, roughly 38% of all patients have had trouble finding and filling their prescription medication over the last year, and 21% continue to suffer treatment disruptions today. Here, ADDitude readers share how they have been forced to forgo medications, make do with substitutes that aren’t as effective or cause bothersome side effects, and ration out a dwindling supply, often dividing it between multiple family members with ADHD.

Continue reading “‘A Daily Nightmare:’ One Year into the ADHD Stimulant Shortage”

ADHD Medication Shortage: Related Resources

• Read: How the Adderall Shortage Is Casting a Long Shadow on ADHD Treatment
• Read: The Real Reason ADHD Medication Supply Is Lagging Demand
• Read:  Generic Adderall Shortage Extends to Vyvanse, Ritalin

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

In an interview with ADDitude, APSARD President Ann Childress, M.D., discussed the importance and implications of the first-ever U.S. guidelines for ADHD in men and women. Here are excerpts from that interview.

Why are clinical guidelines to diagnose and treat ADHD in adults necessary?

Recent data published by the Centers for Disease Control and Prevention found an increase in stimulant prescriptions for adults with ADHD between 2016 and 2021. Greater recognition of ADHD symptoms and improved access to care through telemedicine have contributed to this increase in the recognition and treatment of adult ADHD.

Guidelines give evidence-based recommendations for the assessment and treatment of medical disorders. We have U.S. guidelines for the treatment of ADHD in children and adolescents, but none for adults. Guidelines will help practitioners who previously may have felt uncomfortable evaluating and treating adults with ADHD, and these will improve access to high-quality care.

ADHD in adults is not just a minor inconvenience — it is a major public health problem. Consequences of adult ADHD can include lower educational achievement, increased risk of unemployment, financial instability, higher rates of divorce, and increased risky behaviors resulting in higher rates of traffic infractions and unplanned pregnancies compared to peers without ADHD.

[Self-Test: Do I Have ADHD? Symptom Test for Adults]

How do ADHD symptoms in adults generally differ from those in children?

Symptoms generally become more subtle as people age. For example, running and climbing at inappropriate times as a child may present as restlessness in an adult. ADHD symptoms may also be more difficult to recognize in adults because of coexisting conditions, such as depression and anxiety.

Many people believe that ADHD medication is no longer necessary once a student with ADHD has graduated from high school or college. With the development of these guidelines for adults, is this belief being debunked?

Although some adult patients manage well using behavioral techniques to control symptoms, many still need medication to reduce symptom severity and improve their quality of life. The guidelines will review the existing evidence for treating adult ADHD and make recommendations based on those findings.

What are the risks for older adults taking ADHD medication? Do the benefits of medication outweigh the risks?

Many older adults with ADHD have comorbid medical conditions, including cardiovascular disease. It is important for practitioners to work with their colleagues in primary care, cardiology, and internal medicine to treat patients collaboratively. For many, the benefits often outweigh the risks, but it is important for all specialists to work together to ensure that patient risks are appropriately managed.

[Free Series: The Adult’s Guide to ADHD Diagnosis]

Just as many adults are discovering they have ADHD that went undiagnosed for years, many girls and women continue to be misdiagnosed or undiagnosed by clinicians. Might APSARD consider new or expanded guidelines for girls and women?

Many women do not recognize that they have ADHD or seek evaluations until their children are diagnosed. They are often treated for anxiety or depression that developed secondarily to ADHD. Helping clinicians recognize the difference in presentation of ADHD symptoms in women is important.

How can we educate clinicians and researchers to mitigate this?

An expert consensus statement providing guidance for the recognition and treatment of ADHD in girls and women was published in BMC Psychiatry in 2020. ¹  Since then, interest in understanding the nuances associated with ADHD in girls and women has continued to increase.

When will the APSARD guidelines for adults be completed and what will happen following their release?

The APSARD Task Force is working diligently on the guidelines, and I expect that we will have a draft in 2024. After the APSARD guidelines are published, we will work with CHADD to expand them for specific populations and specialties. There is much interest from colleagues in other agencies, and we plan to partner with them to educate providers.

ADHD Diagnosis & Treatment Guidelines: Next Steps

• Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
• Download: How Is ADHD Diagnosed?
• Read: Your Complete ADHD Diagnosis and Testing Guide

Ann Childress, M.D., is a board-certified child, adolescent, and adult psychiatrist specializing in research and treatment of ADHD.  

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Source

¹ Young, S., Adamo, N., Ásgeirsdóttir, B.B. et al. (2020). Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women. BMC Psychiatry. https://doi.org/10.1186/s12888-020-02707-9

The Persistence of ADHD Into Adulthood

The essay’s authors, psychiatrist Nassir Ghaemi, M.D. (Tufts University School of Medicine), and Mark L. Ruffalo, MSW, DPsa (University of Central Florida College of Medicine), cite slim evidence, specifically two prospective follow-up studies of children with ADHD tracked to adulthood. These studies, they claim, show that only 20% of subjects with childhood ADHD still have it by adulthood.

The truth is that one of those cited studies, and its limitations, gave expert commentators pause when it first appeared seven years ago.² For one, the adult sample included 18- and 19-year-old subjects, a razor-thin slice of young adulthood. Moreover, the study’s authors used only self-reports in structured interviews to establish the existence of adult ADHD. Yet, we know self-reports to be unreliable until subjects reach their late 20s and 30s.³ By contrast, the study established childhood ADHD diagnoses using parent reports and structured interviews. Therefore, using self-reports risks under-identifying ADHD persistence into young adulthood.

A more recent study of ADHD persistence followed children originally diagnosed between ages 7 and 10.⁴ Researchers administered eight thorough re-evaluations from ages 10 to 25, on average. The results showed that most children went through an up-and-down pattern of remission. That is, results sometimes fell below full DSM diagnostic criteria but at other times fulfilled criteria. Only 10% of children with ADHD achieved full, sustained remission at young adulthood. That left 90% with persistent residual symptoms of ADHD into adulthood.

The waxing and waning of symptoms likely reflects treatment effects as well as the nature of ADHD being overly sensitive to environmental factors affecting symptom expression. Factors might include supportive teachers or bosses, or, on the other hand, the stress of starting middle school or college. Hormonal changes may also play a role in ADHD symptom severity.

[Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.]

Adult ADHD Is Not New or Novel, but Psychiatry Has Not Yet Caught Up

Let’s flip the script here: The diagnosis of ADHD (then called hyperkinetic reaction of childhood or adolescence) first appeared in the DSM-II.⁵ That same year saw a published study of minimal brain dysfunction (another early name for ADHD) in young adult patients, some having persistent symptoms since adolescence.⁶ In other words, adult ADHD is not a diagnosis du jour, as Ghaemi and Ruffalo assert, but part and parcel of ADHD from the start. That said, a different issue could be considered: Why has diagnostic criteria for adult ADHD lingered so far behind the work already done in the field for 55 years?

For example, a decade ago the age-of-onset criterion for an ADHD diagnosis was finally raised from 7 to 12 years old. Still, even the older cutoff misses the adolescent phase, which brings increased demands for attention, impulse control, organization, and overall self-regulation. ADHD-related difficulties often become more apparent during middle school, following years of challenges going masked and unrecognized. Indeed, we find evidence that 16 is a better age threshold for symptom emergence.⁷

At the same time, clinicians are still evaluating adults using ADHD symptom criteria developed for children, which under-represent indicators of executive dysfunction. Even the term ADHD obscures the consensus that the condition is better understood as a neurodevelopmental syndrome of self-dysregulation. ADHD is a chronic delay in the onset and efficient employment of self-regulation capacities and skills. Empirically based reviews of adult ADHD specific symptoms have addressed this issue.⁸ Yet, the absence of adult-specific criteria constrains adult diagnoses and thereby access to evidence-based treatments.

[Read: ADHD Symptoms Checklist – Signs of Hyperactive, Inattentive, Combined Subtypes]

The Effects of Biases Against ADHD

Finally, the framing and wording used in “The Making of Adult ADHD” repeats the stigma and biases many adults with ADHD (diagnosed or not) encounter in daily life. Every day, they endure skeptical comments by loved ones and the public, on social media and via other outlets. This “denialism” can and does wield a profound negative effect. Research on the effects of stigmatization and dismissal of ADHD-related concerns)^9,10 has shown that unconstructive criticisms cause individuals to experience withdrawal from others and heightened sensitivity, hindering their coping skills and preventing them from reaching out for professional support.

In fact, a psychiatrist-in-training published his experience with recognizing his own adult ADHD after harboring misconceptions about it.¹¹ He observed first-hand the bias against the diagnosis (and against mental health issues generally) within healthcare and within his own specialty, which stoked his fears of disclosure. He courageously recounts his coming to terms, seeking help, and benefitting from specialized treatment.

To this psychiatrist and to other adults with ADHD, the diagnosis is well-established,¹² even as behavioral health fields are still catching up. There is more work to do, no doubt. A heartening development underway is the first set of U.S. empirically based guidelines for the assessment and treatment of adult ADHD and corresponding practice tools tailored to support these patients. I am hopeful that these guidelines (used alongside many existing international ones) will offer a helpful hand to those who are working to support adults with ADHD.

Adult ADHD Symptoms Are Real: Next Steps

• Read: How the DSM-5 Fails People with ADHD — and a Better Way to Diagnose
• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Learn: What do I need to understand about ADHD that is not fully represented in the DSM?

Disclosure: Dr. Ramsay is on the scientific advisory board of ADDitude magazine. He has no conflicts of interest relevant to the content of this commentary.

Sources

¹Ruffalo, M. L., & Ghaemi, N. (2023): The making of adult ADHD: The rapid rise of a novel psychiatric diagnosis. Psychiatric Times, 40(9), 18-19.
²Faraone, S. V., & Biederman, J. (2016). Can attention-deficit/hyperactivity disorder onset occur in adulthood? JAMA Psychiatry, 73(7), 655-656. doi:10.1001/jamapsychiatry.2016.0400.
³Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford.
⁴Sibley, M. H., et al. (2022). Variable patterns of remission from ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry, 199, 142-151.doi: 10.1176/appi.ajp.2021.21010032
⁵American Psychiatric Association (1968). Diagnostic and statistical manual (2nd ed.)
⁶Harticollis, P. (1968). The syndrome of minimal brain dysfunction in young adult patients. Bulletin of the Menninger Clinic, 32, 102-114.
⁷Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford.
⁸Fedele, D. A., et al. (2010). Potential symptoms of ADHD for emerging adults. Journal of Psychopathology and Behavioral Assessment, 32, 385-396. doi: 10.1007/s10862-009-9173-x
⁹Beaton et al. (2022). Experiences of criticism in adults with ADHD: A qualitative study. PLoS ONE, 17(2), e0263366. doi: 10.1371/journal.pone.0263366;
¹⁰Morley, E., & Tyrrell, A. (2023). Exploring female students’ experiences of ADHD and its impact on social, academic, and psychological functioning. Journal of Attention Disorders, 27(10), 1129-1155. doi: 10.1177/10870547231168432
¹¹Klein, E. J. (2020). When the edges blur: A future psychiatrist’s perspective on Attention-Deficit/Hyperactivity Disorder. Psychological Services, 19(1), 29-31. doi: 10.1037/ser0000446
¹²Faraone, S. V., & Biederman, J. (2016). Can attention-deficit/hyperactivity disorder onset occur in adulthood? JAMA Psychiatry, 73(7), 655-656. doi:10.1001/jamapsychiatry.2016.0400.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Approximately 25 years ago, when ADDitude published its first newsletter, the diagnosis of ADHD was based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Version III-C. The DSM-IV diagnostic criteria adopted two years later were the most scientifically validated to date.

Its 18 symptoms were evenly divided into two lists: problems with inattention vs. problems with hyperactivity-impulsivity. To warrant a diagnosis, a patient had to exhibit at least six symptoms on either list, suffer impairment in one or more major life activities (home, school, community, peers), and begin experiencing symptoms by age seven. Furthermore, the symptoms could not be better explained as those of another condition.

Yet, problems remained. The committee handling ADHD criteria for the DSM-5 hoped to improve the DSM’s rigor and diagnostic accuracy. It proposed recommendations that reflected independent research findings. Sadly, many of those recommendations were rejected by higher-ranking committees, perhaps partly out of fear they would significantly increase the prevalence of ADHD diagnoses. Thus, the ADHD criteria in the DSM-5, released in 2013, represented only modest improvements.

The Problems with the DSM-5

The DSM-5 does not capture ADHD accurately because its criteria do not conceptualize ADHD as a disorder of executive functioning (EF) and self-regulation (SR). This limitation greatly narrows the concept of ADHD, trivializes its nature as just an attention deficit, and discourages diagnosing clinicians from focusing on the wider range of impairments inherent in ADHD. These impairments impact executive inhibition, self-awareness, working memory, emotional self-regulation, self-motivation, planning/problem-solving, and other functions not typically associated with ADHD. Ignoring them restricts diagnosis and, ultimately, treatment for many patients.

Why Qualifier Symptoms Should Go Unheeded

In the DSM-5, qualifier symptoms were added after each listing of a symptom to help clinicians understand the expression of that symptom beyond childhood. However, problems with these clarifiers include:

[Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.]

• None of these clarifications arose out of prior research that tested them for their affiliation with ADHD, for their relationship to the root symptom they are supposed to clarify, for their accuracy in detecting ADHD, or for their relationship to impairment in major life activities. They were simply invented by committee members in a meeting.
• Adding such new and untested symptoms may have broadened eligibility for the disorder by up to 6 percent in older teens and adults.
• Some clarifications seemed to correlate with anxiety, which could lead to cross-contamination of the ADHD criteria.

These clarifications also were not informed by any theory of ADHD, such as EF-SR theory.

So, until the status of these parenthetical clarifiers is better researched, clinicians would do best to ignore them in making a diagnosis of ADHD in a teen or an adult.

A Better Way to Diagnose ADHD

Clinicians can ensure more accurate diagnoses and more appropriate care by following these five recommendations:

#1. Avoid placing undue emphasis on hyperactive symptoms.

Six of the nine hyperactive-impulsive symptoms on the DSM list reflect excessive activity, even though impulsivity has been viewed as a more prevalent ADHD symptom for the last 40 years. At best, hyperactivity is reflective of early childhood disinhibition of motor movement and, later, the inability to regulate such movement to the demands of the situation (e.g., teacher’s instructions to complete desk work). Those symptoms decline steeply over development and are of little diagnostic value by late adolescence. This is one reason why clinicians before the 1980s thought the disorder was outgrown before adulthood, which we now know is false for most people.

[Research: Only 1 in 10 Children with ADHD Will Outgrow Symptoms]

#2. Look for additional symptoms of impulsivity.

Poor inhibition may manifest not just in speech (currently, the DSM criteria include only three verbal symptoms) but in motor behavior, cognition, motivation, and emotion. Clinicians should screen for any of the following manifestations:

• often fails to consider the consequences of their actions
• has trouble motivating to persist toward goals
• has trouble deferring gratification or waiting for rewards
• lacks willpower, self-discipline, drive, and determination
• seems unusually impatient, easily emotionally aroused and frustrated, and quick to anger

Abundant research shows that these aspects of poor self-regulation are as common in people with ADHD as are the traditional DSM symptoms and, with age, more so than the symptoms of hyperactivity.

#3. Think of inattention as affecting a range of executive function deficits in daily life…

…particularly those involving impaired self-awareness, working memory, self-organization, emotional self-regulation, self-motivation, and time management. This will encourage clinicians to broaden their focus beyond the DSM symptoms when conducting open-ended interviews and selecting rating scales.

After the evaluation is completed, clinicians should explain to clients why their condition is so serious, impairing, and pervasive across major domains of life. This will also help clinicians and parents appreciate why teens (and young adults) may seem to be outgrowing ADHD, based on DSM criteria, when they are far less likely to outgrow their EF-SR deficits (and that these impairments may increase with age).

#4. Use rating scales broken down by sex and not just age.

Research suggests that females in the general population, at least in childhood and adolescence, do not show the same symptom severity as their male peers.¹ This makes it harder for a female to meet the DSM criteria. Another complicating factor: because males were overrepresented in field trials for earlier versions of the DSM, the symptom threshold was male-biased.

#5. Don’t adhere too rigidly to diagnostic thresholds when there are clear signs of impairment.

Empirical research demonstrates that ADHD falls along a continuum in the general population. So, clinicians will see clients who don’t meet all of the DSM criteria, yet who are experiencing enough impairment that they sought a diagnosis. This means clinicians should diagnose ADHD if:

• Clients or their caregivers state that a child or teen has a high number of ADHD (and EF) symptoms (place above the 20^th–16^th percentile in severity) and there is evidence of impairment in major life activities, even if the client fails to meet all DSM-5
• Symptoms became evident sometime during development, usually before age 21–24, and the patient meets all other criteria. DSM-5 raised the age of onset for ADHD from age 7 to age 12, but research repeatedly shows that few people are reliable or accurate in recalling the age of onset of their symptoms. It is a mistake, therefore, to consider age of onset in diagnosing ADHD, where all other criteria are met.

DSM-5 ADHD Criteria Challenged: Next Steps

• Free 7-Part Series: The Clinicians’ Guide to Diagnosing ADHD
• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks

Russell A. Barkley, Ph.D., is a retired clinical scientist, educator, and practitioner.

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Sources

¹ Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., … Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9

Growing up with undiagnosed ADHD negatively impacts women’s self-esteem, mental health, well-being, and relationships, while diagnosis and treatment for ADHD increase feelings of self-acceptance and self-worth, according to new research published in the Journal of Attention Disorders.¹

Women with undiagnosed ADHD are most likely to experience impairment in the areas of social-emotional well-being, relationships, and life control, according to the research — the first of its kind to examine how under-diagnosis impacts the mental, emotional, and physical health of women.

Studies have consistently shown that females are underdiagnosed with ADHD in childhood², ³,⁴; to better understand adult women’s experiences living with undiagnosed ADHD and receiving a late diagnosis, researchers conducted a systematic review of three databases that revealed the following themes.

Theme 1: Social-Emotional Well-Being Impairment

Undiagnosed ADHD can profoundly impact self-esteem and self-worth. Findings indicated that girls with undiagnosed ADHD often endured childhood misunderstanding, self-blame, and rejection.

“Low self-esteem might result from difficulties endured growing up with an undiagnosed disorder that neither they nor those around them understood,” researchers wrote. “With no external cause to attribute functional impairments to, the women in these studies often felt something was wrong with them.”

The researchers noted that many women in these studies felt “different” and alienated in childhood and expressed difficulties relating to their peers. “Women with ADHD had problems picking up on social cues, felt awkward and out of place socially, and struggled with unintentionally saying things considered hurtful or inappropriate,” they wrote. “These women experienced peer rejection, bullying, and difficulty making friends.”

Social difficulties persisted into adulthood for many of these women. “Social anxiety and feeling unable to relate to other women were common experiences suggesting that difficulty in social relationships in adulthood may be a result of peer rejection in childhood,” researchers wrote.

In addition, women with undiagnosed ADHD may have experienced shame and frustration when comparing themselves to their peers. They may have felt that they did not meet society’s expectations, resulting in self-loathing, poor self-esteem, and increased anxiety.

Women also experienced anger issues, poor emotion regulation, and a fear of losing self-control. Some women developed maladaptive behaviors to cope. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD,” researchers wrote.

The researchers’ findings echo ADDitude’s own survey results regarding life transitions for women with ADHD. Of the 1,975 women with ADHD who responded to ADDitude’s survey, 14% said their ADHD symptoms had a life-altering impact at nine or younger, and 35% said their ADHD symptoms were life-altering between the ages of 10-19.

Survey respondents marked adolescence with the following:

• Procrastination and time-management problems: 78%
• Feelings of sadness or depression: 70%
• Rejection sensitive dysphoria: 63%
• Feelings of overwhelm 62%
• Worry or anxiety: 58%

“Things were very confusing for me in middle school, high school, and college before I was diagnosed with ADHD,” one respondent said. “I would test into advanced academic courses but do poorly in them. I was confused. Am I smart or not smart?”

One respondent recalled not knowing how to act “normal” in social situations. Another described herself as “a moody, socially avoidant teenager who always felt rejected.”

Another respondent shared that she was “always the oddball, always on the outside, never knowing how to behave and be accepted.”

“My social anxiety increased [during puberty], and the gap between me and other kids became more apparent,” a respondent said. “Getting close to people was difficult since I seemed to have more emotions and intensity than others.”

Theme 2: Difficult Relationships

Undiagnosed ADHD may affect women’s ability to form and sustain close and meaningful relationships.

“Women in these studies had difficulty with emotionally close relationships, intimacy, and the ability to share emotions with others without losing their own identity,” researchers wrote.

Women with ADHD also reported worse relationships with teachers, peers, and siblings; more abusive homes; more drug and alcohol abuse by their parents; and they perceived relationships more negatively than did women without ADHD.

These findings support those found in ADDitude’s survey, wherein 42% of respondents reported having relationship problems.

“I found myself in abusive relationships, unable to reach my potential or find satisfaction in my work. I’m learning now how my ADHD affected the trajectory of my life and finding myself in these situations,” one reader said.

“I believe the forgetfulness of ADHD and my tendency towards rumination and self-doubt kept me with my abuser longer, as it contributed to second-guessing myself, shame, self-blame, and not trusting what I saw or valuing how I felt,” another survey respondent said.

Said another: “I have nearly quit my job several times. I terminated a relationship that did not really have any issues. I contemplated self-harm. I felt like running away from everything.”

Theme 3: Lack of Control

Results from the review indicated that women with undiagnosed ADHD may feel little control over their lives (academically and in relationships with teachers, peers, parents, and siblings). These women viewed negative events as uncontrollable.

“They often attributed successes to external causes (i.e., luck, powerful others, etc.) and failures to internal flaws (i.e., lack of intelligence, laziness, etc.),” researchers wrote.

Theme 4: Self-Acceptance After Diagnosis

Researchers reported that an ADHD diagnosis and subsequent treatment positively impacted the women’s self-esteem and enabled them to begin to view themselves less critically. With diagnosis and treatment for ADHD, the women could make more sense of their lives and fully accept themselves.

“Many women in these studies experienced a sense of relief after diagnosis and felt that a professional diagnosis served as an external validation of their struggles,” researchers wrote.

Many women reported that it was only after diagnosis that they could feel more in control of their symptoms. “Knowing that they had ADHD may have allowed them to view difficult situations from a different perspective; results suggested they now felt they had more control and viewed situations as more changeable,” researchers wrote. They replaced their shame, anxiety, and depression with feelings of pride as they began to view their “disorder” as strength.

Women also described a change in their behavior after receiving their ADHD, reflected in their relationships with their children, romantic partners, and themselves.

Researchers found that 38% of the women regretted not being diagnosed and treated earlier. “These women felt that an earlier diagnosis would have benefited them growing up,” researchers wrote.

Many ADDitude survey respondents shared these sentiments.

“Most major life events like marriage and parenthood were over before I even suspected I was neurodivergent,” said a respondent diagnosed with ADHD at 65. “It was a relief to finally have a name for how I knew I was different, but I’m left with so many regrets that fall under the heading ‘If I had only known.’”

Another survey respondent shared, “I have struggled my whole life to get ahead, get organized, and be financially stable. While it’s a relief to get a diagnosis, I’m also experiencing a lot of grief. Life could have been different had I gotten this diagnosis and the correct support earlier.”

Diagnosing Women with ADHD: Next Steps

While this review provided summative insight into the experiences of women diagnosed with ADHD as adults, the researchers cautioned that it is impossible to draw definitive conclusions, and more studies are needed.

“Based on these findings, it is apparent that undiagnosed ADHD in childhood can have lasting negative consequences into adulthood,” they wrote. “Missed or late diagnosis can be damaging for a woman’s self-esteem, mental health, and overall well-being, while accurate and timely diagnosis can profoundly change the lives of women and girls with ADHD, allowing them to stop blaming themselves and begin to lead more fulfilling and satisfying lives. Women and girls are too often suffering in silence, being left out of the ADHD narrative; it is imperative that these women are not forgotten.”

Sources

¹Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders. 27(7), 645–657. https://doi.org/10.1177/10870547231161533

² Mowlem, F. D., Rosenqvist, M. A., Martin J., Lichtenstein, P., Asherson, P., Larsson, H. (2018). Sex Differences in Predicting ADHD Clinical Diagnosis and Pharmacological Treatment. European Child & Adolescent Psychiatry. 28, 481–489. https://doi.org/10.1007/s00787-018-1211-3

³ Quinn, P., Wigal, S. (2004). Perceptions of Girls and ADHD: Results from a National Survey. Medscape General Medicine, 6(2), 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395774/#__ffn_sectitle

⁴ Waite, R. (2010). Women with ADHD: It Is An Explanation, Not the Excuse Du Jour. Perspectives in Psychiatric Care. 46(3), 182–196. https://doi.org/10.1111/j.1744-6163.2010.00254

The Adult’s Guide to ADHD Diagnosis is a joint effort from WebMD and ADDitude designed to guide individuals through the difficult, important decisions they face when pursuing an evaluation for ADHD and its comorbid conditions. This guided email course will cover the following topics:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

NOTE: This resource is for personal use only.

SLEEP: What distinguishes sleep disorders from ADHD?

A: If you feel tired, your ADHD symptoms get worse, and that makes it harder to sleep the next night. This cycle repeats… | Keep reading on WebMD »

EATING DISORDERS: What distinguishes eating disorders from ADHD?

A: Many people with ADHD have poor impulse control and emotional regulation. This combination sets the stage for binge eating… | Keep reading on ADDitude »

MEMORY LOSS: What distinguishes cognitive decline (memory impairment) from ADHD?

A: If you have ADHD, forgetfulness is something you’ve dealt with your whole life. But maybe your memory problems are starting to feel different… | Keep reading on WebMD »

BPD: What distinguishes borderline personality disorder from ADHD?

A: People with BPD experience chronic instability — in their emotions, behaviors, relationships, and sense of self… | Keep reading on ADDitude »

BFRB: What distinguishes body-focused repetitive behaviors from ADHD?

A: BFRBs are intense urges like biting, picking, and pulling that can cause damage. As many as 1 in 20 people have a BFRB… | Keep reading on WebMD »

ASPD: What distinguishes antisocial personality disorder from ADHD?

A: ADHD and ASPD share symptoms linked with being impulsive that might make you confuse one with another… | Keep reading on WebMD »

FIRST-PERSON: “My ADHD Was Obscured by Comorbidities”

“I was diagnosed with anxiety disorder, major depression, and OCD. When I finally got my ADHD diagnosis nine years later and went on medication, almost all my problems with depression and anxiety disappeared.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Eating Disorders in Adults

Do you struggle with your body image? Feel out of control around food or feel guilty after eating? | Take the self-test on ADDitude »

SYMPTOM TEST: Borderline Personality Disorder in Adults

How do your behaviors compare to those of this Cluster B personality disorder? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
> DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

ASD: What distinguishes autism from ADHD?

A: Both conditions are neurodevelopmental disorders, so both can affect movement, language, memory, social skills, and the ability to focus… | Keep reading on WebMD »

SPD: What distinguishes sensory processing disorder from ADHD?

A: Adults with SPD feel assaulted by the world and all of its ticking clocks, buzzing lights, itchy tags, and strong perfumes… | Keep reading on ADDitude »

ADHD & TRAUMA: What are the symptoms shared by ADHD and PTSD?

A: Symptoms shared by ADHD and trauma, and often ADHD and PTSD, include difficulty concentrating, emotional dysregulation… | Keep reading on ADDitude »

EFD: What distinguishes executive function disorder from ADHD?

A: ADHD is a condition that can be diagnosed; while you may hear the term executive function disorder, it isn’t a true medical condition… | Keep reading on WebMD »

TIC DISORDERS: What distinguishes Tourette’s Syndrome from ADHD?

A: From time to time, we all have an unexplained twitch, but when tics are severe or repeated for days or weeks, they may be signs of… | Keep reading on ADDitude »

SUBSTANCE USE DISORDER: How does ADHD increase the likelihood of SUD, and vice versa?

A: About a quarter of adults with SUD have ADHD, and individuals with ADHD are three times more likely to develop an SUD… | Keep reading on ADDitude »

FIRST-PERSON: “Building a Life That’s Right for Me”

“In an unpredictable world, routine can calm the autistic brain and allow us to function. ADHD, on the other hand, is all about novelty. The ADHD brain is deadened by repetition and rebels against structure. So how does someone with ADHD and autism find a place in this world?” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Autism Spectrum Disorder in Adults

Do family members call you an “eccentric professor”? Do you follow the same schedule every day? | Take the self-test on ADDitude »

SYMPTOM TEST: Dyslexia in Adults

Could your lifelong reading and spelling challenges be signs of this common learning disability? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
> DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

DEPRESSION: What distinguishes ADHD from depression?

A: Depression is more than just an occasional case of the blues. It’s deep sadness and despair you feel every day for at least 2 weeks at a time… | Keep reading on WebMD »

ANXIETY: What distinguishes ADHD from anxiety?

A: When you have anxiety along with ADHD, it may make some of your ADHD symptoms worse, such as feeling restless or… | Keep reading on WebMD »

BIPOLAR: What distinguishes ADHD from bipolar disorder?

A: Approximately 20 percent of people with ADHD also suffer from bipolar disorder, characterized by depressive and manic episodes… | Keep reading on ADDitude »

MOOD DISORDERS: What distinguishes ADHD from a mood disorder?

A: Making the distinction between moodiness in ADHD, ODD, DMDD, and other disorders requires studying the mood’s intensity and… | Keep reading on ADDitude »

OCD: What distinguishes ADHD from obsessive-compulsive disorder?

A: Symptoms of OCD include recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions)… | Keep reading on ADDitude »

ODD: What distinguishes ADHD from oppositional defiant disorder?

A: Adults with ODD are more than just aggressive and irritating from time to time. They feel mad at the world every day, and lose their temper… | Keep reading on ADDitude »

FIRST-PERSON: “ADHD: ‘I Really Fouled That Up.’ Anxiety: ‘Hold My Beer.’”

“ADHD means I can’t be productive. Anxiety means I can’t relax. ADHD won’t let me resolve problems. Anxiety makes me think I have problems I don’t actually have. ADHD makes planning difficult. Anxiety convinces me I need to plan everything down to the tiniest of detail.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Generalized Anxiety Disorder in Adults

No two people experience anxiety in the same way, however common symptoms do exist. | Take the self-test on ADDitude »

SYMPTOM TEST: Depression in Adults

Do simple tasks take forever to accomplish? Do you feel irritable all the time, or stuck in life? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
> DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

EVALUATIONS: What is the step-by-step process for getting an ADHD evaluation?

A: An evaluation for ADHD often starts with a routine visit to your primary-care physician, but chances are it won’t end it there… | Keep reading on ADDitude »

ENSURING ACCURACY: What should a comprehensive ADHD evaluation include?

A: An accurate and well-rounded ADHD diagnosis is a complex, multi-step process including a clinical interview, a medical history review,… | Keep reading on ADDitude »

ONLINE CARE: Can I get diagnosed with ADHD via a telehealth appointment?

A: While much of the process can be done online, medication fulfillment, physical exams, and cognitive or educational testing may… | Keep reading on ADDitude »

ADULT GUIDELINES: How are current diagnostic criteria unhelpful for evaluating adults?

A: U.S. practice guidelines — and multiple ones at that — currently only exist for childhood ADHD. This is a gap we must close… | Keep reading on ADDitude »

DIFFERENTIAL DIAGNOSIS: How can I be sure my symptoms don’t point to another condition?

A: Several conditions may be confused with, or appear along with, ADHD, including anxiety, a sudden life change, sleep problems… | Keep reading on WebMD »

FIRST-PERSON: “But I Went to Law School! I Couldn’t Have… Oh.”

“The three-part evaluation included a computer test, which indicated that 94% of the people who took it were better able to remain on task than I was — in other words, only 6% of people were more easily distracted.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: How Is ADHD Diagnosed?

Three essential components of an ADHD diagnosis — and a few diagnostic “fads” that simply aren’t worth your time or money. | Download now on ADDitude »

FREE DOWNLOAD: How to Prepare for Your ADHD Evaluation

This handout identifies the six most important steps any adult should take before consulting their physician for an ADHD evaluation. | Download now on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
> DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

HEALTH CARE TEAM: What types of health care providers can diagnose ADHD?

A: There are several types of professionals who typically diagnose ADHD. These include doctors, psychologists, nurse practitioners… | Keep reading on WebMD »

FINDING A DOC: How should I choose a professional to diagnose and treat my ADHD?

A: It’s your right to know the qualifications of the professional you may be working with, and most doctors realize this… | Keep reading on ADDitude »

ASSESSING PROFESSIONALS: What questions should I ask in evaluating health care providers?

A: How many of your adult patients have ADHD? How do you evaluate symptoms?… | Keep reading on ADDitude »

COACHING: Would I benefit from working with an ADHD coach?

A: An ADHD coach is a “life coach” specifically trained to help adults with ADHD better manage their lives… | Keep reading on ADDitude »

COACH OR THERAPIST?: Should I consider seeing a therapist and/or a life coach?

A: If the primary challenge is managing or understanding emotions, a therapist would likely be the appropriate option… | Keep reading on ADDitude »

FIRST-PERSON: “Here’s How I Found an ADHD Specialist Near Me.”

“I lucked out with a phenomenal psychiatrist who recommended a great coach and a therapist who had experience working with people with ADHD. Ask providers you trust for their recommendations!” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: Choosing the Right Professional to Treat ADHD

Use this comparison chart to help you understand the benefits and drawbacks of each option. | Download now on ADDitude »

FREE DOWNLOAD: 7 Biggest ADHD Diagnosis Mistakes

Learn to recognize the most common mistakes doctors make to ensure that you get the diagnosis and care you deserve. | Download now on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
> DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

GENDER: Why is ADHD so often missed or misdiagnosed in women?

A: Girls tend to show less “hyperactive” behavior, and most studies focus on those hyperactive ADHD patterns that are more common in males… | Keep reading on WebMD »

YOUNG ADULTS: How can I recognize signs of ADHD in a young adult?

A: Young adults with ADHD usually don’t show as much hyperactivity as they did when they were kids. But they can be restless, with trouble… | Keep reading on WebMD »

OLDER ADULTS: What distinct diagnostic criteria benefit older adults with ADHD?

A: Clinicians must look beyond DSM-5 criteria when evaluating older patients for ADHD because it does not adequately consider… | Keep reading on ADDitude »

AGE VS. ADHD: How do clinicians distinguish signs of ADHD vs. aging in older adults?

A: Doctors don’t learn to look for ADHD in people over 60. It’s likely they’ll look for other causes of inattention and fuzzy thinking… | Keep reading on WebMD »

MENOPAUSE: How do hormonal fluctuations and aging impact ADHD in women?

A: Higher levels of estrogen are linked to enhanced executive function and attention. Low or fluctuating estrogen levels are associated with… | Keep reading on ADDitude »

ANDROPAUSE: How do hormonal fluctuations and aging impact ADHD in men?

A: Both women and men with ADHD report the greatest symptom severity from ages 50 to 59 — during menopause and andropause… | Keep reading on ADDitude »

FIRST-PERSON: “How I Lost 10 Years of My Life”

“I lost a decade of my life, not just to one arrogant man, but to all of the doctors who hand-waved my symptoms away, each convinced that they knew my body and brain better than I did.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ADHD Symptoms in Women and Girls

In females, ADHD may manifest as shame about organizational skills, difficulty coping, etc. | Take the self-test on ADDitude »

WEBINAR REPLAY: ADHD in Older Adults

Expert Webinar with Kathleen Nadeau, Ph.D.  | Listen now on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
> DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

RSD: Is rejection sensitive dysphoria a symptom of ADHD?

A: Rejection sensitive dysphoria (RSD) is not a medical diagnosis, but a way of describing certain symptoms associated with ADHD… | Keep reading on WebMD »

EMOTIONS: Is emotional dysregulation a symptom of ADHD?

A: Emotional dysregulation is a term used to describe an emotional response that is poorly regulated and does not fall within… | Keep reading on WebMD »

ADHD+: How does the idea of ‘complex ADHD’ change diagnosis and treatment?

A: Two out of three people with ADHD have one or more other problems with learning, behavior, or mood. Doctors call this cluster of conditions… | Keep reading on ADDitude »

DESR: Is deficient emotional self-regulation (DESR) a symptom of ADHD?

A: Though it is not included in the diagnostic criteria, DESR is a core facet of ADHD that carries significant consequences… | Keep reading on ADDitude »

HYPERFOCUS: What explains the phenomenon of ADHD hyperfocus?

A: Like distractibility, hyperfocus is thought to result from abnormally low levels of dopamine, a neurotransmitter… | Keep reading on ADDitude »

ANGER: How is ADHD tied to irritability, anger issues, and emotional dysregulation?

A: These problems walk in lock step with the general difficulties in self-regulation that characterize ADHD… | Keep reading on ADDitude »

FIRST-PERSON: “How Does RSD Really, Actually Feel?”

“Sometimes, rejection sensitive dysphoria hits like a physical punch. The air leaves my lungs because of the hurt. Other times I feel this all-consuming humiliation. Or fierce frustration and anger at myself.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Rejection Sensitive Dysphoria

RSD commonly occurs with ADHD. Could this be the cause of your strong emotional responses? | Take the self-test on ADDitude »

SYMPTOM TEST: Emotional Hyperarousal

Rather than physical hyperactivity, some people with ADHD have passionate reactions and feelings. | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
> DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

SYMPTOMS: What signs and symptoms point to ADHD in adults?

A: If you have adult ADHD, you may find it hard to remember information, organize tasks, finish work on time… | Keep reading on WebMD »

SUBTYPES: What are the key differences between inattentive, hyperactive, and combined-type ADHD in adults?

A: The three types of ADHD are primarily hyperactive and impulsive, primarily inattentive, and combined. Each presentation is… | Keep reading on ADDitude »

INATTENTIVE: What signs of inattentive ADHD in adults are commonly overlooked or mistaken?

A: The first overlooked sign of inattentive ADHD is difficulty completing tasks. People with inattentive ADHD are… | Keep reading on ADDitude »

THE ADHD BRAIN: What should I understand about how the ADHD brain is wired?

A: The ADHD nervous system regulates attention and emotions in different ways than the nervous system in those without… | Keep reading on ADDitude »

EXECUTIVE FUNCTIONS: What should I know about executive dysfunction and its relationship to ADHD?

A: The cognitive skills that help us plan, prioritize, and execute complex tasks are commonly tied to ADHD… | Keep reading on ADDitude »

NEUROSCIENCE: How does the neurology of ADHD help explain my challenges?

A: The ADHD nervous system is rarely at rest. It always wants to be engaged in something interesting and…” | Keep reading on ADDitude »

FIRST-PERSON: “I Branded Myself a Misunderstood Freak. But It Was ADHD All Along.”

“The psychologist listened as I spoke about my life. He then gave me that look people often give when I talk at 200 mph and asked, ‘What do you do when you’re calm?’ ‘I’m never calm!’ I told him, genuinely dumbfounded by this revelation.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ADHD IN ADULTS

Could your disorganization, poor memory, hypersensitivity, and financial struggles be due to ADHD? | Take the self-test on ADDitude »

SYMPTOM TEST: INATTENTIVE ADHD

Symptoms can show up as procrastination and difficulty sustaining attention. | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

> DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?