How to Recognize ADHD in Adults

Attention Deficit Hyperactivity Disorder (ADHD) has traditionally been seen as a childhood diagnosis in some countries, and until recent years, it was not commonly diagnosed in adults. Previously, as children diagnosed with ADHD grew up, the diagnosis was either removed or, in particularly severe cases of maladaptation, described and treated as something else, such as chronic schizophrenia or organic disorder. Indeed, ADHD is a neurodevelopmental disorder, which means its initial manifestations occur early in life. However, these manifestations often go unnoticed. Understanding this disorder is crucial to not miss the opportunity to alleviate the burden it carries. In psychiatry, a condition is only considered a pathology if it leads to subjective distress (unpleasant experiences) and/or functional impairment (maladaptation) or socially unacceptable behavior.

In the case of ADHD, functional impairment occurs due to difficulties with self-control and self-organization, leading to subjective distress, often manifested as anxiety, shame, and other unpleasant emotions. Socially unacceptable behavior may also occur, driven by impulsivity, such as ignoring rules and instructions due to whims, and making thoughtless actions.

Diagnosing ADHD

The diagnosis of ADHD is established when the clinical presentation:

1. Meets the necessary criteria,
2. Leads to the consequences described above,
3. Cannot be explained by other conditions, such as other mental disorders, somatic diseases, or intoxications.

The criteria are divided into two major groups: symptoms of inattention and hyperactivity/impulsivity. Inattention manifests as difficulties in maintaining focus on tasks that do not offer high stimulation or immediate rewards, high distractibility, and problems with planning and organization. Hyperactivity is expressed through excessive movement and inability to stay still, especially noticeable in situations requiring calm and self-control. Impulsivity is characterized by a tendency to act immediately in response to stimuli without prior analysis and consideration of potential consequences.

An excerpt from the latest diagnostic manual revision (ICD-11) describes the symptoms: Inattention:

• Difficulties in maintaining attention on tasks that provide high levels of stimulation or reward or require sustained mental effort; lack of attention to details; making careless mistakes in school or work tasks; failing to complete tasks.
• Easily distracted by extraneous stimuli or thoughts unrelated to the task; often does not listen when spoken to directly; appears to daydream or be lost in thought.
• Often loses things, forgetful in daily activities; has difficulty remembering upcoming daily tasks or actions; has difficulties with planning, managing, and organizing school activities, tasks, and other activities.

Hyperactivity-Impulsivity:

• Excessive motor activity; often leaves places where one is supposed to sit still; children often run around and struggle to sit still calmly; teenagers and adults may feel physical restlessness, discomfort in silence or while sitting still.
• Difficulty engaging quietly in activities; very talkative.
• Blurts out answers in school or at work, interrupts or intrudes on others’ conversations and games; has difficulties waiting their turn in conversation, games, and activities.
• Tends to act immediately in response to stimuli without considering risks and consequences (e.g., behavior that may lead to physical harm, impulsive decisions, reckless driving).

The onset of symptoms typically occurs before the age of 12, often becoming apparent in school when a child is first expected to sit through lessons and absorb information. The hyperactive variant is more obvious to parents, educators, and teachers—as these children are restless, “bouncing off the walls,” constantly talking, and disrupting discipline. The inattentive variant, however, often goes unnoticed and manifests as poor academic performance, poor self-organization, and is often mislabeled as “laziness.” It is more likely that such individuals reach adulthood without understanding what is happening to them and may seek medical help due to accompanying anxiety or depression.

Why the Diagnosis is Made

Everyone is different, and the ability to organize goal-directed activities varies widely. Some can plan their day to the minute, easily manage their tasks, and achieve set goals. Others, however, may struggle with self-organization—forgetting plans, procrastinating, and easily distracted by minutiae. Nevertheless, despite their carelessness, they still fulfill their duties, albeit with great effort, rushing to complete everything overnight before a deadline. This is normal variability in traits, so why pathologize one end of the spectrum?

Previously, we discussed where the line between “norm” and “pathology” in psychiatry lies. Primarily, it involves difficulties adapting to conditions dictated by the environment—whether academic, labor, or social demands, such as the need to listen to a conversational partner to the end or arrive on time for meetings with friends (this is a simplification; in reality, the social problems of people with ADHD are much broader). A vast number of people might see themselves in memes about procrastination, hyperfocus on TikTok, and irritation from having to wait in line. But for most of us, these things do not cause serious life problems, and to adjust discipline, applying recommendations from any self-help books like “Atomic Habits” is sufficient. Thus, the “norm” ends where maladaptation begins—unable to obtain an education, maintain a job, or sustain strong social connections—all due to symptoms of ADHD. By identifying the problem, we can begin to address it. Thus, the purpose of diagnosing is to help the individual. Currently, various methods exist for this—both pharmacological and non-pharmacological, and it would be impractical to neglect them.

Where and Why to Seek Help

For diagnosis, one should consult a psychiatrist. By law in many countries, only a psychiatrist is qualified to diagnose mental disorders. Although diagnostic criteria and self-help materials describing “red flags” are publicly available, why seek someone’s help if you can self-diagnose ADHD and then search for treatment online? There are three reasons:

1. ADHD symptoms are non-specific and can also occur in other conditions, necessitating differential diagnosis. Difficulties in attention concentration and fidgetiness might be explained by an anxiety disorder, while alternating periods of hyperfocus and subsequent burnout might actually be a shift in affective phases in bipolar disorder. At the appointment, the doctor will conduct a detailed interview with clarifications of details and features of the course to understand which hypothesis more fully explains the condition.
2. ADHD often coexists with other disorders—such as anxiety, affective, personality disorders. It is also necessary to identify (or exclude) these to receive the necessary help.
3. If medication therapy is necessary—only a doctor can prescribe medication. Additionally, their role includes assessing the effectiveness and monitoring the side effects of therapy.

The phrase “if medication therapy is necessary” means that it is not always needed. In some countries, only one medication is approved and registered for treating ADHD. Other medications are either not available in the market or are listed as psychotropic drugs prohibited from circulation. Abroad, the choice of medications is broader, but international guidelines do not always recommend medication at the start of treatment. In cases where medication use is not possible due to intolerance or contraindications, therapy is an important treatment component. The most effective form of therapy is considered to be group skill training, based on an algorithm developed by Steven A. Safren, but individual cognitive-behavioral therapy can also be beneficial. Additionally, many find participation in mutual aid groups, often organized online by patients, helpful.

In some countries, there is a problem—many doctors do not recognize ADHD in adults, making it challenging to find a specialist who can confirm or exclude this diagnosis. The likelihood exists in the public health system (such as local psychiatric-neurological dispensaries), but it is small, especially in smaller settlements. In private clinics, one can look for phrases like “evidence-based medicine” in the description of the institution’s principles. Also, some doctors, psychotherapists, and psychologists note that they are “ADHD informed” or list this diagnosis among the conditions they work with—such “green flags” significantly increase the likelihood of receiving qualified help.