Late ADHD Diagnosis in Adults

More adults than ever are being diagnosed with ADHD, many of them women, often decades after symptoms began. Why are so many people missed in childhood, and what tends to prompt them to seek an evaluation as adults?

Often, providers take a conservative "wait and see approach" leading to missed opportunities for diagnosis. Women present with different symptoms such as inattention that is easily missed because teachers and parents view the lack of behaviors as a good sign of following the rules. Later in life evaluations are usually prompted due to a breakdown in executive function skills, i.e., attention, concentration, planning, organizing, and emotion regulation to name a few. Adults who are undiagnosed have learned ways to cope but can only cope for so long until they reach a point of burnout which tends to result in seeking help through an evaluation.

For someone who suspects they have ADHD, what does a thorough evaluation actually look like, and how can they tell a careful assessment from a quick online screening or a social media self-diagnosis?

A thorough evaluation should measure ADHD symptoms and cross-over diagnoses. There are many reasons a person may experience executive dysfunction and other mental health areas such as anxiety, depression, and trauma should be carefully considered due to similar symptoms. A quick online screening or self-diagnosis does not capture the full picture or underlying cause of executive dysfunction. As a Licensed Clinical Psychologist, I prefer to offer comprehensive evaluations so that I am providing the best service to my clients. Comprehensive testing spans multiple areas of psychology and neuropsychology. This evaluation often includes cognitive testing, attention, memory, learning, language skills, executive functioning, emotional and behavioral areas, and personality testing (when appropriate). Through my extensive training in diagnostic evaluations, I am able to consider multiple domains of functioning and integrate those test results to provide an accurate diagnostic picture. If a client relies on a quick online screening, they are often missing out on the depth of their functioning.

Many adults are also dealing with anxiety, depression or burnout by the time they’re evaluated. How do you sort out what’s ADHD and what’s something else, and how does that shape the treatment plan?

I use psychological/neuropsychological measures that provide broad information and an in-depth look at each domain. There are different testing formats that we use as testing psychologists. Objective and subjective test data provides a great look into how the person is functioning (objective data) versus how they view their symptoms (subjective data). For example, a person may feel like memory is a substantial area of weakness (subjective) but the objective testing may show a different picture. This is great information because it can point the psychologist to consider different types of memory, what is happening in the environment, and what strategies have been used. Each test result becomes a data point and possible treatment plan goal for the person.

Beyond medication, what does effective ADHD treatment look like for adults, and what do you wish newly diagnosed patients knew about the months after diagnosis, including the emotional side of being diagnosed later in life?

There are many ways a person can cope with ADHD symptoms after receiving a diagnosis. I often have clients tell me the diagnosis alone provides emotional relief because they are no longer judging their skills against an unfair comparison, someone who is neurotypical. The person is able to say, “this is why everyday tasks are harder for me.” Effective ADHD treatment may include therapy, medication, and daily strategies. A comprehensive evaluation is able to pinpoint the gold standard for ADHD interventions based on your unique presentation.