Why it's so hard to diagnose adult ADHD

Hey everyone,

I’m starting this newsletter to document my journey learning about adult ADHD. I thought I’d start by looking into the basics: what is ADHD, and how is it diagnosed in adults? Diving into research on this, I learned that ADHD can be super difficult to diagnose in adult patients, and the psychiatry field is actively working on developing more effective methods.

As a quick disclaimer, my PhD is in education, and I am not a medical provider. This post is based on my review of current research on ADHD, and it should not be taken as medical advice. If you are looking for an ADHD assessment, I encourage you to consult a licensed medical professional (more info on how to do this here).

Okay, now here’s what I learned about diagnosing adult ADHD…

Adult ADHD is both over- and under-diagnosed

What stood out to me is that, in general, psychiatrists are very worried about false positives in diagnosing adult ADHD. This seems to stem from evidence that a sizable number of college students have faked ADHD symptoms in order to access stimulants. (One study on one college campus estimated that over half of students with stimulant prescriptions were faking their symptoms. The fact that findings like this are out there helps explain why clinicians might be hesitant to refer someone for an ADHD assessment.)

That said, psychiatrists also note that ADHD is likely under-diagnosed among some patients. The current definition of ADHD is based on how the condition presents in white male children, and it may be under-diagnosed among people of color and white women. Researchers also point out that adults with severe ADHD tend to under-report these symptoms when speaking to medical professionals, resulting in false negative diagnoses.

A lot of things can look like ADHD

Part of what makes adult ADHD tricky to diagnose is that the symptoms (like distraction, disorganization, forgetfulness, and restlessness) can have a number of different causes. Things that can cause ADHD-like symptoms include:

• Stressful environments

• Trauma

• Depression

• Anxiety

• Sleep deprivation

• Side effects from medications, such as statins or sleep aids

• Hypothyroidism

• Aging

Now this points at one of the key challenges with adult ADHD diagnoses: people who have ADHD are likely to also have conditions that look like ADHD. ADHD is known to cause or worsen stress, depression, anxiety, and sleep problems. So, you can have someone who is having trouble with disorganization and forgetfulness because they are depressed, not because of ADHD. But you can also have someone who is depressed, disorganized, and forgetful because they have ADHD.

Basically, a variety of things can resemble ADHD, but ADHD can also cause (or at the very least exacerbate) those very same things. This dilemma helps explain why many clinicians are asking for better tools for diagnosing ADHD in adults.

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Thank you so much for reading this post from ADHD Unpacked. I'm eager to continue exploring the complexities of ADHD, mental health, and productivity with you. If there are specific topics you'd like me to cover or if you have thoughts to share, please don't hesitate to reach out.

-Taylor

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