ADHD in adults. What does that look like?

Attention-Deficit Hyperactivity Disorder.

Inattention: difficulty concentrating, being easily distracted, disorganised forgetfulness, and struggling to sustain Focus on tasks that require effort.

Hyperactivity and impulsivity: excessive restlessness or fidgeting, difficulty sitting still, excessive talking, acting without thinking and interrupting others. ~ ADHD: DSM-5 Criteria, Prevalence, Types, and Treatment - MedCentral

What does an ADHD diagnosis look like for adults?

Let's face it. Getting a diagnosis of ADHD can be complex, confusing and costly. With waitlists blowing out and no rebate support available, it can be a huge decision to determine if there is any point in conducting a full ADHD assessment. 

What if the answer is no? What if the assessor doesn't really understand what is going on for me? How can I possibly share the impact ADHD traits have on my life by completing a questionnaire online or meeting with a therapist either in person, over the phone or online for an hour?

Why do all therapists use different tools?

Where is the consistency?

Does this make my diagnosis less valid?

All these questions and more are warranted. It can take an adult up to one year to get around to actually making the appointment for a diagnosis. And then in true ADHD style, they may either be late for their appointment, show up half an hour early or forget altogether! Many adults have an ah-ha moment when their child first receives their diagnosis. They can relate to what the child's therapist is saying and can see the same behaviours throughout their own lives. 

The road to a diagnosis can be confusing. It can also be confusing for the therapist and many therapists report that they are not comfortable or know enough about ADHD to make a diagnosis. So what do you do?

Firstly, let's take a look at a child presenting with ADHD symptoms. The pathway to a diagnosis is more clearly defined. We do a series of questionnaires, getting information from both school and home. We then do a clinical interview based on something like the Young DIVA and wala, we have a diagnosis.

Assessments and diagnoses for adults are not always that simple. 

Adults, especially adults with inattentive ADHD, are often missed in childhood. They don't present as a hyperactive/impulsive young boy. They may be able to get through school, not working to their full potential, but 'good enough' with no extra support needed. And women, don't even get me started! On a side note, it is interesting to read that the ratio for men to women works out to be 1:1 by the time they reach adulthood. 

So adults may have gone through life not really knowing and not really understanding what is going on. They may feel different or not quite right. They may have been bullied as children and not really fit in with their peers as adults. Things like forgetting appointments, walking into the laundry and forgetting to put the washing out, going into a shop and walking out without the things you went in for can be more than annoying. They can really interfere with your quality of life. 

To manage, other things start to pop up. This may be something like anxiety on really needing to get things right and not being able to, no matter how hard you try or how organised you try to be. Examples include: Walking into a group of people and not really knowing what to say. Not sleeping at night and waking without a good reason. Excessive worry about health and hyper-fixating on symptoms with the help of Dr Google or ChatGPT.

So you go to the GP and come back with a diagnosis of generalised anxiety disorder and a prescription. However, the rolling thoughts continue, and the panic about how to manage persists. Is it really anxiety?

Depression may rear its head. Feelings of failure and worthlessness may set in. Things just don't seem to work for you. You begin to loose interest in activities you used to hyperfixate on and choose to stay longer in bed because socialising is just purely exhausting. So you go to the GP and they diagnose depression and you walk away with a script. But the depressive thoughts continue and every time you meet with friends, when you actually do remember your date, you need a day or two to recover. It doesn't make sense. Along with this is an internal feeling of anger that just blows up. This makes you feel like you are a 'bad' person and you give up. 

Adults come with a multitude of complications when it comes to ADHD. Binge eating, disordered eating, substance use and misuse, criminal activity or rather impulsive activities, difficulties with relationships and high levels of divorce rate. Even an increase in suicide rates may actually be undiagnosed ADHD. Not to mention the PTSD, BPD and bipolar disorder diagnoses that have been made in the past, that kind of fit but don't really make sense. 

The key to an adult diagnosis is pulling apart the layers to try and see what's underneath.

Recognising that yes there may be anxiety, but it's also ADHD. It may be recognising that the mood swings are intense and may be mistaken for bipolar disorder, but their duration is different, and it's actually ADHD sitting there. The problem of how to diagnose is compounded by the subjectivity within the assessment process.

You do a questionnaire and a diagnosis is made. Correct? Wrong!

A questionnaire can be a valid screening tool to try to work out if ADHD traits exist, but a full diagnosis needs to be supported by a clinical interview.

So, as the practitioner, this is where we come in. 

Under the guidance of an excellent supervisor, and following a formula in your ADHD assessments.

As a practitioner, I start with an extensive online questionnaire to try to pull apart all the other things that might be going on. Then, based on these results, we plan the next step. The next step may be a full diagnostic assessment, and that's ok. Sometimes the answer is yes, ADHD is confirmed, and sometimes it's a no. To help get a clear picture, we talk to someone who knows the adult well. Research suggests adults downplay their ADHD symptoms and a partner, parent or friend can help to support the process. 

Yes, it has been a long journey, but a validating one. With correct information, we can make a diagnosis and develop an effective treatment plan. This may mean staying on anxiety medication or getting a referral to a Psychiatrist for ADHD medications.

Speaking with a mental health practitioner is key to support with day-to-day living. This would also offer the opportunity to gain key tools, as therapy is recommended to help understand what the diagnosis means and address barriers in your particular context.

For more details and to book an assessment, contact Sarah Vanis ~ General psychologist. / ADHD specialist

The Anna Centre. www.annacentre.com.au