ADHD has long been viewed as solely a childhood disorder. But millions of adults — an estimated 2 to 4 percent — have ADHD.
The condition can look different in adults than in children. Adults with attention-deficit/hyperactivity disorder are more likely to have inattentive symptoms, such as being easily distracted or forgetful, as opposed to hyperactivity.
Researchers also have identified common patterns of behavior in adults with ADHD that are not part of the diagnostic criteria.
Because of these complexities, ADHD may go unrecognized in adulthood, and is underdiagnosed in women and people of color. This is a problem because research shows that undiagnosed and untreated ADHD is linked with higher rates of divorce, lower income, less education, higher rates of substance use disorders, higher risk of dementia, more motor vehicle accidents and even earlier death.
“Untreated ADHD has devastating consequences,” said Jeremy Didier, a clinical social worker and the immediate past president of the nonprofit organization Children and Adults with Attention-Deficit/Hyperactivity Disorder.
“And I am absolutely not exaggerating when I say accurately diagnosing and treating ADHD saves lives,” said Didier, who was diagnosed with ADHD as an adult.
Here’s what to know about the classic and lesser-known symptoms of ADHD.
The classic symptoms of ADHD
There’s a common misconception that having some problems with attention, impulsivity or restlessness are always signs of ADHD.
But these are all normal parts of the psychological human experience, said David Goodman, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine who has been treating ADHD patients for over 40 years. “That, in and of itself, doesn’t mean you have ADHD.”
In fact, studies have found that the brains of people with ADHD look different than those without the disorder, and that these differences may be affected by subtype and whether the person’s ADHD is being treated.
There are three subtypes of ADHD: inattentive, hyperactive-impulsive and combined. Classic symptoms can include:
- Inattention: being easily distracted, making careless mistakes, avoiding tasks that require sustained attention and being forgetful in daily activities.
- Hyperactivity: fidgeting, excessive talking and extreme restlessness.
An ADHD diagnosis requires experiencing several of the symptoms included in the diagnostic criteria as well as significant impairment in your life, whether it’s at home, work, school or in social settings.
“The key is impairment,” Didier said. If you find yourself asking, “‘Why can everybody else do this and I can’t? Why does everybody else make this look so easy?’” that can be a sign, she said.
And because ADHD is considered a neurodevelopmental disorder, some of your symptoms need to have been present in childhood.
Struggling to manage emotions
Emotional dysregulation — difficulty in managing emotions in a controlled way — is exceedingly common in ADHD, estimated to affect 34 to 70 percent of people with the disorder.
But it is not part of the U.S. diagnostic criteria.
Emotional dysregulation in ADHD may look like frequent mood shifts and sensitivity to criticism. A recent study reported that, in adults with ADHD, feeling real or perceived criticism or judgment can lead to profound feelings of anxiety, pain and misery.
Adults with ADHD also more frequently use counterproductive strategies to manage emotions, such as suppressing them instead of reframing them, research finds.
Mood disorders such as anxiety and depression are also common among people with ADHD — five times more for anxiety disorders and 4½ times more for depression than the general population, according to a large 2023 meta-analysis. But emotion dysregulation is different.
Mood disorders are like the “climate,” which requires persistent symptoms for weeks, said Lenard Adler, a professor of psychiatry and child and adolescent psychiatry and director of the adult ADHD program at the NYU Grossman School of Medicine.
Emotional dysregulation in ADHD is more akin to “weather,” he said. “Here it’s bruising more easily, being overly sensitive, overreacting, taking things too much to heart, often in reaction to something that happens in the day. It fluxes pretty quickly and doesn’t persist for days at a time.”
Difficulties in pursuing goals
Adults with ADHD commonly have broader problems with executive functions, which are higher-order cognitive abilities that allow you to pursue your goals, such as making plans, solving problems and staying focused. Executive dysfunction occurs in about half of ADHD cases and at similar rates as inattentive symptoms, Adler said.
In one study, Adler and his colleagues found that adult ADHD is characterized by a broad set of executive dysfunction symptoms, including needing a deadline to work, not completing tasks in time, trouble planning ahead and difficulty prioritizing work.
Other research has found that adult ADHD is associated with deficits in switching between tasks, decision-making and certain types of memory.
Processing time differently
People with ADHD also seem to process time differently, said Kevin Antshel, a professor of psychology and director of the clinical psychology doctoral program at Syracuse University.
“It’s either slower when things are not exciting, or it goes too fast when things are exciting,” he said.
Some studies have found that adults with ADHD have difficulties accurately estimating the passage of time.
Social media often uses the term “time blindness,” but Antshel wouldn’t say people with ADHD are blind to the concept of time — just that they have “difficulty processing time” compared with other people.
Hyperfocus
Antshel also often hears adults with ADHD talking about “hyperfocus” — persistent, intense fixation on something while blocking out everything else. And one 2019 study found that adults with more ADHD symptoms tend to report more frequent hyperfocus.
Some people may think of their ability to fixate on something they are interested in as a “superpower.”
But if you can’t keep the rest of your life going “because you’re so focused on this one thing, then what appears to be a superpower begins to work against you,” Antshel said.
Getting a diagnosis
ADHD diagnoses are rising for children and adults alike, in part because of greater awareness and more vigilance. About 1 in 10 children and teens are diagnosed with ADHD. Roughly half no longer meet the criteria for a diagnosis as adults, though 70 percent still report impairing symptoms.
ADHD has a strong genetic component. As a result, many adults discover they have ADHD symptoms when they take in their child or even grandchild to be evaluated. Others may get an ADHD diagnosis because new stressors or life changes uncover symptoms they were previously able to manage, Didier said.
If you think you may have adult ADHD, bring it up to your health care provider, who can help arrange a comprehensive evaluation. This may include getting insights from people who know you.
In a clinical interview, a skilled professional can help differentiate ADHD from other conditions, as well as help determine if it is accompanied by other commonly overlapping issues such as depression, anxiety or autism, Goodman said.
There is also a six-question screening that can help identify people who are at higher risk. It can’t give you a diagnosis but may be an indication to look further.
New clinical guidelines for adult ADHD are due to be released this year — the first of their kind in the United States — with the goal of clarifying and streamlining the diagnostic and treatment process for clinicians.
A proper diagnosis can help with finding effective treatments, which include stimulant and non-stimulant medications, as well as different types of therapy.
But a diagnosis gives another gift for people. It reveals the “difference between who they are as a person and what they have,” Goodman said.
Many of his ADHD patients say they’ve been criticized their whole life that “they’re lazy, they’re crazy, they are stupid, they’re not motivated” and thought it was about them.
“Then they get an ADHD diagnosis, and they get treated, then they really should know that was not really true,” Goodman said. “They weren’t commenting on me as a person; they were commenting on my ADHD.”
Do you have a question about human behavior or neuroscience? Email [email protected] and we may answer it in a future column.
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