How is Adult ADHD Diagnosed?

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

serious girl walking outside Adults are diagnosed with ADHD using the same criteria as for children and ADHD. However, the symptoms look different in adults and children. To illustrate: An adult might repeatedly tap his pencil eraser on the conference room table; fidget or even spin in his chair, and vigorously doodle on his tablet; all while listening to a training seminar at work. A child might just take a lap around the classroom, and poke a few classmates along the way. Both could be examples of hyperactivity; but it is easier to identify the childhood version.

Summary of Adult ADHD symptoms

We have already reviewed the signs and symptoms of adult ADHD. We refer you to that section for more specific and detailed information. We will now provide just a basic summary before we move on to describe some diagnostic challenges.

The three main symptoms of ADHD are:

1) Inattention;
2) Hyperactivity; &,
3) Impulsivity

The symptoms will occur in some combination.

Inattention refers to a difficulty with concentration and trouble remaining on-task, or focused on an activity. This is especially noticeable with tasks or activities that are unappealing or uninteresting. While all of us may not enjoy boring, unappealing tasks, we nevertheless manage to complete them. The same cannot be said of someone with ADHD. Inattention may include daydreaming, or being easily distracted. The specific behaviors that indicate inattention differ among various age groups.

Hyperactivity refers to an excessive degree of [non-purposeful], physical or mental activity. In adults, hyperactivity tends to be more of a restless mental energy.

Impulsivity refers to rash, imprudent, sudden, or thoughtless words, or actions. These thoughts and actions occur with limited consideration of long-term consequences.

In diagnostic terms, inattention is one type of ADHD, while hyperactivity and impulsivity are combined into a second subtype. This is because hyperactive/impulsive symptoms are comingled and refer to behaviors that are generated by excessive energy. The hyperactive/impulsive types of behaviors are the easiest to observe and identify. The behavioral symptoms are generally quite overt and noticeable. It is more difficult to observe and identify the inattention type as these symptoms tend to be more internal. For example, if I see you looking at the computer, how do I really know if you are actually reading this article or just staring at the page while daydreaming about something else? A third subtype of ADHD is called the combined type. This means there is no one dominant set of symptoms. Instead, symptoms are represented by a fairly equal balance of symptoms from all three symptom sets (inattention, hyperactivity, impulsivity).

Four primary diagnostic challenges of adult ADHD

There are at least four primary diagnostic challenges concerning adult ADHD:

1. ADHD is a diagnosis that requires symptoms be present before age 12. This diagnostic requirement means there must be evidence that symptoms were present before age 12. This requires a retrospective analysis of past symptoms using historical data.

2. ADHD has symptoms shared by other disorders called, differential diagnosis; and, other disorders commonly occur in addition to ADHD called, co-occurring disorders. Teasing ADHD apart from these other disorders can be complex.

3. In a similar manner, teasing ADHD behaviors apart from normal variations in adult behavior often requires specialized skills. Lots of people have ordinary problems with memory, concentration, inattention, excessive energy, daydreaming, inattention, etc. Where's the line between normal and not normal?

4. Cultural expectations, stereotypes, and life-long coping skills can conceal the disorder.

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Diagnostic Challenge 1: Looking into the Past

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