Many people in the general public consider attention deficit/hyperactivity disorder (ADHD) a childhood condition that is “outgrown” by the teenage years. ADHD, however, can span a lifetime with problematic symptoms that may persist past adolescence and throughout adulthood. Though the physical hyperactivity that is so recognizable and outwardly disruptive in the hyperactive-impulsive type of ADHD may decrease with age, the more subtle symptoms like inattention, distractibility, feelings of restlessness, poor planning, poor self-regulation, disorganization, forgetfulness and verbal impulsiveness may certainly continue and cause impairment in adults if left untreated.
DIAGNOSING ADHD IN ADULTS
Childhood History of SymptomsIn order to meet the criteria for an ADHD diagnosis, symptoms of ADHD must have been present in childhood. The adult may not have been diagnosed as a child, but there must be evidence that the individual had deficits in attention and self-control at that stage of development (before 12 to 14 years of age). The only exception to this is if the adult suffered from brain injury or a medical condition that resulted in ADHD symptoms.
Current Evidence Impairment
Does the adult currently experience significant deficits and impairment in functioning across settings –- at work, at home, in relationships? In order to meet the criteria for diagnosis, the adult’s daily life activities must be chronically and pervasively impaired due to the inattentive and/or impulsive symptoms.
Ruling Out Alternative Causes
Can the presenting symptoms be better explained by some other condition besides ADHD? In order to reach an accurate diagnosis of ADHD, the doctor (or other qualified healthcare professional) must first rule out all other possible causes and explanations that could account for the ADHD-like symptoms.
If ADHD is diagnosed, it is also important for the doctor to sort out whether other conditions -- such as anxiety, depression, or substance abuse -- accompany the ADHD. If so, these conditions should be considered in the adult’s treatment plan in order for the treatment approach to be most effective.
During the Evaluation
Though it varies, a typical evaluation for adult ADHD may last approximately 3 hours. During the assessment, the doctor will spend time conducting a detailed interview with the adult, his (or her) spouse/partner, and the parent and siblings of the adult (if available). This clinical interview will include questions about developmental, medical, school, work and social history. It is often helpful for the adult to bring any records of childhood history and behavior. In addition, questionnaires, rating scales, intellectual screenings, and measures of sustained attention and distractibility may all be part of the ADHD evaluation. If appropriate, the adult will also be screened for the presence of learning disabilities. Medical history, past and present, is also important. If the adult has not been seen for a medical examination recently, one may be recommended in order to rule out any medical causes for the problems. Though psychological testing should not be used as the sole basis for diagnosing ADHD, sometimes it may be recommended in order to support conclusions and provide a more comprehensive assessment.
Additional reading:Myths About ADHD
How Do We Know ADHD Is Real?
Healthy Living with ADHD
Improve Time Management
Understanding Your ADHD Spouse
Russell A. Barkley, PhD. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (Third Edition). The Guildford Press. New York. 2006.