There seems to be a lot of buzz around ADHD lately, particularly ADHD in adults. In fact, one large scale study conducted at Kaiser Permanente estimates that adult ADHD diagnoses have increased by about 123% from 2007 to 2016 [3]. What could be the reason for such a drastic rise in cases? Are more adults developing symptoms of ADHD for some reason? It seems unlikely. While some researchers are looking into the possibility of adult onset ADHD, the disorder remains classified as a childhood disorder, meaning symptoms of inattention and/or hyperactivity must have been present during childhood for an individual to be diagnosed with ADHD. So why are more and more adults being diagnosed then? There are a multitude of factors that may be contributing to the phenomenon, which have led to a combination of under, over, and mis-diagnosis of ADHD throughout the years.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) defines ADHD as “Impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity” that have been present before 12 years of age and cause impairment in at least two settings – usually home and work/school [1]. This is a significant change from the previous edition of the DSM which required symptoms to be present before the age of 7 [4]. The DSM-IV also considered autism to be an exclusionary criteria for diagnosis, meaning that an individual with an autism diagnosis could not be diagnosed with ADHD as well [4]. Given that the most recent edition of the DSM was released in 2013, it is possible that many adults who meet the current criteria for ADHD simply did not in the past because of narrower age requirements or an existing autism diagnosis.

In addition to the core symptoms of inattention and hyperactivity, ADHD is also associated with a variety of other symptoms including emotional dysregulation, anger outbursts, anxiety, and a tendency to overreact to difficult situations [1]. Men with ADHD tend to present with more externalizing problems, like anger and antisocial behavior, while women tend to experience more emotional problems, anxiety and depression [5]. Because there is so much overlap between these symptoms and those of other psychiatric conditions, not recognizing ADHD is common in adults. ADHD is a complex disorder that often coexists with other psychiatric conditions. The most common comorbid conditions include depression, anxiety, and substance abuse [3]. When ADHD occurs with another condition, the symptoms of, for example, anxiety or depression often become more debilitating and end up being the reason an individual seeks help from a mental health professional, further contributing to an overlooked ADHD diagnosis.
Many undiagnosed adults have developed unique strategies to cope with their ADHD symptoms, allowing many to lead relatively normal and successful lives. While talking to patients at the Center for Psychiatry and Behavioral Medicine, I learned a few of these tricks. One person I spoke with carries a notebook with them everywhere they go so that they can write down important dates, instructions, etc. so they don’t forget throughout the day. Another person has a specific pocket in their backpack where they place their wallet and work badge at the end of the day. While some of these things may seem trivial to an outsider, to people with ADHD, these little habits take a tremendous amount of effort to maintain structure in their lives. These strategies certainly have helped these people manage their ADHD symptoms, and in doing so, may have helped to mask them from others.

In more recent years, social media, like TikTok, Facebook, and Instagram have helped increase awareness of ADHD (and many other psychiatric conditions), which may also be contributing to increased diagnoses over the past decade. While social media platforms have undoubtedly increased the reach of who can access important information, it isn’t always accurate. In a world where we are essentially conditioned to absorb information in 30 second reels, we all probably feel a little ADHD at times! So be mindful of where you’re getting information from. Accounts run by medical professionals provide much more accurate and reliable information than those from the general public.

Adult ADHD isn’t a new phenomenon, but it has certainly garnered much more awareness over the past few years. Most children diagnosed with ADHD continue to have symptoms into adulthood and adults who have not yet been diagnosed will almost always recall similar struggles as a child. Continued education and appreciation for the many ways ADHD may present in adulthood and in childhood is an essential step in proper diagnosis, which can be made through a formal interview with a psychiatric provider. Here at the Center for Psychiatry and Behavioral Medicine, we are currently conducting a clinical trial for adults with ADHD diagnoses. This is an exciting opportunity to help the scientific community learn more about new potential treatment options for adults with ADHD.
Written by Frankie Colosimo (with the help of Buddy!)
References
American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force.: Diagnostic and statistical manual of mental disorders : DSM-5. 5th ed.
Choi WS, Woo YS, Wang SM, Lim HK, Bahk WM. The prevalence of psychiatric comorbidities in adult ADHD compared with non-ADHD populations: A systematic literature review. PLoS One. 2022 Nov 4;17(11):e0277175. doi: 10.1371/journal.pone.0277175. PMID: 36331985; PMCID: PMC9635752.
Chung W, Jiang S, Paksarian D, et al. Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups. JAMA Netw Open. 2019;2(11):e1914344. doi:10.1001/jamanetworkopen.2019.14344
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/
Young S, Adamo N, Asgeirsdottir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20:404.