Untreated ADHD can lead to depression, stress and low self-esteem. (For Corewell Health Beat)

At some point during the week, just about everyone experiences a moment of forgetfulness.

Or maybe a mood swing, or feelings of restlessness. Or even the occasional frustration.

But if you experience these issues often, and you find it difficult to prioritize or difficult to follow a plan—or your temper flares and you struggle to manage stress—it might be hinting at something else going on.

If you struggle with these issues as an adult, it could be a sign of attention deficit hyperactivity disorder.

“(ADHD) symptoms present differently in adults than in children,” said Lyndsay Volpe-Bertram, PsyD, clinical psychologist and section chief of psychology at Corewell Health in West Michigan.

For adults, ADHD can be more about inattention, rather than hyperactivity. You may be overly talkative, tap your pen all the time, forget to pay a bill, or frequently get up from your desk, she said.

“By adulthood, we have learned what is socially acceptable and can control the hyperactivity, but still show signs of distraction,” Dr. Volpe-Bertram said.

Approximately 3% of adults and about 5% to 6% of children in the U.S. have ADHD, she said.

“And about 30% to 50% of people who have ADHD as children grow out of it as adults,” said Jeffrey Guina, MD, program director of psychiatry residency at Corewell Health in Southeast Michigan.

People do not develop ADHD as adults, Dr. Guina said.

“If it is diagnosed in adulthood, it is only because it was missed in childhood,” he said. “Symptoms develop by age 12. People tend to say ADHD is either over-diagnosed or under-diagnosed. Both are true.”

It is easy to mistake other conditions for ADHD, but it can also be easy to overlook it, he said.

Making a diagnosis can be a long and involved process, not just a single test.

The gold standard of testing for ADHD begins with meeting with a qualified mental health care professional or physician who gathers information from multiple sources, he said.

A physical exam helps rule out other possibilities, such as poor sleep, nutritional issues, autism, traumatic brain injury or stress.

“A person might be suffering from depression or anxiety, especially since the pandemic and being in isolation for so long,” Dr. Guina said.

“Or a person might have a diagnosis of PTSD or bipolar disorder,” Dr. Volpe-Bertram said. “That’s why the interview is so important. We talk to you and gather collateral information, and the testing process can take two to three hours.”

Informative interview

The evaluation process begins with gathering a history and timeline of your life. During the interview, a clinician also observes behaviors.

If symptoms appear at only one place—at work but not at home, for instance—the problem may be situational and not ADHD, Dr. Volpe-Bertram said.

“We gather collateral information, talk to family members and friends and coworkers,” Dr. Guina said. “The symptoms have to show up in multiple areas in your life.”

There may also be tests of cognitive ability and academic achievement to rule out a possible learning disability.

Use of cannabis can also create symptoms that mimic those of adult ADHD, according to Dr. Guina.

“Now with legalization, more people are using marijuana,” he said. “And frequent users experience an effect on the frontal lobe of the brain that can last as long as six months.”

The frontal lobe of the brain is responsible for memory, attention, language and other cognitive functions. Substance abuse and some medications can affect the brain and cause symptoms that mimic ADHD symptoms.

“We may do lab work and/or psychological testing to assess for other causes of inattention,”
Dr. Guina said. “The hardest part of the diagnosis is ruling out every other possibility.”

Value of treatment

Once the diagnosis is made, in most cases stimulants are prescribed, often in combination with cognitive behavioral therapy, Dr. Volpe-Bertram said.

“In cognitive behavioral therapy we can work on behaviors,” she said. “We work on developing consistency and routine, planning tasks, how to approach projects. We look at patterns in behavior and develop skills.”

Physical exercise, especially when using fine motor skills, can also be a good treatment for ADHD.

Stimulants are most important, however, Dr. Guina said.

“Therapy is beneficial, but the right medicine can dramatically change your course of life,” he said.

Under treatment, adults with ADHD who are prone to car accidents as a result of distracted driving have become safer drivers, Dr. Guina said. They are also less likely to exhibit addictive behavior, which is common for adults with ADHD.

“While it may seem odd to prescribe stimulants for someone with hyperactivity, the frontal lobe in people with ADHD is underactive, so the stimulants help the mind focus and filter out distractions and regulate impulses,” Dr. Guina said.

If a patient has a history of substance abuse, non-stimulant medications can be prescribed but they may be less effective, he said.

Music can benefit patients, too, especially learning to play an instrument, which helps focus and calm the mind.

Untreated ADHD, on the other hand, can lead to depression, stress and low self-esteem.

“If you aren’t succeeding in life, that is going to affect how you feel about yourself,” Dr. Guina said. “It will not only frustrate you, but those around you. So it can be tough on all your relationships, especially partners, when you don’t follow through.”

Dr. Volpe-Bertram added a word of caution: “We have seen a proliferation of online assessments recently to diagnose ADHD. If it is fast and easy, it is probably not a good idea.”

Instead, talk to your primary physician for a referral to a professional and reputable testing, she said.