Diagnosis of adults can be particularly difficult. Many adults grew up at a time when very little was known about ADHD. Diagnosis requires evidence of a history of pervasive problems since before the age of seven. This can be a problem since the parents, teachers and caregivers of adults seeking diagnosis may be deceased, difficult to locate, or unable to remember circumstances many years in the past.
The relatively recent acceptance of adult ADHD means that many adults remain undiagnosed and are unaware that their behaviors are part of an identifiable condition. Adults who have learned they have the disorder often say that before they were diagnosed, they had come to the conclusion that they were incapable, unintelligent, and sometimes even crazy. They are likely to have frequently changed jobs, experienced difficulties with relationships, partners, and marriage, and often have a history of alcohol or substance abuse.
The current criteria for diagnosing ADHD in adults are the same as the DSM-IV criteria used to diagnose children. Although other symptom checklists are sometimes used in assessing adults for ADHD, the DSM-IV criteria are currently considered the most empirically valid.Clinicians must look for the symptoms as they would appear in the life of an adult. These core symptoms of ADHD are often disguised as other mental, social and psychological problems. Here are the criteria, according to the DSM-IV, reworded to reflect symptoms as they would appear in an adult.
Often fails to give close attention to details or make careless mistakes at work
Often fidgets with hands or feet or squirm in seat
Often has difficulty sustaining attention in tasks or fun activities
Often leaves seat in situations where seating is expected
Often doesn't listen when spoken to directly
Often feels restless
Often doesn't follow through on instructions and fail to finish work
Often has difficulty engaging in leisure activities quietly
Often has difficulty organizing tasks and activities
Often feels "on the go" or "driven by a motor"
Often avoids, dislikes, or is reluctant to engage in work that requires sustained mental effort
Often talks excessively
Often loses things necessary for tasks and activities
Often blurts out answers before questions have been completed
Often easily distracted
Often has difficulty awaiting turn (impatient)
Often forgetful in daily duties
Often interrupts or intrudes on others
The above symptoms often lead to associated problems and consequences that often co-exist with adult ADHD. The following is a list of some of those problems.
Problems with self-control and regulating behavior
Poor working memory
Poor persistence of efforts toward tasks
Difficulties with regulation of emotions, motivation and arousal
Greater than normal variability in task or work performance
Chronic lateness and poor time perception
Easily bored
Low self-esteem
Anxiety
Depression
Mood swings
Employment difficulties
Relationship problems
Substance abuse
Risk-taking behaviors
Poor time management
The impairment from both the core symptoms and associated features of ADHD can range from mild to severe in its impact on academic, social and occupational domains. Symptoms of ADHD are common to many other psychiatric and medical conditions, so adults should seek a comprehensive evaluation from a qualified professional. The first step in getting help for ADHD is making a correct diagnosis.