How ADHD is diagnosed in young adults and adults

A young adult who struggles to stay organized and focused may wonder, “Do I have ADHD?” The same is true for parents who struggle with managing time and who have a child with ADHD. They may ask, “Do I have ADHD, too?”

It’s common for ADHD not to be diagnosed until adulthood, especially for girls and women. If kids do well in school and aren’t hyperactive, their symptoms are often overlooked. But as adults they face the demands of living independently, having a job, or dealing with family. And those responsibilities can make it harder to stay organized and remain focused.

Signs of ADHD in adults include:

• Being generally forgetful or “absent-minded”; may frequently miss meetings or lose items like keys
• “Tuning out” during conversations; may be called a “bad listener” by others
• Frequently interrupting others or blurting things out
• Having trouble sitting still for long periods of time
• Struggling to finish tasks at home, at school, or at work
• Having a family member with ADHD

Specialists who test adults for ADHD

Only certain types of professionals are likely to be qualified to diagnose ADHD. They include:

• Psychologists
• Psychiatrists
• Neuropsychologists
• Physicians or APRNs (advanced practice registered nurses) who have had extra training on ADHD

It’s possible that some of the professionals listed above haven’t had adequate training in ADHD assessment and treatment. It’s important to ask whether your provider has had the proper training.

If you live in an area where there aren’t a lot of specialists, your primary care doctor may be able to diagnose and treat ADHD.

How specialists test for ADHD in adults

An ADHD evaluation needs to have certain components, no matter who does it. These are:

• An initial meeting to identify how you are struggling. The doctor or specialist will want to know how your symptoms are affecting daily life and why you’re seeking an evaluation. They’ll also ask about education and health history to figure out if these are lifelong symptoms or if they cropped up recently. That’s because an ADHD diagnosis requires a history of having at least some ADHD symptoms before age 12.
• Checklists and questionnaires. You may also complete one or more questionnaires or checklists designed to look at the frequency of ADHD-like behaviors. The clinician may send these in advance to complete before the meeting. Or you may fill them out during the meeting.
• A follow-up meeting to discuss results and develop a plan. The goal of this meeting is to figure out a treatment plan and how you’ll monitor progress.

These are the three basic components of an ADHD evaluation. The doctor or specialist typically focuses on different things, however, depending on the age of the person being evaluated.

Evaluating young adults for ADHD: At the initial meeting, the evaluator may spend more time asking about past (and present, if appropriate) performance in school. They may also recommend a full evaluation for learning differences like dyslexia, which often co-occur with ADHD.

In that case, they should refer you to a specialist to do this assessment if they can’t do it. If you have insurance, you’ll need to find out if it will cover the cost of that evaluation. If it doesn’t, explore resources for finding free or low-cost private evaluations.

Young adults should complete what’s called “normed ADHD rating scales.” Some rating scales help to assess whether a person has specific symptoms. Others compare the frequency and intensity of symptoms to people who are the same age and don’t have ADHD. There’s also a version for parents to complete so the evaluator can get their input, too.

Young adults often seek an ADHD evaluation because they’re struggling in school or having trouble deciding on a major or choosing a career path. They may also want to ask their specialist for a referral for career aptitude testing.

Evaluating adults for ADHD: The older you get, the more likely it is that a medical condition (like anxiety, depression, or hypertension) could be mimicking the symptoms of ADHD. A good clinician will always be thinking “What else could be going on besides ADHD?”

That’s why they may spend more time doing a medical and psychological history with adults than with younger adults. (Read more about the connection between ADHD and anxiety, and ADHD and depression.)

Adults tend to seek an ADHD evaluation because of how ADHD symptoms affect their career or home life. The doctor may also focus more on relationship and work history, rather than school history.

Clinicians don’t always use the “normed ADHD rating scales” when evaluating adults. Instead, adults may complete a structured questionnaire to figure out how many symptoms are present.

Treating adults with ADHD

If the doctor or specialist diagnoses you with ADHD, the next step is to come up with a treatment plan.

ADHD medication is often helpful for both young adults and adults. Young adults with ADHD need to learn the skills that will allow them to live and work independently. The clinician may recommend coaching or therapy to help them develop success strategies.

For adults, medication is often enough. It can help them follow through on strategies they’ve known about but have been unable to execute. Many adults benefit from counseling or coaching in addition to or instead of medication. This can be especially helpful for coping with anxiety, depression, substance abuse problems, and other issues that may be complicating the ADHD.

At this meeting, the clinician should address the plan to monitor progress. If you are on medication, you should be seen regularly to fine-tune the medication as needed. You need to make sure the dosage is effective and has minimal side effects. You also need to check in regarding whether counseling or coaching is working.

If you think you might have ADHD, an evaluation can give you a fuller picture of what’s going on and what can help.

You may also want to learn about the connection between ADHD and emotions. See a graphic that shows how ADHD medication works.