How to handle a misdiagnosis

You were pretty sure that your longtime trouble with focus, memory, and organization was ADHD. But when you went for an evaluation, you came back with a different diagnosis — one that you think is wrong. Now what?

Misdiagnosis isn’t uncommon with ADHD. But it most likely means you’ll keep struggling with symptoms. You need a correct diagnosis of ADHD, or any other conditions you may have, to get the best treatment for your challenges.

If you suspect your diagnosis is wrong, there are things you can do to get an accurate one. The most important step is having a full evaluation. A good evaluation can also help catch an inaccurate diagnosis of ADHD, which happens sometimes.

ADHD is complex, with a wide range of symptoms that often change over time. Not everyone has the same challenges to the same degree. Symptoms often look different in adults than in kids, and in males versus females. 

Also, ADHD shares symptoms with (and co-occurs with) other conditions. That makes diagnosing it trickier. For example, trouble focusing could be ADHD. It could also be depression. These two conditions often co-occur, so it might be both.

Stereotypes can come into play, too. Some people still think of ADHD as a problem of overactive boys. Professionals who aren’t familiar with what ADHD often looks like in girls and in women may attribute their symptoms to something else. 

Misdiagnosis is more likely if you don’t have a thorough ADHD evaluation. A good evaluation takes some time, and it may involve using different screening methods and tools. 

The professional who evaluates you should ask many questions about your symptoms. That might happen through an interview or questionnaire. You might also fill out a ratings scale. This tool asks you to rate how much symptoms affect you.

It’s also key for the person doing the evaluation to ask about your history of symptoms and challenges, according to psychologist Sharon Saline, PsyD. 

“If you’re misdiagnosed or underdiagnosed, your [health care provider] or therapist likely didn’t ask enough historical questions,” she says.

Understood Expert Ari Tuckman, PsyD, agrees. “The best way to make a good diagnosis of ADHD is taking a really thorough history,” he says.

The professionals who do adult ADHD evaluations include:

• Psychologists

• Psychiatrists

• Advanced practice registered nurses

• Psychiatric mental health nurse practitioners

• Physicians

There are many symptoms and signs of ADHD. The key symptoms are inattention, impulsivity, and hyperactivity. The most common one in adults is inattention. 

Some ADHD symptoms are also signs of other conditions. If you weren’t diagnosed with ADHD as a child, some professionals may look for other reasons for your symptoms first. 

Here are some conditions with symptoms that overlap with ADHD. These conditions also often co-occur with ADHD.

Autism spectrum disorder: ADHD and ASD share some symptoms like trouble with social interaction and sensory processing issues. ADHD and ASD also frequently co-occur. That’s often referred to as AuDHD.

Mood disorders: ADHD hyperactivity and impulsivity can look like mania, a common symptom of bipolar disorder.¹ ADHD can also look like depression, with forgetfulness, tuning out, and low motivation as shared symptoms. 

Anxiety disorders: Trouble regulating emotions and feeling overwhelmed are common in both ADHD and anxiety.² Some people have just one condition or the other. But other people with ADHD also have anxiety or an anxiety disorder. It’s not unusual for people with ADHD — especially women — to be misdiagnosed or diagnosed first with anxiety. 

Sleep disorders: Sleep difficulties and disorders like insomnia are common in people with ADHD. Lack of sleep can cause problems with focus and alertness, or make them worse.

Obsessive compulsive disorder: OCD causes intrusive thoughts, repetitive behaviors, and compulsions.³ Those symptoms can happen with ADHD, too. People with ADHD often get distracted by their own thoughts, and dwell on them. 

If you suspect you’ve been misdiagnosed, follow your instincts. There are things you can do to make sure you have an accurate diagnosis. Consider these:

Make an appointment to discuss the diagnosis with the professional who made it. “You can ask your health care provider to help you understand how they came to this diagnosis,” says Tuckman. 

“Why do they believe the current diagnosis is right? And why don’t they think that it’s ADHD?” he adds. “A good provider should be able to explain that to you.” 

Professionals use a manual called the DSM-5 to diagnose ADHD. It lists the criteria for meeting that diagnosis. 

As an adult, you need to have at least five symptoms of inattention and/or impulsivity-hyperactivity. (Kids must have six symptoms.) You also need to have had ADHD symptoms before you were 12 years old.⁴

Here are some examples from the list:⁵

• Often fails to give close attention to details or makes careless mistakes.

• Often doesn’t seem to listen when spoken to directly. 

• Often doesn’t follow through on instructions.

• Is often easily distracted by thoughts.

• Is often forgetful in daily activities. 

• Often fidgets or taps hands or feet.

• Often talks excessively.

• May intrude into or take over what others are doing.

• Often blurts out an answer before a question has been completed. 

If you weren’t asked a lot of questions the first time, you should have another evaluation that’s more complete. You may need to find a new professional to do it. Before you have the evaluation, ask if that person has a lot of experience diagnosing ADHD in adults.

Ask what the process is to make sure you’ll be getting an in-depth assessment. The more information the evaluator asks for and gets, the likelier you are to end up with a correct diagnosis. 

Diagnosing ADHD isn’t simple, especially when the challenges aren’t obvious. Many adults with ADHD are able to mask their symptoms and struggles. You and the professional doing your evaluation should look beneath the surface. 

Tuckman gives an example. “Let’s say you got out of college in four years. Clearly you don’t have ADHD, right? But it’s more than that — you should be talking about how you got there. Did you pull all-nighters for every single paper? Did you have lots of late and missing assignments, but talked your professors into accepting it late?” 

With ADHD, you’ve got to dig a little deeper.

The diagnosis you got may not be wrong, just incomplete. Having another condition doesn’t mean you don’t have ADHD. And having ADHD doesn’t mean you don’t also have something else. Sometimes, a misdiagnosis is actually a missed diagnosis. 

“In women, ADHD is more likely to be missed, and they are diagnosed with something else instead — like anxiety or depression. But what if they had both?” says Tuckman. 

Diagnosing both conditions correctly is key to getting the right treatment for each one. Make sure the professional doing your evaluation is looking at the complete picture. 

Having a diagnosis that’s correct can explain a lot about the challenges you’ve always had. And it can help you get support that improves your daily life.

ADHD is a common condition that affects focus, impulse control, and more. About 15.5 million U.S. adults have an ADHD diagnosis. But many others are misdiagnosed with something else.

You’re more likely to be misdiagnosed when you don’t have a full evaluation. In a full evaluation, a professional asks many detailed questions about your symptoms and history.

ADHD is complex and can be tricky to diagnose. It shares some symptoms with other conditions. It often co-occurs with them, too. These include autism, anxiety, depression, and sleep disorders.

If you think you’ve been misdiagnosed, there are steps you can take:

• Ask the professional who diagnosed you what they based the decision on.

• Check if your symptoms match the criteria for an ADHD diagnosis.⁵

• Have a second evaluation.

• Take a closer look at your challenges, past and present.

• Don’t dismiss other conditions you may also have.

Having a diagnosis that’s correct can explain a lot about the challenges you’ve always had. And it can help you get support that improves your daily life.