Episode Transcript
Interviewer: Attention deficit hyperactivity disorder, or ADHD, is a condition that is often associated with children. However, an increasing number of adults are being diagnosed, leading to new challenges and questions for many.
Today, we're diving into what adult ADHD looks like and why diagnoses are on the rise. We're joined today by Doctor of Psychology Britt Holmes with University of Utah Health and Huntsman Mental Health Institute, and an expert in the field of ADHD assessment.
Now, Dr. Holmes, let's start from the beginning. Can you give us just kind of an overview of what adult ADHD looks like?
Understanding Adult ADHD
Dr. Holmes: Sure. Most people who have some awareness of ADHD are familiar with the most common problems, like having trouble paying attention or being easily distracted. Sometimes people also picture a child who can't sit still. Adults have a lot of the same kinds of problems that we see in children who are more commonly diagnosed, but they're often more subtle.
An adult who hasn't been diagnosed before, that's often because they've learned a lot of ways to cope with their challenges. Adults may have trouble paying attention in meetings or classes if they're in school, and then compensate in different ways like doodling, or we see many people who bounce their legs over and over.
Some form of fidgeting, some form of effort to be able to stay on task, not get distracted, but that isn't maybe outwardly obvious. Adults are not normally getting out of their chairs, for example, in these situations.
Adults often have trouble organizing their tasks, so chores around the house or different life tasks that we have, paying bills, making appointments. That can be very challenging.
Similar issues can come up in the workplace, like not knowing where to get started on a different work assignment, especially one that you're doing on your own, sitting still.
There are challenges adults will face, like double-booking themselves. So they forget that they have one commitment, someone invites them to some other event, and they simply space.
They tend to blurt things out or interrupt other people, but sometimes it's an internal experience of wanting to do it and having to work very hard not to. There are some issues with impulsiveness that can translate to reckless behavior. Reckless driving is not uncommon with adults.
Recognizing Adult ADHD Symptoms
Interviewer: One of the questions I have, though, is that a lot of those symptoms . . . some of them seem a little less specific than others, and they might just be fidgeting or doodling because they're bored. What is the kind of dividing line between when it's ADHD and when it's just everyday type of stuff?
Dr. Holmes: Sure. That's a great question. Many of us have trouble paying attention in that class that we just find super boring, but we have to take to graduate, or the annual budget meeting that's just super . . . there's nothing that we're adding to the discussion.
I do think it is important if someone is having a tough time paying attention to consider, "Well, is this kind of a thing that most people struggle with?" versus immediately jumping to the idea that, "I should be able to pay attention always without any effort," when it's simply not true.
When we think of it as becoming more pathological, it's happening across settings. So it's not just at work. It's not just at school or just at home. It's occurring pretty consistently across settings, even if kind of many other things are managed.
So it's not that we didn't get enough sleep. It's not that we're under a lot of stress. Those things can influence attention a lot, and then we do have to use those strategies.
But when it becomes more pervasive, pretty impairing, and evident across multiple settings is when we got more concerned that maybe this isn't just "I don't like this particular class" and this is more of a "maybe I'm actually very interested in the topic in general, but I cannot bring myself to pay attention to the lecture or the reading."
Or I can't maybe even choose when to pay attention or not, or I get sidetracked. I'm so interested in one part of the class or one part of a meeting that I lose track of all time and only study or pay attention to that one thing and I kind of miss the need to pay attention to other things as well.
Factors Contributing to Increased Adult ADHD Cases
Interviewer: It seems like, according to some of the research that I've read, that adult diagnosis is actually on the rise in the United States. What do you think is causing this kind of increase in diagnoses in people that have never had one before?
Dr. Holmes: I think there are a bunch of different factors, some of which are coming together to make sure that people who do have ADHD are finally getting diagnosed and treated.
We know that a majority of adults who have ADHD don't get effective treatment and it's definitely under-recognized, but we are also seeing a rise in individuals who have just everyday problems paying attention, and then may see something that leads them to think they have ADHD.
One factor was that many people lost some of the guardrails that they had during the pandemic. At its height when people were working from home and no longer had maybe some of the day-to-day cues that they had in the workplace to keep them on track, they never really realized how much they had to rely on those before, and then they were experiencing more problems.
There's more awareness and I think less stigma related to ADHD, and that's had people come forward more with that question, "Could this be ADHD?"
More awareness also with doctors who may ask more questions and be less dismissive if someone indicates that they're concerned about an attention problem, which would lead to more access.
The other thing that we see is an increase with social media, people see things online. They may have a TikToker that they follow who has ADHD and says that they have particular problems. Maybe things that they have that they think are because of ADHD, someone hears it and thinks, "Oh, I have that too. I think I have ADHD."
But they're not always getting good information. People are often misinformed or they have a particular experience that while may be true for them and they have ADHD, someone with a similar problem may not really have the full-blown condition or may have one symptom and not the rest.
Impact of ADHD Diagnosis: Emotional and Practical Implications
Interviewer: For someone who maybe themselves or someone in their lives might be getting a diagnosis in adulthood, what does that kind of mean for a person?
Dr. Holmes: When I work with adults who are coming to me and end up getting a diagnosis of ADHD, it can be really powerful for them to feel heard and understood.
They'll speak of having felt validated that the problems that they've had in their life, difficulty maybe passing classes in college, for example, or they have to work twice as hard as one of their colleagues to get certain things done, to have an explanation for that can be a relief in and of itself to think, "Oh, it's not that I was bad in some way or that I wasn't working hard enough, but it's that I actually had a medical condition that wasn't treated and wasn't managed."
For some individuals, there's also a benefit of getting accommodations in school or at work. In school, some of the most common ones would be having extra time to take a test or being able to take tests in a separate area that doesn't have the distractions maybe of lots of other people in the lecture hall, noises, visual movement that can make it harder to focus.
In the workplace, there may be more flexibility with certain deadlines, or for getting to work on time, less stringent expectations. If someone does run late, that can be because of ADHD, and not face as many consequences, that there be an understanding or an accommodation for that.
And then, of course, the most important impact is the access to care, whether that's treatment using medications that might be prescribed by a primary care doctor or by a psychiatric specialist, or working with a therapist to learn skills to manage ADHD, learning more strategies that can help them cope with the symptoms that are most problematic for them.
Seeking Support for ADHD: Resources and Next Steps
Interviewer: So maybe there's a listener or maybe a listener who has a loved one who might be curious as to could some of their symptoms be caused by ADHD. What resources and next steps are available to these patients after they have this kind of curiosity about whether or not this is a condition they may have?
Dr. Holmes: If someone thinks they may have ADHD, I'd of course encourage them to speak with their doctor. They can do some research online, but I would look to real scientific-based resources like the National Institute of Health, and the CDC. They have reliable information. There's a nonprofit organization that can be found at add.org that may also be a good resource.
I think before going to the doctor, it can also help to keep track of some of the symptoms. Are there situations in which they're better, or worse?
Give your doctor the best information possible to determine whether the attention problems you may be having are caused by ADHD, or whether those are some other health condition, or may be the reality of the number of stressors that person is facing or other medical issues they may have that could be causing the symptoms that they're reporting.