'How do I know if I have ADHD?' Your questions about adult ADHD, answered by medical experts.

September 13, 2022

Tell us - what do you think of when you try to picture someone with ADHD?

That naughty boy in primary school? The hyper kid who was always fidgeting and couldn't sit still? The one kid who always had to be the centre of attention?

Chances are, you never think of a girl.

You never think of that girl in your class who was always a bit of a 'scatterbrain'. A 'daydreamer'. The one who always seemed disorganised. Distracted.

That's because the stereotypes of ADHD very much still exist. And for decades, the signs of attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) in girls have been missed.

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"With stigma comes silence and misunderstanding, and particularly for women conditions like autism and ADHD have often been misinterpreted as other diagnoses or been thought of as things that don’t affect them," said medical doctor and psychiatry resident Dr Kieran Kennedy

This means many girls and women remain undiagnosed and overlooked - unaware they have the condition and not receiving the help they need.

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While it was once thought that ADHD affects males more than females, new evidence now suggests that it likely affects males and females equally, but that girls are far less likely to be diagnosed.

ADHD is largely misunderstood, and the myths and misconceptions about how symptoms appear in women are widespread.

This is partly because their symptoms can look very different - leaning more toward inattentiveness and disorganisation.

Similar to autism, women and girls can mask their symptoms more than boys, and overcompensate in an attempt to appear organised and in control.

Below, we have a chat with medical doctor and psychiatry resident Dr Kieran Kennedy and adult psychiatrist Dr Peter Hoey and take a deep dive into absolutely everything you need to know about ADHD.

What is ADHD?

According to ADHD Australia, Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects about one in 20 Australians. That’s about one million people.

According to ADHD Foundation, most of these people are adults with no diagnosis or access to treatment, which could improve the quality of their lives.

It's a disorder that has a spectrum of different severity levels and symptoms, but it's most commonly characterised by signs such as inattention, distractibility, hyperactivity and impulsivity.

Dr Hoey said to picture it like this: "If you happen to be blessed with normal attentional functioning, like most of us are, life is like going to the theatre where the stage lighting is well-designed to highlight what’s important.

"Having ADHD is like going to the theatre and having no stage lighting design, but rather with all the stage lights, all the house lights, and all the sidelights on.

"Although the drama is still happening on stage, your attention is just as likely to be drawn to someone you think you recognise a few rows away, or someone climbing a ladder at the side of the stage, or some part of the stage which isn’t important at that time.

"You can still catch some of the drama, but it’s chopped up by extraneous cues, so you miss parts and become frustrated and discouraged."

Can you grow out of ADHD?

While experts once believed that ADHD only occurred in children and ended after adolescence, people don't necessarily 'grow out' of ADHD. A number of studies have proven that it can continue to affect a person's functioning into adulthood.

It is also common to have co-existing conditions with ADHD - such as anxiety, depression or autism. For example, studies show that around 50 per cent of adults with ADHD have an anxiety disorder.

Of course, multiple disorders can sometimes make it difficult to diagnose ADHD - which means unfortunately, some people are treated for their presenting problem, and the underlying ADHD diagnosis is overlooked.

What causes ADHD?

While there is no single cause of ADHD, decades of research and studies has shown that genes play a vital role in the development of ADHD - it's a disorder that runs in the family, with a heritability of 74 per cent.

So, if one of your parents has ADHD, there is a higher chance of you having it too.

The disorder impacts several areas of the brain - specifically, the frontal lobe and areas that control the regulation of behaviour, memory, planning and organising.

Other risk factors for ADHD may be related to factors that impact early brain development and functioning, such as exposure to toxic substances or trauma and disease.

It's also important to note that poor parenting, problems in family life, and factors such as diet and vestibular dysfunction are all things that do not cause ADHD.

Is it possible for someone who was not diagnosed with ADHD as a child to be diagnosed as an adult?

Yes, it is common to be diagnosed with ADHD without it having been recognised in childhood.

"ADHD is now more commonly recognised in childhood than it was in the past," said Dr Hoey.

"Many children who are now picked up in their school years were not recognised as such in the past and have grown up into our current adults. In particular, if you were a day-dreamy 'off with the pixies' child, you’re likely to have been seen as quirky, but not as having a problem.

"If you are reasonably bright and have a high drive towards pleasing others, you might well go unnoticed throughout your school years and even managed to succeed in tertiary study.

"It might then only be when the organisational challenges of work and family life become more difficult that someone's ADHD becomes noticeably limiting."

How is adult ADHD different to childhood ADHD?

According to Dr Hoey, between two to three per cent of the adult population have been diagnosed with ADHD, with the rate being slightly higher in men than women.

"There is of course a good deal of continuity between childhood and adult symptoms, however there are some noticeable differences too."

While childhood ADHD is often associated with symptoms such as fidgeting and difficulty sitting still, in adults, Dr Hoey said physical hyperactivity and impulsive symptoms are less obvious.

"Adults tend to have reigned this in more, so they might simply feel very internally restless instead. Distractibility and procrastination are evident over the lifespan, but in adulthood they have greater impacts on achievements in education and work which are more consequential."

Instead, inattentive symptoms are more pronounced, with adults struggling with a lack of focus and disorganisation, which can often impact deadlines and time management.

"The gap between potential and achievements becomes wider and more evident," adds Dr Hoey.

"Having ADHD is akin to being in a game of football in which you’re playing on a field always tilted 15 degrees against you. Consequently, as the game (life) goes on, you tend to get more discouraged and exhausted. By the time you’re an adult you’ve become used to losing games, causing low self-esteem and depression, and being anxious about playing on."

Many adults with ADHD may also have issues controlling their emotions - exhibiting anger, impatience, or finding it difficult to manage stress.

"ADHD in adults is frequently hidden by such symptomatic presentations and the various unhelpful mechanisms some people have adopted to cope with them, such as drug and alcohol abuse."

Adult ADHD also looks very different in men versus women.

"'Internalising' problems which are more easily hidden are probably more common in women, while 'externalising' problems, which are more overt, are more common in men."

According to a recent study, women with ADHD are more likely to report depressive symptoms, anxiety, stress, and lower self-esteem.

Why are women with ADHD underdiagnosed?

As girls are less likely to be diagnosed than boys, the prevalence of ADHD in women is largely under-recognised.

"Gendered notions of illness and diagnosis is something that’s followed medicine throughout its history - but when it comes to mental health, this has all too often been blown far beyond what the science really shows," said Dr Kennedy.

"Whether it’s that men don’t struggle with depression or that girls don’t become hyperactive or suffer from ADHD, there are conditions we’ve come to wrongly label in the past as affecting one sex or the other," he said.

"Another factor at play is that medicine and mental health aren’t blankets of the same struggles or symptoms - a mixture of genetics, biology, gender pressure and culture can all impact how men and women present when it comes to certain illnesses."

A 2018 study aimed to pinpoint what differentiated both boys and girls who met the diagnostic criteria for ADHD. It was found that parents seemed to underrate girls' hyperactive and impulsive symptoms, while overrating those of boys.

It was also found that girls who met the criteria displayed more emotional or behavioural problems than girls who didn’t. This was not the case for boys.

"It’s now thought that a significant part as to the difference in diagnosis rates (which have traditionally shown these to be conditions that primarily affect boys and men) come down to the fact that these conditions don’t present exactly the same in men and women, alongside stereotypes having sidetracked medicine from picking these up in girls early on," Dr Kennedy said.

"In general, women tend to be better socialised and more compliant than men; they are groomed more to fit in than stand out. It’s more common then for women to 'fly under the radar' and simply not be noticed as having problems early on and later on," adds Dr Hoey.

"More is expected from women in the realms of domestic and general life organisation. It’s common for women to simply feel that they are failures in these domains. They can be labelled and self-labelled as being 'spacey' or 'ditzy' without further looking in to what might be the cause of this.

"ADHD symptoms can also vary markedly through the menstrual cycle, generally with pre-menstrual worsening. They might then not be recognised as such, but simply rolled into the experience of premenstrual symptoms."

Meaning? Many girls end up falling through the cracks - and it can impact their entire lives.

For those whose symptoms are missed as children, many of these women grew up trying to manage (or hide) this condition on their own - unaware why they don't think and act like their peers.

In 2022, these disorders are being diagnosed in women in higher-than-ever rates.

According to a study in The Journal of Clinical Psychiatry, ADHD has been diagnosed with increasing frequency over the past several years, increasing 55 per cent for girls between 2003 and 2011. Among women ages 26 to 34, ADHD prescriptions shot up 85 per cent between 2008 and 2012 alone.

According to Dr Kennedy, understanding that the problem exists in the first place and creating greater awareness around the symptoms of ADHD in women is the key to ensuring these conditions do not go undiagnosed and overlooked.

"All of the above comes together as a bit of a perfect storm for girls and young women suffering these conditions - a mixture of biology, different symptom profiles, stereotypes and culture means that many young women receive a diagnosis much later than their male counterparts.

He adds, "Thankfully, new research, greater awareness and a push to correct unequal outcomes when it comes to gender means this trend is changing!"

How do you know if you have ADHD?

If you are concerned about whether you might have ADHD, the first step is to talk with your doctor or healthcare provider to find out if the symptoms fit the diagnosis.

"While it is important to avoid self-diagnosis, you might get some idea from doing an online questionnaire such as the Adult Self-Report Scale for ADHD. Bear in mind that this is not a diagnostic test," recommends Dr Hoey.

"The most certain way for this diagnosis to be ruled in or out is to consult a psychiatrist or psychologist who has a special interest in this area.

"Such practitioners can be located via the 'Find a Psychiatrist' section of the Royal Australian and New Zealand College of Psychiatrists website or the 'Find a Psych' section of the Australian Psychological Society website."

Can you treat ADHD?

While there is no cure for ADHD, there are treatments available to help reduce symptoms - and it can have a massive impact in day-to-day life.

When considering the best treatment options for you, Dr Hoey said, "There are several factors to consider before embarking on a trial of medication treatment for ADHD."

Beyond medication, a mix of lifestyle changes and strategies like cognitive-behavioural therapy, mindfulness and exercise can also prove effective, and help address underlying symptoms and improve functioning.

"Physical exercise, in particular aerobic exercise, has clinically demonstrable beneficial effects for ADHD patients. There is a known neurophysiological mechanism behind this."

Along with physical exercise, Dr Hoey said dietary supplementation with omega-3 fatty acids have been shown to improve attentional abilities in ADHD patients.

"Supplements which contain at least 750mg/day of EPA - one of the subvarieties of omega-3 - have been shown to have clinically demonstrable effects in improving attentional ability."

In combination with health and lifestyle changes, Dr Hoey also recommends implementing strategies to help with organisation.

He suggests techniques such as setting up and using reminders on your phone and having unavoidable visual cues such as whiteboard lists in front of you at your desk (and if necessary, on the fridge!).

Depending on the individual and severity of ADHD, medication may also be used to help reduce the symptoms of hyperactivity and impulsivity, improving focus.

"The mainstay of medical treatment for ADHD is stimulant medication which is, in terms of its symptomatic impact, one of the most effective treatments in psychiatry."

There are two stimulants available - with one being more effective in adults and the other in children.

"Generally speaking, these are safe and well-tolerated medications, though there are some circumstances in which they cannot be used in which case there are other treatment options," adds Dr Hoey.

What are some good resources for adult ADHD?

While the challenges of living with ADHD may seem daunting, the right treatment plan and support will ensure you are able to effectively manage the condition.

If you're looking for some online resources, we recommend ADDults with ADHD and ADHD Australia.

Dr Hoey adds, "Professor Russell Barkley is an internationally recognised expert in this field."

"If you search 'Russell Barkley ADHD' in YouTube, you'll come across a number of informative lectures including a series entitled 'ADHD - The 30 Essential Ideas Everyone Needs to Know'. I highly recommend this series.

"In a somewhat more light-hearted, but also well informed vein, Jessica McCabe, an American actress, hosts the website howtoadhd.com which has a great deal of useful information and encouragement."

Want to read more about other women's experiences with ADHD? Check out some of the articles on Mamamia:

Tags: health , mental-health