Over the past few weeks, we have explored some of the basic features of ADHD as well as the major strategies for managing symptoms, including medication and psychosocial interventions. A couple of vocal readers have reached out to suggest that we build upon this information by presenting about the experience of being first diagnosed with ADHD as an adult; that is, the experience of growing up with ADHD symptoms that are not properly understood, explained, or treated until adulthood. This article will explore the differences in child and adult presentations of ADHD and will provide insight into the impact of having undiagnosed ADHD throughout childhood development.
In general, ADHD is a condition that can be boiled down to deficits in executive functions, such as difficulty with self-directed attention (choosing where to place and sustain attention) and self-restraint (being able to resist impulses and inhibit undesirable behaviors). Specifically, there are commonly heightened challenges associated with organization, planning, flexibility (being able to adjust), attention to detail, peer relationships, and generally being able to appreciate future-oriented rewards and consequences (people with ADHD often make choices in the moment that reflect more weight placed on immediate impact rather than future ones). The central features of ADHD often remain consistent throughout the lifespan, but the specific ways in which these symptoms manifest and create issues vary.
Individuals with ADHD tend to struggle with the impact of the condition on their ability to follow rules, remain calm in emotionally evocative situations, and stay on top of their work and chores. As children, this looks like missing homework, angry outbursts at losing Monopoly, numerous “careless” mistakes on math worksheets, talking out of turn in class, and waiting until the night before the science fair to begin the project. As adults, these issues present themselves in more developmentally mature contexts, such as reckless driving, unsafe sexual practices, missed deadlines at work (or staying up all night to complete it at the last minute), difficulty budgeting finances, and frequently interrupting people in social settings. Adults who have developed effective coping strategies, such as approaches that encourage organization, structure, time management, planning, goal-setting, and emotional regulation fare better in terms of the impact of their ADHD on their daily lives.
Individuals with more severe presentations of ADHD, particularly those with noticeable hyperactivity, are more likely to be diagnosed earlier than those with more mild and inattentive presentations. As children, girls with predominantly inattentive symptoms are statistically the most likely to stay under the radar in terms of receiving a referral for an ADHD evaluation; instead, they’re likely to receive feedback such as “doesn’t try hard enough” or “not achieving potential.” Even girls with hyperactive symptoms are more likely viewed as “chatty” than as having classic symptoms of ADHD because they tend to present hyperactivity symptoms through talkativeness in the classroom more than acting as physically “hyper” as boys tend to do such as through squirming in their seats. Girls are also more likely to have their symptoms attributed to apparent anxiety, depression, or daydreaming than are boys with similar behaviors.
From a teacher or parent’s perspective, children with inattentive symptoms tend to be less obvious and problematic than those with hyperactive presentations. Consequently, adults with this form of ADHD are more likely to be first diagnosed in adulthood compared to their peers with more disruptive and noticeable hyperactive behaviors. While children who are diagnosed earlier on have some insight into the nature of their difficulties, children who slip through the cracks have trouble understanding why they cannot perform at the level of their friends, classmates, and family member who do not have ADHD. This relative lack of understanding regarding their underlying condition leads these children to be harder on themselves in comparison to their peers and often serve to exacerbate issues with insecurity, peer relationships, and anxiety. Attempts to overcompensate for ADHD symptoms are also common, including perfectionism and obsessive checking and list-making.
As adults, individuals who are diagnosed for the first time often express feeling relieved to have an explanation for their lifelong difficulties. Many are amazed at how effectively medication and various psychosocial approaches address their symptoms and support them in overcoming challenges they have struggled with throughout their lives. A diagnosis also provides a new perspective for interpreting their difficulties, which often helps alleviate the self-guilt and low self-esteem that commonly results from years of low performance and conflict despite what is often a lot of hard work and concerted effort. Medication and other approaches to treatment allow these individuals to finally experience the full range of their potential and to make choices that more accurately reflect their long-term goals and values. They also commonly describe insights in terms of their tendency to prefer and gravitate towards various roles and tasks (including a general preference for variety and stimulation) and the nature of the challenges they have encountered throughout their lives.