Adult ADHD
The adult presentation of ADHD may vary considerably due to the subjective nature of ratings, and the fact that adults may only show certain features of ADHD according to their environments. Children often get diagnosed as they are required to focus in a relatively uniform environment of school, where they are required to sit and learn in a quiet, non-disruptive manner. Once adults with ADHD leave school, they often seek out environments that tap their strengths and minimise weaknesses. For example, adults with a lot of energy may go into job that require them to move around a lot, such as personal training, sales jobs which are on the road or on their feet all days, or other jobs which are highly varied and need little administration or desk time. In these environments they can often excel, and hence ratings often become subclinical. This does not however mean that if they were put in a 40 hour desk job, the ratings wouldn’t immediately revert back to clinical levels.
This shows how difficult it can be to diagnose ADHD in adulthood, and how subjective and arbitrary the diagnosis can sometimes become. For the disorder to remain at clinical levels the symptoms need to be present still in two environments. For many people with ADHD they find friends who get used to them running late or drifting off, and hence ADHD no longer affects them on the whole socially. These people often then get rated as ‘in-remission’ if they also have a workplace that taps more strengths than weaknesses, however, they may encounter another friend or a different workplace in the future where the issues rise again, and again the symptoms may become clinical.
For this reason regular monitoring is recommended by completing a behavioural checklist. We have included a checklist for you to complete and score to see whether currently you are falling within clinical ranges. As you complete this course it is hopeful that some of these ratings reduce, even hopefully to within non-clinical ranges. We recommend however you keep a copy of this checklist with you so that you can monitor your performance and as needed add interventions listed in this course to help you maintain you ratings at subclinical levels.
How is Adult ADHD Diagnosed
When having an assessment your clinicians will do a thorough medical, developmental, educational and psychological history. As part of the diagnostic criteria the issues need to be established prior to the age of 12 years. ADHD is a developmental disorder, hence the issues cannot arise only in childhood, and another disorder will need to be considered if no symptoms were present prior to the age of 12 years.
Adult ADHD is poorly misunderstood and in some of these cases if a history is not taken properly, a misdiagnosis can be made. Adult ADHD does not involve a sudden onset of inattention or hyperactivity and it is essential that if these symptoms present suddenly you immediately see your GP (or even go to your local emergency room if very severe). Attention issues are very common to many illnesses. Even the basis flu can make us feel sluggish and inattentive. Any neurological insult is likely to cause some level of attention weaknesses, for example, attention weaknesses are common after a concussion, head injury or stroke. Bipolar disorder can create poor attention in the lows of the disorder, and excess energy and hyperactivity in the highs of the disorder. Borderline Personality Disorder can show high levels of impulsivity.
One of the most common misdiagnoses we see in our clinics is that of sleep apnoea or other sleep disorders (issues falling asleep, waking during the night, not being able to sleep long enough). Sleep-based issues have been shown to have very detrimental impacts upon attention skills, and the longer the sleep issues present for, the worse the attention issues. If you snore and you find your attention skills are becoming worse as you age, particularly as you gain weight, you should speak with your GP about testing for sleep apnoea. Sleep-based attention disorders should not be treated with the classic stimulant medication, even though they are likely to boost attention skills in the short-term. Proper treatment of the cause of the inattention is necessary as otherwise the brain will continue to get worse and worse if the sleep issue is not treated. Sleep issues should be treated as a matter of priority, even before a diagnosis is confirmed. If a diagnosis has already been confirmed and sleep issues are present, sleep issues should be treated and then screening questionnaires completed to confirm that attention issues are still falling within clinical limits. If the attention issues resolve, then the ADHD diagnosis should be removed.
Common issues noted in adult ADHD include:
- Daydreaming frequently
- Careless work performance
- Missing important deadlines
- Late to appointments
- Hard to focus and pay attention throughout meetings
- Unable to read for lengths of time
- Losing keys or wallet frequently
- Fidgeting or tapping hands
- Often gets up: leaves their workplace desk, taking more breaks
- Take more risks, i.e. driving recklessly
- Abuse alcohol or drugs
- Difficulty waiting in line
- Uncomfortable sitting still in workplace meetings or eating out at a restaurant
- Completes other people’s sentences, interrupts conversations
- Impact chances of getting into university/TAFE or receiving a promotion at work
- Difficulties in maintaining employment
- Strained social relationships
- Poorer quality of life

One of the most common issues that impair adults with ADHD is actually the executive issues that are often present. Adults with ADHD often have issues with planning and organisation. They can often run late to appointments and miss deadlines. This creates issues both in the workplace as well as socially. Adults with ADHD tend to change jobs more quickly than others, sometimes out of boredom, sometimes because they struggle to keep a job and can get fired for being disorganised at work and not completing work in a timely fashion. To help improve executive weaknesses please see our section under cognitive training and executive issues.