How doctors are suddenly diagnosing adults with ADHD

The doctors had it wrong. For decades, many psychiatrists believed that children with attention deficit hyperactivity disorder—commonly known as ADHD—might simply outgrow it. But new evidence reveals a different truth. While approximately seven million children in the United States are currently diagnosed with ADHD, a recent survey from the Centers for Disease Control shows that 15.5 million American adults also have the disorder. In fact, about half of them were diagnosed as adults.

Today, researchers recognize that adult ADHD tends to look different because adults are often better at masking the symptoms. People living with ADHD typically have difficulty paying attention or staying on task. They may feel restless, talk excessively, act impulsively by interrupting others, or struggle in situations that require waiting their turn. “Where a child may not be able to sit calmly in a classroom and continuously gets out of their seat, an adult may be very impatient at red lights or waiting in grocery store lines,” says Jill RachBeisel, a psychology professor at the University of Maryland Medical Center. “And where a child may impatiently raise their hand in class and disrupt the flow, an adult may interrupt others’ conversations.”

Then there is the intensity of the reactions to consider. In children and adults alike, such symptoms can range from “very mild to very severe,” RachBeisel says. Having ADHD means that a person frequently exhibits these tendencies across multiple situations, including school, home, or work, impairing the ability to complete tasks. Craig Surman, a physician and psychiatrist who runs the adult ADHD research program at Massachusetts General Hospital, explains that though the impulsive and hyperactive nature of the disorder usually diminishes in adulthood, “the inattentive traits often persist.”

The growing prevalence in adults is driven in part by greater awareness of the disorder and people with previously missed diagnoses reaching out for help. ADHD is a neurodevelopmental condition, meaning it affects how the brain develops and functions, and is predominantly genetic. Environmental factors or issues during pregnancy may also play a role. Some researchers are now suggesting that our overreliance on technology could exacerbate the disorder or cause similar symptoms.

(What role does technology play in rising ADHD rates?)

“It is legitimate to look at the possibility of acquired attention deficit,” says John Ratey, a physician, neuropsychiatrist, and associate clinical professor of psychiatry at Harvard Medical School. People today are pushed to multitask and are bombarded by constant technological stimulation, which may result in screen addiction. This “could potentially lead to a shorter attention span,” he says.

Although some research has explored the connection, the conclusions aren’t definitive. Nearly a decade ago, a study in Psychology of Addictive Behaviors affirmed that ADHD is associated with compulsive and excessive use of video games and social media. More recently, in 2020, scientists at the University of California, Los Angeles found that although the majority of research has focused on children and adolescents, the link between extensive screen time and symptoms of ADHD has been found in individuals of any age.

To be clear, acquired ADHD is not an official diagnosis. The connection between technology use and attention problems could also be attributed to the fact that people who are constantly in front of screens have fewer opportunities to allow their brains to rest in their default mode. “For a long time, the association between ADHD and heavy online use was a chicken-and-egg question in our field,” says Elias Aboujaoude, a clinical professor at Stanford University School of Medicine. “Do people become heavy online consumers because they have ADHD and online life better suits their attention span, or do they develop ADHD as a result of excessive online consumption?” Both clinical experience and continuing research, he says, increasingly suggest screens are influencing behavior.

Some scholars dispute this idea. But Lidia Zylowska, a psychiatrist at the University of Minnesota Medical School and author of The Mindfulness Prescription for Adult ADHD, says that our always-on, smartphone-connected culture probably contributes to some people feeling distraction and “may worsen preexisting ADHD or train an otherwise non-ADHD brain to feel scattered.”

Factors beyond technology use may also be contributing to or causing ADHD traits in adults. Ratey says that hormonal changes relating to menstruation or menopause commonly bring out latent ADHD symptoms in women. “Women are one of the most undiagnosed demographics of ADHD and are often given antidepressants and anxiety medication when, in reality, they are suffering symptoms related to having ADHD,” he explains.

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The tendency of ADHD symptoms to overlap with other mental health conditions certainly isn’t unique to women. “In adults, ADHD rarely travels alone,” Zylowska says. “Just like a fever can have different explanations, attention problems can be due to different reasons.” She says that factors such as stress, side effects of medication, and insufficient sleep can also make focusing difficult. “Similarly, other mental or physical health symptoms,” she says, “including anxiety, depression, sleep apnea, age-related cognitive changes, and thyroid problems may mimic ADHD.”

Because ADHD often appears alongside other disorders, there is nothing benign about leaving the condition untreated, says Mark Stein, a psychologist in the ADHD program at Seattle Children’s hospital and professor of psychiatry and behavioral sciences at the University of Washington. “My most important piece of advice is to get a good evaluation,” he says.

What adults seeking a clinical diagnosis may find, of course, is that the underlying issues have always been there. Psychiatrists often look for symptoms that presented at a young age (the diagnostic cutoff is age 12), even if they went largely unnoticed. And they can spot clues by reading old journals or teacher notes, interviewing family members, or listening to a patient’s recollection of memories from that time.

It may turn out that when parents or teachers failed to recognize symptoms, the child developed work-arounds. Some children simply may not struggle enough to prompt concern. “It is not uncommon to have an inattentive child that is not disruptive in the classroom and thus overlooked,” Zylowska says. Fixed schedules, structured activities, and help from parents can also make it easy to overlook symptoms until a person loses such structure and help once becoming an adult. RachBeisel explains that when ADHD is missed and these children grow up and leave home, they sometimes begin to struggle or “notice they have to work two to three times harder to achieve the same level of success as their peers.”

The good news is that once the disorder has been properly identified, numerous options are available to those seeking help. “It’s a very treatable condition” after diagnosis, RachBeisel says. Treatments often include medication or therapeutic approaches such as cognitive behavioral therapy. Speaking with a professional who diagnoses and treats ADHD can determine if medication or non-medication therapies may be helpful.

“ADHD has its challenges, but it also comes with tremendous gifts that include creativity, enthusiasm, curiosity, loyalty, and project-oriented focus when something is of interest,” Ratey explains. “It’s about finding the right job, the right friends, and the right partner to build on the strengths of the ADHD brain to make it soar.”