Being an older adult with ADHD is a double whammy. In addition to older-age loneliness, we struggle with maintaining old friendships and making new friends in our later years. Building and maintaining relationships requires skills that are often impaired by ADHD — initiating contact, making and noting plans on a calendar, and showing up on time. Many older people with ADHD have told me, “I talk too much,” or “I annoy everyone by interrupting, but if I don’t interrupt, I’ll forget what I wanted to say.”

What can we, as older adults with ADHD, do to fight the looming loneliness of our 60s, 70s, 80s, and beyond? Think structure, strategies, and support.

[Self-Test: How Severe Is Your Loneliness? Take This Quiz]

Prevent Loneliness with Structure, Strategies, and Support

• Find an environment with structure. Adults with ADHD function best within structure. Consider moving to a community that plans activities designed for older adults. You won’t need to organize anything, and no one will be upset if you run a few minutes late. Some senior centers also provide many of the same kinds of planned activities.
• Develop strategies to keep in touch with people. I often encourage older adults with ADHD to make it a daily habit to reach out to a friend or relative. Send a text, message friends on social media, or make a phone call. Set up a daily walk with a neighbor. It will keep you socially connected and provide exercise and exposure to nature and sunshine.
• Interact with other neurodivergent people your age. Socializing with a group of people who get and accept you can be emotionally supportive and validating. It may also improve your mood and decrease your social anxiety.
• Need help making changes and decisions that will help you re-establish ties with friends and family? Working briefly with an ADHD coach or therapist may be the catalyst you need to reconnect with your social world.

How to Deal with Loneliness: Next Steps

• Download: Free Guide to ADHD in Older Adults
• Read: “I Feel Utterly, Hopelessly Alone.”
• Read: The Loneliest Generation
• eBook: ADHD After 40

Kathleen Nadeau, Ph.D., is the author of Still Distracted After All These Years. (#CommissionsEarned)

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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ADHD Symptoms in Women: Key Takeaways

• ADHD continues to be overlooked in girls and women because of male-centric views of the condition.
• Emotional dysregulation, overwhelm, and social challenges are major clues of female ADHD, which often leads to other health concerns when left unaddressed.
• Clinicians must recalibrate approaches to diagnosing and treating female patients with ADHD to consider emotional dysregulation, hormonal fluctuations, and other specific factors.

ADHD symptoms in women and girls aren’t “hidden” or “easy to miss.” They are obvious, persistent, and often quite serious. Why, then, do we continue to disregard or misdiagnose ADHD in girls and women? And why do we more accurately diagnose boys, who get a head start of about four years on treatment?¹

The reason: ADHD is still viewed from a largely male-centric point of view. This bias toward recognizing externalizing symptoms and disruptive behaviors means that female manifestations of ADHD — including the critical role of hormonal fluctuations on symptoms and functioning — are all but disregarded. Clinicians readily misattribute the downstream consequences of undiagnosed ADHD in women, and this is why, in a bizarre twist, girls and women often show up everywhere in the health care system before they’re identified with ADHD.¹

ADHD in Girls and Women: Under Our Noses, Off Our Radars

Emotional Dysregulation: A Major Clue for Female ADHD

Emotional dysregulation — a core feature of ADHD — and distressing social-emotional outcomes impact girls and women with ADHD in the following ways:

• Masking and overcompensating. Girls realize earlier than boys what’s expected of them in social settings, so they try their best to hide their symptoms and challenges — an exhausting feat.²
• Social difficulties and bullying. Girls with ADHD are more likely than girls without ADHD to experience peer rejection and victimization, and to face challenges with social skills, among other social difficulties.³
• Tantrums and meltdowns. While girls and women keep it together in the world, they lower their guards at home and other safe places. Emotional dysregulation shows through here as big emotions damage interpersonal relationships and further harm self-concept.
• Low self-esteem and negative self-talk. Without answers or explanations for their challenges, girls and women with ADHD assume that something is terribly wrong with them.

Over time, teen girls and young women with undiagnosed and untreated ADHD become increasingly impaired by emotional dysregulation, and they begin to show up in the healthcare system seeking help for depression, anxiety, eating disorders, self-harm, and other related conditions.¹ They also seek social services for trauma or victimization.¹ Over and over again, we miss identifying ADHD in these girls and women, despite the signs. We get the causality backwards; we blame their struggles on trauma, depression, or social failure instead of considering that ADHD is at the core.

[Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks]

Hormonal Fluctuations Matter

Complicating the picture are hormonal fluctuations during the menstrual cycle (and across the entire lifespan). Given that sex hormones influence neurotransmitters like serotonin and dopamine — which is heavily implicated in ADHD — it’s plausible that fluctuating hormonal levels through the monthly cycle impact symptom severity, mood, functioning, and even medication efficacy. That the medical community at large overlooks this relationship is astonishing, especially when we consider that hormone-related mood disorders like premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), disproportionately impacts women with ADHD.⁴

Most of our approaches, unfortunately, are based on studies done on males with ADHD, who do not experience monthly fluctuations of estrogen and progesterone once they hit puberty.

Girls and Women with ADHD Deserve Better: Steps for Clinicians

Girls and women with ADHD continue to fly under the radar because our tracking systems are calibrated to signs of male ADHD only. The result is that girls and women with ADHD feel abandoned by healthcare and left to ‘fix’ life with an incomplete toolbox of strategies and treatments.

Consider the following insights, approaches, and steps to recalibrate how you evaluate, diagnose, and treat female patients.

[Read: Protecting the Emotional Health of Girls with ADHD]

1. Understand that female ADHD isn’t male ADHD-lite. (If anything, research indicates that ADHD may be even more impairing for women than it is for men.) Lead with the understanding that you will need to adopt a differentiated view when looking at your female patients with ADHD and their challenges.

2. Look for signs of emotional distress and educate yourself on how ADHD may appear in girls and women, from perfectionism to low self-esteem. Understand that masking and mimicking are coping mechanisms that may, alongside shame, impair your patient’s ability to fully report their symptoms and symptom severity. Overwhelm, in my experience, is a major theme of discussion among undiagnosed girls and women with ADHD. Be curious, clever, and receptive when you evaluate your patients.

3. Disentangle emotional dysregulation. Consider the full picture to separate ADHD emotional dysregulation from distinct and overlapping comorbidities like bipolar disorder, borderline personality disorder, anxiety, and depression. The presence of these conditions, of course, will require different treatment approaches. Given that 85% of adult patients with ADHD also have at least one comorbid condition, it’s your duty to screen your female patients thoroughly.

4. Consider hormones and how a naturally cycling patient’s symptoms, ADHD medication efficacy, and overall functioning may change with monthly fluctuations in estrogen and progesterone. High-estrogen states may improve mood, symptoms, and functioning in some patients, while low-estrogen states may exacerbate symptoms and render ADHD medications ineffective. For patients who struggle with impulsivity, high-estrogen states may trigger greater levels of dopamine and increase the likelihood of engaging in risky behaviors due to a surge in positive emotions.^{5 6}

• Encourage menstruating patients to track their cycles. They should log objective data on changes to their mood, ADHD symptoms, and functioning through their cycles to improve shared medical decision-making and treatment.
• Consider cyclic dosing by fine-tuning a patient’s ADHD medication dosages based on hormonal status and functioning. A 2023 study found that increasing premenstrual psychostimulant dosage in women with ADHD resulted in improvements in ADHD symptoms, mood stabilization, emotional control, and productivity, with minimal side-effects.⁷

5. Bolster your patient’s care toolbox. Some patients abandon medication because of inconsistent results (perhaps due to hormonal fluctuations that weren’t factored into care), and feel that self-care, emotional regulation, and skills training are their only options. Help patients understand that the most effective treatment takes a multimodal approach including pharmacological treatment and coping/life skill strategies.

ADHD Symptoms in Women: Next Steps

• Self-Test: ADHD Symptoms in Women
• Free Workbook: Track Your ADHD Symptoms During Your Menstrual Cycle
• Read: Women with ADHD – No More Suffering in Silence
• Read: Why Women with ADHD Feel Disempowered — And What We Can Do About It
• Find: ADHD Specialists or Clinics Near You

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app co-founded by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Skoglund, C., Sundström Poromaa, I., Leksell, D., Ekholm Selling, K., Cars, T., Giacobini, M., Young, S., & Kopp Kallner, H. (2023). Time after time: failure to identify and support females with ADHD – a Swedish population register study. Journal of child psychology and psychiatry, and allied disciplines, 10.1111/jcpp.13920. Advance online publication. https://doi.org/10.1111/jcpp.13920

² Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16(3), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596

³ Kok, F. M., Groen, Y., Fuermaier, A. B., & Tucha, O. (2016). Problematic Peer Functioning in Girls with ADHD: A Systematic Literature Review. PloS one, 11(11), e0165119. https://doi.org/10.1371/journal.pone.0165119

⁴ Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of psychiatric research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005

⁵ Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

⁶ Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and behavior, 158, 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

⁷ de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

For individuals with ADHD who menstruate, fluctuating estrogen and progesterone across the menstrual cycle invariably impact ADHD symptoms, emotions, and functioning. We know this to be true, but there is almost no research validating this relationship. So, we arrive at this conclusion using available research on how hormonal changes affect the body, along with anecdotal information and clinical observations of patients with ADHD.

But how hormonal fluctuations affect your ADHD symptoms  — and even medication efficacy — is for you to learn and discuss with your doctor.

[Get This Free Guide: Women, Hormones, and ADHD]

ADHD Symptoms Through the Menstrual Cycle

Estrogen and progesterone are produced in the ovaries, among other places in the body. These hormones easily pass through the blood-brain barrier to access the brain, which is filled with receptors that are involved in emotional regulation and cognitive functioning. Note that dopamine, which is heavily implicated in ADHD, is modulated by estrogen.

Through the menstrual cycle, which lasts 28 days on average, estrogen and progesterone levels rise and fall as the body prepares for possible pregnancy. Day 1 through Day 14 marks the follicular phase, where estrogen levels rise and rise, peaking at ovulation. After this point comes the luteal phase, where progesterone levels rise, and estrogen levels fall quite steeply before stabilizing at a low level. In this hormonal environment leading up to menstruation, women generally report more symptoms of depression, anxiety, stress, sleeping problems, binge eating, cognitive difficulties, memory problems, and other symptoms of premenstrual syndrome (PMS).¹

If your ADHD profile comprises traits like low energy levels, inattention, and anxiety, then the follicular phase, when estrogen is highest, might offer a welcome boost of energy, good mood, and clarity. In the luteal phase, you may suffer tremendously with PMS or its more severe form, PMDD, which disproportionately impacts women with ADHD.^{2 3 4}

If your ADHD profile comprises impulsivity and hyperactivity, high-estrogen states may be the most challenging part of each month for you. This is because high estrogen levels could cause a surge in positive emotions that may increase the likelihood of engaging in risky, sensation-seeking behaviors.²

[Read: PMS and ADHD — How the Menstrual Cycle Intensifies Symptoms]

Medication Efficacy Through the Menstrual Cycle

Many individuals with ADHD who menstruate report differences in symptom severity and, thus, stimulant efficacy across the menstrual cycle.^{2 5} Research on this front is limited, but it’s a valid hypothesis that fluctuating hormonal status can influence the effectiveness of ADHD medication. In the low-estrogen luteal phase, for example, some individuals may find that their ADHD medication doesn’t work at all, which only worsens functioning. For those who face increased risk for risky behaviors in the high-estrogen follicular phase, it’s possible that a medication dose can suddenly be too high (as estrogen and dopamine potentiate each other) further increasing the risk for these behaviors and other side effects.

Tailoring medication dosages to hormonal status — known as cycle dosing — could be key for optimizing treatment.^{2 5} Tracking your cycle will give you powerful insights into how hormonal fluctuations influence your ADHD symptoms, medication effectiveness, and overall functioning. With this data, you’ll be in a better position to talk to your doctor about enhancements to your treatment plan to improve your health and wellbeing.

ADHD and Periods: Next Steps

• Free Workbook: Track Your ADHD Symptoms During Your Menstrual Cycle
• Read: Women, Hormones, and ADHD
• Read: “PMDD Has Affected My Whole Life.”

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app co-founded by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry, 30(2), 100–117. https://doi.org/10.1097/HRP.0000000000000329

² Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

³ Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005

⁴ Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and behavior, 158, 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

⁵ de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

Despite the unbearable pain and nausea associated with migraines, I attended regular work and school hours. With then-undiagnosed ADHD, untreated migraines, severe mood swings, and an unpredictable body, I completed all of my responsibilities with a smile on my face, masking the feeling of being a walking zombie. Experiencing – or rather, trying to act like I wasn’t experiencing any of it – was likely a big reason why I was diagnosed with depression before I was diagnosed with ADHD.

All Roads Lead Back to Estrogen

After my ADHD diagnosis, I poured myself into research, as I quickly learned I would need to educate myself about ADHD’s unique presentation in women. One finding that struck me was just how much hormonal fluctuations influence ADHD symptoms in women, which complicates an already-complicated picture. The villain causing all of my challenges, it seemed, was low estrogen levels.

[Get This Free Download: Hormones & ADHD in Women]

It turns out that there’s a strong relationship between estrogen and dopamine, which is one of the main neurotransmitters involved in ADHD. Low estrogen levels mean low dopamine levels. The inverse is true. When we consider that there are predictable drops in estrogen throughout the female lifespan, like right before getting a period or during perimenopause, to name a few, it means there’s a predictable worsening of ADHD symptoms, too. Low estrogen levels seem to hit us hard, which may be why premenstrual mood disorder (PMDD), a severe form of premenstrual syndrome (PMS), disproportionately affects women with ADHD.¹

But that’s not all. Low estrogen levels are also known to trigger migraines.² Could this connection explain why migraines, which are more prevalent in women, co-occur with ADHD about 35% of the time?³ As I tried to put the pieces together, I felt like a detective uncovering the mystery of my life. I finally understood why I felt so out of my body and mind in the midst of a migraine attack. I understood why, on migraine days with yet undiagnosed ADHD, it felt like there was an ineffective replacement version of me steering the ship, and the vessel that was me was constantly on the verge of collapse.

Silent Conditions

As I tried to learn more about the migraines-ADHD connection in women, I learned that, as with ADHD, research on migraines and the scientific attention given to migraines are biased with respect to gender. In Migraine: Inside a World of Invisible Pain (#CommissionsEarned), Maria Konnikova writes that, despite the disease’s prevalence, migraines receive little to no attention in medical schools. Further, Konnikova explains that Sigmund Freud can be thanked for the gender divide in migraine diagnosis. If women are suffering, it must be, quite literally, an unobservable, unexplainable phenomenon in their heads. Like ADHD, migraines are a silent and overlooked condition in women. As with my own ADHD diagnosis journey, I suffered from migraine headaches for years before going to a neurologist to finally get them treated.

[Read: Hormonal Changes & ADHD — a Lifelong Tug-of-War]

Invisible No More

In her 1968 essay “In Bed,” Joan Didion writes that the public often views migraines as “imaginary.” I argue that ADHD is often viewed similarly in women. And why wouldn’t this be the case? As long as we mask our pain and our symptoms — a habit I’m still unlearning — ADHD in women will continue to be difficult to detect. As long as the medical community dismisses the relationship between hormonal fluctuations and ADHD, women will go misdiagnosed and improperly treated.

Here’s the truth: Women with ADHD, like women with migraines and other conditions heavily tied to hormonal and dopamine imbalances, are boiling pots with ill-fitting lids that we and the people around us use to avoid being misperceived as untamed shrews. And I’d venture to guess you’re just as tired of acting as I am. Regardless of the condition, we deserve to have all of our symptoms taken seriously.

ADHD in Women: Next Steps

• Take This Self-Test: ADHD Symptoms in Women
• Read: ADHD Looks Different in Women. Here’s How — and Why.
• Read: The Fate of Females with ADHD Is Improving Too Slowly
• Learn: Menopause, Hormones, & ADHD — What We Know, What Research is Needed

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Sources

¹Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of psychiatric research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005

²Reddy, N., Desai, M. N., Schoenbrunner, A., Schneeberger, S., & Janis, J. E. (2021). The complex relationship between estrogen and migraines: a scoping review. Systematic reviews, 10(1), 72. https://doi.org/10.1186/s13643-021-01618-4

³Hansen, T. F., Hoeffding, L. K., Kogelman, L., Haspang, T. M., Ullum, H., Sørensen, E., Erikstrup, C., Pedersen, O. B., Nielsen, K. R., Hjalgrim, H., Paarup, H. M., Werge, T., & Burgdorf, K. (2018). Comorbidity of migraine with ADHD in adults. BMC neurology, 18(1), 147. https://doi.org/10.1186/s12883-018-1149-6

Emotion dysregulation, which research has shown to be a fundamental component of ADHD,^{2, 3} is one such symptom. Another is gender differences, particularly in females who tend to mask or internalize their symptoms.⁴ “There’s some research on whether there might be a completely different presentation [of ADHD], at least in females, with a different time of onset and a different level of severity,” said Dave Anderson, Ph.D., in a recent ADDitude webinar on understanding the evolution of ADHD.

If you could add any symptom to the DSM diagnostic criteria for ADHD, what would it be? The answers we received from ADDitude readers included many familiar ADHD behaviors like rumination, daydreaming, time blindness, insomnia, sensory sensitivity, anger, and anxiety. Some readers even suggested changing the name entirely.

“‘Attention deficit’ seems to be the exact opposite of my experience,” said Amanda, an ADDitude reader in Utah. “I cannot pull myself away from the things I am interested in! And hyperactivity represents such a small portion of diagnosed individuals (primarily boys younger than 12). It is only one of dozens of significant symptoms that affect the greater population.”

Below, ADDitude readers share the symptoms that they feel are central dimensions of ADHD. What would you choose to add? Tell us in the Comments section, above.

[Download: 3 Defining Features of ADHD That Everyone Overlooks]

ADHD Symptoms Not in the DSM

“I would love to see separate sets of diagnostic criteria for boys, girls, adult men, and adult women, because (generally speaking) ADHD can look quite different in each of those four groups. Yes, there is some overlap, but I don’t think it serves girls or adult men and women to compare them to a single ADHD picture, that of the stereotypical hyperactive young boy. The rest of us know that isn’t the only face of ADHD.” — Jen, Missouri

“I think the biggest thing I would like to see is more of a focus on emotional dysregulation and the intense emotions that you can feel as a symptom of ADHD. This is one of the main ADHD symptoms that I personally struggle with, and it was never recognized. I was misdiagnosed with bipolar as a teenager because my intense emotions were more associated with BD than with ADHD.” — Kate, Florida

“I’d make sure that comorbidities are noted more directly with the DSM diagnosis of ADHD.” — An ADDitude reader

“I believe today’s criteria don’t adequately address adult patients. The word ‘adult’ obliquely refers to patients age 17 and older, but ADHD may manifest differently in older adults. Our prefrontal cortex continues to develop into our mid-20s, does it not? Typically, career advances are met with increased responsibility and visibility, and ADHD traits can become more of an encumbrance further up the corporate ladder (as I learned in my 40s and 50s). Clinicians would likely benefit from a subset of criteria for adults 25 and older.” — Greg, Ohio

[Read: A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60]

“Feeling like you have multiple thoughts at once; thinking spherically as opposed to linearly.” — Sunshine, Colorado

“Apparently, sleep issues are a telltale sign [of ADHD] for young children, yet I read every sleep training book I could get my hands on when [my daughter] was a baby, and not one of them mentioned [ADHD]. I didn’t learn this until she was in high school, which I feel is not just criminal negligence by so-called sleep experts but a huge disservice to parents and to kids with ADHD who could be assessed earlier.” — Kelly, California

“The emotional regulation symptoms of ADHD are sorely lacking.” — An ADDitude reader

“The social impacts of ADHD and how it impacts the ability to maintain friendships is a big hallmark for me. In general, I wish the DSM had a great deal more nuance, especially when it comes to identifying ADHD in girls and adults.” — LeAnn, Wisconsin

“I would differentiate between symptoms that boys have versus symptoms that girls have.” — Tracy, New York

“Anything about sensory challenges. To me, this is actually what ADHD is all about: difficulty blocking out sensory input. ADHD encompasses the challenges and ways people deal with sensory overwhelm. The fact that the DSM — and as a result, many practitioners — don’t understand this is so frustrating. Without this understanding, they are missing so many people who are probably unable to get support.” — Katie, Maryland

“Communication lapses: The tendency [for my son] to think that he communicated something verbally because he already thought it in his mind. We’ve had many incidents where family dynamics were impacted by communication lapses. From his point of view, the communication happened even though nothing verbal was spoken, so the other person wasn’t in the know. This also happens with my spouse (who was diagnosed at 52 after our son).” — Julieann, Ohio

“Clumsiness — anecdotally, this is very common among ADHDers, even being accident-prone. I see this a lot in the chat rooms I frequent for ADHDers.” — Diane, New Hampshire

“If it is not already in there, I believe the aspect of emotional dysregulation and/or rejection sensitivity dysphoria is such a huge component of ADHD that gets so very little attention – especially when it comes to treatment for younger children. But even for me as an adult, when I learned about the term RSD and what it meant, it stopped me in my tracks and totally changed the way I looked at my ADHD.” — Geoff, Rhode Island

“I would add criteria under affective disorders relating to anxiety and personality disorders like BPD/OCD to ensure it isn’t ADHD before making one of those other diagnoses.” — Greg, Canada

“Include not recalling content in a conversation literally right after or immediately after the information is shared. I think my kids are ready to kill me; they have told me that they purposefully don’t talk with me that much because I never remember. It’s awful.” — Shannon, Ohio

“I would make sure that something like survivalist, problem-solver, or despiser of mundane tasks were all in there!” — Blythe, Oklahoma

“A ‘constant state of overwhelm’ would be one. Or ‘takes tons of effort just to exist.’” — Natalie, Pennsylvania

ADHD Symptoms Not in the DSM: Next Steps

• Download: Common ADHD Diagnosis Mistakes
• Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
• Watch: The Grave Consequences of Persistent Gender Role Expectations in ADHD
• Read: ADHD Needs a Better Name. We Have One.

Sources

¹ PsychDB. (n.d.) History of the DSM. https://www.psychdb.com/teaching/1-history-of-dsm

² Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H.. (2018). Emotional dysregulation is a primary symptom in adult attention-deficit/hyperactivity disorder (ADHD). Journal of Affective Disorders, 232, 41-47. https://doi.org/10.1016/j.jad.2018.02.007

³ Soler-Gutiérrez, A.M., Pérez-González, J.C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: a systematic review. PLoS One, 18(1), e0280131. https://doi.org/10.1371/journal.pone.0280131.

⁴ Young, S., Adamo, N., Ásgeirsdóttir, B.B., et al. (2020). Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20, 404. https://doi.org/10.1186/s12888-020-02707-9

The use of fMRI brain scans in ADHD research has helped scientists spot abnormalities in underlying neural networks and circuitries. Differences in the default mode network (overactivity) and frontostriatal circuits (underactivity) of the ADHD brain remain key findings.

“The default mode network (DMN) is one of the most fascinating and significant discoveries to come out of neuroscience in the past 20 years,” writes Edward Hallowell, M.D., in his ADDitude article, “ADHD’s Secret Demon — and How to Tame It.” “The DMN seems to be more active in those of us who have ADHD, and it may explain our tendency to make ‘careless’ mistakes. In fact, when using a functional MRI, you can predict a mistake 20 seconds before it is made by watching for activity in the DMN.”

The emergence of multiple large-scale, multi-site studies has called into question other previous conclusions from neuroscience research. In short, complex answers are replacing some of our more simple ones, and care is improving as a result.

“Large-scale, multi-site, open-science data sharing brings us closer and closer to the idea that we might discover either objective task-based markers or objective biological markers that would allow us to index risk for ADHD and make this not so much dependent on therapists’ subjectivity and the quality of a diagnostic interview,” Anderson said during his 2023 ADDitude webinar on the evolution of ADHD.

For more information about the evolution of ADHD research and diagnostic tools, watch Dr. Anderson’s free ADDitude webinar, “ADHD Then and Now: How Our Understanding Has Evolved.” Dr. Anderson is Vice President of School and Community Programs and former Senior Director of the ADHD & Behavior Disorders Center at the Child Mind Institute.

ADHD Research: Next Steps

• Download: Unraveling the Mysteries of Your ADHD Brain
• Read: 3 Areas of Research Advancing Our Understanding of ADHD
• Quiz: Check Your Knowledge — ADHD Myths vs. Reality
• Read: ADDitude’s Top 25 Reads for Professionals

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Approximately 25 years ago, when ADDitude published its first newsletter, the diagnosis of ADHD was based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Version III-C. The DSM-IV diagnostic criteria adopted two years later were the most scientifically validated to date.

Its 18 symptoms were evenly divided into two lists: problems with inattention vs. problems with hyperactivity-impulsivity. To warrant a diagnosis, a patient had to exhibit at least six symptoms on either list, suffer impairment in one or more major life activities (home, school, community, peers), and begin experiencing symptoms by age seven. Furthermore, the symptoms could not be better explained as those of another condition.

Yet, problems remained. The committee handling ADHD criteria for the DSM-5 hoped to improve the DSM’s rigor and diagnostic accuracy. It proposed recommendations that reflected independent research findings. Sadly, many of those recommendations were rejected by higher-ranking committees, perhaps partly out of fear they would significantly increase the prevalence of ADHD diagnoses. Thus, the ADHD criteria in the DSM-5, released in 2013, represented only modest improvements.

The Problems with the DSM-5

The DSM-5 does not capture ADHD accurately because its criteria do not conceptualize ADHD as a disorder of executive functioning (EF) and self-regulation (SR). This limitation greatly narrows the concept of ADHD, trivializes its nature as just an attention deficit, and discourages diagnosing clinicians from focusing on the wider range of impairments inherent in ADHD. These impairments impact executive inhibition, self-awareness, working memory, emotional self-regulation, self-motivation, planning/problem-solving, and other functions not typically associated with ADHD. Ignoring them restricts diagnosis and, ultimately, treatment for many patients.

Why Qualifier Symptoms Should Go Unheeded

In the DSM-5, qualifier symptoms were added after each listing of a symptom to help clinicians understand the expression of that symptom beyond childhood. However, problems with these clarifiers include:

[Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.]

• None of these clarifications arose out of prior research that tested them for their affiliation with ADHD, for their relationship to the root symptom they are supposed to clarify, for their accuracy in detecting ADHD, or for their relationship to impairment in major life activities. They were simply invented by committee members in a meeting.
• Adding such new and untested symptoms may have broadened eligibility for the disorder by up to 6 percent in older teens and adults.
• Some clarifications seemed to correlate with anxiety, which could lead to cross-contamination of the ADHD criteria.

These clarifications also were not informed by any theory of ADHD, such as EF-SR theory.

So, until the status of these parenthetical clarifiers is better researched, clinicians would do best to ignore them in making a diagnosis of ADHD in a teen or an adult.

A Better Way to Diagnose ADHD

Clinicians can ensure more accurate diagnoses and more appropriate care by following these five recommendations:

#1. Avoid placing undue emphasis on hyperactive symptoms.

Six of the nine hyperactive-impulsive symptoms on the DSM list reflect excessive activity, even though impulsivity has been viewed as a more prevalent ADHD symptom for the last 40 years. At best, hyperactivity is reflective of early childhood disinhibition of motor movement and, later, the inability to regulate such movement to the demands of the situation (e.g., teacher’s instructions to complete desk work). Those symptoms decline steeply over development and are of little diagnostic value by late adolescence. This is one reason why clinicians before the 1980s thought the disorder was outgrown before adulthood, which we now know is false for most people.

[Research: Only 1 in 10 Children with ADHD Will Outgrow Symptoms]

#2. Look for additional symptoms of impulsivity.

Poor inhibition may manifest not just in speech (currently, the DSM criteria include only three verbal symptoms) but in motor behavior, cognition, motivation, and emotion. Clinicians should screen for any of the following manifestations:

• often fails to consider the consequences of their actions
• has trouble motivating to persist toward goals
• has trouble deferring gratification or waiting for rewards
• lacks willpower, self-discipline, drive, and determination
• seems unusually impatient, easily emotionally aroused and frustrated, and quick to anger

Abundant research shows that these aspects of poor self-regulation are as common in people with ADHD as are the traditional DSM symptoms and, with age, more so than the symptoms of hyperactivity.

#3. Think of inattention as affecting a range of executive function deficits in daily life…

…particularly those involving impaired self-awareness, working memory, self-organization, emotional self-regulation, self-motivation, and time management. This will encourage clinicians to broaden their focus beyond the DSM symptoms when conducting open-ended interviews and selecting rating scales.

After the evaluation is completed, clinicians should explain to clients why their condition is so serious, impairing, and pervasive across major domains of life. This will also help clinicians and parents appreciate why teens (and young adults) may seem to be outgrowing ADHD, based on DSM criteria, when they are far less likely to outgrow their EF-SR deficits (and that these impairments may increase with age).

#4. Use rating scales broken down by sex and not just age.

Research suggests that females in the general population, at least in childhood and adolescence, do not show the same symptom severity as their male peers.¹ This makes it harder for a female to meet the DSM criteria. Another complicating factor: because males were overrepresented in field trials for earlier versions of the DSM, the symptom threshold was male-biased.

#5. Don’t adhere too rigidly to diagnostic thresholds when there are clear signs of impairment.

Empirical research demonstrates that ADHD falls along a continuum in the general population. So, clinicians will see clients who don’t meet all of the DSM criteria, yet who are experiencing enough impairment that they sought a diagnosis. This means clinicians should diagnose ADHD if:

• Clients or their caregivers state that a child or teen has a high number of ADHD (and EF) symptoms (place above the 20^th–16^th percentile in severity) and there is evidence of impairment in major life activities, even if the client fails to meet all DSM-5
• Symptoms became evident sometime during development, usually before age 21–24, and the patient meets all other criteria. DSM-5 raised the age of onset for ADHD from age 7 to age 12, but research repeatedly shows that few people are reliable or accurate in recalling the age of onset of their symptoms. It is a mistake, therefore, to consider age of onset in diagnosing ADHD, where all other criteria are met.

DSM-5 ADHD Criteria Challenged: Next Steps

• Free 7-Part Series: The Clinicians’ Guide to Diagnosing ADHD
• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks

Russell A. Barkley, Ph.D., is a retired clinical scientist, educator, and practitioner.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., … Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9

For one, the rest of the world already defines the criteria for conditions using the International Classification of Diseases (ICD-10-CM), which became the official health classification of the U.S. government in 2014. But, more significantly, the DSM simply does not describe ADHD as the rest of us experience it.

The DSM was written solely by and for the use of researchers, not for consumers or for practicing clinicians, and it describes only childhood behaviors. Everything else has been intentionally ignored since the very beginning of ADHD, for the sake of publishing research validating ADHD as a real thing with extremely significant impairments in children ages 6 to 12.

Our diagnostic definition is incomplete and grossly inadequate by virtue of ignoring emotional dysregulation, cognition, gender, hormones, ADHD in old age, ADHD at menopause, and the effects of ADHD on a developing personality.

[Free Resource: Rein In Intense ADHD Emotions]

Here are the dimensions missing from the DSM‘s criteria for ADHD:

Emotions: The most impairing feature of ADHD at all ages, emotional dysregulation, was not mentioned in the DSM as a fundamental component because emotions are hard to research. Why?

• They are not always present.
• They are very difficult to measure. (For example, how bad is a temper tantrum? Exactly how would anyone measure and compare one tantrum to another, even in the same child? It can’t be done.)
• People are embarrassed when they cannot control their own emotions and, thus, hide the very impairments that need to be studied.

The problems of controlling emotions are more disruptive and painful than are all the other core features of ADHD (inattention, impulsivity, and hyperactivity/hyperarousal) combined. The subject of emotional regulation in ADHD has begun to appear in research literature only within the last few years and, even now, mostly in European journals.

Age: The ADHD criteria have never been validated in a study of participants over the age of 16. All the research on adults has been done using twisted versions of the childhood criteria. For an adult to meet the child-based criteria, they would have to be functioning on the level of an elementary school-age child with untreated ADHD. Though it was officially acknowledged in 1980 that ADHD usually persists into adult life, work has only just begun on writing official adult ADHD criteria 43 years later.

[Read: Why We Need U.S. Guidelines for Adults with ADHD]

Development: ADHD remains the same throughout life. We are the ones who change as the challenges of life grow, shift, and demand more of us. We are very different at age 28 from what we were at eight or 18. This makes ADHD look as if it is changing when it’s not. The sources of the impairments from ADHD are the same, the medications and doses of medications used for ADHD are the same, and the problems with controlling emotional expression remain the same.

Gender: Simply put, it was once thought that females did not get ADHD because they are not as hyperaroused and disruptive as are males. This is still a significant problem. No existing research studies involve only females in adulthood.

It’s Time for a Shift in Thinking

ADHD was once a vague, controversial idea. Today, no rational person doubts that ADHD exists and that, if left untreated, it can have devastating consequences through adulthood. The time has come to see the full picture of ADHD. It is more than a disorder of behavior; it impairs emotions and affects the lives of millions of people.

While we are at it, we should give the same attention, thinking, and research to additional components of ADHD that impair people every day: the sleep disturbances caused by the hyperarousal of ADHD, rejection sensitivity, and the effects of an ADHD nervous system on the development of personality.

William Dodson, M.D., is a psychiatrist and consultant on adult ADHD medicine.

Emotional Dysregulation & Adult ADHD: Next Steps

• Watch: The Emotional Symptoms of ADHD That Everyone Overlooks
• Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately
• Read: The Controversy That Was Adult ADHD

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SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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SLEEP: What sleep disorders commonly co-occur with ADHD in children?

A: In one study, about half the parents said their child with ADHD had difficulty sleeping. They said their child felt tired when they woke up, had nightmares, or had… | Keep reading on WebMD »

SPD: What distinguishes ADHD from sensory processing disorder?

A: Both disorders will make you restless and unable to concentrate. You could also find it hard to control your emotions. Children might have frequent meltdowns… | Keep reading on WebMD »

EATING DISORDERS: What distinguishes eating disorders from ADHD?

A: For individuals with bulimia nervosa, food is self-medication for anxiety, stress, anger, and boredom. Eating is stimulating, and food fills the gap. People with ADHD who… | Keep reading on ADDitude »

PTSD:  Does trauma increase the likelihood for ADHD in children, and vice versa?

A: ADHD is a largely genetic condition that impacts specific areas of the brain. Because trauma affects those same areas of… | Keep reading on ADDitude »

BFRB: What body-focused repetitive behaviors common co-occur with ADHD in children?

A: Recent studies suggest that 20 to 38 percent of children with trichotillomania also meet the criteria for ADHD. Available prevalence rates are few, but they suggest that… | Keep reading on ADDitude »

TRAUMA: What should I know about the impact of trauma and stress on developing brains?

A: Under stress and exposure to trauma, the brain effectively enters survival mode. It funnels more fuel and resources into the limbic system and diverts them away from the prefrontal cortex… | Keep reading on ADDitude »

FIRST-PERSON: “Sometimes, Raising My Sensitive Child Was Hell”

“Baths, sounds, clothing textures, food textures, naptime, bedtime — almost every daily routine set off meltdowns that made our daily life hell. I called them tantrums, but looking back, they were much more than that. My thought every day was ‘just get through it.'” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Sensory Processing Disorder in Children

SPD interferes with the body’s ability to interpret sensory messages from the brain, and may manifest as meltdowns or anxiety. | Take the self-test on ADDitude »

SYMPTOM TEST: Eating Disorders in Children and Teens

Does your child express concerns about their body size? Feel guilty after eating? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
> DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

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LDs: What distinguishes ADHD from learning differences?

A: Between 30–50% of those with ADHD also have a learning disability — and if an LD is not recognized early, a child might exhibit ADHD-like symptoms… | Keep reading on ADDitude »

ODD: What distinguishes ADHD from oppositional defiant disorder?

A: ADHD is a type of brain disorder that often lasts well into adulthood. ODD is a type of behavior disorder that’s mostly diagnosed in childhood. If your child has ODD, they tend to be… | Keep reading on WebMD »

AUTISM: What distinguishes ADHD from autism in children?

A: Autism spectrum disorders are a series of related developmental disorders that can affect language skills, behavior, socializing, and… | Keep reading on WebMD »

CD: What distinguishes ADHD from conduct disorder?

A: While kids with ADHD might be disruptive, they aren’t typically aggressive. When kids show a pattern of more aggressive, violent, or antisocial behaviors… | Keep reading on WebMD »

TIC DISORDERS: What distinguishes ADHD from Tourette’s Syndrome?

A: The main symptom of Tourette’s syndrome is repeated movements or sounds, called tics, that a person can’t control. They can be simple, like constant eye blinking, sniffing… | Keep reading on WebMD »

FIRST-PERSON: “How My Son’s ADHD Masked His Dyslexia”

“Some of the signs were obvious, in retrospect. He was a late reader. He had significant struggles with spelling. But here’s where I went off track: I wrongly assumed that these issues were due to his ADHD distractibility. So many other things had landed in that bucket, why not this?” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ODD in Children

Is your child touchy, prickly, or easily offended? Test limits by ignoring rules or arguing? | Take the self-test on ADDitude »

SYMPTOM TEST: Learning Disabilities in Children

Could your child’s reading, math, spelling, or coordination challenges be signs of a learning difference? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
> DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

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COMORBIDITIES: What co-existing conditions should my child’s doctor consider when evaluating for ADHD?

A: ADHD rarely exists in isolation. Clinicians must properly screen for and address ADHD and its comorbidities… | Keep reading on ADDitude »

DEPRESSION: What distinguishes ADHD from depression in children?

A: Clinical depression is more than just the blues. It’s a serious illness, and it affects more young people than parents realize… | Keep reading on ADDitude »

ANXIETY: What distinguishes ADHD from anxiety in children?

A: Some anxiety disorders can be hard to spot in children because symptoms include internal thoughts and feelings that don’t always… | Keep reading on WebMD »

OCD: What distinguishes ADHD from OCD in children?

A: Obsessive-compulsive disorder is marked by repetitive thoughts or fears (obsessions) that may turn into repetitive behaviors… | Keep reading on WebMD »

BIPOLAR: What distinguishes ADHD from bipolar disorder in children?

A: Medical science is learning more about bipolar disorder in children and teens. But the condition is still difficult to diagnose. That’s especially true for teenagers in whom irritability and moodiness… | Keep reading on WebMD »

DMDD: What are the symptoms of disruptive mood dysregulation disorder in children?

A: DMDD causes children to experience unstable emotions they cannot regulate, including extreme outbursts of anger, leading to temper tantrums. These outbursts often occur in response to… | Keep reading on WebMD »

FIRST-PERSON: “How I Calmed My Daughter’s Anxiety Attack”

“It’s critical that you accept the attack as real. The dizziness, sweating, chest pain, racing heart — all of it is real. Don’t tell her that it’s just in her head or that she’s OK. So what can you do? Start by holding her close.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Generalized Anxiety Disorder in Children

Every child worries sometimes — about monsters or tests or new experiences. A child with anxiety feels anxious about nearly everything. | Take the self-test on ADDitude »

SYMPTOM TEST: Depression in Children

Does your child say they’re ‘too tired’ to do activities they used to love? Have trouble making even simple decisions? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
> DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

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EVALUATIONS: What is the step-by-step ADHD evaluation process for children?

A: Diagnosing ADHD is a process that takes several steps and involves gathering information from multiple sources. You, your child… | Keep reading on WebMD »

EARLY DIAGNOSIS: Can my child be evaluated for ADHD as early as preschool?

A: Most children aren’t checked for ADHD until they’re school age, but kids as young as 4 can be diagnosed, according to guidelines… | Keep reading on WebMD »

TESTS: What tests are used to diagnose ADHD in children?

A: There’s no single test to diagnose ADHD. Instead, doctors rely on several things, including interviews with the parents, relatives, teachers, or other adults, questionnaires or rating scales… | Keep reading on WebMD »

ONLINE CARE: Can my child get diagnosed with ADHD via a telehealth appointment?

A: While much of the process can be done online, medication fulfillment, physical exams, and cognitive or educational testing may… | Keep reading on ADDitude »

DIFFERENTIAL DIAGNOSIS: How can I be sure my child’s symptoms don’t point to another condition?

A: Many other disorders have the same, or similar, symptoms as ADHD, so it’s important for your doctor to look for all possibilities before coming to a conclusion… | Keep reading on WebMD »

TIMELINE: How long will it take to get my child evaluated for and diagnosed with ADHD?

A: An initial consultation with the patient (and parents) could range from 45 minutes to two hours or more. You should also expect to fill out questionnaires, checklists… | Keep reading on ADDitude »

FIRST-PERSON: “How a Diagnosis Unlocked My Son’s Best Self”

“Gone was my happy, carefree boy who would sing in his room and laugh at our cats. In his place was a struggling child who could not focus on schoolwork, who had trouble getting along with other kids, and whose mishaps were bleeding him dry.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: ADHD Diagnosis Guide

There is no definitive way to check for ADHD. No blood test or X-ray. There is, however, a logical set of steps that medical professionals should take. | Download now on ADDitude »

FREE DOWNLOAD: Common ADHD Diagnosis Mistakes

Doctors sometimes diagnose ADHD too quickly. Here’s what you need to know to avoid common mistakes. | Download now on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
> DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

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HEALTH CARE TEAM: What types of providers should be on my child’s ADHD health care team?

A: If your child has ADHD symptoms, contact their doctor or pediatrician as a first step. They should already have a strong relationship with your family… | Keep reading on WebMD »

FINDING A DOC: How can I choose the best health care professional(s) to manage my child’s ADHD?

A: When you find out your child has ADHD, you can turn to a team of pros who can get them the right treatment. Each one plays a different role… | Keep reading on WebMD »

ASSESSING PROFESSIONALS:  What questions should I ask in evaluating health care providers to diagnose my child’s ADHD?

A: How many of your pediatric patients have ADHD? How do you evaluate the symptoms of ADHD in children?… | Keep reading on ADDitude »

SPECIALISTS: What steps should I follow to find an ADHD specialist for my child?

A: If your pediatrician dismisses your worries, you should request a referral to a specialist in child behavior and development… | Keep reading on ADDitude »

THE RIGHT FIT: How can I tell if a doctor is a good fit for our family?

A: What qualities in a health care provider are important to you? The following is a list of traits that people most often mention when asked what they want from a health care professional… | Keep reading on ADDitude »

FIRST QUESTIONS: How can I best prepare for my child’s ADHD evaluation?

A: Strong, engaged advocacy will help ensure the best outcomes for your child. Knowing the right questions to ask yourself and other professionals before your child’s ADHD evaluation will… | Keep reading on ADDitude »

FIRST-PERSON: “7 Therapists — and Counting”

“And then there were seven. Later this week, we’ll be meeting Dr. P, a cognitive behavioral therapist recommended by ‘the team.’ And I’ll do my best to stop judging who we are, who we’ve become, and how we got here.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: Choosing the Right Professional to Treat ADHD

Use this comparison chart to help you understand the benefits and drawbacks of each option. | Download now on ADDitude »

EXPERT WEBINAR: Forming a Cross-Functional Care Team

Expert webinar with Leslie F. Graham, MSW, Douglas Russell, M.D., and Sheryl Morelli, M.D. | Listen now on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
> DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

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SYMPTOMS: What signs and symptoms point to ADHD in adults?

A: If you have adult ADHD, you may find it hard to remember information, organize tasks, finish work on time… | Keep reading on WebMD »

SUBTYPES: What are the key differences between inattentive, hyperactive, and combined-type ADHD in adults?

A: The three types of ADHD are primarily hyperactive and impulsive, primarily inattentive, and combined. Each presentation is… | Keep reading on ADDitude »

INATTENTIVE: What signs of inattentive ADHD in adults are commonly overlooked or mistaken?

A: The first overlooked sign of inattentive ADHD is difficulty completing tasks. People with inattentive ADHD are… | Keep reading on ADDitude »

THE ADHD BRAIN: What should I understand about how the ADHD brain is wired?

A: The ADHD nervous system regulates attention and emotions in different ways than the nervous system in those without… | Keep reading on ADDitude »

EXECUTIVE FUNCTIONS: What should I know about executive dysfunction and its relationship to ADHD?

A: The cognitive skills that help us plan, prioritize, and execute complex tasks are commonly tied to ADHD… | Keep reading on ADDitude »

NEUROSCIENCE: How does the neurology of ADHD help explain my challenges?

A: The ADHD nervous system is rarely at rest. It always wants to be engaged in something interesting and…” | Keep reading on ADDitude »

FIRST-PERSON: “I Branded Myself a Misunderstood Freak. But It Was ADHD All Along.”

“The psychologist listened as I spoke about my life. He then gave me that look people often give when I talk at 200 mph and asked, ‘What do you do when you’re calm?’ ‘I’m never calm!’ I told him, genuinely dumbfounded by this revelation.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ADHD IN ADULTS

Could your disorganization, poor memory, hypersensitivity, and financial struggles be due to ADHD? | Take the self-test on ADDitude »

SYMPTOM TEST: INATTENTIVE ADHD

Symptoms can show up as procrastination and difficulty sustaining attention. | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

> DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

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CLINICAL REQUIREMENTS: What clinical requirements are required to confirm a diagnosis of attention deficit hyperactivity disorder (ADHD)?

A: All patients must have a full psychiatric evaluation and physical examination. Here is a cautionary note underscoring the need for a full assessment for late-onset ADHD in adolescents and young adults… | Keep reading on Medscape »

PEDIATRIC ADHD: Which diagnostic tests should I administer for the evaluation of pediatric ADHD?

A: Workup in attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), includes the following… | Keep reading on Medscape »

ADHD DIAGNOSIS: What steps comprise an authoritative ADHD diagnosis?

A: An accurate ADHD evaluation includes several standard diagnostic steps and nuanced considerations; other “tools” are unproven and worth neither your time nor your money… | Keep reading on ADDitude »

COMPLEX ADHD DIAGNOSIS: What tests, assessments, and questionnaires are used to evaluate patients for complex ADHD?

A: Many children and adults begin by taking an online test of common ADHD symptoms and then taking the results to an ADHD specialist for review and evaluation… | Keep reading on ADDitude »

Free Webinar: Expert Guidance for Securing an Accurate ADHD Evaluation

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

Free Webinar: How Brain Imaging Helps Us Understand and Treat ADHD

Expert Webinar with Jonathan Posner, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
> DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

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