Attention-deficit/hyperactivity disorder presents differently when you’re older. Here are the red flags to look for.
With everything there is to juggle in life, it’s easy to assume that everyone experiences that sinking-in-quicksand feeling as they navigate another busy day.
But if you find this feeling is paired with extreme levels of disorganization, inattention and overwhelm, these might be signs of attention-deficit/hyperactivity disorder.
Roughly 10 million American adults (and over 365 million globally) are thought to have ADHD — and because symptoms can show up differently in adults, realizing you might have the disorder is typically a slow burn, the overlooked signs of which can cause significant strain on your life and health.
The hallmark symptoms of ADHD — inattention, impulsivity and hyperactivity — typically aren’t as noticeable in adulthood, likely because adults whose ADHD wasn’t diagnosed in childhood have had a lifetime to parse together the skills necessary to compensate for their symptoms.
“Some symptoms of ADHD also mimic those of anxiety or depression,” Cristina Louk, a clinical psychologist based in Washington state, told HuffPost. “Most people will first get diagnosed with these disorders and get frustrated when treatment fails to alleviate their symptoms.”
In the moment, you might find yourself attributing certain feelings and behaviors to other things — blaming feelings of hype on too much coffee or snapping at your frozen computer on sleep deprivation — when really, they’re symptoms of adult ADHD.
Here are some of the sneakier signs you might be overlooking:
1. Procrastinating to the extreme
ADHD brains are always on the lookout for activities that will cause a rush of dopamine, a chemical in the brain that leads to feelings of reward and pleasure and that tends to be lower in people with the disorder.
Because people with ADHD have trouble sustaining enough dopamine during routine tasks that aren’t as interesting to them, they might find themselves doing everything possible to avoid them.
“The average person might feel bored by a routine task, but with ADHD, the negative feeling is more extreme — and so, too, the avoidance of it,” O’Shea said. “It can be missed as a potential ADHD symptom because it looks like intentional laziness and lack of motivation.”
2. Hyperfocusing on the same task for hours
If you have ADHD, starting tasks can be a grind — especially tasks you find daunting or believe will be time-consuming — but once you get started, you might find yourself so absorbed by what you’re doing that other important tasks end up neglected as a result.
“Hyperfocus is a symptom that can easily be missed because it looks like the person is only motivated to do certain activities,” O’Shea said. “It’s sometimes mistaken as selfishness and overzealousness.”
Difficulty switching gears is thought to be caused by low dopamine levels in the brain: The more engrossed you are in a task, the greater the dopamine boost. It’s similar to being in the zone, only in this context, it feels like you’re trapped there.
“Hyperfocus at its worst can look like writing and rewriting your response to a simple email and being unable to transition to a new task or missing an important event because you’re unable to pull yourself away from a work project,” Louk said.
3. Spending impulsively
Adults with ADHD are more likely to make poor financial decisions — say, making impulsive purchases for that hit of dopamine, putting off the boredom of paying bills or losing track of when they’re due.
Deficiencies in the basal ganglia — a set of structures in the brain that process how you evaluate emotions, motivations, goals and risks — may be a factor.
These structures act as a communication highway for different areas of the brain that need to work together to help you learn and form habits (like following a budget), as well as plan and carry out tasks (like saving for the future).
“In a way, the basal ganglia in a person with ADHD can be found to almost short-circuit when it comes to its ability to manage the signals that are passing through,” Dr. Zishan Khan, a psychiatrist with Mindpath Health, told HuffPost.
4. Losing all sense of time
Better known as time blindness, people with ADHD find it tricky to keep track of time or to know how much time they’ll need to do an activity.
So far, no single brain region has been identified as the one responsible for time perception, but time estimation seems to be linked to the prefrontal cortex (the part of the brain that assists with executive functioning, focus and attention, as well as organizational skills, Khan said), which relies on signals from dopamine-related pathways to function properly.
“This might translate into always running late — thinking you have enough time and then rushing,” O’Shea said. “You might know the exact time of an appointment, but leave the house at that time rather than in advance to give yourself room to travel there, park and sign yourself in.”
5. Experiencing emotional outbursts
From anxious and edgy to happy and chatty to angry and aggressive, people with ADHD can experience emotional dysregulation that causes them to have strong emotional reactions even they don’t see coming.
“This is related to the difficulties that can come with managing attention and directing energy, as well as finding the appropriate level of mental stimulation,” O’Shea said. “By only focusing on the result — which looks like an emotional disorder — and not the underlying problem, it’s another adult ADHD symptom that’s easily overlooked.”
6. Forgetting to eat
Research suggests a strong link between ADHD and abnormal eating patterns, the more prominent patterns being binge eating and forgetting to eat entirely.
The exact mechanisms have yet to be sussed out by researchers, but there could be a combination of factors at play, including impaired brain activity in the prefrontal cortex and limbic system.
When the prefrontal cortex lacks the dopamine necessary to function properly, this can mess with your ability to organize, plan and execute healthy meals and maintain consistent eating habits in general. The dopamine drought can also increase the likelihood of your grabbing convenience foods to satisfy the brain’s reward centers and give it the stimulation necessary to focus.
Meanwhile, the limbic system is in charge of regulating our emotions, in addition to attention, Khan said. As a result, you might use food as a way to unconsciously cope with boredom and emotional distress — or get sucked into a task to the point where you forget to eat for hours, thanks to feeling disconnected from your body’s hunger and fullness cues.
7. Having trouble sleeping
Insomnia doesn’t necessarily mean you have ADHD, but research suggests adults with ADHD may be predisposed to sleep issues. It could be a side effect of impaired activity in the reticular activating system (RAS) — a network of nerve pathways in the brainstem that are essential in mediating a person’s level of consciousness.
The RAS acts as a screening device that filters through incoming sensory data and sends bat signals to the brain as it comes across important sensory stimuli that need to be addressed.
Only, for people with ADHD, RAS dysregulation makes it difficult to distinguish between what’s important sensory information and what’s just noise. The result? “Difficulty regulating arousal and sleep-wake transitions,” Khan said.
Some people with ADHD can also have biological disruptions to their circadian rhythm, O’Shea said. Two such disruptions are delayed sleep phase disorder — where your sleep is persistently delayed by two or more hours past what’s considered a standard bedtime — and delayed onset of melatonin production, the sleep hormone that kicks in at night to help you doze off.
8. Taking forever to make decisions
“People with ADHD may experience slower processing speeds,” Louk said. Processing speed refers to how quickly you can react to a given stimulus (in this case, a set of choices) within a limited time frame.
It’s not necessarily a sign you’re indecisive — rather, that you need more time to navigate the decision-making process.
You might have difficulty with things like putting together the details necessary to see the big picture, foreseeing the potential outcomes of each option, or getting stuck on one idea and having trouble weighing all of the options to make a decision.
“This is a result of controlling attention well enough to sort through the pros and cons of a decision and remember what you were thinking,” O’Shea said.
9. Feeling perpetually restless
Restlessness tends to be one of the sneakier signs of adult ADHD, largely due to how easily the external behaviors of restlessness can be attributed to other things, like an intense workload or drinking too much coffee.
“Adults are more likely to show restlessness through having to get up and pace around,” O’Shea said. “They might not be able to sit through a movie without talking or getting out their phone.” Some may even avoid more subdued activities like this entirely.
Persistent fidgeting of the hands, legs and feet, as well as picking at your skin, can also be subtle signs of restlessness.
10. Rambling and monopolizing conversations
People with ADHD can have trouble tracking a conversation thanks to poor attention control and retaining information in the moment.
“This can lead to frequent interrupting because they might not remember what they want to say or what the other person said,” O’Shea said. “They can also feel restless and have an urge to jump in with a thought that interests them.”
Here’s when you should get tested for ADHD
You might want to get evaluated for ADHD if you’re experiencing five or more symptoms of ADHD — and these symptoms have been persisting for longer than six months, are present in two or more settings (say, at work and in your relationships) and are reducing the quality of how you function in your life.
“Talking to your primary care doctor is a good place to start with an initial review of your symptoms, followed by connecting with an ADHD specialist in your area,” O’Shea said.
The diagnosis of ADHD is made by taking a proper history and gathering relevant information and data to help not only diagnose ADHD but also rule out other causes for the presenting symptoms.
Important aspects of the exam include the collection of details regarding the presenting complaint, a complete psychiatric review of symptoms, and both personal and family psychiatric and medical histories.
ADHD rating scales and psychological tests can also be used to further confirm the diagnosis of ADHD.
“Psychological testing is typically used in adults where it’s not clear from the history alone that the symptomatology is indicative of ADHD,” Khan said. “This is because a lot of the rating scales and tests to help diagnose ADHD haven’t been studied in adults and therefore can’t be utilized as sole diagnostic tools or proof an adult has ADHD.”
Once you’re diagnosed with ADHD, what’s next?
An official ADHD diagnosis can be a game changer for so many adults who were struggling all their lives. Having a diagnosis starts a journey to build back confidence and motivation.
“You may have been called or thought of yourself as ‘lazy’ or ‘unsuccessful’ and the diagnosis can provide a framework for your lifelong struggles,” Dr. Heather Goodman, a psychiatrist at Weill Cornell Medicine and NewYork-Presbyterian, told HuffPost.
Treatment for adult ADHD is similar to treatment for childhood ADHD and includes medication, psychotherapy focused on improving organization and functioning in your daily life, and treatment for any mental health conditions that you have along with ADHD.
“Gaining clarity as a result of your ADHD diagnosis is the first step on a healing path,” O’Shea said. “Finally, what’s next can feel more in your control.”
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