On the one hand, you hear everywhere that doctors and diagnosticians are throwing diagnoses right and left. That there is too much of it, that “in my day it was just called laziness.”
I’m 30, 40, 50 years old, and no one has ever diagnosed me with ADHD. Why didn’t anyone catch it earlier?
I hear phrases like this all the time from clients or acquaintances who discover for the first time in adulthood that they don’t actually know much about this whole ADHD thing. And on top of that, the more they read about it, the more familiar it all starts to sound….
Why can an ADHD diagnosis be so troublesome? Why do so many people reach adulthood without even a shadow of a suspicion that ADHD affects them?
The reasons, of course, are many. Starting with the fact that, however, myths and misunderstandings about ADHD are still fairly well established, and teachers in schools do not have the training (nor the time or energy) to diagnose it effectively.
What is ADHD?
So, what exactly is this ADHD?
The acronym comes from the English language, in which it expands on Attention-Deficit Hyperactivity Disorder or attention deficit hyperactivity disorder. It is a syndrome of neurodevelopmental, mental disorders primarily associated with abnormalities of the prefrontal cortex and reward center, which manifests as problems with executive functions related to maintaining attention and inhibiting impulses. Because of abnormal dopamine metabolism, activities, topics, and tasks, even those that are highly enjoyable, do not provide enough dopamine, causing attention spikes and rapid boredom. This is not out of laziness or weak willpower but precisely because the reduced amount of dopamine makes it harder to maintain interest.
Looking at the diagnostic side, ADHD is divided into three subtypes:
- inattentive type
- hyperactive-impulsive type
- combined type
The inattentive type, for example, can manifest as inattention and absentmindedness, loss of important objects, or an inability to plan the day and responsibilities.
The hyperactive-impulsive type can show through physical agitation and the need for constant movement, but it can also cause a feeling of having “a thousand thoughts per minute” and cause an inability to work on tasks without constantly jumping from one to another.
The symptoms of each of these subtypes can occur at low, moderate, or high levels and can also change in intensity over time.
In practice, this means that we may have four different people with a diagnosis of ADHD in front of us who will behave in ways that are almost highly different from each other.
Person A, for example, perpetually forgets where they have put away important notes and is famous for being late to all meetings.
Person B can sit still, but although they seem attentive, they are always lost deep in their own thoughts. It’s almost like they don’t care.
Person C is constantly on the move, keeps pacing the room when they talk and seems to take breaks every 15 minutes. But their memory is excellent, and they always remember everything.
One person sits quietly in the back of the class and never speaks up. The other is always loud and always has to speak first.
All of them have ADHD.
ADHD Comorbidity
- ADHD vs. Anxiety Disorders
The term anxiety disorder covers the whole gamut of experiences from experienced panic attacks, social anxiety syndrome (a.k.a. social phobia), post-traumatic stress disorder (PTSD), phobia-related anxieties, to generalized anxiety syndrome. For example, to diagnose the latter, a person must experience at least three of the following symptoms:
- a sense of constant anxiety,
- excessive and constant feelings of fatigue,
- difficulty concentrating and a feeling of emptiness in the head,
- increased irritability,
- a constant state of muscle tension,
- sleep disturbances.
According to one study, roughly half of people with ADHD experience heightened anxiety (Katzman et al., 2017).
Working memory disorders, the presence of intrusive thoughts, restlessness and muscle tension, high fatigue, sleep problems, low levels of GABA, and difficulty concentrating—all are present in both ADHD and anxiety sufferers.
You can read more here: https://neurodivergentinsights.com/misdiagnosis-monday/adhdvsanxiety
- ADHD vs. Central Auditory Processing Disorder (CAPD)
Central auditory processing disorder (CAPD) results from an internal deficit in a person’s ability to process and/or understand sounds. The disorder manifests itself in a wide range of possible problems, such as:
- difficulty understanding speech when there is increased noise (albeit in a classroom), over the phone or from recordings,
- confusion and twisting of similar-sounding words,
- secondary dyslexia and language learning difficulties,
- hypersensitivity to sounds,
- difficulty remembering, especially information and instructions given orally,
- easy distraction.
As is probably easy to guess here, the problems most clearly manifest themselves in childhood and in the school context. Still, the similarity of the two coarse disorders means that incorrect diagnoses are often made.
To further complicate the situation, studies show that CAPD and ADHD co-occur in as many as 60% of cases (Abdel-Fattah Hegazi et al., 2024).
You can read more here: https://www.healthline.com/health/adhd/adhd-and-auditory-processing#adhd-vs-apd
- ADHD vs Autistic Spectrum
And here we come to the most difficult but also the most present relationship in the discussions around ADHD-that between ADHD and autism. Geraldine Dawson, director of the Duke Center for Autism and Brain Development, admitted in an interview that we still don’t really know whether ADHD and autism actually belong to the same spectrum or are completely independent of each other.
According to estimates, 30-80 percent of children diagnosed with autism also meet the diagnostic requirements for ADHD, and 20-50 percent of children with ADHD could receive a diagnosis of autism (Rommelse et al., 2010). These are, after all, extremely high numbers! And at the same time, until 2013 DSM, the entry of the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was not possible to issue a dual diagnosis!
Some similarities and places where symptoms overlap are:
- difficulties with emotion regulation and impulsivity
- distinctive modes of communication (so-called infodumping, i.e., conveying a lot of information at once, focusing on one’s own experiences and the need to share them)
- difficulties with executive functions
- hypersensitivity to external stimuli
- strong involvement in one’s passions (e.g., experiencing hyperfocus)
- difficulty reading social cues
You can read more here: https://neurodivergentinsights.com/adhd-infographics/adhd-and-autism-overlap
So, why do we need this diagnosis?
That’s a good question, isn’t it?
Sure, the more accurate the diagnosis, the easier it is for the psychiatrist to choose the right medication. Still, an accurate diagnosis is not always necessary in therapeutic processes that focus on making one’s life easier.
Often, however, a diagnosis brings relief and allows one to tame one’s difficulties—this is one incredibly important step toward better and easier functioning in the world.
Ultimately, it’s up to you if you want to get a diagnosis.
Selected sources:
Abramovitch, A., & Schweiger, A. (2009). Unwanted intrusive and worrisome thoughts in adults with Attention Deficit\Hyperactivity Disorder. Psychiatry research, 168(3), 230–233. https://doi.org/10.1016/j.psychres.2008.06.004
Edden RAE, Crocetti D, Zhu H, Gilbert DL, Mostofsky SH. Reduced GABA Concentration in Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry. 2012;69(7):750–753. doi:10.1001/archgenpsychiatry.2011.2280
Hegazi, M.AF., Khalil, G.M., Mohamed, S.M. et al. Exploring the relation between the central auditory processing functions and language development among Arabic-speaking children with attention deficit hyperactivity disorder. Egypt J Otolaryngol 40, 1 (2024). https://doi.org/10.1186/s43163-023-00557-2
Katzman, M.A., Bilkey, T.S., Chokka, P.R. et al. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 17, 302 (2017). https://doi.org/10.1186/s12888-017-1463-3
Rommelse, N. N., Franke, B., Geurts, H. M., Hartman, C. A., & Buitelaar, J. K. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European child & adolescent psychiatry, 19, 281-295.
