By Mary Carpenter
“I’M A WOMAN in my 40s recently diagnosed with ADHD. Cool. Explains a lot,” writes “Recently Diagnosed” to the Washington Post help column Dear Carolyn. “Since receiving my diagnosis, I’ve had a major shift in how I perceive myself…a lot of societal expectations I simply don’t conform to…I am not a bad person because I struggle to complete tasks a certain way…very freeing.”
ADHD (ADHD, for attention-deficit, hyperactivity disorder, includes what used to be called ADD and is now considered an outdated term) among adults is on the rise, with a “massive increase” between 2020 and 2022, and a near doubling in the number of women in the 23-to-49 age group receiving this diagnosis, according to National Geographic. National Geographic poses such questions as: “is tech rewiring the brains; ADHD and binge eating—possible connection?”
“Most of the increased incidence in the adult age groups can be attributed to increases in new diagnoses for females,” according to Epic Research. “The ratio of males to females diagnosed with ADHD decreased nearly five-fold” [from 2020-2022; and] an increase in the number of stimulant medication prescriptions is likely driven by the increase in new ADHD diagnoses.”
Untreated adult ADHD, on the other hand, is especially concerning because it appears to “take a toll on cognition,” writes Richard Sima in the Washington Post. In an Israeli study of more than 100,000 adults ages 51 to 70, those with untreated adult ADHD were almost two times more likely to develop dementia than those with the diagnosis who were taking a psychostimulant medication, such as Ritalin or Adderall. Even when accounting for hypertension and depression—known risk factors for dementia, and considered more likely in adults with ADHD—“the increased risk associated with adult ADHD and dementia remained,” according to Sima. Said Toronto cognitive neurologist Sandra Black, “If you do have [ADHD], you’re going to have more trouble with normal brain aging.”
A complicating factor is that ADHD and dementia can have similar cognitive symptoms: Someone who is not paying attention can then have more trouble remembering what was said. And while the study highlighted benefits of psychostimulant medication, these might also pose cardiovascular risks in older adults. Israeli public health professor Stephen Levine, lead author on the study, nonetheless noted the “potential for psychostimulant medication to mitigate the risk of dementia in individuals with ADHD.”
Being easily overwhelmed; becoming hyper-focused on projects or specific areas of interest; having a poor sense of time; difficulty structuring and prioritizing tasks; difficulty managing stress; and extreme sensitivity to rejection—are all signs of ADHD in adults, according to Toronto psychologist Tali Shenfield.
A major problem is that current ADHD diagnostic guidelines require symptoms to be present before age 12. And because many ADHD symptoms are non-specific, adults are more likely to receive a diagnosis of related conditions, such as depression, anxiety, poor sleep quality and other physical ailments. Around 80% of adults with ADHD remain undiagnosed, according to a New York Times article on Jessica McCabe, creator of the YouTube channel “How to ADHD.” And as McCabe points out, living with ADHD itself can cause psychiatric disorders.
Adults without a childhood diagnosis could have had “silent” ADHD, which is more likely in girls; or their ADHD only became fully evident after a challenging event or lifestyle change, writes Shenfield. Alternatively, ADHD in adults could be a distinct syndrome that differs from childhood ADHD in severity and characteristics.
ADHD in adults looks different than it does in children—with the inattention component “felt more internally than observed outwardly,” according to South African clinical psychologist Sybrand Hagan. For adults, inattention tends to appear as making careless mistakes, not paying attention to details, difficulty with organization, “or they try to multi-task without actually completing any of the tasks.”
In addition, adults can experience the hyperactivity component more as general restlessness, difficulty sitting still for long periods of time—rather than the fidgeting children do, writes Hagan. Also, because adults have lived with ADHD for “a much longer time, they’re more likely to have found ways to cover up their symptoms or make excuses for them.”
Under “6 Things That Can Trigger ADHD in Adults,” Shenfield lists: poor sleep habits; stressful life events; medical conditions (thyroid disease, sleep apnea, untreated diabetes); medication side effects (mental health medications including some antidepressants as well as corticosteroids, cholesterol-lowering drugs and sleep aids); nutritional and vitamin deficiency; and “too much screen time.”
When I have trouble paying attention or struggle with restlessness that I think may be signs of ADHD, I am reluctant to make excuses using the label. Especially in the absence of an official diagnosis, most people don’t understand or take ADHD very seriously in adults. If I talk about struggling to read most anything that is dense or very long, friends say, “but you were an English major.” Or if I mention restlessness or having trouble paying attention for long periods of time—not signing up for classes, dreading jury duty or wishing even the most entertaining evenings didn’t last so long—friends say, “but everyone struggles with things like that.” And that’s a problem—because they are correct.
—Mary Carpenter regularly reports on topical subjects in health and medicine.