Do You Have ADHD and Not Know It?

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We often hear people make off-handed remarks about “being so ADD.” Is it possible that they actually are? Though it’s one of the most common childhood disorders, affecting 9 percent of American kids between ages 13 and 18, can you really make it to adulthood with Attention Deficit Hyperactivity Disorder (ADD or ADHD) and not know you have it?

That’s what happened to reporter Lisa Ling, who recently revealed that she was diagnosed with ADHD at age 40—way past its typical age seven onset. Ling told ABC, “As a journalist, when I’m immersed in a story, then I feel like I can laser-focus. But if I’m not working, my mind goes in every direction but where it’s supposed to go. I’ve been like that since I was a kid.”

How do you know if you have undiagnosed ADHD?

What is ADHD?             

Though many use the term “ADD” or “ADHD” loosely to signify general restlessness, people with the actual disorder show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with everyday life. This interference goes beyond the occasional memory lapse—it’s a profound hindrance on normal functioning. People with untreated ADHD may often lose important objects or completely forget about important assignments and responsibilities.

What are the symptoms?

ADHD has three subtypes:

  • Predominantly hyperactive-impulsive
  • Predominantly inattentive
  • Combined hyperactive-impulsive and inattentive

Symptoms associated with inattention:

  • Being easily distracted beyond an occasional lack of focus. People with ADHD may have trouble completing thoughts when talking or finishing magazine articles and books.
  • Failing to pay attention to details or constantly making careless mistakes.
  • Often having trouble organizing tasks and activities.
  • Often avoiding tasks that require mental effort over a long period of time.
  • Often losing things necessary for tasks and activities (e.g. wallets, keys, paperwork, eyeglasses, cell phones).

 A few symptoms associated with hyperactivity and impulsivity:

  • Fidgeting with or tapping hands or feet, squirming in your seat.
  • Often “on the go” acting as if driven by a motor.
  • Talking excessively.
  • Often interrupting or intruding on others.

For a positive ADHD diagnosis, adults must present at least five of the signature symptoms in either the hyperactive-impulsive category or predominantly inattentive category. The clinical definition also stipulates that symptoms must be present from childhood on, but some people don’t know that their symptoms indicate anything outside the norm. Symptoms must cause “clinically significant” impairment in two out of three settings—social, work, or academic—and they can’t be attributed to other mental illnesses like anxiety or obsessive-compulsive disorder. Only a trained professional can decide whether all the conditions are met to qualify a diagnosis.

For the full diagnostic criteria, visit the CDC’s ADHD homepage.

What if I have symptoms?

“It’s important to recognize that these symptoms need to exist in more than one area of your life,” says One Medical Group’s Christine Celio, PhD. “If you’re an adult looking back, the symptoms should happen consistently across circumstances. If you’re having trouble concentrating at your investment banking job where you clock 80 hours per week, but you were fine before you started the job, that is not ADHD.” She adds, “Most people can see ADHD in their childhood report cards—they were always out of their seat, or daydreaming, making careless mistakes on homework, or just forgetting to turn it in.”

Celio points out that many of the symptoms associated with the disorder may just be indicative of a lack of interest. “You can easily have many of these symptoms if you just hate your job, school, teacher, etc.,” she says.

“Most of us who lead busy, stressful lives with demanding jobs meet criteria for one or all symptoms of ADHD at some point.” says One Medical Group’s Ellen Vora, MD. “It’s human nature to occasionally procrastinate or to have difficulty staying on task when we’re doing mentally demanding work.” Meanwhile, technology isn’t doing you any favors. “The problem is only exacerbated by the current state of surround-sound technological distractions,” Vora adds. “Video games and Facebook are more ‘rewarding’ to the brain than reading through a legal brief, so it’s understandable why our tired, overworked brains are weak in the face of this temptation.”

Can you develop ADHD as an adult?

An adult diagnosis—as in the case of Ling—isn’t unheard of, but it’s unlikely a person develops the disorder after adolescence. “There is no literature I know of to suggest that ‘adult onset’ ADHD exists,” Celio says. “You can have undiagnosed ADHD as a child, but new symptoms coming on as an adult are unlikely ADHD.”

So what is the issue?

Too Much on Your Plate
Celio speculates that most self-diagnosers are just spreading themselves too thin. “Many adults think they have the symptoms of ADHD not taking into account that they are trying to multitask, which in and of itself makes it more difficult to concentrate,” she says. “Cliff Nass studied this at Stanford and found that multitasking actually makes us worse at all tasks.”

The need to get everything done at once doesn’t just intensify the scatterbrained feeling, it can cause it. “We ask our brain to do more in ways that it shouldn’t be functioning,” Celio says. “And then we get frustrated at ourselves and blame ADD when, in reality, we are creating problems by not being mindful of doing one task at a time.”

More Responsibilities
“As we get older, we have more to juggle,” Celio explains. “We could read a book for hours when we were 13 years old, but now we have smartphones tugging at our attention figuratively, and children tugging our attention literally. So many additional responsibilities mean we need to employ better techniques like using a calendar, setting reminders, and keeping comprehensive notes and to-do lists.”

Undiagnosed Mood Disorders
Celio believes many adults who suspect ADHD may be dealing with other, undiagnosed mood disorders. “Attention is often a symptom, not the problem,” she says. “Many patients come in wanting an ADHD evaluation, or, more commonly, go to their PCP for a stimulant, when the real culprit is unmanaged anxiety or depression, both of which interfere with attention.”

Sleep Deprivation
According to Vora, another culprit is lack of sleep. “Recent surveys show that American adults are sleeping less than we used to,” she says. “This can show up during the day as inattention, poor concentration, mental fatigue, and a tendency to make careless mistakes.” To rule out sleep deprivation as a cause, shoot to get seven to nine hours of shut-eye a night, and turn off all electronics an hour before bedtime.

And if it really is ADHD?

There are many treatments for ADHD. Cognitive Behavioral Therapy (CBT) is a common recommendation, which is also effective for depression and anxiety. Celio says CBT helps people struggling with these issues build an arsenal of coping tools.

Some health care providers will also prescribe medications, most often psychostimulants like Adderall or Ritalin. Though these medications can be helpful, they may come with side effects like decreased appetite, headaches, jitteriness, and sleep problems.

There are many non-pharmacological options that can help support treatment and in certain cases, even eliminate the need for stimulants.

It’s important to note that only a trained professional can diagnose or treat ADHD, and that experiencing a few of the symptoms doesn’t indicate a full-blown disorder. There are many conditions that must be met to be diagnosed with ADHD.

Interested in these integrative approaches? Learn more in part 2 of our series: Natural Treatments for ADHD.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.

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