Adult ADHD: Grown-Up Problems

When adults with ADHD go undiagnosed and untreated, the consequences are hardly kid-stuff. So why aren’t we getting the help we need?

When you think of ADHD, what comes to mind? The little boy who can’t stay in his seat? The talkative girl who always interrupts the teacher?

Ten bucks says it isn’t the the hyper-organized project manager everyone at the office depends on. The doctoral student. The award-winning film director. The EMT who saved your life.

We hear a lot about ADHD being overdiagnosed in kids, but if there’s one group that’s largely underdiagnosed, it’s adults. For ADHDers who make it to adulthood without a diagnosis, life can be more than just challenging — it can be in real jeopardy.

Why is ADHD often overlooked in adults? Before we go there, let’s go over some ADHD basics. Everybody thinks they know what ADHD is, but unless you have it, or are raising (or sleeping with) someone who does, you know as much about ADHD as Sam Cooke knew about Trigonometry.

Understanding ADHD: Please Take a Number

As you probably already know, ADHD stands for Attention Deficit Hyperactivity Disorder. In addition to being the gag gift of superpowers, it’s also the worst-named of all the disorders. Because we don’t actually have a deficit of attention, rather, we have way too much of it. Our brains notice everything, and have an opinion about all of it.

Imagine you’re having lunch with an ADHDer. You’re telling us about that cute sputnik lamp you’re thinking of buying from CB2 … and suddenly you notice our eyes unfocus. That’s because we’re thinking about the Sputnik launch (you said “Sputnik,” how could we not?) And that got us thinking about Russia, and the Mueller investigation, and …

Huh? Sorry. What were you saying?

Neurotypical brains can, under most circumstances*, organize the constant barrage of internal thoughts and external stimuli thrown at them. They’re like the Returns Counter at IKEA: everybody take a number.

The ADHD brain, on the other hand: Anarchist IKEA. No numbers, a long line of customers, all the registers closed but ours, and we’re always a trainee on our first day. Keeping it all together takes so much work, it’s pretty inevitable that, at some point, we will give a customer the wrong change, burst into tears, smash a Poang chair to bits, or just say eff it and decide to build a cool sculpture out of tiny hex wrenches.

Understanding ADHD: Dopamine is Dope. (Boredom, Not So Much.)

If there is any deficit going on, it’s not in attention, but in dopamine, the neurotransmitter connected to pleasure, reward, novelty, motivation, and other important duties as assigned.

All brains need it, and the quickest way to get it is to engage in something pleasurable, interesting, or stimulating. Because the ADHD brain doesn’t churn out enough of the stuff, we need novelty and excitement to keep us at optimal functioning. But where the neurotypical brain gets off on a nice sunset, we kinda need fireworks shooting out of Katy Perry’s bra.

The good news is that in times of trauma, or when stakes are high, the ADHD brain can perform exquisitely (hence those of us who work in hospitals, courtrooms, and crisis centers, as well as those of us who are exceptionally good at Call of Duty.) And when we’re really into something, we don’t just focus, we hyperfocus, which is as intense as it sounds.

The bad news is … we’ll get to that in a minute.

In addition to low dopamine production, the ADHD brain also features impairment in two key, connected areas: Gets Shit Done (a.k.a. executive function) and Where The Hell Are My Keys (a.k.a. short term memory.)

So, generally speaking, what you have with ADHD is a person who often misplaces their keys, is completely unmotivated to do things in which they have zero interest, and gets hyperfocused on things (and people) in which they are interested (because dopamine).

As you can imagine, this can cause some trouble. In childhood, “trouble” can mean bad grades, difficulty with friendships, time in detention. In adulthood, though, it can mean lost wages, failed marriages, car wrecks, jail time, addictions, and/or untimely death. Because when you’re a kid, life is generally Lisa Frank rainbow-colored. But when you grow up? That’s when shit gets John-Cheever-real.

(Have I sold you on it yet? Don’t you wish you had this brain? No? You sure?)

If the stakes are so high for adults with undiagnosed ADHD, why are so many of us making it to middle age without a proper diagnosis? Because, generally speaking - with the exception of Donald Trump and maybe that one dude at work - children and adults behave differently. That goes for those with ADHD, too. After spending most of our childhoods trying to not fail spectacularly at almost everything, we’ve learned to blend in and get by via 1,000 little workarounds.

See that guy in the three-hour budget planning session drinking the venti latte and doodling all over his legal pad? ADHD, yo.

Masters of The Workaround

Despite the stereotype of childhood ADHD, a lot of us are quite successful as adults. (And by the way, not all ADHDers even fit the profile in childhood. Seek and you shall find some high school valedictorians among us.) Our success is partly due to luck (a.k.a. opportunity and access to good support systems) but also partly to our incredible resourcefulness. People with ADHD tend to have high IQs, and we employ those smarts in figuring out how to bypass our weaknesses. We major in stuff we’re really into, so that focus comes easy. Knowing that our brains need novelty for maximum functioning, we seek out jobs that provide variety, movement, and even excitement. Since we tend to be “idea people,” many of us land in creative fields that value our visionary thinking. The luckiest of us end up in roles where other people (i.e., people with better executive function) execute our ideas for us.

We also learn to avoid failure. Some of us grow up to be rigid perfectionists. We gravitate toward things that come easily to us (which the Gallup folks say is just fine), and if something seems too daunting (say, reading Infinite Jest), we just tend to avoid it. By only taking on challenges we know we can handle, we give the appearance of … well, of not having ADHD?

We learn to cope with our impaired executive function. We’re the obsessive list-makers, the Post-It Noters, the color-coders, the Asana-addicts, the Trello-tyrants, the ones with the cleanest desk in the office. The wealthier among us pay other people to keep them organized: behind many an ADHDer with an impeccable filing system is a damn good assistant.

Okay, so now the bad news.

Move the bowl where we place our wedding ring at night, or turn off all of our Outlook notifications, and watch us fall apart, telenovella-style. Peek inside our beautifully color-coded files and you’re likely to find the microwave manual under “Health Insurance” and a hook-up’s phone number scribbled on a bevnap under “Home Repairs.” We organize the way most people diet: a lifelong cycle of attempt and failure. For us, having our shit together is never a state of being, as much as an eternal state of becoming. And that, as you can imagine, is downright exhausting. But it’s just the tip of the Adult ADHD iceberg. Beneath our successes hide troubles that can’t be outsmarted, outrun, or solved by an Excel formula.

We’re Bored to Tears

Yes, yes, yes - I know what you’re thinking, because I’ve heard it 1,000 times before: Everybody gets bored. And you’re right! But most people can rally through it. Not us. (Remember that low-dopamine stuff we covered earlier?) If an ADHD brain gets bored long enough, we’ll likely go one of two ways: into pleasure-seeking overdrive (which rarely ends well), or into depression. For us, boredom is hell. So we, naturally, avoid it at all costs. Which is remarkably smart, right? Except: it sometimes means skipping class, or not filing our taxes, or generally letting everything go to shit. In avoiding the state most detrimental to our wellbeing, we end up making our lives that much more difficult. In other words, our entire state of existence is an O. Henry plot twist.

We’re Probably Facebook Stalking Our Exes While Listening to Sufjan Stevens

A lot of ADHDers suffer from Rejection Sensitive Dysphoria. Dysphoria is Greek for “difficult to bear,” which pretty much nails it. For us, the difficulty applies not only to actual rejection, but also perceived rejection. We take it unusually hard, and have a hard time letting go. We tend to ruminate and fixate (which is why some of us can’t watch horror movies or listen to BBC World), and we suck famously at bouncing back from break-ups. Our sensitivity isn’t helped by the fact that a lot of us also have low-self esteem from a lifetime of feeling incapable, or being told in veiled language that we’re lazy underachievers. “You’re capable of so much more,” we so often heard, as if we didn’t already (shamefully) know.

We’re Swiss Cheese Behind the Eyeballs

Please don’t think we don’t love you if we forget: what you wanted for your birthday, your actual birthday, that one time we went to that one party with you in 2003 and that thing happened, your spouse’s name, how your sister died, or really … anything? For us, memory is hit-or-miss. It’s proven that ADHD severely impairs short-term memory, but anecdotally, a lot of ADHDers report other memory holes, too, which might result from what we were (or weren’t) focused on at the time of an event. If we do remember something, we remember it crystal-clear, in photographic detail, because of that hyperfocus business (when we pay attention, we really pay attention.) But if we don’t remember, it might mean we were with you, but … not really with you?

We’re With You, Until We’re Not

We have a tendency to zone out, drift off, interrupt, finish your sentences - sometimes in the middle of really crucial moments or conversations. We can, in fact, give off a general vibe of impatience, like we’ve always got something more important to do. We also suck at multitasking (remember the IKEA metaphor?), which means we’re incapable of loading the dishwasher and listening to you talk about your feelings. And sometimes we might tune out because we’re … actually just kinda bored? A normal human unaware of our ADHD might, understandably, think we’re total assholes. But we’re actually kind, generous, loyal, loving people; It’s our brains that are the assholes.

We Run and Climb Excessively (On the Inside)

For some reason, the adult version of the ADHD questionnaire lists “runs/climbs excessively” as criteria, despite the fact that most of us figured out a long time ago that running and climbing wasn’t gonna fly at the office. Instead, we twirl our hair, doodle, tap our feet, chew our fingernails, and annoy the hell out of you when we click-click-click our retractable pens. We’re highly prone to fidgeting, especially BFRBs (body-focused repetitive behaviors). They help us focus, combat boredom/anxiety, and they feel good (until they don’t — please never ask my cuticles what they think of me.) Our hyperactivity can also be in our heads. If a neurotypical brain could talk, it might sound like Morgan Freeman enjoying a tumbler of scotch by a warm fire. Meanwhile, our brains are pretty much Gilbert Gottfried on a cocaine bender.

We’re Probably Awake When You’re Not

It’s hard to sleep when you lay your head on your pillow and you brain responds with: Hey … let’s write a concept album. Right now. A lot of us report struggles with insomnia, and tend to keep late hours. If we’re lucky, we find flexible jobs that work with our sleep schedules, so that if we’re up until 2 A.M. playing video games, drawing a graphic novel, or trying to solve the world’s problems — no big deal. Those of us with strict 9-to-5 gigs will often rely on external helpers like Ambien, valerian root, magnesium, marijuana and other regulated/unregulated sleep-aids to silence our head-chatter. We hate having a cold as much as you do, but we adore the kind of dreamless, flat-on-your-face, numbskull sleep that Nyquil gives us. And it doesn’t take a well-rested genius to guess where that can lead…

We’re In Trouble

We may appear successful and highly-functioning, but we’ve got enough problems to fill a whole season of “Dr. Phil.” We tend to have compulsions and addictions, which are rarely without consequence. Lots of us suffer from eating disorders (and we’re more likely to be obese.) We might smoke. We’re more likely to drink heavily or abuse drugs. Our overactive brains (and relationship troubles, nagging sense of incompetency, low self-esteem, etc.) make us prone to anxiety, so we quiet our brains, self-soothe and self-medicate with food, alcohol, drugs. And it becomes a feedback loop - the methods by which we self-soothe also give our dopamine-deficit brains a boost, so Brain says, “More, please,” even if our bodies are screaming “Hey, dude, cut it out, YOU’RE KILLING ME.”

And our brains? Those assholes? In their quest to avoid boredom and score dopamine, they send us out on the devil’s errands. We might gamble, or watch too much porn, or drive recklessly, or binge-eat doughnuts, or cheat on our partners, or stir up drama just for funs. We’re impulsive, and statistically more likely to find ourselves in trouble with the law, in court-ordered anger management programs, or incarcerated. And we can’t seem to manage our impulsivity or compulsions even when our happiness, relationships, and jobs are suffering because of them. Because we’re bad people with zero self-discipline and no hope of redemption? NO. Because we’re zombie-slaves to our dopamine-hungry brains. But - here’s the kicker - if we’re undiagnosed, we probably believe the former.

Oh, yeah: adults with ADHD are also more likely to kill themselves.

Who Me? Depressed?

So now we know that extended periods of boredom, as well as the shame of our failures and inability to control our compulsions, can lead to depression for a person with undiagnosed ADHD. Sometimes, though, we can’t even recognize our own depression enough to seek treatment. I mean, we’re just bored, right? Who seeks psychiatric treatment for boredom? Not only may we think ourselves undeserving of the label “depressed,” but undeserving of professional help, too, when we’ve been told so often that we’re simply undisciplined and not living up to our true potential.

If we do decide to seek help, we’re likely to walk away with a diagnosis of clinical depression and a prescription for something that, for us, may as well be Runts. Most clinicians, if trained in ADHD at all, aren’t trained to recognize the unique ways it manifests (or rather, hides) in adults. Ask someone with confirmed adult ADHD how many different antidepressants they were prescribed prior to their diagnosis, and how that worked out for them. They’ll likely tell you anywhere from one to three, with most having been anywhere from “I dunno, kinda helpful?” to no-help-at-all (with the exception of Wellbutrin, which we love, because it’s the amphetamine of antidepressants.)

The other day, a friend who suspected she might have ADHD searched her insurance site for an in-network doctor. Her insurance is one of the largest providers in Texas, yet she couldn’t find a single doctor who listed adult ADHD as a speciality. This is not uncommon. Many adult diagnoses happen when a child is diagnosed, and their parent recognizes the symptoms in themselves (it’s believed to be genetic.) Others are led to screening via treatment for an eating disorder or addiction. But few addiction treatment options (like Alcoholics Anonymous, for instance) include ADHD screenings. Some clinicians, despite evidence to the contrary, fear that prescribing ADHD meds to people with addictions will lead to amphetamine addiction. Though it seems counterintuitive, many ADHDers find their prescribed amphetamines calming, and experience a reduction in their compulsive behaviors (including substance abuse.)

Not only is a good clinician hard to find, but many maintain the belief that ADHD disappears after childhood. There’s really no intake questionnaire for adult ADHD - rather, it’s based on the screener for children, with slight adjustments to fit adult life (and zero questions relating to adult ADHD’s comorbidities or compulsions.) But the criteria only fit in severe cases. For instance, the first question is “Do you make a lot of mistakes in school or work?” Our aforementioned Perfectionists (of which I’m included) would answer “Nope, NEVER.” (And how about that “climbs excessively” stuff? Who does that at 40?) If a clinician only inquires into an adult’s present behavior, and not the patient’s childhood as well, a diagnosis could be missed.

If You Read This Far, You Probably Don’t Have ADHD

I kid! (Actually … I don't.) But I hope you did make it this far. I also hope that if you recognize yourself in these words, you’ll consider getting screened by an adult ADHD specialist - especially if you struggle with addiction or compulsions - for no other reason than to rule it out.

For some of us who were diagnosed as adults, it was a bit of a shock to learn we had ADHD — we were as uninformed about adult ADHD as you may have been when you started reading this.

But for a lot of us, that diagnosis was nothing short of liberation from a lifetime of shame, struggle, and self-blame. And for some, it was the difference between life and death.

That’s hardly kid-stuff.

If you think you might have ADHD, start here, and keep pounding on doors until you get the help you need, and deserve.

*Under duress, people who don’t have ADHD can exhibit ADHD-like symptoms.