Adult ADHD: Overlooked and Under-Recognized Symptoms

Often thought of as a childhood disorder, the challenges of ADHD (Attention Deficit/Hyperactivity Disorder) typically, but not always, begin during childhood, but often affect individuals throughout their adult lives. For decades, ADHD was viewed as a behavioral disorder affecting school-age children, mainly boys, causing them to be disruptive, fidgety, inattentive, and lacking focus.

We now know, based on brain imaging and decades of research, that ADHD is a neuro-developmental disorder that impacts the brain’s executive functions, causing difficulties with organization, impulse control, focus, motivation, and more. Not long ago it was believed that, if an undiagnosed adult had been an excellent student in their early years, it was highly unlikely that they could have ADHD.

We know now that some individuals with ADHD may not experience considerable difficulties functioning during childhood but develop more significant symptoms either during adolescence or as adults when they are met with greater executive functioning challenges in more advanced academics, career, or family life.

While it may seem unusual, or even unnecessary to some, receiving an ADHD diagnosis as an adult can be critical in maintaining or regaining physical, social, and emotional well-being, and even safety.

Adults with undiagnosed or untreated ADHD have a greater likelihood of substance abuse, gambling problems, job performance concerns, car accidents, heart disease, risky sexual behaviors, eating disorders, higher divorce rates, increased mental illness, higher incarceration rates, and decreased life expectancy.

Seeking professional diagnosis and treatment for ADHD is life-changing for previously undiagnosed and untreated adults. For many adults with previously undiagnosed ADHD, their journey toward healing and treatment began with an increased awareness of ADHD symptoms and challenges, some widely known, and others overlooked and under-recognized.

Girls and women with ADHD.

Girls and women with ADHD are often not diagnosed until later in life, and sometimes never are. Because ADHD behaviors in boys tend to be more obvious in the classroom and at home, they draw more attention from educators and parents.

Girls more often than boys have inattentive symptoms that fly under the radar at school, and even at home. Rather than being overly active physically, some girls and women with hyperactive-type ADHD will be overly talkative, interrupt others, or blurt out their thoughts.

Many women are diagnosed with ADHD as adults when they find themselves struggling in their careers, social lives, or raising children with ADHD when they experience challenges regulating their own behaviors and emotions and staying on top of the multitude of responsibilities of raising a family, running a household, and maintaining a career.

The ADHD iceberg.

ADHD is often compared to an iceberg, with its visible symptoms representing just the tip. The ADHD Iceberg model illustrates that observable symptoms are merely a fraction of the challenges individuals with ADHD face.

The surface-level symptoms, like difficulty staying seated, distractibility, fidgeting, and impulsive behavior are just the beginning, with deeper and often more debilitating symptoms lying beneath. The hidden challenges below the surface include executive function deficits, which impact planning, organization, time management, motivation, memory, attention control, and regulating emotions.

Women with ADHD often experience unique challenges, adding layers to the metaphorical iceberg, with more internalized symptoms like emotional sensitivity and feelings of restlessness. Their symptoms often ebb and flow with hormonal changes throughout different stages of life, sometimes becoming the most severe during perimenopause and menopause.

The hidden challenges of adult ADHD extend beyond the person with ADHD on an individual level. Undiagnosed ADHD in adults can lead to persistent difficulties in various areas of life, affecting employment, relationships at work and home, as well as the overall well-being of loved ones and themselves.

Additional overlooked signs, symptoms, and effects of ADHD.

There is a multitude of additional lesser-known signs and effects of ADHD that are often not associated with ADHD directly. Some of these under-recognized signs shed light on aspects of ADHD that cause considerable challenges and frustration to those who experience them.

The ADHD tax.

Financial challenges and money problems can be linked to adult ADHD. Difficulty managing finances, late payments, and impulsive spending are common struggles that are sometimes referred to as “the ADHD tax.” Difficulties handling money, while not recognized as an ADHD symptom, can significantly impact the financial and emotional well-being of adults with ADHD.

Internal restlessness.

Internal restlessness is experienced by many adults with ADHD. Rather than physical hyperactivity, internal restlessness is a subtle, constant restless feeling that can affect concentration and overall well-being. This internal agitation can be a key indicator of ADHD, often overshadowed by more visible symptoms and can also be confused with general anxiety.

Hyperfocus.

When experiencing “hyperfocus,” individuals become intensely absorbed in a task, especially preferred tasks, to the point of losing track of time and sometimes forgetting about other responsibilities.

While difficulty focusing is commonly associated with ADHD, hyperfocus is a less recognized aspect that can impact daily life. When channeled properly, however, hyperfocus can be a benefit or “ADHD superpower,” allowing those affected to be incredibly productive on specific projects.

Piles, piles, and more piles.

Unopened mail, whether paper or digital, often piles up for adults with ADHD, causing challenges at work and at home. Difficulty organizing spaces – desks, shelves, drawers, rooms, homes, and offices – can cause feelings of being overwhelmed, anxiety, and inaction for those with ADHD. Not only can belongings be difficult to organize, but thoughts, as well, which causes challenges in prioritizing, planning, and initiating tasks.

Emotional dysregulation.

Emotional dysregulation is another hidden sign of Adult ADHD. While mood swings are often considered a separate issue, they can be interconnected with ADHD. Emotional intensity, quick shifts in mood, and difficulty regulating emotions are aspects that might not be immediately recognized as linked to ADHD but are common experiences for adults and children with ADHD and directly affect their relationships with family, friends, and coworkers.

Rejection sensitivity.

When individuals with ADHD perceive criticism or rejection, it may result in intense anxiety, social withdrawal, or at times, hostility. Many adults with ADHD have been consistently labeled as lazy or flawed throughout their lives by teachers, parents, spouses, and others, due to symptoms and behaviors caused by ADHD.

Consequently, this can foster emotional sensitivity and a heightened vigilance toward criticism, often causing them to feel rejected or criticized, even when that may not be the case. Whether real or perceived, criticism and rejection can cause severe emotional pain and anxiety for those with ADHD.

Time blindness.

The struggle of accurately perceiving and managing time is common for people with ADHD and is sometimes referred to as “time blindness.” Individuals may underestimate the time required to get ready for the day or complete tasks, leading them to arrive late for work, meetings, and events or fail to complete assignments and work projects on time.

Often late or perpetually racing the clock, individuals with ADHD not only often struggle at work or school, but also have relationship challenges at home caused by poor time management.

Procrastination.

Although procrastination is often thought to be a time management issue, studies have shown that it’s really caused by difficulty regulating moods and emotions, particularly those regarding the task at hand. Everyone procrastinates at times, but those with ADHD tend to struggle with procrastination much more than neurotypical people.

What’s more, procrastination often fuels itself by causing the individual additional anxiety, knowing that they need to complete a project and the consequences of not completing it, combined with a sense of shame for not having been unable to motivate themselves to do it. Perfectionism, another hidden ADHD challenge, can also lead to procrastination because of self-criticism and the fear of failure.

Boredom intolerance and thrill-seeking behaviors.

Boredom can be frustrating and even distressing for people with ADHD. Because they often crave stimuli, adults with ADHD may feel anxious and on edge when not engaged in stimulating activities. This restlessness may cause difficulties starting or finishing tasks or cause avoidance of them altogether, another explanation for ADHD-related procrastination, impacting productivity at school, work, or home life.

In addition, boredom intolerance may play a role in impulsivity, causing individuals to pursue intense or novel experiences to alleviate these sensations. This behavior could potentially lead to engaging in risky activities for gratification, such as careless driving, sometimes with catastrophic results.

Sleep disturbances.

Sleep disturbances are also often-overlooked signs of ADHD, for both children and adults. Often caused by racing thoughts or difficulty calming their bodies, individuals may struggle with initiating or maintaining sleep, impacting overall sleep quality. Another issue – delayed sleep phase syndrome (DSPS), a disorder involving circadian rhythm – is common among individuals with ADHD.

DSPS, while sometimes confused with sleep procrastination (delaying sleep purposely to do preferred activities, like video games, binge-watching, and scrolling social media), DSPS is caused by one’s internal clock, or circadian rhythm, being delayed by at least several hours compared to those with normal sleep cycles.0

Sleep procrastination, as mentioned earlier, is also experienced by many with ADHD. These sleep issues contribute to a cycle of challenges with focus, memory, and daily functioning.

Forgetfulness and brain fog.

Misplaced keys, unsent birthday cards, forgotten household chores or instructions, and unfulfilled commitments are often part of the daily experience for many with ADHD. The ADHD brain’s ability to store and retrieve both short-term and long-term memory can be impaired. In addition, brain fog, a feeling of sluggishness or inability to focus, can also be a symptom of ADHD, affect memory, and cause anxiety.

Shame.

Adults with ADHD often describe a sense of having always felt different from their peers and of feeling inadequate from an early age. Children with ADHD, diagnosed or undiagnosed, receive significantly more negative and corrective messages from teachers, parents, caregivers, friends, and family members than neurotypical children.

Repeated negative feedback causes feelings of failure and consistently falling short of expectations, both their own and those around them. People with ADHD often go to great lengths to hide this shame. Some turn to perfectionism to overcompensate, while others simply give up and stop trying, avoiding challenging situations and not reaching their potential.

Living with adult ADHD.

Adult ADHD is a complex spectrum disorder with symptoms that can be mild, moderate, or severe, and can differ from person to person. Recognizing the often-overlooked signs, symptoms, and effects of ADHD, which is crucial for a comprehensive understanding, will hopefully encourage those who have not yet been diagnosed to pursue diagnosis and treatment.

Adults with ADHD, especially those who are undiagnosed or untreated, often experience increased mental health challenges, particularly anxiety and depression. ADHD affects all aspects of life, including work, home, relationships with friends and loved ones, emotional well-being, and physical health. However, those with ADHD can function, thrive, and experience all the good life has to offer.

Once diagnosed, there are many treatment options to manage symptoms, including counseling to learn effective organizational, relationship, and communication strategies, heal broken relationships, improve self-worth, process grief and shame, and identify, express, and regulate emotions.

Combining counseling, education, and skills training with medication management is the most effective treatment. However, for those with reservations regarding ADHD medications, counseling that includes skills training, education, and cognitive behavioral therapy can offer numerous benefits and improvements in quality of life and well-being.

Support is available.

If you or a loved one are struggling with ADHD symptoms, consider learning more about the benefits of counseling and the services offered. Reach out to a doctor or speak to a counselor, so you can begin moving toward a more productive, peaceful, and joy-filled life.