World Health Day: Expert insights on ADHD diagnosis, impact & treatment options

Over the past few years, awareness around Attention Deficit Hyperactivity Disorder (ADHD) has grown, but we are still far from adults getting the correct diagnosis due to stigma and mischaracterisation of symptoms such as inattention as personality flaws. While children get labelled ‘difficult’, adults often are termed to be ‘lazy’ and ‘careless’. Left untreated, the quality of life of individuals can be negatively impacted on a day-to-day basis.

“ADHD is a disorder of neural development in the brain with documented changes in brain structure and functioning. It’s not a simple lack of willpower. Furthermore, ADHD can co-exist with mental health conditions like anxiety disorders, depression or substance use disorders which necessitates careful consideration during diagnosis and treatment,” explains Dr Shaunak Ajinkya, consultant psychiatrist at Kokilaben Dhirubhai Ambani Hospital, Mumbai.

This World Health Day, Ajinkya and Dr Pallavi Joshi, consultant psychiatrist at Manipal Hospital, Varthur Road, provide their expert insights on recognising the often-overlooked signs of ADHD in adulthood, understanding how its presentation differs from childhood and debunking prevalent misconceptions surrounding this condition. The psychiatrists also answer significant questions on seeking an ADHD diagnosis, explain the potential negative impacts of untreated ADHD on mental health and outline essential treatment options.

Many adults with ADHD are labelled `lazy` or `careless.` How can we differentiate between negative tendencies and the symptoms of undiagnosed ADHD?

Ajinkya: ADHD`s core symptoms are inattention (difficulty focusing, careless mistakes, trouble sustaining attention, not listening, not following through, distractibility, disorganisation, forgetfulness, reluctance towards mentally demanding tasks – a neurological difficulty, not lack of will) and hyperactivity-impulsivity (restlessness, fidgeting, difficulty staying seated or engaging quietly in leisure, trouble waiting turns, interrupting, acting on urges and making hasty decisions).

If the above  symptoms cannot be better explained by another mental disorder (e.g. mood disorder disorder/anxiety disorder/ substance use disorder/etc) and if 6 or more of the above symptoms have: (a) persisted for period of 6 months minimum, (b) been present prior to the age of 12 years, (c) been present in 2 or more settings (home/school/work/with other activities/with friends or relatives) and (d) there is clear evidence that the symptoms have reduced the quality of the person’s social/academic/occupational functioning, then that person is most likely suffering from ADHD.

Hence, it can be challenging to distinguish between the symptoms of undiagnosed ADHD in adults, and some other mental disorders as some symptoms/behaviours may overlap. Key questions to consider include: presence of recognised ADHD symptoms, childhood history of these tendencies, pervasiveness across life domains, apparent intention versus struggle despite effort (ADHD is the latter), expressed distress and history of genuine attempts to change. A thorough professional evaluation is the most reliable way to differentiate ADHD from “character flaws.”

How does the presentation of ADHD in adults differ from its presentation in children and what are the implications for diagnosis and treatment?

Joshi: ADHD presents differently in adults compared to children. In kids, hyperactivity is often obvious, rushing in class, struggling to sit still, or responding impulsively before a question is fully asked. However, in adults, hyperactivity may appear as internal restlessness rather than physical movement. They may feel mentally agitated, experience a constant urge to move or have difficulty sitting in one place.

Impulsivity also differs, children may blurt out answers or struggle to wait their turn, while adults often show impatience, impulsive spending, or reckless behaviour. Inattention in kids is seen as missing instructions or zoning out, whereas adults struggle with focus, organisation and time management, impacting their work and personal life.

Diagnosing ADHD in adults is challenging, as they often seek help on their own rather than being identified by parents or teachers. Some self-diagnose accurately, but the key factor is whether ADHD affects daily functioning. If it disrupts responsibilities, relationships or career performance, clinical evaluation is essential. Treatment varies based on severity and may include medication, behavioural therapy or structured coping strategies.

Common misconceptions surrounding ADHD in adults

Stigma plays a major role in the realm of adult ADHD and is often a reason behind misdiagnosis. “Understanding common misconceptions, discussing negative stereotypes surrounding ADHD and debunking myths is crucial for reducing stigma, promoting accurate diagnosis, and ensuring that adults with ADHD receive the appropriate treatment and support they need to thrive,” insists Ajinkya. He outlines some common misconceptions surrounding ADHD in adults:

1. You can`t develop ADHD as an adult, it must be diagnosed in childhood or ADHD is only a childhood disorder and people outgrow it

ADHD is a neurodevelopmental condition that often persists into adulthood. The diagnostic criteria for ADHD require symptoms to have been present in childhood, ADHD can go undiagnosed until adulthood. Symptoms like inattention may evolve with time, becoming more prominent and impacting areas like organisation, planning and focus in adult life. This is particularly true for individuals with less obvious symptoms or those who developed coping mechanisms that masked their difficulties earlier in life. Increased life demands in adulthood can make previously manageable symptoms more apparent and impairing.

2. Adults with ADHD are just lazy, unmotivated or careless

The fact is that these labels often stem from a lack of understanding of ADHD being a neurodevelopmental condition. Difficulties with initiating and completing tasks, managing time and staying organised are neurological challenges, not character flaws. Individuals with ADHD want to succeed but struggle due to these underlying issues.

ADHD is not related to intelligence. People with ADHD can have a wide range of intellectual abilities, from below average to gifted. In fact, some studies suggest a higher prevalence of ADHD in certain creative and innovative fields.

3. ADHD is not a real medical condition and is over-diagnosed

The truth is that ADHD is a well-researched neurodevelopmental disorder with a biological basis. Studies using brain imaging and genetic research support its validity. While diagnostic criteria and awareness have evolved, leading to increased recognition, this doesn`t necessarily equate to overdiagnosis. Certainly not when proper assessments by qualified mental health professionals are conducted.

4. If someone can focus on things they enjoy, they can`t have ADHD or If someone with ADHD can succeed in some areas, their ADHD isn`t that bad

People with ADHD can experience a ‘hyperfocus’ on topics or activities that intensely interest them. This doesn`t mean they have control over their attention in other areas. In fact, this intense focus can make it even harder to shift attention to less stimulating but necessary tasks. ADHD is not a deficit of attention, but rather an inconsistency in regulating and directing attention. Individuals with ADHD may find ways to compensate or excel in areas that are highly interesting or structured. However, they may still struggle significantly in other areas of their lives. Success in one domain doesn`t negate the challenges posed by ADHD in others.

5. Medication is the only or the best treatment for adult ADHD

Medication is very effective in managing ADHD symptoms for many adults, but it`s not the only solution. A comprehensive treatment plan often includes counselling (like cognitive behavioural therapy or dialectical behaviour therapy), development of coping strategies and lifestyle adjustments. The most effective approach is a combination of these.

For adults who suspect they may have some degree of ADHD, what are the recommended steps and resources for pursuing a formal diagnosis?

Ajinkya: Seek evaluation from a qualified mental health professional. The diagnostic process typically involves a clinical interview where the mental health professional will ask detailed questions about your current symptoms, personal history (including childhood), family history of mental health conditions and how your difficulties impact your life.  The professional also requests inputs from significant others (e.g., partner, family member) who know you well, especially regarding your childhood behaviours. Past records (if available) such as school report cards or other records from childhood can provide valuable information about the onset of symptoms. Later, the professional administers tests to assess for ADHD. These tests can help provide objective data to support the diagnosis of ADHD and identify any co-occurring mental health conditions that might mimic ADHD symptoms.

Online quizzes are not a substitute for a professional evaluation. Seek diagnosis and treatment only from licensed mental health professionals. Importantly, the diagnostic process takes time and involves multiple appointments, so be patient. Be honest and thorough in providing accurate and detailed information about your symptoms and history to the evaluating mental health professional. Don`t hesitate to ask questions if in doubt at any time.

Lastly, the diagnosis of ADHD is just the first step. Ongoing treatment and support are crucial for living well with ADHD.

Given that many adults with ADHD have gone undiagnosed for years, what are the potential long-term consequences of untreated ADHD on their mental and emotional well-being?

Joshi: ADHD is frequently underdiagnosed and undertreated, particularly in India, where awareness remains limited. Many children with ADHD were historically labelled as ‘difficult’ rather than receiving a proper diagnosis, and this lack of recognition often persists into adulthood.

Untreated ADHD can significantly impact an individual`s academic and professional achievements. Many adults with ADHD feel they are not reaching their full potential. For instance, someone capable of excelling at 100&#37 may only achieve 70–80&#37 due to difficulties with focus and organisation. It’s similar to having poor vision but not wearing glasses, performance suffers despite ability.

The mental health consequences of untreated ADHD are also significant. Since ADHD is part of the anxiety spectrum, individuals with untreated ADHD frequently experience generalised or situational anxiety. Chronic struggles with focus and impulsivity can lead to frustration, self-doubt, and even depression. Many adults with ADHD report feeling helpless about their difficulties, which worsens emotional distress.

Additionally, ADHD can cause challenges in social and personal relationships. Impulsivity and impatience can impact communication, making it difficult to listen or engage in meaningful conversations. Sleep disturbances, such as insomnia, are also common, further affecting overall well-being.

While untreated ADHD may not be life-threatening, it can severely hinder an individual`s personal growth, career success, and emotional stability, leading to frustration and lower life satisfaction.

Managing ADHD in adults

The way we say diabetes medicines don’t cure diabetes but keep the sugars in control, similarly, ADHD medications don’t cure ADHD, but they help in managing various domains. However, not everyone is a candidate for medication. Some people benefit from non-medicinal strategies as well.

Joshi outlines practical strategies for managing ADHD:

1. Time management techniques: Using structured schedules, visual planners and setting reminders can improve productivity. Breaking tasks into smaller, manageable steps makes them easier to complete.

2. Executive function support: Since ADHD affects planning and organisation, structured routines and prioritisation techniques can help. Learning to set realistic deadlines and using tools like planners can be beneficial.

3. Cognitive behavioural therapy (CBT): Therapy can help individuals manage impulsivity, develop coping mechanisms for frustration and improve self-awareness.

4. Stress reduction practices: Techniques such as mindfulness, deep breathing exercises and meditation can help manage anxiety and impulsivity.

5. Healthy lifestyle choices: Staying hydrated, maintaining a balanced diet and engaging in regular exercise contribute to better cognitive function and emotional stability.

6. Accountability partners: Having a mentor, coach, or trusted friend provide reminders and support can help individuals stay on track with goals.

7. Medication (if necessary): ADHD medications, primarily stimulants, can improve focus, motivation and impulse control. There are also non-stimulant options available, depending on individual needs.