ADHD Assessments For Adults: Diagnosing Adult ADHD

While attention-deficit/hyperactivity disorder (ADHD) is often diagnosed in childhood, this is not always the case. There are many potential reasons that an individual may receive an ADHD diagnosis for the first time in adulthood, some of which we’ll explore below. Regardless of the cause for the delay, seeking evaluation for symptoms of ADHD can be an important first step in the process of receiving treatment. Here, we’ll give an overview of what to expect when seeking an ADHD assessment as an adult.

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Why do some people not get diagnosed with ADHD until adulthood?

Adult ADHD may be undiagnosed due to a lack of awareness

It’s estimated that the prevalence of ADHD in children is between 5–7%, while the prevalence in adults is 3–5%. Many adults with ADHD may be undiagnosed, possibly because they’ve lived with their symptoms for so long without realizing they may indicate a treatable condition that they can seek help for. Plus, children typically interact more frequently with individuals who may be experienced in recognizing signs of this disorder, such as teachers. In other words, a lack of awareness around ADHD and its symptoms may be one cause of late diagnoses.

In addition, ADHD diagnoses have become more common in recent years as more individuals and providers alike become informed on the clinical signs, which have been clarified over time as well. Continually increasing awareness of this condition may mean that the diagnosis gap will close over time. 

Attention-deficit/hyperactivity disorder symptoms can be masked

Finally, it’s also worth noting that some people may engage in what’s known as “masking,” or the concealing of their symptoms in an effort to avoid judgment—which can make recognizing the signs of ADHD more difficult. This is suggested as one reason girls are less likely to receive a diagnosis in childhood than boys, as girls may be socialized to mask their symptoms more. Symptoms of co-occurring conditions, which are not uncommon in those with ADHD, could also make it more difficult to recognize signs of this condition.

What is the purpose of an ADHD assessment?

A mental health care provider will usually perform a thorough assessment to determine whether to diagnose an individual with ADHD. However, simply deciding whether ADHD is or is not present is only one of the reasons these assessments are performed. They may also:

• Help rule out other possible explanations for observed behaviors, such as medical conditions, learning disabilities, and sleep disturbances
• Be used to screen for comorbid mental disorders common in people with ADHD, such as anxiety and depression
• Help determine the specific ADHD presentation that best describes the individual's symptoms
• Determine symptom severity and the impact of symptoms on an individual's daily functioning—all critical information for developing intervention strategies and treatment planning
• Be used to monitor the individual's treatment progress over time 
• Be required for individuals seeking accommodations in educational or workplace settings, such as extended time on exams, modified assignments, or other adjustments to support optimal functioning

ADHD assessments for adults depend on individual circumstances

Common components of an ADHD assessment

If you suspect you may have ADHD, seeking an assessment from a qualified mental health professional can have many benefits. Whether you receive a diagnosis or not, they may be able to help you develop coping mechanisms and get connected with resources that could support improved functioning in your daily life. Plus, undiagnosed and untreated ADHD can come with its own potential challenges, from ongoing trouble with daily functioning to an increased risk of depression and substance misuse. 

If you are struggling with substance use, contact the SAMHSA National Helpline at 1-800-662-HELP (4357) to receive support and resources. Support is available 24/7.

What are the components of ADHD assessments for adults?

The following are components that might be included when receiving an ADHD assessment.

Initial interview

The assessment process usually begins with an interview to gather information about your current symptoms, family history, medical history, educational/occupational background, and any past experiences related to ADHD symptoms. The provider might also ask about any other physical and mental health concerns you may have. 

Symptom assessment

Next, standardized tools such as rating scales and questionnaires will often be used to assess any current symptoms of ADHD. These may include self-report measures, observer ratings, and/or interviews with people who know you well (such as family members or close friends) to obtain a comprehensive understanding of your symptoms. ADHD is considered to be a spectrum and symptoms can vary widely, so this portion of the assessment is likely to be detailed.

Adult ADHD symptoms are typically divided into categories that reflect the three core presentations outlined by the American Psychiatric Association. These are: a primarily inattentive presentation, a primarily hyperactive/impulsive presentation, and a combined presentation. Some of the most common symptoms of each include:

Primarily inattentive presentation

• Difficulty concentrating on tasks
• Being easily distracted by external stimuli
• Tending to "zone out" or appear like they aren't listening when directly engaged with others
• Forgetfulness in daily activities
• Problems with organizing tasks and activities
• Difficulty following instructions and completing tasks
• Tending to misplace items

Primarily hyperactive/impulsive presentation

• Restlessness or fidgeting
• Trouble staying seated or quiet in situations where it's expected
• Talking excessively
• Interrupting others in conversation
• Difficulty waiting one's turn
• Constantly moving from one activity to another
• Marked impatience

Combined presentation 

Some individuals may experience a combination of both inattention and hyperactivity/impulsivity symptoms. For example, they may have difficulty paying attention when completing a project and then quickly become impatient and abandon the task. 

Also note that emotional dysregulation in the form of mood swings, trouble coping with stressful situations, and self-esteem issues are common symptoms of all presentations of ADHD. 

Medical evaluation 

If you see a doctor or psychiatrist for your assessment, they may also conduct a medical evaluation to rule out any medical conditions that could mimic ADHD symptoms or contribute to them, like a seizure disorder or thyroid dysfunction. This step may involve reviewing your medical history, conducting physical exams, and ordering laboratory tests if necessary. The physician will also likely ask about any medical conditions that may run in your family.

Psychological testing 

In some cases, psychological testing may be performed to assess cognitive functioning, attentional abilities, and other relevant psychological factors. This process can provide additional information to help the clinician confirm or rule out an ADHD diagnosis. Psychological testing can also be used to determine the presence of any other mental health conditions with symptoms that may resemble ADHD, like some personality or mood disorders.

Functional assessment 

This step involves the provider identifying any difficulties with executive functioning that you might face in everyday life and learning about how they impact your ability to meet your goals and responsibilities.

Examples of such challenges include but aren't limited to:

• Difficulty planning, organizing, or breaking down tasks into manageable steps 
• Poor organization of work or personal spaces
• Difficulty estimating and managing time effectively
• Procrastination and difficulty starting or completing tasks
• Short- and/or long-term memory issues
• Difficulty mentally processing information
• Challenges sustaining effort over time, leading to unfinished projects
• Rigid thinking that makes it difficult to adapt to changes and transitions in plans
• Impaired or impulsive decision-making, especially when faced with multiple options
• Difficulty regulating emotions, managing frustration, and coping with stress
• Limited awareness of one's behavior and its impact on others
• Difficulty reflecting on and learning from past experiences
• Challenges with interpreting social cues and maintaining appropriate social behavior
• Impaired ability to listen actively and engage in reciprocal conversations

If you receive an ADHD diagnosis and work with a care provider like a coach or therapist, they may also measure your ability to meet these challenges repeatedly throughout your treatment to see how you’ve improved and what strategies are working.

Evaluation against diagnostic criteria 

Once all the necessary information is gathered, the clinician will use the guidelines for diagnosing ADHD from the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Adults must meet the following criteria as outlined in the DSM-5 to qualify for an ADHD diagnosis:

• Individuals 17 years and older must present five or more of the listed symptoms for at least six months. 
• Several of the symptoms must have been observed before 12 years old. 
• Symptoms should not occur exclusively during a schizophrenic episode or as effects of other psychotic disorders and cannot be better explained by another physical or mental disorder. 
• They must be present in two or more settings (work, social functions, home, school, or other activities).
• They must cause significant impairment in social, academic, or occupational functioning. 

Treatment recommendation to improve mental health

Once the assessment is complete, the clinician will provide feedback on the findings and discuss whether it’s appropriate to diagnose ADHD given the information gathered. They may also offer treatment recommendations, which usually include therapy, medication, lifestyle changes, behavioral interventions, and/or accommodations to support your needs.

You don’t have to face ADHD symptoms alone

Get support from a licensed therapist

Seeking an ADHD assessment for adult ADHD

Again, there are several different types of providers that may be able to offer an ADHD assessment and a diagnosis, if applicable. Examples include medical doctors and psychiatrists as well as therapists, psychologists, and social workers, in many cases. If you’re interested in being evaluated for ADHD, you can visit your primary care doctor, ask them for a referral, check with your insurance company for recommendations, or look for another type of provider in your area.

Online therapy for improved mental health

Another option to consider is speaking with a therapist virtually through an online therapy platform. This format can be convenient for those who have trouble locating a provider in their area. It can also be more comfortable for anyone who feels intimidated at the prospect of sharing information about their symptoms with a provider in person. Speaking with a licensed therapist remotely can help you learn more about your symptoms and get support in managing them—all from the comfort of home. A growing body of research suggests that online therapy can be a similarly effective alternative to in-person therapy for treating symptoms of ADHD as well as commonly comorbid conditions like anxiety and depression.