Is it possible to have ADHD as an adult but not during childhood?
February 4, 2018 2:05 PM   Subscribe

I'd like to hear about any experiences of having adult ADHD without obvious childhood symptoms, or of having anxiety that causes a lot of issues with focus and distraction. Do you know of differences between the symptoms of adult ADHD + anxiety vs. anxiety by itself?

Over the past year I've realized that I've been struggling with anxiety and depression, a lot of which is related to my procrastination and time management issues. I'm on a health leave from college so I can focus on improving my mental health, and I'm starting to see a therapist for CBT and a psychiatrist--first real appointment is this week. I know that anxiety exacerbates my procrastination a lot, but I've been wondering if I might have ADHD as well.

When I had the intake appointment with my new therapist she asked if I experienced problems with focus and distraction as a child...but my childhood experience doesn't really seem to line up with the usual ADHD symptoms. Schoolwork was pretty easy up until junior and senior year of high school--I always had problems with procrastination and distraction, but when I was put under last-minute pressure I usually ended up being able to focus well and complete assignments in time. So my therapist ruled out ADHD.

However, because a lot of my current symptoms seem to line up with ADHD as well as anxiety I wonder if it's possible that I have it. My procrastination usually revolves around the act of decision-making and planning. I've also felt distracted in situations that aren't as stressful as writing essays and emails--I might be doing something that takes up part of my attention (reading, cooking, practicing piano) but my mind seems to wander uncontrollably while I do it.

I'll definitely bring up these concerns with my therapist, but I was wondering if any of you have had similar experiences and doubts, and how those turned out for you.
posted by Lurch to Health & Fitness (15 answers total) 16 users marked this as a favorite
Typical just means more likely, but there also can be more subtle signs of ADHD especially in females. Here is an article that talks about how ADHD manifests differently for girls . If you are female and recognise any of the traits listed, you should ask your therapist to reconsider.
posted by rakaidan at 2:48 PM on February 4, 2018 [9 favorites]

My pattern matches yours exactly and my doctor suspected ADHD (with no hyperactive component). I've also heard it's a pretty common difference in ADHD for girls. I was very good at school, but it came naturally; I didn't really study, rarely did the reading, daydreamed in class. In college my grades took a nosedive till I cobbled together some VERY shoddy study skills.

Definitely read more about ADD in women; if you look at an ADHD quiz and take out the "when you were a kid" questions, I pretty much score 100%. For the "when you were a kid" questions, you have to interpret things and I really have to think about my subjective experience, rather than my grades or the trouble I (never) got into.
posted by gideonfrog at 2:54 PM on February 4, 2018 [9 favorites]

Yes, different for women. Also other things get misdiagnosed as ADHD all the time — after effects of trauma resulting from chronic stress, for example. It’s very possible your therapist does not specialize in this stuff and was trained on outdated research. Stuff has changed a lot in the last 15 years or so.
posted by schadenfrau at 2:58 PM on February 4, 2018

The diagnosis requires that symptoms were present before age 12, but like people are saying, it can be hard to tease out whether symptoms were present, and in what form, that far in the past.
posted by lazuli at 3:06 PM on February 4, 2018

I always had problems with procrastination and distraction, but when I was put under last-minute pressure I usually ended up being able to focus well and complete assignments in time. So my therapist ruled out ADHD.

Sorry what?! That's a hallmark of ADHD.
posted by lokta at 3:29 PM on February 4, 2018 [25 favorites]

"When I was put under last-minute pressure I usually ended up being able to focus well and complete assignments in time."
What lotka said. This is a symptom of adhd for sure. I also didn't have "classic" adhd symptoms as a child, but developed them as an early adult. Did you have trouble as a child with organization with schoolwork? Did you learn better when doodling in your notebooks or listening to music? Did you get "burnt out" with too much sensory stimulus or have regular afternoon/after school "crashes"? Adversity to excessive or unnecessary authority?
I've read much on the neurodiversity of adhd in women and apparenly our brains most closely mimic that of teenaged men. Does this resonate at all?
I'd get into reading up on more recent adhd research particularly that of in relation to the differences in presentation in females. Then if you still suspect adhd and your healthcare provider still rules it out, you can always get a second opinion or find someone who specializes in it for a final answer.
posted by OnefortheLast at 3:39 PM on February 4, 2018 [7 favorites]

I was just coming in to say what lokta said. Procrastination and the ability to complete work under pressure is a hallmark of ADHD. So is the ability to focus when you're interested in something.

I wasn't hyperactive as a kid, but I certainly am as an adult. I can't sit still. I always have to be doing something (and listening or "watching" something at the same time) and I'm a constant foot jiggler. As a kid I could sit perfectly still and read a book for hours. But it had to be a book I wanted to read.

So I think you might want to get a second opinion.
posted by elsietheeel at 3:48 PM on February 4, 2018 [2 favorites]

If you have them you should read your old primary school report cards. I never figured out I had adhd until I was in my 40s but all my old report cards say I was careless. I remember zoning out constantly but I was a good, smart girl so I did not attract concern.
posted by i_mean_come_on_now at 4:43 PM on February 4, 2018 [2 favorites]

My experience sounds a lot like yours, and I was diagnosed with ADD well into adulthood. Like many girls and women in my age cohort, no one guessed what was going on during my school-age years because at the time, the typical presentation of AD(H)D was thought to be either a hyperactive boy (almost always a boy) bouncing off the walls and clowning around in class, or a daydreaming "artsy" type girl staring out the window. I didn't fit either of those types. I was, instead, quiet and well-behaved, smart enough to get easy As in a lot of things without putting much work in, and adept at using procrastination to create hyper-focus. That said, when I got into more advanced subject matter that didn't come easily to me, in high school and especially in college, I really struggled. I was thus often written off as "smart but lazy", but one teacher said it was like my eye—my focus—kept "slipping" even though I was clearly putting in effort by seeking out extra help, etc.

If your therapist has the idea that AD(H)D means you can't ever focus on anything, that's not correct. Hyperfocus is definitely an AD(H)D trait. The problem is more that you don't get to choose where your focus goes, or where it doesn't. I don't think the distinction between anxiety and ADD is necessarily clear cut, and IIRC they are often comorbid conditions. If nothing else, feeling worry or shame about inability to direct your focus and performance can definitely cause anxiety.

I received my adult ADD diagnosis unexpectedly when I went to see a psychiatrist for a more general mental health "checkup" related to another condition. It's not something I sought out, and because I am high-functioning and smart enough to develop workarounds for my condition it took me a while to accept that the diagnosis might be correct. However, after some medication tuning it's been a fairly significant and (mostly) positive change. I have less trouble prying myself out of bed in the morning. My apartment is cleaner and mail, laundry, and dishes no longer pile up because doing these chores no longer seems so overwhelming or onerous. I don't feel like I drain all of my organizational energy at work and tolerate chaos at home. I cleared out a list of very stale life maintenance chores that had been lingering for years. More fundamentally, I feel a greater sense of control over where my focus goes. I feel a lot less prone to negative rumination. I have less of a struggle returning to a task after being distracted from it, and also feel less prone to being distracted in the first place. I have less of a struggle also with keeping focus on material that is challenging and not immediately engaging.

It's not a complete non-issue (especially when I'm tired or didn't sleep well) but it's certainly better than before.
posted by 4rtemis at 5:07 PM on February 4, 2018 [5 favorites]

OHHHH report cards! If you have any old report cards that say things like "not applying herself"*, "not working to ability/expectations", or even "lazy" or "careless" then that's a massive ADHD flag.

Also if you were initially in gifted/honors classes and then you were knocked down to "regular" classes as you got older? That's another ADHD flag (and another thing I've personally experienced!) And it doesn't mean that you "stopped being smart", it just means that your gifted ability was finally outpaced by your inability to (unknowingly) manage your ADHD.

Finally, please note that there is no longer such a thing as ADD and ADHD. It's all ADHD, and there are three subtypes:

- ADHD-predominately inattentive (which once was known as ADD)
- ADHD-predominately hyperactive-impulsive (which is what most people imagine when they hear ADHD), and
- ADHD-combined type (which is a mix of both and what I have)

Referring to ADD specifically to exclude hyperactivity ends up stigmatizing ADHD, so even if you're talking about ADHD-PI, please don't call it ADD. Someone may not personally be hyperactive, but it's okay if they are. Either way, they're both ADHD. Aaaaanyway...

Here's my ADHD comment from 8 years ago that has a lot of favorites for some reason.

* One of my old LJ handles was "applyingmyself" because I was feeling ironic one day in my early 20s.
posted by elsietheeel at 7:35 PM on February 4, 2018 [8 favorites]

I went through the same questioning because I've always been very high anxiety but started to suspect as an adult that I had ADD too. In my case, the problems included focus difficulties but mainly a lot of flakiness and absent-mindedness. I talked to my therapist, who had an adult son with ADD and agreed that I had symptoms. Then I went to my psychiatrist. The *only* screening he did was to ask what kind of grades I got in school. Like gideonfrog, I had done really well in school, but it was easy. I gave up on that psychiatrist. My therapist wrote a letter to my GP and from there we started exploring ADD meds. I tried a handful, but the stimulants were bad for my anxiety and the non-stimulants made me tired. I don't feel like I found an answer. But I do think PTSD explained some of my symptoms.
posted by mermaidcafe at 7:40 PM on February 4, 2018

*raises hand* I got diagnosed two years ago shortly after turning 41 and agree with pretty much everyone else has said. My therapist caught it first, and I had to jump through a ton of hoops at the Cleveland Clinic to get tested and medicated but things are much better now — I can identify when I’m falling into patterns and make choices accordingly.
posted by at 8:24 PM on February 4, 2018

Schoolwork was pretty easy up until junior and senior year of high school--I always had problems with procrastination and distraction, but when I was put under last-minute pressure I usually ended up being able to focus well and complete assignments in time. So my therapist ruled out ADHD.

Especially if you weren't really challenged to learn concepts that were difficult for you (difficult because of the concepts themselves, not difficult because of executive function stuff), you might have been able to use coping skills so that ADHD didn't really affect you academically until college.

It sounds like your current therapist might not have much experience with people who haven't run into ADHD not really causing them serious difficulties they couldn't work around until they got to college or grad school. If your school has a clinic which is only for students, that does ADHD diagnoses, that might be a good place to try, as it would be common for them to see people in your situation. I went to one at my school and they had an extended interview for screening as well as some computer testing to do before and after trying medication.

They also seemed to be interested in knowing about coping strategies I was already using, because having coping strategies that most people don't need to use is a pretty strong clue.

Yeah it manifests differently in women, but I don't think that's what's going on here -- it seems more like your therapist doesn't even work with adults generally. Seems more like they are acting like since certain things weren't a problem for you as child that they are dismissing any issues it could be causing for you as an adult with a much more self directed and complicated academic, professional, and personal life.

On preview: I guess you aren't in school right now, but do try to see someone who normally sees college students who are facing possible ADHD related difficulties. You deserve to have someone in your corner who can help you be the best you can be academically, not someone who thinks that it was good enough for you to get through high school so you don't need help.
posted by yohko at 8:53 PM on February 4, 2018 [1 favorite]

I'm sorry to keep commenting, but if you have an MD that's apprehensive about prescribing you ADHD meds, you really might want to think about finding a new MD. Consider this: a recreational dose of Adderall is three to ten times more than a therapeutic dose; I've seen Erowid and Bluelight posts from people talking about first time 100+mg doses of Adderall for funsies - my starting Adderall dose was 10mg at 7 and 11am. I'm currently taking double that and when I was working I prescribed 60mg a day, but that was after nearly 6 years of tolerance buildup. A doctor who considers your ADHD concerns as "drug seeking" likely doesn't care about your well being. Also if your therapist and/or psych isn't supportive, try going straight to your GP.

Note: My ADHD was diagnosed by two psychiatrists and my therapist, but I got my Adderall RX from my regular doctor because the psychiatry department of my old HMO was useless and getting appointments was impossible - and Adderall is a triplicate prescription in the US and you have to see the doc on the regular to get a physical prescription on a piece of paper. Also I loved my GP so I preferred to go see her and have a chat than to go see the jerkass Psy.D who was regularly 45 minutes late to every appointment.
posted by elsietheeel at 9:57 PM on February 4, 2018 [3 favorites]

I have no experience with Adderall but Buspar has made a measurable difference in my adhd and my anxiety. I basically begged my doctor to let me try it. He flat out didn't want to but I took a deep breath and kept pushing. I am so glad I did.

You really can trust your gut. I used to worry a lot about seeming pushy or neurotic with my health care but the older I get, them more determined I am to stand up for myself.
posted by i_mean_come_on_now at 3:55 AM on February 5, 2018 [1 favorite]

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