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Feature Article

Could it be ADHD? Recognising ADHD in youth and adults

HEIDI J. SUMICH, HUGH MORGAN
OPEN ACCESS

What does ADHD look like in an adult?

The common problems experienced by people with ADHD are experienced by all of us, but not in the same volume and not to the same level of occupational and social impairment. These common problems, although not necessarily being DSM-5 diagnostic criteria,5 are clinically useful observations to bear in mind when assessing for the possibility of ADHD.

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  • Problems with day-to-day responsibilities – for example, difficulty completing household chores effectively, cleaning and household maintenance, monitoring children’s homework or planning family holidays.
  • Being forgetful and appearing unreliable – for example, not turning up for appointments, losing track of belongings and prescriptions/referrals, forgetting important dates, or leaving doors or windows unlocked.
  • Difficulties with time management and prioritising – for example, chronically running late for work and other commitments, double booking, overcommitting or focusing on less important activities at the expense of more important ones.
  • Difficulty managing finances – for example, paying bills on time, managing the household budget, completing tax returns, paying off debt and saving money for future needs.
  • Lack of planning and life goals, or having ambitions but no effective strategy or commitment to achieving the desired goals.
  • Relationship problems – for example, not pulling their weight at home, not listening, not doing what they say they are going to do, fighting over impulsive spending, leaving chores half finished, getting bored in a relationship, blurting out inappropriate comments. 
  • Occupational problems – for example, taking longer than anticipated to complete studies or dropping out once parental support is wound back, academic or workplace underachievement or inconsistency, history of frequent job loss or change, or career frustration or boredom.
  • Emotional dysregulation and distress – for example, chronic feelings of stress, frustration, guilt or anxiety, feeling overwhelmed, often leading to depression, anger outbursts or low self-esteem.
  • Persistent problems with procrastination – for example, leaving things to the last minute, chronic and disabling task avoidance, failure to follow through on planned activities.
  • Motivational problems despite desiring a particular outcome – for example, difficulty getting started, difficulty persisting if the task is boring or unrewarding.
  • Behavioural and circadian sleep problems6 – for example, longstanding difficulty falling asleep due to an overactive mind at bedtime, resisting having a healthy bedtime routine, staying up too late on devices or unfinished work, delayed sleep phase with difficulty waking in the morning, not explained by sleep apnoea, restless legs syndrome or other sleep disorders. 
  • Problems with substance use (both stimulants and depressants) are common and often secondary to impulsivity, risk-taking behaviour, poor concentration and ­self-medication of insomnia – for example, caffeine or energy drinks, nicotine, alcohol, illicit substances (e.g. marijuana). Substance misuse can cause attentional problems but in ADHD the ADHD symptoms were present before the substance use. 
  • Problems stemming from impulsivity – for example, excessive internet shopping, gaming, porn addiction or gambling losses.
  • Problems with driving – for example, car accidents, frequent fines, loss of licence, driving under the influence, forgetting to renew registration or insurance on time or failing to maintain vehicle.

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Ms Sumich is a Consultant Clinical Psychologist; and Director of Mindcare Centre, Sydney. She is also a founding co-author of the first edition of the WHO textbook, Management of Mental Disorders. Dr Morgan is a Consultant Psychiatrist; Director of Mindcare Centre, Sydney; Senior Clinical Lecturer, The University of Sydney, Sydney, NSW; and is a committee member of The Royal Australian and New Zealand College of Psychiatrists Section of Youth Mental Health.