ADHD in Disguise: When Adults Slip Through the Diagnostic Cracks

ADHD in Disguise: When Adults Slip Through the Diagnostic Cracks

ADHD misdiagnosis can occur when symptoms overlap with those of other conditions, necessitating a thorough evaluation to ensure accurate diagnosis and appropriate treatment.

Published on
16/10/2022
Updated on
16/10/2022
estimated reading time
minutes

Written by

Alice

The mini Adhd coach

Reviewed by

In this Article

Reviewed by

A word form our expert

Is It Really ADHD? Understanding ADHD Misdiagnosis in Adults

Could your ADHD diagnosis be a misstep? Often, when being assessed for Attention Deficit Hyperactivity Disorder (ADHD), adults are misdiagnosed with ADHD due to criteria tailored for children, not recognizing ADHD's varied adult presentation, or confusing it with similar conditions. To ensure accuracy, a detailed evaluation beyond surface symptoms is essential. Dive into our article for a deeper exploration of why ADHD in adults is frequently misunderstood and what steps to take if you think your diagnosis doesn't quite fit the bill.

5 Reasons Why Your Diagnosis Might Not Be Quite Right 

Have you ever felt like you're reading a description of yourself when scrolling through ADHD symptoms, yet your diagnosis says otherwise? 🤨Adults face unique hurdles when it comes to diagnosing ADHD, which can happen for a few reasons:

  • Diagnostic Criteria: ADHD's diagnostic standards often don't match adult presentations, overlooking how symptoms evolve with age. 👶

  • Lack of Training: A lack of ADHD awareness among physicians can lead to misdiagnosis, particularly in adults. 💊

  • Overlapping Symptoms: Adult ADHD can mimic anxiety, bipolar, and depression, leading to diagnostic mix-ups. 🔁

  • Masking: Adults may mask ADHD symptoms with coping strategies, complicating accurate diagnosis. 🙈

  • Gender Bias: Women's less noticeable ADHD symptoms frequently result in misidentification as other mental health conditions. ♀

Want to unpack it a bit further? This article explores the reasons behind misdiagnosis and why ADHD might fly under the radar for so many adults. 

Reason 1 - An Inappropriate Diagnostic Criteria for Adults

When it comes to an ADHD diagnosis, many adults find themselves at odds with a system that's still rooted in identifying the disorder in children. The diagnostic criteria in the Diagnostic and Statistical Manual are primarily child-centric, often including behaviors like restlessness and a propensity for interruption - actions that adults with ADHD have typically outgrown or learned to mask. These guidelines can render adult ADHD practically invisible, leading to an inappropriate diagnosis or none at all. 

What makes this even more complex is that according to many diagnostic guidelines, such as those from the Centers for Disease Control and Prevention (CDC), most symptoms must have been present before the age of 12 years old. However, many adults getting a diagnosis later on in life may not remember how they felt or behaved as a child, and so may not get an accurate diagnosis.

Reason 2 - Skepticism in Healthcare

The skepticism about adult ADHD within the healthcare industry is staggering. A significant number of physicians still hold outdated beliefs, not recognizing the legitimacy of diagnosing ADHD in adults. According to recent reports from the CDC, a vast majority of adult psychiatrists admit to having no formal training in ADHD, especially concerning women and adults. 

This gap in knowledge and harmful beliefs around adult ADHD can lead to a misdiagnosis of ADHD, with many doctors overlooking the nuanced ways it manifests in adulthood, depriving many of the correct diagnosis and treatment they need. 😓

Reason 3 - ADHD's Identity Crisis

As adult ADHD is so complex, its symptoms are commonly mistaken for other mental health disorders. The overlapping nature of conditions like anxiety disorders, OCD, and various mood disorders such as bipolar disorder exacerbates this confusion. The diagnostic and statistical manual lists symptoms that can mimic ADHD symptoms, but without a careful and comprehensive assessment, adults can end up misdiagnosed with ADHD when they have a different disorder or receive a diagnosis that fails to encapsulate the complete picture of their mental health. 

Some of the overlapping symptoms of ADHD that may be misdiagnosed as another condition or vice versa include:

Cognitive Challenges (Inattention and Forgetfulness)

  • Major Depressive Disorder: Concentration issues in this mood disorder can mimic ADHD symptoms.

  • Anxiety Disorders: Chronic worry disrupts focus, resembling ADHD's inattention.

  • Bipolar Disorder: Similarities in concentration difficulties during depressive states can confuse an ADHD diagnosis.

  • Learning Disabilities: These include similar issues with inattention and forgetfulness, especially in school-age children and adults in academic or learning-intensive settings. These can include difficulties with processing and retaining information.

Behavioral Symptoms (Hyperactivity and Impulsivity)

  • Mood Disorders: Agitation and mania in mood disorders can be mistaken for ADHD's hyperactivity and impulsive behaviors.

  • Personality Disorders: Impulsive behaviors can overlap with ADHD symptoms.

Executive Dysfunction (Poor Time Management and Disorganization)

  • Anxiety Disorders: Excessive worry can lead to disorganization, a symptom commonly attributed to ADHD.

  • Depression: The reduced motivation can result in poor organizational skills, sometimes seen in ADHD.

Emotional Regulation Difficulties

  • Bipolar Disorder: The emotional instability between manic and depressive episodes can be confused with ADHD.

  • Borderline Personality Disorder: This condition is characterized by significant challenges in regulating emotions, which can appear similar to the emotional dysregulation seen in ADHD.

Physical Restlessness (Fidgeting)

  • Anxiety Disorders: Nervous energy may present as fidgeting, similar to ADHD.

  • Bipolar Disorder: During manic episodes, restlessness and an inability to sleep or rest is common.

A mental health professional should be able to distinguish between ADHD symptoms and those of other conditions, leading to a correct diagnosis and effective ADHD treatment. It's crucial not to be misdiagnosed with ADHD when another disorder may be present. ✅

Reason 4 - Masking Symptoms of ADHD

After living with undiagnosed attention deficit hyperactivity disorder for years, adults often develop coping mechanisms to manage and mask their symptoms. From relying on detailed lists ☑️ to overcompensating with hyperfocus, these strategies can conceal underlying issues, complicating an accurate diagnosis of ADHD. Such adaptations can be particularly nuanced in work and social settings, where adults with ADHD might seem to function well despite struggling internally with hyperactivity and difficulty concentrating.

Reason 5 - Gender Gaps in Diagnosis

Findings from recent peer reviewed studies highlight a diagnostic gap where ADHD in women is frequently underdiagnosed. Women often exhibit less overt symptoms of ADHD, like hyperactivity, and more internalized symptoms, such as inattention, leading to the misinterpretation of an anxiety disorder, depression, or borderline personality disorder. The American Psychiatric Association and other bodies emphasize the need for improved awareness and behavioral treatment approaches to address this disparity and ensure treatment is accessible to all genders. 🚺

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How To Advocate For Yourself If You Think You’ve Been Misdiagnosed

So, you feel like your diagnosis was slightly off the mark - what's next? 🤷 I know it's tough, but it's time for a bit of self-advocacy. 💪Self-advocacy is about understanding your own needs, knowing your rights, effectively communicating those needs to your healthcare provider, and making informed decisions about your treatment. 

Advocating for yourself is about becoming an active participant in your healthcare journey, ensuring that the diagnosis and treatment align with your actual experiences of symptoms of ADHD or any other related mental disorders. 

Here's how you can take charge:

  • Know Your Symptoms: Keep a detailed log of your symptoms of ADHD, including situations like difficulty concentrating or hyperactivity in multiple settings - at work, at home, and socially. ✍🏽
  • Research Thoroughly: Before your appointment, read up on ADHD from reputable sources to understand potential treatment options. 📲

  • Prepare Your History: Document not your childhood experiences, family history of ADHD and related mental disorders. 📖

  • Communicate Clearly & Honestly: Discuss your symptoms with your healthcare provider, focusing on how they impact your daily life, including anything related to an anxiety disorder or depression. 💬
  • Get Curious: Ask about the reasons behind the chosen ADHD treatment plan or medication, including the diagnostic process and assessments. ❓

  • Seek Clarification: If you are diagnosed with a different disorder or told you don't have ADHD, ask for a clear explanation and which symptoms led to that conclusion. If you do better with written communication, ask for a copy of the report or ask to record the assessment using dictation software or an app. 🔊

  • Consider a Second Opinion: If you're not satisfied with the diagnosis, it's within your rights to seek another professional's perspective, especially if you feel your symptoms align with ADHD but were possibly misdiagnosed. 👍

  • Advocate for Accuracy: Emphasize the importance of an accurate diagnosis to your provider. Accurate identification of ADHD or any other health conditions is crucial for effective management. 💕

  • Follow-Up: Track your symptom response to treatment closely and maintain regular contact with your healthcare provider for adjustments. If symptoms persist, additional evaluation or a change in medication may be needed to confirm your diagnosis. 📩

Remember; proactive self-advocacy is key to receiving comprehensive care for ADHD or any other mental health concerns.

Key Takeaways

Getting an accurate ADHD diagnosis for adults is not always a straightforward process, which can result in misdiagnosis.

  • There are a few reasons why some adults may be diagnosed with ADHD but have other co-occurring conditions ignored or have their ADHD missed completely. ⬇️

These include

  • The diagnostic criteria used for diagnosing Attention Deficit Hyperactivity Disorder are often unsuitable for adults.

  • There is a lot of skepticism and lack of training among physicians, which can result in a misdiagnosis or overlooking of the condition, particularly in women.

  • The complexity of adult ADHD often leads to symptoms being mistaken for other conditions, such as anxiety, bipolar disorder, and depression, due to their shared characteristics.

  • Adults with ADHD often develop compensatory strategies (masking) to cope with their symptoms, which can mask the true extent of their ADHD, complicating the diagnosis and treatment process.

  • Women with ADHD tend to exhibit less visible symptoms, often leading to their condition being misinterpreted as other mental health issues, thus highlighting the importance of gender-sensitive diagnostic approaches.
  • Empowering oneself through self-advocacy is crucial when navigating a potential misdiagnosis of ADHD, which includes understanding your own symptoms, communicating effectively with healthcare providers, and seeking further assessment when necessary. 


What’s Next?


Navigating the diagnostic process is a bit of a wild ride, but hang tight - we've got you. Below, you'll find more articles to help you find your way through the diagnostic process from start to finish. 👇

TMAC’s Guide To The DSM-5 Diagnostic Criteria for Adult ADHD

A Step-by-Step Guide to the ADHD Diagnosis Process

Common Co-occurring Conditions with ADHD

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ADHD Misdiagnosis: FAQs (Frequently Asked Questions)

Is there a specific test for ADHD?

Unfortunately, there is no specific ADHD test to confirm a diagnosis. It's not a physical illness or disease that can be identified through a laboratory exam or imaging test. It's a behavioral disorder that can be identified through history-taking and symptoms and signs.

Why is it difficult to diagnose ADHD?

If you’re struggling with ADHD, it can be difficult to receive a diagnosis because there are many conditions that mimic or overlap with symptoms of ADHD (such as anxiety disorders). Like mentioned, there's also no single test (laboratory or imaging) that can pinpoint ADHD. To be diagnosed a person MUST satisfy certain criteria. ‍

What conditions have similar symptoms as ADHD?

There are other conditions that have symptoms that are similar to those of ADHD. It's important to be familiar with these conditions so you can get an accurate diagnosis. Some of the most common include depression, anxiety, learning difficulties, and substance abuse. 

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