Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral condition that usually starts during childhood. ADHD can affect adults as well, whether they were diagnosed in childhood or not.
Unfortunately, it is not uncommon for ADHD in adults to go untreated, either because people don’t recognize the need for treatment or don’t realize that they even have ADHD.
This article explores the potential effects of untreated ADHD in adulthood, including how it can affect important areas of a person’s life.
At a Glance
ADHD in adults may go untreated because people don’t realize they have this neurotype. Signs of untreated ADHD in adults include mood swings, forgetfulness, poor time management, and restlessness, among others. Untreated ADHD in adults can contribute to low self-esteem, relationship problems, anxiety, and depression. Adults may not realize they have ADHD, may mask their traits to fit in, or hide their struggles to avoid stigma.
Recognizing that you might have ADHD and getting an accurate diagnosis is the first step toward understanding your neurotype, including your strengths and the challenges you may face.
Signs of Untreated ADHD in Adults
Signs of untreated ADHD in adulthood can involve:1
- Difficulty multitasking
- Distractability
- Forgetfulness
- Impulsiveness
- Low frustration tolerance
- Mood swings
- Poor listening skills
- Poor planning
- Poor time management
- Problems staying on task
- Restlessness
Adults with ADHD may also have problems with interrupting others when they are speaking, misplacing things, missing important deadlines, and struggling to deal with stress or frustration.
The problem is that these signs are often labeled as immaturity or misdiagnosed as anxiety or depression. Because people with ADHD frequently have those conditions as well, being misdiagnosed or underdiagnosed then leads to undertreatment.2
Estimates suggest that around 2.5% to 5% of the adult population has ADHD. Some research also suggests that these rates appear to be increasing. While fairly common, it is frequently undiagnosed and untreated, with less than 20% of adults with ADHD receiving an appropriate diagnosis and treatment.2
In adults, signs of inattention can include paying less attention to detail, having problems, and not managing time effectively. Signs of hyperactivity can involve problems with sitting through work meetings or changing jobs frequently.
While ADHD characteristics are often more readily apparent in children because they interfere in classroom performance and behavior, adults have more options when it comes to making changes in their lives to cope with such behaviors. For example, they might rely on a more organized partner to deal with time management issues or choose jobs suited to their needs.
Recap
Untreated ADHD in adults is often characterized by impulsivity and inattention, although some people may also experience hyperactivity. These traits tend to present differently than in children, so it is sometimes missed.
Why Is ADHD in Adults Is Often Untreated
There are a number of different factors that can contribute to the underdiagnosis and undertreatment of ADHD in adulthood.
Lack of Awareness
One reason why ADHD in adults goes without treatment is that people are often unaware of how having this neurotype can affect behavior. This includes both those with ADHD and healthcare providers.
It was previously believed that ADHD was primarily a childhood disorder that mostly went away as children transitioned to adulthood. While the research now indicates that ADHD does often persist into adulthood,3 many people are unaware that adult ADHD is a valid diagnosis.
How ADHD Differs in Adults
ADHD does not present the same in adults as it does in children. This may be why many adults who have this neurotype don’t recognize the hallmark signs of inattention, impulsivity, and hyperactivity that characterize ADHD in children. Adults with ADHD often have less hyperactivity, but they may still have other characteristics that interfere with their ability to function in different areas of life.
It is also common for people to miss the signs of ADHD in adulthood because they believe that ADHD is primarily marked by hyperactivity. However, these characteristics not only appear differently in adults, but it is also more common for some adults, particularly women, to have more inattention than hyperactivity and impulsivity.4
The Presence of Co-Occurring Conditions
Studies also indicate that adult ADHD frequently co-occurs alongside other mental health conditions, including anxiety disorders and substance use disorders.5
Some studies have suggested that as many as 90% of adults with ADHD have another psychiatric condition.5
Some of the most common co-occurring disorders include:
- Bipolar disorder
- Depression
- Eating disorders
- Generalized anxiety disorder
- Social anxiety disorder
- Substance use disorders
Unfortunately, the presence of co-occurring conditions not only sometimes complicates the diagnosis but also affects outcomes. People who have more than one condition tend to experience more severe problems that last longer and cause more complications.
Masking or Self-Medicating Symtoms
Adults who live with untreated ADHD often utilize a variety of strategies to disguise or compensate for their struggles. These behaviors are sometimes called ‘masking.’2
Also known as camouflaging or impression management, masking can involve actions that are helpful or adaptive at times. An example of this would be choosing a fast-paced job to deal with excess energy or an inability to stop moving.
In other cases, these behaviors can be unhealthy or even destructive. For example, people with untreated ADHD might avoid situations that cause distress or become overly perfectionistic to hide problems with forgetting.
Self-medicating with drugs and alcohol is another way that people try to manage or disguise their ADHD traits.
Stigma
Stigma about mental health problems can also play a part in explaining why ADHD often goes untreated in adults. People may suspect that they have ADHD but may choose not to get an official diagnosis for fear of getting labeled. Others may have worries about taking medications to manage their ADHD characteristics.
Because adults who have untreated ADHD often have a lifetime of difficult experiences related to their symptoms, it is not uncommon for people to have poor self-esteem. They may feel they are behind their peers or have not lived up to their full potential.
All of these factors can play a role in whether a person chooses to talk to a healthcare provider about the signs of ADHD they are experiencing.
Poor Access to Treatment
Lack of access to healthcare can also affect whether or not people get the treatment that they need. Not having adequate health insurance problems is still an issue for many people.
One older study found that the average annual medical costs for adults with ADHD ranged between $4,929 and $5,651 per year.6 The increased costs of healthcare may mean that these numbers have grown since that time.
Gender,7 racial, and ethnic inequalities8 can also lead to disparities in the availability and quality of treatment.
Effects of Untreated ADHD in Adults
Potential complications associated with a ‘missed’ ADHD diagnosis include increased criminal involvement, car accidents, unemployment, relationship problems, and substance misuse.
Because ADHD in adulthood is often undiagnosed, people who have this form of neurodivergence may struggle to understand the signs and behaviors they are experiencing. They might attribute the symptoms to anxiety or depression, which can appear in similar ways, but they may also believe them to be character flaws. This can contribute to a lack of self-confidence, feelings of shame, and poor self-esteem.
Studies suggest that untreated ADHD in adults increases the risk for:9
- Accidental death
- Addiction
- Anxiety
- Depression
- Impaired quality of life
- Relationship problems
- Unemployment
- Suicide
However, research suggests that the number of people who have been diagnosed with adult ADHD has increased significantly over the last ten years.10 Part of this may be due to a greater awareness of the signs of ADHD in adults.
Treatment for ADHD in Adults
Getting a diagnosis of ADHD in adulthood often comes with a sense of relief. It allows them to better understand the source of many of their problems and recognize that these symptoms are due to a differences in how their brain works and not because of their own failings.
It can mean that adults who previously went untreated can access the help and interventions that they need to manage their ADHD traits successfully.
It is important to remember that ADHD is considered a neurobehavioral condition because we live in a society with neurotypical expectations that create challenges for people with brains that work differently. ADHD is not a problem that needs to be “fixed.” It’s a neurotype that should be accommodated and supported. Having adult ADHD can create challenges, but it also means that you have many strengths as well.
Treatment for adult ADHD often involves a combination of medications, psychotherapy, skills training, and self-help strategies.
Medications
Stimulant medications are often used to treat ADHD in both adults and children. Non-stimulant options are also available. Both can be effective, although non-stimulants take longer to work than stimulants.11
Research has found that 70% of adults who take stimulant ADHD medications have immediate improvements in attentiveness within one hour of taking the medication.12
However, some people may experience side effects; stimulants should be avoided if a person has a substance use disorder.
Psychotherapy
Different types of psychotherapy can help adults learn new strategies to manage their ADHD traits. Therapy can also be helpful for addressing some of the symptoms of co-occurring conditions.
Cognitive behavioral therapy (CBT) can help people change negative thinking patterns that make it hard to cope. Couples therapy or family therapy can also be helpful for improving relationships.
Self-Help Strategies
Adults With ADHD may benefit from a variety of self-help strategies. However each person is unique and each strategy will work for everyone. Some techniques that might be helpful:
- Use lists: Make lists of tasks that you need to accomplish each day. Check off each one as you complete it. Consider carrying a planner or appointment book with you so you can keep track of important information or appointments.
- Break projects up into smaller tasks: It is easy to feel overwhelmed by large projects, but breaking them down into smaller components and tackling them step by step can make it less intimidating.
- Have a routine: Having a structured schedule can help adults with ADHD stay on track and reduce distractibility.
- Minimize distractions: Reducing clutter and eliminating distractions may also be helpful when you are trying to stay on task.
Because untreated ADHD in adults can have an impact on many different areas of a person’s life, including their relationships and self-esteem, it is essential to receive an accurate diagnosis if you think you have ADHD traits.