Symptoms of Adult ADHD
Adults with ADHD predominantly present with inattentive symptoms rather than hyperactivity, including poor attention to detail, difficulty concentrating, organizational challenges, chronic lateness, and reluctance to engage in tasks requiring sustained mental effort. 1
Core Symptom Categories
Adult ADHD manifests through two primary symptom clusters that must cause functional impairment in at least two different settings (home, work, social) 1:
Inattentive Symptoms
- Poor attention to detail - making careless mistakes in work or other activities 1
- Difficulty concentrating or sustaining attention on tasks 1
- Appearing preoccupied - difficulty shifting focus even when spoken to directly 1
- Difficulty completing tasks - getting distracted or side-tracked frequently 1
- Organizational challenges - resulting in chronic lateness for appointments or deadlines, messiness, and disorganized work 1
- Reluctance to engage in sustained mental effort - such as preparing reports or reviewing lengthy papers 1
- Forgetfulness in daily activities 1
Hyperactive-Impulsive Symptoms
- Frequent fidgeting - such as tapping a desk 1
- Difficulty sitting still for prolonged periods 1
- Feeling of inner restlessness or agitation 1
- Often loud and disruptive 1
- Always on the go - difficult for others to keep up 1
- Talking excessively 1
- Interrupting others frequently 2
Diagnostic Criteria
For adults aged 17 and older, at least 5 symptoms from either the inattentive or hyperactive-impulsive category must be present for at least 6 months. 1, 3
Additional diagnostic requirements include 1:
- Symptom onset before age 12 years - even if not formally diagnosed in childhood
- Symptoms present in 2 or more settings (work, home, social situations)
- Clear evidence of functional impairment - interfering with interpersonal, occupational, or social functioning
- Symptoms not better explained by another mental disorder (psychotic disorder, mood disorder, anxiety disorder, personality disorder, substance intoxication/withdrawal)
Screening Tools
The Adult ADHD Self-Report Scale (ASRS-V1.1) Part A is the recommended initial screening tool, with a positive screen defined as checking "often" or "very often" for 4 or more of the 6 questions. 1
Other validated assessment tools include 1:
- Wender Utah Rating Scales
- Brown Attention-Deficit Disorder Scale for Adults
- Conners Adult ADHD Rating Scale
Associated Features and Functional Impairments
Adults with ADHD commonly experience 1, 4:
- Poor time management and chronic procrastination 5
- Disorganization affecting work and personal life 1
- Mood lability and temper outbursts 6
- Stress sensitivity 6
- Impulsivity affecting decision-making 6
- Difficulties with school, work, family interactions, and social activities 4
Important Clinical Considerations
Adults with ADHD are notoriously poor self-reporters and often underestimate the severity of their symptoms and resulting impairments. 1, 7 Therefore, obtaining collateral information from a spouse, significant other, parent, or friend is essential for accurate diagnosis 1, 2.
ADHD symptoms often become more challenging to manage as adults deal with increased demands of work, relationships, and parenting, even though it is a chronic condition that preceded these life stages. 1
Common Comorbidities to Screen For
Approximately 10% of adults with recurrent depression and/or anxiety disorders have ADHD, and treatment of depression/anxiety alone will likely be inadequate without addressing the underlying ADHD. 1
Other common comorbidities include 1, 2:
- Substance use disorders
- Bipolar disorder
- Personality disorders
- Learning disabilities
A detailed history of drug and alcohol use must be undertaken, with consideration of urine drug screening, given the high rate of comorbid substance abuse. 1