Why it's so difficult to diagnose ADHD in adults

The COVID-19 pandemic wreaked havoc on more than just our physical health. It revealed (and contributed to) a nation struggling with its mental health—and seeking treatment for it. The first and second years of the pandemic, 2020 and 2021, saw significant growth in the number of American adults receiving help with their mental health, according to data from the CDC.

While more Americans than before sought assistance with anxiety and depression during the pandemic, diagnoses of attention-deficit/hyperactivity disorder were on the rise, too. In 2022, roughly 1 million more children than in 2016 received an ADHD diagnosis. Prescriptions for ADHD medication also surged during the pandemic, especially for women and young adults.

ADHD Advisor investigated the age, gender, racial, and wealth disparities in ADHD diagnoses and why diagnosing and treating is more difficult in adults, using data from the CDC, medical studies, and news reports.

The rise in ADHD diagnoses and treatment during the pandemic has been attributed to various circumstances created by lockdowns. As work and school moved into the home, time on electronic devices like computers, tablets, and smartphones increased, and both children and adults faced the need to self-motivate and organize, making ADHD symptoms more evident and leading many to seek treatment. Yet even with this jump in diagnoses, disparities in ADHD diagnoses and treatment persist for adults, particularly women, Black and brown people, and people with lower incomes.

While ADHD is among the most common psychiatric disorders in adults, most physicians and even many psychiatrists don't undergo training on the disorder, psychiatrist and ADHD specialist Dr. William Dodson told ADDitude. Adding to the confusion around adult ADHD is a total lack of diagnostic and treatment guidelines for adults in the U.S.

ADHD diagnoses and treatment are rife with disparities—and this has consequences

Age disparities in ADHD diagnoses have gained attention in recent years, particularly as myths of ADHD as a "disorder of childhood" have been debunked by further research. Studies have shown that the vast majority of children with ADHD diagnoses experience symptoms as adults also. Meanwhile, many adults receive their first diagnosis as adults, not children. Adult symptoms can be missed or misconstrued as a result of presenting differently than children's symptoms, being mistaken for other mental health issues, or lack of provider knowledge.

The underdiagnosis of girls and women with ADHD has also received more public awareness. In childhood, boys and girls are diagnosed with ADHD at a ratio of 4 to 1, according to a 2019 study published in Psychiatric Genetics. Much of this gender disparity has been attributed to the differing ways the disorder presents between girls and boys. While younger boys with ADHD tend to exhibit symptoms like impulsiveness and hyperactivity, young girls with ADHD often experience more internalized symptoms, such as disorganization and forgetfulness. Research has shown that because symptoms associated with boys are more hypervisible and disruptive, they receive more frequent interventions and diagnoses.

In addition to age and gender disparities, racial and ethnic disparities persist in diagnosing ADHD. Multiple studies published over the past decade have shown that African American, Asian, and Latino children are underdiagnosed and receive less treatment than white children. One of these studies, published in Pediatrics in 2013, suggested clinicians are more receptive to white parents seeking treatment for their children than to parents of other races and ethnicities and recommended that health care providers provide "culturally sensitive monitoring."

Another barrier to equitable diagnoses and treatment of ADHD is access to health care. Allison Gornik and Rod Salgado, Ph.D., state that families with more financial, insurance, and education resources have an easier time accessing support for the disorder. A lack of these resources limits access to quality health care providers, medication coverage, and other important services. At the same time, young people coming from lower-income backgrounds are often misdiagnosed with ADHD due to a conflation of ADHD symptoms and other behavioral issues linked with food or housing insecurity or exposure to trauma.

The implications of disparities in ADHD diagnoses can be far-reaching. Untreated ADHD can make succeeding in school, work, and even relationships more difficult. It can also impact mental health; children whose ADHD goes untreated often also suffer from low self-esteem or depression. Systemic racism and sexism that Black, Indigenous, and Latino people, and people from low-income backgrounds experience create obstacles to success in school, work, and other areas of life. Undiagnosed or untreated ADHD can compound these issues.

Part of the cultural increase in awareness about ADHD, particularly among young people, has come from the rise of content creators posting informative videos on social media platforms like TikTok. Many users have shared videos in which they talk about their personal experiences with the disorder.

According to an article from the BBC, videos with the hashtag ADHD have been viewed over 20 billion times as of May 2023. Critics of this trend argue these videos are often inaccurate or misleading and can lead to potentially incorrect self-diagnosis by viewers, as well as to the perpetuation of stereotypes. At the same time, an increase in awareness has normalized the disorder, chipping away at decades-old stigma and allowing for a sense of community and understanding for those with ADHD.

Story editing by Shannon Luders-Manuel. Additional editing by Kelly Glass. Copy editing by Janina Lawrence.

This story originally appeared on ADHD Advisor and was produced and distributed in partnership with Stacker Studio.