If left undiagnosed, adult ADHD can reduce overall quality of life, psychiatrist says

Edmonton resident Nikki Houde was 41 when she was formally diagnosed with attention-deficit/hyperactivity disorder (ADHD).

In November 2021, the middle school success coach was working from home during the COVID-19 pandemic, often finding her concentration drifting during video meetings, regularly avoiding tasks and making up distractions to get out of completing her work.

“I was just creating things so I didn’t have to do things that I didn’t want to do,” she said

After speaking with a friend who had been diagnosed with ADHD, Houde decided to seek help and learned that she was one of the thousands of adults who struggle with undiagnosed ADHD.

If left undiagnosed, experts like Dr. Ainslie Gray — a psychiatrist who founded the Springboard Clinic in Toronto and serves as the facility’s medical director — say that adult ADHD can seriously reduce a person’s overall quality of life.

“ADHD can impact every element of an individual’s life and the stereotype that it resolves by adulthood, even if it has been diagnosed in childhood, is not true,” she said, adding that the majority of people diagnosed in childhood and adolescence continue to experience challenges in adulthood.

When Houde was finally diagnosed, she said she “felt relief because it explained a lot of things about myself that I didn’t have to feel so bad about myself, because there are things beyond my control.”

Houde’s feelings of relief are familiar to Gray.

“Adults often feel tremendous relief because they gain an understanding of what areas of their life have been responsible for their impairment,” Gray told The Dose host Dr. Brian Goldman.

According to Gray, ADHD is a “usually genetic” neurodevelopmental disorder that can range in symptoms, most often associated with hyperactivity, restlessness and inattention.

According to the Centre for ADHD Awareness, Canada (CADDAC), roughly five per cent to seven per cent of children are diagnosed with the condition, while four per cent to six per cent of adults are diagnosed.

While children may have a harder time processing their symptoms, Gray says adults can “learn to mask their symptoms,” making it difficult to determine if patients have ADHD or other mental health concerns.

Still, the life impacts of adult ADHD are very real.

“There’s real concrete stats saying there’s compromised socioeconomic status, there’s lower annual incomes, there’s higher divorce rates, there’s less workplace satisfaction and less job security,” she said.

A study published in 2022 concluded that “adults diagnosed with ADHD and their spouses had more unfavourable patterns in their marriages with regard to the level of conflict, marital adjustment, conflict resolution styles and reciprocal evaluations” compared with non-ADHD couples.

ADHD in girls often harder to spot

Gray added that boys are more likely to be diagnosed than girls, but the ratio shifts to roughly 50/50 by adulthood.

“In children and adolescents, the male individual often presents with more overt emotional dysregulation or physical hyperactivity,” she said.

In comparison, girls are more likely to be inattentive rather than hyperactive — which makes it harder to diagnose their symptoms.

Gray speculates that one of the reasons the ADHD diagnosis ratio shifts in adulthood is because women are often more likely than men to seek medical help.

Looking back at her experiences, Houde acknowledged that she showed signs of ADHD even during childhood.

She would hyperfixate on things, often finishing books in a single night. She would also have trouble following conversations, either getting distracted or interrupting the other person while waiting for her turn to speak.

Additionally, Houde remembers often being told by her mother that she spoke very quickly — which is one of the many symptoms of hyperactivity associated with ADHD.

Since her overall experiences didn’t line up with those of the boys diagnosed with ADHD in her class, Houde didn’t think she had ADHD.

As she grew older, Houde’s experienced difficulty completing tedious tasks — like paying bills — often procrastinated and completed work at the last minute or not at all.

Coping with symptoms

Nonetheless, she found ways to cope with her symptoms.

“Post-its all over my office with to-do lists, things that I need to get done or reminders,” she said. “I have my calendar on my phone, and then I had a paper calendar, then I had a calendar on the wall to remind me of things.”

Dr. Sara Binder, an adult psychiatrist in Calgary, said adults with undiagnosed ADHD often find workarounds to manage their symptoms, sometimes even choosing professions that are “naturally stimulating and interesting for them.”

Binder said she often treats professionally successful adults with ADHD who are struggling in other areas of their life due to the undiagnosed condition.

“When you dig a bit deeper and you find out what’s going on in the rest of their life, or how hard they have to work just to stay at that level of functioning compared to their peers, you realize that there is actually significant impairment of functioning.”

According to Binder, part of the challenge with diagnosing adults with ADHD is that patients can sometimes present symptoms associated with other conditions — like anxiety, depression and substance abuse.

“By adulthood, if somebody has not been diagnosed and treated for ADHD, about 85 per cent of them will have at least one other psychiatric comorbidity,” she said.

How to treat ADHD

Gray says the first step in treating ADHD at any age is consulting with an appropriate specialist to receive a diagnosis.

Her clinic typically has patients meet with a psychiatrist, clinical psychologist and a coaching therapist.

“When those three interviews get together, along with questionnaires, it’s pretty clear when someone has ADHD and when they don’t,” she said.

After being diagnosed, Gray says a combination of prescribed medication and coaching or behavioural intervention to “deal with their signs and symptoms of impairment” is often best.

She says stimulants are an effective treatment, adding that long-acting preparations are significantly safer than immediate-release pharmaceuticals.

“Prescribing immediate-release stimulants, in my opinion, should never happen,” she said.

A better life after diagnosis

For her part, Houde says her life has improved in the two years since her diagnosis, and she no longer struggles with managing her responsibilities.

She pays bills on time, stays in touch with friends and family and has enhanced her overall communication skills.

For those adults who might be worried about being diagnosed with ADHD or worried about the use of medication, Houde says her own journey has helped boost her self-image.

“If you think there’s something going on, there usually is,” she said. “It’s eye-opening and it helps you walk your path that you’re actually supposed to be walking on.”