When most people think about ADHD they think of a child who is hyperactive. A child who has a very limited attention span, is disruptive and by lunchtime is bouncing, jumping, and leaning against the walls. It is a far cry from any picture that an undiagnosed ADHD adult might have in mind.
If left untreated, ADHD is stealthier (and seriously damaging) in adults. Seems like a job that always fails even though they have some intelligence. It appears as if relationships that are not listening to each other, missed deadlines, missed appointments. It feels like complete fatigue, a fatigue which not enough sleep can cure and a ticking inside the head reminding you that you have not turned yet.
If any of those sound familiar, you’re not alone – and you’re not failing. It could be something that has been overlooked, or perhaps an illness that you have lived with for a while.
In this guide, you will learn about what the symptoms of untreated ADHD in adulthood are, what you can look out for that might indicate the condition has been missed, and how an accurate assessment can make all the difference.
Why So Many Adults Have Never Been Diagnosed
Adult ADHD is not a sudden and unexpected occurrence. It starts early in childhood – and for millions of adults, it was never detected. A child with hyperactivity becomes conspicuous. The neglectful child, the one who doesn’t pay attention, the smart kid who just doesn’t apply themselves – these are kids that are often overlooked.
The statistics are shocking. It is believed that there are 404 million adults with ADHD worldwide and a significant majority of these are undiagnosed. Uncontrolled ADHD costs adults in the U.S. an average of 22 days of productivity at work a year costing them approximately 20 hours, or $40,000 in lost productivity.
Especially women who are diagnosed at a much later age. Their ADHD is often manifested by inattention, restlessness from within, anxiety, instead of the disruptive hyperactivity that sends boys for assessment. Many women are diagnosed with ADHD when they are adults, and a lot of unnecessary suffering has already occurred.
9 Signs of Untreated ADHD in Adults
The following are some of the most frequently reported presentations in adults who present for an ADHD evaluation in NYC or NJ without a formal diagnosis. They don’t just happen on their own – and they’re usually blamed for stress, personality or poor discipline before thinking of ADHD.
1. Chronic Procrastination That Goes Beyond Laziness
It’s not the usual form of putting things off. Many adults who have not received treatment for ADHD find themselves paralyzed when it comes to starting a project, even one they’d like to undertake. They may wait until a time limit triggers the adrenaline rush and they finally get to the move, only to repeat the process. The behavioural pattern that appears to be laziness on the outside is actually lack of executive functioning – the brain’s inability to initiate without a strong outside cue.
2. Time Blindness
An impaired sense of time is one of the most distinctive and misunderstood ADHD symptoms for adults. Many adults who haven’t been treated for ADHD often underestimate the time required for tasks, forget to mark down hours and often arrive late – not out of sheer neglect, but due to their brain not working on time. In essence, they live in just two time zones: now, and not now.
3. Difficulty Finishing What You Start
A house that has been a victim to three unfinished renovations. The job for someone with nearly completed certifications. A drawer containing 10 journals with 10 items in each. Undiagnosed ADHD can make the maintenance of effort on long-term projects very challenging, particularly after the initial excitement has faded, and what’s left is maintenance, repetition and/or administrative details.
4. Working Memory Failures
Losing touch with what you were just doing when entering a room. Frequent loss of keys. Failure to attend scheduled appointments that were planned but not on time. Adults with ADHD and forgetfulness don’t care less – forgetfulness is a structural issue involving the brain’s ability to hold and use information in real time, known as working memory. One of the reasons why adults who don’t have an ADHD diagnosis have well-developed compensatory systems is because their working memory is not very reliable.
5. Emotional Dysregulation
That symptom does come as a surprise. Attention isn’t the only problem with ADHD – emotional regulation is a big issue as well. Untreated ADHD adults may be more easily provoked to frustration, anger, or disappointment, and may be less able to ‘cool off’ after an incident. Rejection Sensitive Dysphoria (RSD) is a situation where a person experiences intense emotional reactions to perceived criticism or failure, often mistaken for a mood disorder.
6. Chronic Disorganization
People with untreated ADHD are often much more than just desk messes. It has an impact on systems, finances, relationships and health. Bills weren’t being paid because they did not have the money to pay them; it was that they were overwhelmed by the paperwork. Appointments are missed for medical care. Chores become overdue and take a whole day to handle. This disorganization isn’t some kind of personality defect, it’s the result of poor executive functioning.
7. Hyperfocus at Unpredictable Times
Counterintuitively, adults with untreated ADHD and focus problems can hyperfocus intensely on things that interest them – sometimes for hours without noticing time passing. This makes her or him and others around her confused. What about that if you can focus on that, how can it be ADHD? It’s not that ADHDers cannot focus, it’s that they can’t regulate their focus. The brain runs without control or it gets stuck on something and can’t get off.
8. Underperformance Relative to Potential
It is one of the most bothersome and repetitive symptoms of untreated adult ADHD. These are often smart individuals with definite abilities who have undergone years of being told that they aren’t living up to their potential. There is a difference between what they know they can do and what they can actually do and it is neurological, not a lack of effort or character, caused by the neurological effects of not medically treated ADHD.
9. Anxiety, Depression, and Burnout as Secondary Conditions
Untreated ADHD often starts in adults when they develop anxiety and/or depression. These are not just random. It takes a big blow after years of under-achievement, being made up, being passed over and blamed for things you can’t control. In fact, anxiety and depression are often a consequence of, not separate from, ADHD; that is why treating anxiety and/or depression is not likely to bring about significant relief without treatment to the ADHD first.
The Long-Term Cost of Leaving ADHD Untreated
There is more to the effects of untreated adult ADHD than inconvenience. Unmanaged ADHD has been consistently linked to reduced lifetime earnings, increased job loss and increased relationship breakdown. One study which tracked children with ADHD over a lifetime found that those who were untreated might end up with significantly lower lifetime earning potential than kids who were not diagnosed with ADHD.
This makes a difference in the workplace. Adults with untreated ADHD are more likely to change jobs often, have trouble performing consistently, and suffer from burnout from trying to compensate for executive dysfunction in environments that do not tolerate it.
Relationships are also greatly impacted. Partners often report the frustration accompanying the individual with untreated ADHD and forgetfulness, emotional shifts, and unpredictability without understanding why. The ongoing conflict is frequently blamed on personality and not a treatable disease.
All this is preventable. Most adults with ADHD can improve significantly in all of these areas when they have the proper diagnosis and treatment.
What an ADHD Evaluation Involves – and What Happens Next
If any of the above signs sound familiar, you may need an adult ADHD diagnosis from a psychiatrist who specializes in that field.
A proper evaluation is not a survey. Involves complete clinical interview of current symptoms and how they affect various aspects of your life, childhood or developmental past, and a thorough evaluation of other conditions that might be contributing to the picture, including anxiety, depression, sleep problems, and thyroid problems.
When a diagnosis is established, treatment usually involves one of or a combination of the following:
ADHD medication management – Stimulant medications (Adderall, Vyvanse, Ritalin, Concerta) are the first-line of treatment for adults with ADHD – and do have evidence of effectiveness. Adults whose stimulants are not tolerated have other choices for non-stimulants. The selection of a specific drug and dosage will require follow-up visits and titration.
Cognitive Behavioral Therapy (CBT) for ADHD – CBT for adult ADHD emphasizes skills from the executive functioning domain, including time management, organization, procrastination, and emotional regulation. Studies have consistently demonstrated that medication plus CBT is most effective, as compared with either treatment alone.
Telehealth ADHD care in New York and New Jersey – After an in-person appointment with a doctor, adults who are struggling with a schedule might be able to schedule follow-up appointments through telehealth in New York and New Jersey.
You Do Not Have to Keep Explaining It Away
Even adults with undiagnosed ADHD are very good at rationalizing their symptoms. I’m just a procrastinator, I’ve been like this all my life, I work better under pressure, I’m just anxious. Explanations make sense – but they also delay the only thing that could jump-start one’s treatment: an accurate diagnosis and a true treatment plan.
Dr. John C. Shershow, M.D. is a psychiatrist with a specialization in diagnosing and treating adult ADHD in New York and New Jersey. He provides holistic assessments, ADHD medication management, and continues psychiatric treatment for both adults who have never received an ADHD diagnosis or those who have been diagnosed and treated incorrectly elsewhere.
Call (212) 265-4310 to schedule your adult ADHD evaluation, or visit drjohnshershow.com/contact-us to get in touch online.
Frequently Asked Questions
Can you have ADHD as an adult if you were never diagnosed as a child?
Yes – and this happens very frequently. Symptoms of ADHD start in childhood, but many adults weren’t assessed because their symptoms were not as pronounced or perhaps because they were confused with personality or they were clever. Late is still late and treatment is still treatment, because a diagnosis at any time is a diagnosis at all.
What is the difference between untreated ADHD and just being disorganized or stressed?
We all have days and times that we’re disorganized, and we all have periods of stress. There are two big differences between untreated ADHD and other forms: It lasts a long time, for years in different situations of life; and it has been there from childhood. When disorganization, procrastination or problems with focus are not one-off circumstances resulting from a particular moment but a way of life, that’s a situation for discussion with a psychiatrist.
Is untreated ADHD the same as ADD?
The term ADD is now obsolete and has been replaced with diagnosis of ADHD. All of this is now part of the ADHD definition, classified by presentation. Formerly known as ADD, this is the most common type of ADHD seen in adults who were not diagnosed as children. Under the current diagnostic criteria, the signs of adults with untreated ADD and adults with untreated inattentive ADHD are identical.
Can untreated ADHD cause anxiety and depression?
Yes and often. Over the years, the frustration at the self-perceived deficits in work performance, social functioning, and self-criticism, common among many adults with ADHD, can lead to anxiety and depression. In most cases, prevention of excessive anxiety and depression symptoms is possible, especially when successfully treated for ADHD; however, sometimes, direct treatment for anxiety and depression is necessary.
How do I know if I need medication or therapy – or both?
This is exactly what a psychiatric evaluation is meant to find out. There is no one right answer among adults with ADHD. Many people respond to medication very well, many benefit from skills therapy as well that they don’t get in therapy, and many adults do benefit from both. Your psychiatrist will consider your individual history and symptoms and will advise you on the treatment that will work for you.
Is ADHD treatable in adults, or is it something you just have to manage?
Adults with ADHD are very responsive to treatment. Although it does not go away, most adults with the disease who receive the appropriate medication and behavioral treatments can improve their focus, organization, emotional control and functioning in an important and measurable way. The diagnosis and treatment are said to be truly life-changing to many adults.
How do I start the process of getting diagnosed in New York or New Jersey?
The first step is scheduling an evaluation with a psychiatrist who specializes in adult ADHD. Dr. Shershow’s practice accepts new patients and offers both in-person and telehealth appointments across New York and New Jersey. Call (212) 265-4310 or visit drjohnshershow.com/contact-us to begin.