Dr Ashlee Williams (Host): If you experience constant distractions, forgetfulness, chronic procrastination, or feeling overwhelmed by everyday task, it could be more than just stress. For many adults, these challenges may be a sign of ADHD, which often goes unrecognized well into adulthood. Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm joined with Dr. Diane Ukwuoma, a board-certified psychiatrist here at Kaiser Permanente, about how ADHD shows up differently in adults, why many people are diagnosed later in life, and what treatments can make a real difference. Dr. Ukwuoma, thank you so much for being here.

Dr. Diane Ukwuoma: Of course. Thank you for having me.

Host: Yes. This is such an important topic. It comes up in my clinic so much. So, let's just start with the basics. What is ADHD and how does it typically present in adults?

Dr. Diane Ukwuoma: Sure. So, ADHD, it stands for attention deficit hyperactivity disorder. And essentially, it's a neurodevelopmental disorder, which means that we see the symptoms in childhood. So, we're speaking about before the age of 12 years old symptoms need to be present. There's two classes or categories of ADHD. We have the hyperactivity or the hyperactive type, and then the inattentive type. And impulsivity is really grouped in with hyperactivity.

Adults, the most common type of ADHD that we diagnose is the inattentive type. So, we're speaking about an individual who is forgetful, can't triage task, maybe procrastinates a lot, things like that. And then, when it comes to hyperactivity and impulsivity in adults, typically that looks like inner restlessness or anxiety. That's typically how it presents.

Host: Got it. So, let's just say I have difficulty concentrating. Does that mean I have ADHD?

Dr. Diane Ukwuoma: Yeah. And that's a really good question that I speak to my patients about pretty frequently. So, no, not typically. So, decreased concentration or deficits in concentration, that's actually a core symptom in several psychiatric diagnoses. So, anxiety, we can see deficits in concentration, depression, OCD, bipolar, and then there's sleep disorders, and medical disorders like hypothyroidism where we consider decreased concentration. So, we really have to look at the whole picture when making a diagnosis of ADHD.

Host: That's so true. I know for us, when we are sending someone to psychiatry for screening, we also screen for anxiety and depression because a lot of those symptoms can overlap. Absolutely. Can you talk a little bit about how do you go about diagnosing ADHD?

Dr. Diane Ukwuoma: Yeah. So, it's a clinical diagnosis. And a lot of people don't know that. So, there's several tests and, you know, evaluations that are offered, but it really is a clinical diagnosis. So, it's about taking a good history and following diagnostic criteria. So, what we pay attention to is we need to make sure that these symptoms present in childhood, even if the diagnosis wasn't made in childhood. We need to notice that it's present before the age of 12. And then these deficits that we're speaking about, inattention, or if it's hyperactivity or impulsivity, they need to be seen in two different environments. So, work and school, whatever the case is, just two distinct environments.

The symptoms also need to be sustained over a period of time. So, it's not just about like, maybe you're in exam week in college and you can't concentrate. It's not that. It needs to be seen like consistently over the course of six months. And then, lastly, the deficits in attention or hyperactivity and impulsivity, they need to impair functioning, And that's a big one.

Host: Got it. I will say I feel like I saw an uptick in people wondering if they have ADHD, especially during the pandemic. Can you talk a little bit about why we're seeing an uptick in adults being diagnosed with ADHD?

Dr. Diane Ukwuoma: I think people are just starting to speak more about psychiatric diagnoses in general, but especially ADHD. We're seeing on TikTok or Instagram, social media in general, on podcasts more people are speaking about ADHD. So, I think that has something to do with it. And obviously during COVID, a lot of us were at home, a lot of us were scrolling, and we're starting to relate these symptoms to ourselves.

And then, because there's more access to psychiatric care, we're seeing more children get diagnosed with ADHD. And that sometimes has parents wondering like, "Is this what happened to me when I was young? Is this what I was going through?" And they're starting to get evaluated. So, it's kind of a full circle type of thing.

Host: Yeah, that's a great point. It's great that we have so much access to information. And you talked a little bit about how parents are looking at their children And the children are getting the diagnosis. Is it possible to have a new diagnosis of ADHD as an adult? Like, can you develop ADHD as an adult?

Dr. Diane Ukwuoma: So, no, you can't develop it as an adult. And I think that's really important for our patients to know. What typically happens, or what I see during clinic is that in childhood the diagnosis was missed, those symptoms have to be present during that time. And that can happen. I mean, if a child has a very structured environment or less demands placed on them, they can accommodate for deficits in attention or whatever the case is. So then, in adulthood, because it was a diagnosis in childhood, they will obtain the diagnosis, but it's never a new thing, if that makes sense.

Host: Yeah. No, that makes a lot of sense. Is there a difference in how ADHD shows up in men and women?

Dr. Diane Ukwuoma: Oh yeah, for sure. So, what we see is, at least in boys and girls, like in childhood and adolescence, boys typically are diagnosed more frequently than girls because we're thinking about like the hyperactive boys who are fidgety, getting kicked out of class compared to young girls who maybe are just dozing off, maybe head in the clouds, that type of presentation. So, what we find in adulthood is that more women are actually being diagnosed with ADHD in adulthood.

Host: Got it. So, what about treatment? So, you've gotten diagnosed with ADHD. What treatment options are available or ones that you would recommend?

Dr. Diane Ukwuoma: Yeah. So, the gold standard for treating ADHD is stimulant medications. That's like Concerta and Adderall, and Vyvanse. Those common names that we hear. That's the gold standard, meaning it's the most effective in terms of treating ADHD. But we also have non-stimulant choices. Sometimes that's a patient's preference and there's other reasons why we would choose a non-stimulant over a stimulant. There's also therapy, which we recommend in usually younger people, not so often in adults. But yeah, essentially with treatment, we're speaking about stimulant medication, non-stimulants and therapy.

Host: Yeah. That's good to know that there's lots of options. Well, thank you so much for this great information, Dr. Ukwuoma. We learned a lot about ADHD, how it presents in adults. and treatment that can help. Here are the top takeaways.

One, adult ADHD is real, common, and often goes unrecognized until later in life. Two, trouble concentrating alone does not mean ADHD since many other conditions like anxiety and depression can cause similar symptoms. Three, ADHD symptoms must begin in childhood and affect multiple areas of life to meet diagnostic criteria. Four, if you think you or a loved one might have ADHD, a proper evaluation can identify whether symptoms are in fact caused by ADHD, anxiety, depression, sleep issues, or another condition. And five, treatment options like medication or therapy and practical coping strategies can make a big difference.

For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcastS. If you enjoyed this episode, be sure to subscribe and share it with others. Have questions or health topics that you would like to discuss? Be sure to let us know in the comments. Thank you. And from all of us at Kaiser Permanente, be well.