Does This Sound Like You? Understanding Adult ADHD
Let’s clear one thing up: forget the old stereotype of a little boy bouncing off the walls. That picture is a tiny, often misleading, part of a much bigger story.
For many adults, Attention Deficit Hyperactivity Disorder (ADHD) looks and feels completely different. The core challenges are still grouped into three areas: inattention, hyperactivity, and impulsivity. But how they show up in a grown-up life can be surprising.
Inattention isn’t just spacing out. It’s the constant, draining battle with disorganisation. It’s losing your keys, wallet, or phone again. It’s finding it "hard to follow instructions or finish tasks," especially boring ones. It’s the “careless mistakes” at work that aren't from a lack of care at all, but from a brain that finds it painful to focus on details.
Hyperactivity in adults often isn't physical. You’re not climbing the curtains. Instead, it’s a powerful internal feeling. Experts describe it as "extreme restlessness" or a constant, agitating "inner restlessness". It might feel like a “ceaseless mental activity” or racing thoughts. You may fidget constantly, talk excessively, or just feel “on the go” all the time, wearing out the people around you.
Impulsivity can be subtle. It’s not always about grand, risky behaviours. It can be interrupting conversations, finishing people’s sentences, or "blurting out an answer before a question has been completed". It’s a struggle to wait for your turn. It’s a "little or no sense of danger" that might just mean acting without thinking through the consequences.
Step 1: Talking to Your GP
So, you’ve read the lists, and you feel that jolt of recognition. What now?
Your first, and sometimes most nerve-wracking, step is to book an appointment with your GP.
It’s important to manage your expectations for this meeting. Your GP is generally not a specialist who can diagnose you. The goal of this first appointment is one thing: to get a referral for a specialist assessment.
Many people worry they won't be "taken seriously". The best way to have a clear and productive conversation is to go prepared. You are your own best advocate.
Here’s how to prepare:
- Write it down. Don't just list symptoms. Explain how they affect your life. Think about all the different areas:
Work: Do you miss deadlines? Struggle with organisation? Make mistakes?
Home: Is your home life chaotic? Do you struggle with chores or life admin?
Relationships: Do friends or partners call you forgetful? Do you interrupt people?
Mental Health: Do you feel constantly overwhelmed, anxious, or low?
- Think about your past. The specialist will need to know if symptoms were present in childhood. Try to remember what you were like at school.
- Know about the screener. Your GP may ask you to fill in a screening tool. A very common one is the Adult ADHD Self-Report Scale (ASRS). It's an 18-question checklist based on diagnostic criteria. On the short 6-question screener version, scoring four or more is "highly consistent with ADHD in adults" and shows that "further investigation is warranted".
After your conversation, the GP may decide to refer you to your local Community Mental Health Team (CMHT) or a dedicated adult ADHD service for a full assessment.
Step 2: The NHS Referral and Specialist Assessment
Once your GP sends the referral, you are officially in the system. The next step is a full diagnostic assessment with a specialist, usually a psychiatrist, specialist nurse, or other qualified healthcare professional with deep expertise in ADHD.
It’s important to know that a diagnosis cannot be made from a rating scale or checklist alone. The specialist needs to build a complete, 360-degree picture of you.
The assessment is a long, in-depth clinical interview. The specialist is looking for several key pieces of evidence:
- A Developmental History: This is "critical". The specialist needs to find clear evidence that "several symptoms" of ADHD were present before the age of 12.
- A Corroborative History: This is considered "vital". The specialist will want to speak to someone who knows you well. This could be a parent (if possible), a partner, or a close friend who has known you for a long time. They are looking for an outside perspective on your challenges.
- Pervasiveness: They need to see that your symptoms affect you in "two or more settings"—for example, at work and in your social life.
- Significant Impairment: The symptoms must be shown to "interfere with, or reduce the quality of, social, school, or work functioning".
This part can cause a lot of anxiety. What if you were a "good student" who masked your symptoms? What if your parents aren't around to ask?
Remember, "evidence" isn't just bad school reports. It can be old reports that say "is a daydreamer," "doesn't live up to their potential," or "talks too much." A partner's testimony about your lifelong struggles with organisation or your emotional volatility is also powerful evidence. The specialist’s job is to put these pieces together.
Step 3: Life After the Assessment
A diagnosis isn't an end point; it's a starting line.
Receiving a diagnosis as an adult is often a "life-changing" and intensely emotional experience. It’s not just about getting a label. It’s about "re-framing" your entire past. It is the profound, earth-shattering relief of learning that decades of struggle were not due to a "personality flaw" or "self-blame". You’re not lazy, or stupid, or bad. Your brain just works differently.
Your specialist will discuss support options with you. These usually fall into two main categories:
1. Medication
For many adults, medication (like methylphenidate or lisdexamfetamine) can be incredibly effective.
A specialist must be the one to start this process. They will work with you to find the right medicine and "titrate" the dose, which means starting low and adjusting it slowly until it’s right for you.
2. The Shared Care Agreement (SCA)
This is the most important piece of post-diagnosis admin you will ever do. A specialist cannot manage your repeat prescription forever. A GP cannot start ADHD medication.
The Shared Care Agreement (SCA) is the formal bridge between them.
Once your dose is stable, your specialist and your GP will both sign an SCA. This formal document, recommended by NICE guidelines, passes the responsibility of prescribing to your GP, while the specialist remains in overall charge. To keep your SCA active, you will usually need to have an annual review with your specialist.
3. Talking Therapies
Medication helps manage the core symptoms, but it doesn't un-learn decades of difficult coping mechanisms.
The National Institute for Health and Care Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as the main talking therapy for adults with ADHD.
This isn't a "cure." It’s a practical toolkit. It provides "practical coping strategies" to help you build the skills that ADHD may have left you struggling with—like organisation, time management, emotional regulation, and procrastination.
Support is also available from charities like ADHD UK, which offer peer support groups, resources, and a community of people who just get it.
Your Journey, Your Manual
This path is long. It is often frustrating. It asks for patience from people who, by definition, find waiting hard.
But a diagnosis is powerful. It’s not a label. It's an explanation. It is the instruction manual you were never given. It is the first, and most powerful, step to finally building a life that works with your brain, not against it.
