An increasing number of adults believe they have ADHD. But many people have a hard time getting diagnosed.

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For years, Casey Marie Ecker suffered from inattention and constant fatigue. But when she continued to work 9-to-5 jobs during the pandemic, she reached a breaking point.

And she had to quit.

“All my work was just delayed and I had no focus or motivation,” the 29-year-old said. He currently works odd jobs to make a living in Montreal. “At some point, my symptoms got so bad that I had to go to the clinic.”

Ever since high school, Ecker suspected he had undiagnosed ADHD. Her therapists suggested that some of Ms. Ecker's symptoms were consistent with this condition, but they were not qualified to make a diagnosis.

The Montreal resident said a rotating team of doctors at her primary care clinic had been prescribing psychostimulants for her since February, but no one told her whether she had ADHD. That's what it means.

Instead, she's taking repeated doses of drugs commonly used to treat the symptoms she suspects will be working, trying to figure out what works.

But what she really wants is a diagnosis.

“It's incredibly validating and just understanding why you function the way you do.”

Her story is part of a growing trend, both in the increase in prescription drugs distributed for ADHD and in the number of adults suspected of having ADHD but not formally diagnosed.

According to one study, one in four adults in the United States suspect they have undiagnosed ADHD. recent research Commissioned by The Ohio State University Wexner Medical Center. At the same time, only 13% of respondents shared these suspicions with their doctors.

Although there is no similar recent data in Canada, there is evidence that the number of adults taking medication for ADHD is increasing.

Roughly 600,000 more Canadians received a prescription for psychostimulant drugs in 2023 than in 2019, according to statistics from health research firm IQVIA. This is an increase of 67.7% over four years. The biggest increase was seen among young women aged 18 to 24, who increased from 4.6% to 8.6% of the population. Among women ages 25 to 44, it also increased from 3 percent to 6.4 percent.

It's unclear how many of them, like Ecker, have not received a formal diagnosis.

back to childhood

Psychologist Anne Bailey said some people may not have been diagnosed as children for a variety of reasons. Children with undiagnosed ADHD may have been able to grow into high-functioning adults by developing coping mechanisms early on, such as using certain smells and sounds to ground themselves. the scholar said. When the pandemic forced people to work in different environments, many were no longer able to use the same coping tools, Bailey said.

Bailey, who practices at a private clinic in Toronto specializing in ADHD, said she has seen a significant increase in the number of adults who notice symptoms and want to get tested since the pandemic.

However, diagnosing ADHD in adults is not easy. To make a diagnosis, health care professionals must trace the person's symptoms back to childhood.

“We want to see clear evidence that it's been there since childhood and adolescence, and perhaps compensated for,” Bailey said. “Still, there is evidence [is] There's… it's not just something new to someone. ”

Another factor behind the rise? The proliferation of social media videos about adult ADHD.

“Customers come in familiar with the language,” Bailey said. “They're very good at explaining their symptoms. I think they've obviously learned about adult ADHD and how it manifests and are affected in some way.”

She says 60 to 70 percent of adults who come for counseling are convinced they have the disorder.

“For some reason, I think people are very attached to this diagnosis.”

Many of the symptoms of ADHD are relatable, such as forgetfulness and tendency to get sidetracked. Also, some symptoms, such as difficulty concentrating, can be caused by a variety of mental health issues, said Dr. Nikola Grujic, a psychiatrist at Toronto's Sunnybrook Hospital.

“When you look at the diagnostic criteria, it's easy to say something like, 'Oh, yeah, I have that.' But the actual diagnosis of ADHD is a complex clinical evaluation.”

For example, feeling like you can't keep up isn't necessarily a sign of ADHD, he said. In some cases, it may be a sign for a person to take a step back and look at the number of obligations they are juggling.

Why it is difficult to receive a diagnosis

Increasing demand for ADHD diagnosis in adults is confronting a shortage of health care workers.

“Many people identify with the diagnosis of ADHD,” Grujic said. “But many people with adult ADHD probably struggle.” [when it comes to] Please visit and receive an official diagnosis. ”

Dr. Grujic says that family doctors, psychiatrists and psychologists can all make a diagnosis of ADHD if they have knowledge of the disease. But the psychiatrist said many GPs told him they didn't know how to diagnose and treat the disorder, especially in adults.

“Whenever I meet with my GP, the first question they ask me is how to understand and make sense of this relatively new diagnosis of adult-onset ADHD.”

Using a dedicated system allows for faster diagnosis. There are clinics like Bailey's that specialize in this condition, but they can be expensive. Tests at her clinic start at $2,300.

He said patients are sometimes referred to the clinic by their primary care physician who mistakenly believes the service is covered by their public insurance plan.

“Those are some of the more difficult decisions,” she said.

She and Grujic said they hope family doctors and nurses will be provided with more education and better tools to help diagnose ADHD in adults.

“The most important thing here is to reassure our family practice colleagues in establishing the diagnosis and educating them about which treatments are most effective,” Grujic said.

These are the needs highlighted in recent opinions part of diary JAMA Psychiatry.

Clinicians not only need to better understand ADHD in adults, but they also need to know the pros and cons of ADHD medications and how to follow up with patients, the opinion piece says. The authors hope that clearer diagnostic criteria for adult ADHD will be created so that people can receive the most effective treatment beyond medication alone.

ADHD is highly treatable, the letter notes. Just make a diagnosis first.