As speech-language pathologists (SLPs), we’re likely to work with adults who have undiagnosed ADHD. These may be people whose symptoms have been present all along, hidden beneath coping strategies or misunderstood as personality quirks. While we don’t diagnose ADHD, recognizing its signs can help us avoid one-size-fits-all interventions. Traditional executive function strategies may fall flat if they’re not adapted for ADHD brains. With greater awareness, we can make our treatment more relevant, individualized, and effective.
Free DIRECT download: Adult ADHD SLP cheat sheet. (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- 1. Kids don’t outgrow ADHD.
- 2. Adults have different symptoms.
- 3. ADHD is under-diagnosed in adults.
- 4. Stigma and bias in ADHD diagnosis.
- 5. Explanations for increased rate of diagnosis.
- 6. Ferrari engine, bicycle brakes.
- 7. Key points about recognizing signs of possible adult ADHD.
- 8. Things adults might report to SLPs.
- 9. What an SLP might notice during the interview.
- 10. Traditional executive function tools may not work.
- 11. Adult ADHD is controversial.
- Learn more about ADHD in adults.
- Related Eat, Speak, & Think posts.
- References.
1. Kids don’t outgrow ADHD
ADHD is “a neurodevelopmental condition… that does not magically disappear when you grow up.” (National Library of Medicine, 2024). The symptoms are severe enough to negatively impact with daily function in multiple settings.
According to the Cleveland Clinic, childhood symptoms of inattention include the following (2025).
- Avoiding tasks that feel difficult.
- Misses details or makes careless errors.
- Forgets to do things.
- Easily distracted by surroundings or own thoughts.
- Difficulty with organization.
- Loses important things.
- Starts tasks but gets sidetracked and doesn’t finish.
Symptoms of hyperactivity/impulsivity include the following (Cleveland Clinic, 2025):
- Trouble sitting still.
- Hard time playing or doing tasks quietly.
- Difficulty with waiting for their turn.
- Interrupts others.
- More talkative than their peers.
In the past, experts believed that kids outgrow ADHD, but we now know that this is not true.
Traditionally thought to resolve by young adulthood, it is now recognized that ADHD persists into adulthood.
Rivas-Vazquez, et al., 2023
The childhood symptoms of ADHD may change as a person learns coping and masking strategies or engages in risky activities such as alcohol/drug abuse, gambling, or extreme sports as they grow up (Hallowell & Ratey, 2011).
2. Adults have different symptoms
Adults with ADHD will likely have difficulty in all arenas of life (or have inconsistent performance or “not live up to their potential”). Here are common symptoms of adult ADHD from Hallowell & Ratey (2021, p. 7-13):
- Underachievement that is unexplained by physical or cognitive disability.
- Difficulty focusing and staying on task.
- Trouble organizing and planning.
- Highly creative and imaginative.
- Difficulty with time management.
- Strong will, stubbornness, refusal of help.
- Restlessness (males tend to be physically restless, females tend to be internally restless).
- Social and relationship problems: gruff, awkward, rude, self-centered, unfiltered, or aloof.
- Hyper-sensitive to criticism or rejection.
- Impulsive and impatient.
- Feel a need to improve or augment the conditions of one’s life.
- High energy alternating with lassitude.
- Highly accurate intuition paired with tendency to overlook the obvious.
- Transparency, honest to a fault.
- Tendency to addictions and compulsive behavior.
- Inaccurate negative self-image.
The symptoms above often lead to misdiagnosis with depression, anxiety, or other mental health condition. (Hallowell & Ratey, 2011)
It’s important to stress that diagnosing ADHD is difficult and involves ruling out other conditions that may explain some or all of the symptoms a person is experiencing. For adults, diagnosis is complicated by any secondary conditions they’ve developed because of undiagnosed ADHD, such as anxiety, depression, or low self-esteem.
3. ADHD is under-diagnosed in adults
For many decades, ADHD was believed to be a childhood condition that kids (generally white boys) would outgrow. In addition, ADHD was historically under-diagnosed among kids. As a result, many adults who have ADHD today simply don’t know it.
It’s not rare. [ADHD] occurs in at least 5 percent of the population, though we believe that the number is much higher because there are people who seem to be doing well in life (but who could be doing so much better) who do not get diagnosed.
Hallowell & Ratey, 2021
Although ADHD-like symptoms were noted as far back as ancient Greece, it wasn’t until the 1900s that treatment began. Even then, the focus was on children (and male children, at that). Ritalin came on the market in 1954. Adult ADHD wasn’t recognized formally until the 1990s. (CHADD, 2018; Strohl, 2011)
Many adults continue undiagnosed with ADHD, because they:
- Have developed coping strategies and are functioning well enough.
- Are misdiagnosed with anxiety, depression, bipolar disorder, or a conduct disorder.
- Aren’t receiving appropriate medical care due to lack of access.
Stigma and bias also play a role in people remaining undiagnosed with ADHD.
4. Stigma and bias in ADHD diagnosis
As with many areas in healthcare, race, biological sex, and other systemic factors influence who receives a diagnosis of ADHD. This is a complicated topic that I’m just learning about, but I wanted to highlight this as something to be aware of.
A large-scale 2024 analysis by Shalaby and colleagues found clear disparities in how ADHD and conduct disorders are diagnosed. Here are a few points:
- White individuals were 26% more likely to be diagnosed with ADHD and 61% less likely to be diagnosed with conduct disorder than Black individuals.
- White and Black females are less likely to be diagnosed with either ADHD or Conduct Disorder than males of the same racial background.
- Black females were the least likely group overall to be diagnosed with ADHD.
- White females were the least likely group to be diagnosed with Conduct Disorder.
- White adults, particularly white women, are more likely to be diagnosed with ADHD than Black adults.
This reflects long-standing stereotypes. ADHD has historically been viewed as a disorder of hyperactive white boys, so boys of color and girls are often misdiagnosed or overlooked (Schmitz, et al., 2003). ADHD symptoms look different in girls and women (Climbing the Walls, 2025).
In Black children, ADHD symptoms can be disproportionately misconstrued as willful or defiant behaviors, contributing to a greater likelihood of a diagnosis of ODD or CD and a corresponding lack or mismatch of appropriate interventions or inappropriate use of disciplinary strategies.
Shalaby, et al., 2024 (p. 5)
Women and girls, particularly those with internalized symptoms, are more likely to be diagnosed with anxiety, depression, or bipolar disorder without the underlying ADHD being identified.
As SLPs, we should be mindful that the person sitting in front of us may have undiagnosed ADHD. When we’re teaching executive function (EF) strategies, we should consider if traditional EF tools and teaching methods are the best fit.
5. Explanations for increased rate of diagnosis
While the symptoms of ADHD were described as far back as ancient Greece, awareness and understanding of this condition is quite recent. Even as recent as twenty years ago, many experts believed that children outgrew ADHD, even though research already existed showing that ADHD can occur in adults. (Even today, some skepticism remains among medical professional regarding adult ADHD.)
Diagnosis of ADHD increased in the 1990s due to improved research and awareness among the medical community, the school system, and the general public. For instance, the first edition of “Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood” was released in 1994 and was very successful in raising awareness in the general public.
The pandemic shutdown in 2020 kicked off another increase in the diagnosis of ADHD, this time centered on adults (Climbing the Walls, 2025; Time, 2023; University of Alabama at Birmingham, 2024). The reasons for this boost are varied and include:
- Loss of structure and support systems with the pandemic shutdown, unmasking symptoms in many people.
- Coping strategies breaking down under increased stress and distraction.
- Telepractice was authorized, improving access to ADHD evaluations and treatment.
- A surge in public awareness fueled by social media, leading people to recognize their symptoms and seek help.
Even with the increased awareness, it is still difficult to receive a thorough evaluation. The wait lists are long, as there are limited practitioners who diagnose adult ADHD. Insurance may not cover the evaluation. And treatment rarely consists of medication alone, so the person would have to be able to participate in mental health intervention and/or coaching. All of this can be quite expensive.
Finally, when we consider the stigma and bias on top of the expense of time and money, it’s easy to see how ADHD would be under-diagnosed in adults, even today.
6. Ferrari engine, bicycle brakes
People with ADHD are not lazy, crazy, or stupid. Hallowell & Ratey (2021) use an evocative metaphor. “A person with ADHD has the power of a Ferrari engine but with bicycle-strength brakes” (p. xvii).
It’s the mismatch of engine power to braking capability that causes the problems.
Hallowell & Ratey, 2021, p. xvii
Interventions are aimed at “strengthening the brakes” by training executive function skills in an ADHD-friendly way, as part of a larger treatment plan.
A word here about ADHD being a superpower. There are advantages to having an ADHD brain. Many famous and successful people have ADHD.
But having ADHD is not automatically a superpower. Much depends on the situation a person is in. If someone has a strong support network and belongs to a financially-stable family, then they are likely to view ADHD as a superpower. But it is easy to imagine that someone who grows up misunderstood and struggling would not have the same belief.
7. Key points about recognizing signs of possible adult ADHD
Here are some important points that we can keep in mind when assessing people for cognitive-communication impairment. (Climbing the Walls, 2025; Delaney, 2025; National Library of Medicine, 2024; Rivas-Vazquesz, et al., 2023; Schmitz, et al., 2003; and Shalaby, et al,. 2024)
- SLPs don’t diagnose ADHD, but we can pay attention to signs or symptoms that suggest a person might have ADHD.
- It’s easy to assume that the patient’s complaints are wholly explained by recent medical history.
- If a person has ADHD that is undiagnosed or thought to have resolved in childhood, they will have compensated for their symptoms in a positive way or with maladaptive strategies, such as alcoholism, drug abuse, or other risky behavior.
- We may find a history of depression, anxiety, bipolar disorder, or other mental health illness, particularly if a person has undiagnosed ADHD.
- Adults with ADHD may or may not be aware they have challenges. They may have managed their lives brilliantly with a wonderful support system, or they may have constantly felt like life was harder for them than others.
- Adults are likely to attribute their life-long challenges to personality quirks, normal aging, medical or mental health conditions, or the stresses of modern life.
- If a person has underlying ADHD, we would likely obtain better results if we deliver our interventions in an ADHD-friendly way.
8. Things adults might report to SLPs
Our patient (or care partner) might report on the patient’s baseline cognitive status as one of these patterns:
- Our patient may report they’ve had trouble adjusting to major life changes but function well enough when life settles down. Major life changes include hormonal changes in women, moving to a new location, starting college or a new job, a change in relationships, etc. (Hallowell & Ratey, 2011; Climbing the Walls, 2025)
- The patient was normal prior to the recent medical event. This might be true, or they may have undiagnosed ADHD (or other neurodiverse condition) and were functioning well enough that their quirks were seen as personality traits. (Hallowell & Ratey, 2011)
- Our patient has a history of cognitive challenges that are attributed entirely to other causes, such as anxiety, depression, bipolar disorder, aging, other medical conditions, or the stresses of modern life. (Hallowell & Ratey, 2011)
Here are some specific complaints that an adult with ADHD (or a loved one) may report during an interview:
- Jumbled thoughts, losing train of thought, forgetting details.
- Mind wanders when someone is talking.
- Planning tasks is challenging. Procrastinate, get side-tracked, have trouble finishing.
- Terrible with time management. Lose track of time. Work better under a deadline.
- Misplace belongings.
- Forget to do planned tasks.
- Blurt out things or interrupt when don’t mean to.
- Overwhelmed by emotions over minor issues.
- Difficulty following conversations in a group.
Notice that these complaints are not specific to ADHD! The key is determining if there were ADHD-like symptoms at other points in our patient’s life. Recent research indicates that ADHD symptoms don’t have to be present from childhood (Climbing the Walls, 2025; Hallowell & Ratey, 2021).
9. What an SLP might notice during the interview
In the process of setting up the appointment and meeting the person in their own space, we might notice the following signs of executive dysfunction:
- Difficulty making the appointment.
- Forgetting you were coming.
- Double-booking your appointment.
- A disorganized environment.
- Absent, messy, or under-utilized calendar.
It’s important to bear context in mind! If someone has just returned home from rehab, we wouldn’t expect them to be caught up on household tasks. As we conduct our interview, we may observe:
- Difficulty presenting information in a clear, logical way.
- Trouble staying on topic.
- Missing your non-verbal cues or attempts at redirection.
- Requests for repetition.
- Distractibility (from internal or external stimuli).
Of course, these signs aren’t exclusive to ADHD, but if we dig deeper into a person’s history and discover a history of ADHD-like challenges, then we may suspect an underlying ADHD which can inform our clinical decision-making.
Taking the time to understand our patient’s baseline cognitive performance across their lifetime can help us provide more personalized, effective care.
10. Traditional executive function tools may not work
Executive function skills help us plan, organize, and follow through on tasks. As SLPs, we often teach patients to use tools, such as:
- To-do lists, calendars, and reminders.
- Visual schedules or planners.
- Timers and alarms.
- Strategies such as the Eisenhower Matrix or Goal-Plan-Do-Review.
These tools often work best for people who can get started easily, stay organized, and follow through consistently, especially without external structure or support. But ADHD isn’t a disorder of lacking tools; it’s a disorder of consistent follow through. As Dr. Alan Graham put it:
ADHD is not a disorder of knowing, it’s a disorder of doing.
Delaney (2025)
Keep an eye out for a follow up article that dives into executive function training for people with ADHD!
11. Adult ADHD is controversial
Some medical professionals believe that adult ADHD is being over-diagnosed due to a perfect storm of drug companies pushing their medications, increased awareness across the internet, and well-meaning physicians wanting to help patients who are stressed by modern life. In addition, practitioners are wary of drug-seeking.
Other medical professionals believe that ADHD is not real. Ruffalo & Ghaemi (2023) argue that attention-related difficulties in adults don’t constitute “a scientifically valid disease (adult ADHD) and are better explained by more classic and scientifically validated psychiatric conditions.” They go on to say:
[ADHD] is a case of disease mongering, when a condition that has never been observed is suddenly made popular overnight as a result of social, cultural, and economic reasons.
Ruffalo & Ghaemi (2023)
I have not made a deep dive into the literature, but I don’t find their arguments compelling. There is a long, albeit quite spotty, description of ADHD in western medical literature, and modern treatment began over 100 years ago.
I imagine that some people have been mistakenly identified as having ADHD when they don’t. These people may have environmentally-induced ADHD, caused by a busy, stressful, or high-speed lifestyle.
Hallowell & Ratey (2021) refer to this as “situational ADHD” or “variable attention stimulus trait” (VAST). The symptoms of VAST mimic ADHD.
I heard on one of the ADHD Wise Squirrel podcasts, that if you take a person with environmentally-induced ADHD and put them in a calm, soothing environment for a week, they will find their ADHD-like symptoms have resolved. But a person with ADHD will not be a happy camper to sit and chill for a week! They will still put the milk in the cupboard or misplace their water bottle for the tenth time before lunch, or do the ADHD things they would typically do at home.
Learn more about ADHD in adults
I have been taking a deep dive into adult ADHD over the past couple of months. I’ve learned enough to know that this article barely scratches the surface. I would encourage you to learn more about adult ADHD with the following books and podcasts.
Books:
- Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder From Childhood Through Adulthood (Edward M. Hallowell & John J. Ratey, 2011).
- ADHD 2.0: New Science and Essential Strategies for Thriving with Distraction-from Childhood Through Adulthood (Edward M. Hallowell & John J. Ratey, 2021).
Podcasts/Videos:
- Climbing the Walls – hosted by Danielle Elliot (explores the sharp rise in ADHD diagnoses among adult women).
- ADHD for Smart Ass Women with Tracy Otsuka (host Tracy interviews successful women with ADHD).
- ADHD Wise Squirrels with Dave Delaney (candid conversations with ADHD experts, coaches, and people who have ADHD).
Related Eat, Speak, & Think posts
These articles are not written about ADHD, but do offer strategies and exercise to support memory.
- How to improve prospective memory.
- How to improve short term memory.
- What to do when your memory fails you (and how to make it better).
References
- CHADD. (2018, October 4). More fire than water: A short history of ADHD. CHADD. https://chadd.org/adhd-weekly/more-fire-than-water-a-short-history-of-adhd/
- Cleveland Clinic. (2025, March 12). Attention-deficit/hyperactivity disorder (ADHD). https://my.clevelandclinic.org/health/diseases/4784-attention-deficithyperactivity-disorder-adhd
- Climbing the Walls. (2025, April 9). She wrote the book on women, shame, and ADHD (Season 1, Episode 2) [Audio podcast episode]. In Climbing the Walls. Understood.org. https://www.understood.org/en/podcasts/climbing-the-walls/she-wrote-the-book-on-women-shame-and-adhd
- Delaney, D. (Host). (2025, June 4). ADHD Misinformation, Coaching, and Relationships with Dr. Alan Graham [Audio podcast episode]. ADHD Wise Squirrels. https://wisesquirrels.com/adhd-podcast/adhd-coaching-with-dr-alan-graham
- Hallowell, E. M., & Ratey, J. J. (2011). Driven to distraction: Recognizing and coping with attention deficit disorder from childhood through adulthood. Vintage Books.
- Hallowell, E. M., & Ratey, J. J. (2021). ADHD 2.0: New science and essential strategies for thriving with distraction—from childhood through adulthood. Ballantine Books.
- National Library of Medicine. (2024, April 2). ADHD across the lifespan: What it looks like in adults. NIH MedlinePlus Magazine, 17(2). Retrieved from https://magazine.medlineplus.gov/article/adhd-across-the-lifespan-what-it-looks-like-in-adults#.
- Rivas-Vazquez, R.A., Diaz, S.G., Visser, M.M. et al. Adult ADHD: Underdiagnosis of a Treatable Condition. J Health Serv Psychol 49, 11–19 (2023). https://doi.org/10.1007/s42843-023-00077-w
- Schmitz, M. F., Filippone, P., & Edelman, E. M. (2003). Social Representations of Attention Deficit/Hyperactivity Disorder, 1988–1997. Culture & Psychology, 9(4), 383-406. https://doi.org/10.1177/1354067X0394004 (Original work published 2003)
- Shalaby, N., Sengupta, S. & Williams, J.B. Large-scale analysis reveals racial disparities in the prevalence of ADHD and conduct disorders. Sci Rep 14, 25123 (2024). https://doi.org/10.1038/s41598-024-75954-5 [open access]
- Strohl M. P. (2011). Bradley’s Benzedrine studies on children with behavioral disorders. The Yale journal of biology and medicine, 84(1), 27–33. https://pmc.ncbi.nlm.nih.gov/articles/PMC3064242/ [open access]
- Time. (2023). What’s driving the demand for ADHD drugs like Adderall. Time. Retrieved from https://time.com/6271049/adhd-diagnoses-rising/
- University of Alabama at Birmingham. (2024, November). Adult ADHD diagnoses soared during the pandemic. UAB Reporter. Retrieved from https://www.uab.edu/reporter/in-the-know/adult-adhd-diagnoses-soared-during-the-pandemic-this-expert-says-it-is-still-undertreated.
Free DIRECT download: Adult ADHD SLP cheat sheet. (Email subscribers get free access to all the resources in the Free Subscription Library.)
Disclosure: Some ideas and language were shaped with the support of ChatGPT, a large language model developed by OpenAI, as part of the drafting and editing process. All final content reflects Lisa’s own synthesis, clinical judgment, and voice.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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