Last Updated 2025/10/07 at 1:52 pm

As Mentavi celebrates its Validation Study and enters an era of additional research initiatives, and as misinformation about ADHD spreads throughout social media, we will refresh our existing article about the shortage of research on adult ADHD with new information and perspectives from our team 

To help us make this article clinically sound and helpful while expanding our digital footprint in the area of ADHD research, please take a minute to provide your insight in response to the following questions.

Questions

1. Researchers point out that despite there being more adults with ADHD, and more research into adult ADHD, there is still a lack of guidelines around diagnosis, treatment and care. Why does that continue to be the case?

Part of the reason for this is funding–the majority of the money is focused on children and adolescents, and you can’t do research without funding. Additionally, even though more adults are receiving an ADHD diagnosis, it remains a pervasive myth that you can grow out of ADHD or that ADHD is a “childhood issue” that is simply not applicable to adults. We need to keep fighting this misinformation.

2. Are there more guidelines around the diagnosis and treatment of ADHD in children than it is in adults? If so, why?

There aren’t really guidelines for much of anything in mental health to be honest. The DSM-5-TR specifically says there is no “ADHD test,” and there is no test or set of tests that are required to confirm or rule out ADHD regardless of the client’s age. While this is intended to allow for professional discretion, it can turn into a barrier to care when people who do not conduct the evaluations arbitrarily require clients to get a specific type of test to receive treatment. For instance, I have had physicians with little or no diagnostic training in mental health tell me that my assessment is “incomplete” because I did not conduct a full-scale IQ, when there is absolutely nothing in the diagnostic criteria for ADHD about any specific IQ score in order to confirm or rule out the diagnosis! So, there is a need for more clear guidelines as far as ensuring that those who do not conduct assessments to understand what is and is not an ADHD evaluation.

Additionally, there are companies that have tried to capitalize on vague requirements to seriously cut corners on an assessment. For instance, I do reviews of telehealth platforms for a couple of online publications, and one gave me an ADHD diagnosis following a 30-minute “interview,” half of which was just the short version of the ASRS, a screening measure. I don’t think it is possible to get sufficient information about history and symptoms in 30 minutes, but they claimed they could confirm my ADHD diagnosis in that period of time. 

Basically, providers who are practicing ethically get the latitude to make clinical decisions using their judgment without overreach, but we also need guardrails in place to protect the public from a pseudo-assessment that does not collect enough information to answer the diagnosis question.

3. What’s the most significant difference in approach to evaluating and diagnosing children and adults? What about the differences in treatment?

ADHD is neurodevelopmental, meaning that if you have ADHD, you were born with ADHD. If symptoms develop later in life, that’s not ADHD even though some conditions that develop later in life can look like ADHD. So, one big challenge with adults is establishing that early childhood period. This does not mean, by the way, that you have to be diagnosed as a child or that having good grades as a child rules out ADHD (hi, ADHD psychologist who was diagnosed as an adult). You can establish how symptoms were masked, compensated for, or overlooked in childhood, but it can be challenging to establish that information. Not all adults have access to early childhood records or collateral to back up their memory. With children, though, it can be a challenge to establish symptoms if they are high-masking and adults in their life misunderstand ADHD (for instance, I have had teachers insist that my diagnosis is wrong because “I don’t see that in the classroom,” when I have clearly explained how I established that the child was masking).

With treatment, the medication recommendations are the same regardless of age (with differences in dosage, of course). For therapy interventions, the differences in treatment are pretty similar for ADHD in children versus adults–therapy with kids often requires parent involvement to address environmental factors in the home that contribute to symptoms, whereas adults usually implement the interventions themselves.

4. Are there any particular areas of focus within the topic where more research is especially needed? What specific questions or issues most need answers or attention?

Although there has been some progress, there absolutely needs to be more research on ADHD across gender and ethnicity. We still focus so much on white, cis males. While this does not mean that a white, cis man cannot experience misdiagnosis or barriers to treatment, but there is a dispiritingly massive gap in accurate diagnosis for BIPOC, female, and nonbinary individuals with ADHD. This is because existing research focuses on cis, white male experiences and symptom presentation, and because of clinician bias in assigning diagnoses. More awareness has been brought to this issue, but the disparities have not been addressed in research and diagnostic measures.

5. Has increased access to adult ADHD diagnosis and treatment such as telehealth resulted in more or improved opportunities or data to inform guidelines?

Telehealth has been amazing for improving access to an accurate diagnosis and treatment. Also, while social media is a bit of a mixed bag, access to more information on the different ways that ADHD symptoms can present has increased referrals because people realize that they could be ADHD and that ADHD can look more than one way.

With increases in telehealth, there has been improved acceptance to telehealth assessments–previously many people were under the misconception that you could not conduct a valid evaluation via telehealth, which there is now ample research to discredit. But again, there is no set guideline around this, just what is generally accepted and preferred.

6. Have there been any significant breakthroughs or insightful data to come from adult ADHD research in recent years?

I’m not sure your definition of what constitutes breakthroughs, but the highlights that come to my mind are:

• Some people who choose to take medication for ADHD choose to take their medication on work days only. If you choose this, please be mindful that ADHD-ers who have not taken their medication today are at a massively increased risk for car accidents, so maybe have someone else drive if you do this.
• I am not sure exactly how recent this is, but it used to be believed that you grew out of ADHD when you became an adult. We now know this is false. Adults can sometimes show fewer symptoms because 1) we have more control over our environments and can play to our strengths, 2) we have had more time to develop compensatory strategies to cope with our symptoms, and 3) ADHD-ers are at higher risk for accidents, so we do have slightly shorter life expectancies.
• Adults who received appropriate treatment in childhood have lower rates of depression and anxiety.
• The genetics that predispose us to ADHD also increase risk for depression, anxiety, and OCD, providing an explanation for one of the reasons why these conditions tend to co-occur.

7. What’s the most significant risk of a lack of guidelines around adult ADHD?

The risks of not having set guidelines go in two directions. I’ve touched on this before but will reiterate and expand on that here. A lack of guidelines leads to some providers developing their own set of guidelines for what they feel the guidelines should be, which can often be unnecessarily gatekeeping. For instance I spoke with a psychiatrist once who told me they would not prescribe ADHD medication to anyone who had not had a full neuropsychological evaluation because “That’s the gold standard.” Well, there actually is no “gold standard” in assessment; you’ve just fallen prey to the test developer’s marketing department. And now that psychiatrist is requiring clients to seek out a specialized evaluation that costs thousands of dollars, can take several day-long sessions, and books sometimes over a year in advance. This prevents people from getting the care they need.

On the other hand, some take advantage of the lack of guidelines as an excuse to cut corners and not actually put in the level of work that they should. I mentioned how I met with a provider who talked to me for 30 minutes, part of that meeting was administering a testing measure, and diagnosed ADHD when there was no way they had learned enough about my background and symptoms to know for sure that I had ADHD. A certain telehealth company who I won’t name here had their CEO arrested a while back because it was determined that the company was simply handing out ADHD diagnoses to any client who contacted them without doing due diligence, again because there is no set standard for these evaluations.

We both need more stringent guidelines, and less gatekeeping for arbitrarily high standards. We need providers who are thorough and accurate without inflating testing strategies to the point of not being affordable or accessible.

Clinically reviewed by Amy Marschall, PsyD. Dr Marschall has been a licensed psychologist since 2016 and currently owns a private practice, RMH-Therapy, where she provides therapy primarily to children and adolescents and does psychological evaluations and also provides ADHD assessments through ADHD Online.