Identifying and Supporting ADHD: Screening, Recognizing, and Supporting ADHD in Adults and Adolescents
ADHD is common, frequently masked, and serious when missed — how to screen for it and support it in adults and adolescents.
ADHD is one of the most prevalent neurodevelopmental conditions seen in clinical practice—and one of the most frequently missed. With a population prevalence of approximately 5% (Faraone et al., 2015), ADHD affects far more people than many clinicians realize, and in Australia the diagnostic rate still sits below population prevalence (AADPA, 2022). That means the waiting rooms of mental health clinicians contain people who have never been asked the right questions. For a condition that is 74–90% genetic (Faraone & Larsson, 2019) and associated with a life expectancy reduction of 8–12 years when unmanaged (Catala-Lopez et al., 2022), that is a significant clinical blind spot.
Unmanaged ADHD is associated with a life-expectancy reduction of 8–12 years, for a condition that is 74–90% genetic.
What Is ADHD?
ADHD is not so much a deficit of attention, as its name states—it is a difference in how attention is regulated, driven by genetic differences in information processing. It is characterized by executive functioning difficulties (planning, working memory, task initiation, and impulse control), emotion regulation difficulties, repetitive behaviors for self-regulation, and a strong orientation toward interests—the well-known phenomenon of hyperfocus (Groen et al., 2020). Executive functioning is estimated to be 99% heritable, and ADHD shares genetic origins with autism and Tourette’s syndrome (Koi, 2021). The DSM-5 defines three presentations—predominantly inattentive, predominantly hyperactive–impulsive, and combined—but these are no longer considered fixed subtypes; presentations can shift across the lifespan.
Unmanaged ADHD is associated with a reduction in life expectancy of 8–12 years.
The webinar Identifying and Supporting ADHD: Screening, Recognizing, and Supporting ADHD in Adults and Adolescents, presented by clinical psychologist Jennifer Kemp, walks through the full clinical picture—when to screen and with which tools, how masked and internalized presentations evade recognition, and behavioral strategies that work with the ADHD brain rather than against it. Watch the recording for case examples and practical demonstrations you can apply in your next session.
ADHD Comorbidity Rates
One of the most clinically important things to understand about ADHD is its extraordinary comorbidity profile. Anxiety, depression, autism, OCD, PTSD, substance use disorders, eating disorders, sleep disorders, and specific learning disabilities are all well-documented co-occurrences (Faraone et al., 2015). This has two important implications: ADHD is easy to miss when a more prominent diagnosis is already in the frame; and when clients fail to respond to standard therapeutic approaches for those other conditions, unidentified ADHD should be near the top of other diagnostic considerations. When a client with “chronic anxiety” continues to be overwhelmed, disorganized, and unable to maintain routines despite solid therapeutic work—is that a signal of ADHD?
Signs of ADHD
ADHD screening in adults and adolescents is warranted in a wider range of presentations than many clinicians appreciate. Key indicators include: identification as autistic (the likelihood of co-occurring ADHD is approximately 85%), one or more co-occurring mental health diagnoses (particularly chronic anxiety), non-response to standard therapeutic approaches, chronic overwhelm and disorganization, difficulty completing therapy homework, and difficulty maintaining routines or attending appointments reliably (AADPA, 2022). In adults, ADHD can be particularly well-masked: high intelligence may compensate for executive functioning difficulties (Rommelse et al., 2016), partners and personal assistants can inadvertently scaffold difficulties out of visibility, and unhelpful coping strategies—substance use, rigid routines, workaholism—may sit prominently in the foreground while the underlying ADHD goes undetected.
Masking of ADHD Symptoms
Much of the public (and clinical) mental model of ADHD features a hyperactive boy who can’t sit still. In reality, hyperactivity in adults and adolescents—particularly women—is frequently internalized: a rapid, looping, chaotic inner mental life; a persistent sense of restlessness; the feeling that other people are speaking in slow motion. These presentations are easily mistaken for anxiety—and indeed anxiety is a frequent comorbidity. Recent increases in ADHD diagnoses are not evidence of overdiagnosis—they reflect improved recognition of inattentive and masked presentations, the relationship between estrogen and executive functioning, and a generation of adults who were simply not identified at school (AADPA, 2022).
Screening for ADHD
The Adult ADHD Self-Report Scale (ASRS) is a simple, fast, and clinically affirming screening tool that provides subscale scores for inattentiveness and hyperactivity/impulsivity, and benchmarks results against both ADHD and non-ADHD samples. It is available through NovoPsych, where it integrates into your clinical workflow alongside automated scoring and report generation. For retrospective identification of childhood ADHD behaviors—frequently relevant when assessing adults—the Wender Utah Rating Scale (WURS-25) can support the diagnostic picture.
Behavioural Treatments for ADHD
Here is something clients with ADHD have heard far too many times: “Why don’t you just use a diary?” If that were going to work, it already would have. Many people with ADHD construct elaborate organizational systems—and then lack the executive functioning to maintain them. Effective support requires thinking beyond neurotypical strategies. The framework of scaffolding difficulties while harnessing strengths is a clinically useful organizing principle. On the scaffolding side: reducing mental load by simplifying decisions, building emotional regulation skills, and adapting therapy to explicitly support working memory (shorter explanations, visual cues, written summaries, in-session homework reminders). On the strengths side: harnessing hyperfocus by making tasks NICE—Novel, Interesting, Challenging, or carrying a sense of Emergency—and working with repetitive self-regulatory behaviors, including intentional stimming, rather than against them.
Tracking Progress in ADHD Treatment
Routine outcome monitoring is as important in ADHD treatment as in any other area of clinical practice. The ADHD Clinical Outcome Scale (ACOS) covers attention and functional difficulties, hyperactivity/impulsivity and emotional dysregulation, co-occurring mental health problems, and risk behaviors and interpersonal problems. The Executive Skills Questionnaire – Revised (ESQ-R) tracks executive functioning skills across plan management, time management, organization, emotional regulation, and behavioral regulation—and is designed to detect change over time. Both are available through NovoPsych.
Medication for ADHD
For clients where medication is appropriate, the evidence base is clear: stimulant medications (methylphenidate and dexamphetamine) are first-line treatment, with high efficacy rates and generally good tolerability (AADPA, 2022). They take effect immediately and wear off quickly, which means effects can be monitored in real time. Importantly, stimulant medication is associated with lower mortality rates—including lower rates of accidental death and suicide (Catala-Lopez et al., 2022)—a finding worth communicating clearly to clients and families who are apprehensive about medication. Non-stimulant medications (atomoxetine, guanfacine, clonidine) exist but are generally less effective.
Clinical Takeaway for Identifying and Supporting ADHD
ADHD is common, frequently masked, and carries serious long-term consequences when unidentified. If you are seeing clients with chronic anxiety, treatment non-response, autism, eating disorders, or substance use difficulties, there is a meaningful probability that ADHD may be part of the picture—whether or not it has ever been considered.
The webinar, Identifying and Supporting ADHD: Screening, Recognizing, and Supporting ADHD in Adults and Adolescents with clinical psychologist Jennifer Kemp, walks through the full landscape of ADHD identification and support—from understanding ADHD as a neurodevelopmental difference, to recognizing masked and internalized presentations, to practical therapeutic strategies and validated outcome measures. It is a neurodiversity-affirming, evidence-based resource for any clinician working with adults or adolescents.
Because ADHD doesn’t always look like the kid who can’t sit still. Sometimes it looks like the 35-year-old who has been diligently completing your CBT worksheets for six months and somehow still can’t get to work on time.
View over 150 of the current psychometric tools available on NovoPsych here.
Warm regards,
Dr Ben Buchanan
Psychologist
NovoPsych Co-founder
[email protected]
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