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10 Ways ADHD Can Hide in Plain Sight

ADHD is sometimes impossible to miss — and other times far too easy to overlook. The children who exhibit stereotypical symptoms (i.e. hyperactivity or impulsivity) are often diagnosed, while those with not-so-obvious signs (i.e. emotional dysregulation or sleeplessness) may be misdiagnosed into adulthood — or entirely. Here are the ADHD signs most likely to hide in plain sight.

By Dara Abraham, D.O. Updated on June 25, 2021
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Though it manifests in disparate and dichotomous ways, ADHD is often associated with only a handful of stereotypical behaviors and presentations. So when not-so-obvious ADHD symptoms show up in broad daylight, they may go ignored or misdiagnosed.

Then, when subtle-but-lifelong symptoms of ADHD explode (as they are likely to do) under unique and stressful circumstances, they suddenly become unmanageable. And it’s only then that many adults get the help they need.

Here are commonly overlooked signs of ADHD, including unexpected symptoms and even those that seem contrary to the diagnosis.

Signs That Point to ADHD

1. Your lifelong difficulties with focus, restlessness, and impatience did not affect your work or family – until life drastically changed.

You can still have ADHD even if you were not diagnosed as a child. Commonly, symptoms of poor focus, hyperactivity, and impulsivity remain manageable thanks to well-honed coping mechanisms that fall apart with a major life event — like obtaining your first job, getting married, or starting a family. Perhaps, for example, your symptoms remained under control until you found yourself amid the global pandemic.

2. You are not hyperactive or impulsive, but instead have periods of little motivation and choice paralysis.

ADHD exists on a spectrum and presents with multiple symptom variations. The DSM-V classifies ADHD into three subtypes: predominantly inattentive type, predominantly hyperactive type, and combined type. Girls present with inattention more often than do boys, who are more commonly hyperactive and impulsive.

[Click to Read: 3 Defining Features of ADHD That Everyone Overlooks]

A disruptive little boy is more likely to trigger the concerned attention that leads to an ADHD diagnosis than is an unfocused yet non-disruptive little girl who forgets her homework assignments. When young girls do present with hyperactivity, it is usually the more benign and less disruptive form of excessive talkativeness. These “invisible” symptoms are seldom associated with ADHD in girls.

In addition, overt hyperactive and impulsive behaviors sometimes subside or morph earlier in girls, who commonly become more sensitive to others’ perceptions than do most boys. However, their hyperactivity does not disappear; it transforms into an internal restlessness and a noisy brain, which looks like difficulty making decisions and a seeming lack of motivation.

3. You can focus, sometimes to a fault.

“ADHD” is a misnomer. It is not so much a disorder of inattention, but rather a disorder of inconsistent attention. Attention fluctuates depending on a person’s level of interest in an activity. Hyperfocus, or intense interest, is on one extreme, but still tied to the dopamine deficiencies that also contribute to inattention.

ADHD is often missed in adults who hyperfocus more than they struggle with inattention. Hyperfocusing, in some ways, can be seen as a positive and helpful symptom. But it does have its cons – transitioning out of intense focus can be difficult, which can interfere with daily activities.

[Read: ADHD Hyperfocus Is a Blessing and a Curse]

4. You lack a history of difficulties at school – in stark contrast to your peers with academic problems that led to their earlier ADHD diagnosis.

ADHD is NOT related to your intelligence, school performance, or level of success. You can be a good student, highly knowledgeable and successful, and still have a diagnosis of ADHD.

Individuals with a high IQ are often overlooked for ADHD, as they may still function above average or at an adequate level despite their deficits. Often masking their “normal” functioning is the time and effort it takes to compensate for ADHD symptoms.

5. You are organized and meticulous, not disorganized and careless.

It is common for individuals with ADHD to develop somewhat obsessive and compulsive behaviors to manage their symptoms. You may, for example:

  • Over-prepare for an exam to manage anticipated problems with time management, concentration, and planning that may impact your grade.
  • Become obsessed with tidiness and have a fascination with decluttering techniques and gadgets. For you, it’s a must in order to compensate for your overconsumption and organizational difficulties.
  • Engage in near-compulsive checking behaviors to manage chronic forgetfulness and the misplacing of items.

These ADHD coping strategies can mimic Obsessive Compulsive Disorder (OCD), but the two disorders are distinct.

6. You struggle to manage your feelings, fluctuate between excess emotions and lack thereof.

Whether diagnosed as a child or late in life, a person with ADHD is more likely to hear negative comments about their symptoms and behaviors. They may hear from parents, friends, and others about their underachievements, and be accused of laziness, immaturity, and selfishness. These lifelong criticisms can lead to feelings of guilt and shame, and they exacerbate problems with emotional regulation.

Rejection Sensitive Dysphoria, a phenomenon referring to intense negative feelings from perceived or actual criticism, is also part of emotional dysregulation as a major part of the ADHD experience for adults.

7. You already have a mood disorder and/or anxiety.

Unless you are directly assessed for ADHD, a more apparent mood or anxiety disorder may be diagnosed first — or misdiagnosed instead. A misdiagnosis, especially, may lead to multiple failures with medications before receiving a correct diagnosis.

Most psychiatrists are not as familiar with adult ADHD as they are with mood and anxiety diagnoses. It’s only in recent years that adult ADHD has been taught in psychiatry residency training programs.

ADHD symptoms can be confused for other conditions during an initial psychiatric assessment. Your clinician may inaccurately label your “overwhelmed and excitable” emotions as anxiety. You may even suspect you have a mood disorder because you feel “bored and unmotivated.” In fact, a study conducted in 2016 by Sternat found that 34% of patients referred for a treatment-resistant mood disorder met the criteria for ADHD.

8. You struggle with sleepless nights.

Historically, poor sleep had been considered a separate issue from ADHD. However, researchers have recently hypothesized that ADHD is also associated with a dysregulated sleep-wake cycle. It is estimated that 75% of children and adults with ADHD have a sleep problem. (European College of Neuropsychopharmacology)

Adults with ADHD often encounter several sleep problems. They find it difficult to fall asleep due to a brain that won’t turn off, and struggle to stay asleep due to physical restlessness. They also have problems waking, as they tend not to enter the deepest sleep stage until early morning.

9. You struggle with substance abuse and eating disorders.

The lack of sufficient dopamine in your brain can lead to boredom and impulsive behaviors such as misuse of illicit substances and even disordered eating, especially if ADHD goes undiagnosed.

When individuals finally seek help, they can be misdiagnosed, or diagnosed with only a mood and or anxiety disorder, leading to an ineffective medication regimen and more despair and hopelessness, perpetuating the cycle of substance misuse, self-medication, and disordered eating patterns.

10. You have trouble with all kinds of relationships.

It is harder to be mindful and emotionally attuned to others when distractibility is a problem. ADHD may affect your ability to communicate and naturally connect with a wide range of people. Your relationships may suffer, and you may ultimately feel disconnected from your partner, family, and friends.

You may easily lose touch with others because of ADHD symptoms like forgetfulness and disorganization. Unfortunately, it can cause others to label you as self-centered and selfish.

ADHD can also disrupt your emotional and physical intimacy with your partner, and possibly prevent you from forming romantic relationships in the first place.

ADHD Signs: Next Steps

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