• Just sit still!
• Why are you always fidgeting?
• Stop interrupting!
• Why are you always in such a hurry?
• Stop daydreaming!
• What did I just tell you?
• You should have thought before you acted!
• Are you ever going to get started?

Recognize yourself? This is ADHD. Attention Deficit Hyperactivity Disorder. Maybe. And that “maybe” needs some explanation. Let’s take a closer look.

Over the past few years, we have indeed seen a real boom in “new” ADHD diagnoses. In my practice, almost every fifth new patient comes in with the question: “Do I have ADHD, or am I just lazy and disorganized?” People over 30 seek help particularly often. Their stories tend to sound remarkably similar:

• I have absolutely no motivation.
• I can put off a simple task for weeks.
• I start a dozen things and finish none of them.
• There is a constant, relentless swarm of thoughts in my head.
• I can’t stand sitting through a long meeting.
• I act first and think later.
• I’m constantly late, forgetting things, and losing things.

Does this mean that a person has ADHD? No, not necessarily. The first thing to understand is that ADHD does not suddenly appear at 25, 35, or 45. ADHD is a neurodevelopmental disorder. Its foundations are formed during brain development, which means that the symptoms must have begun in childhood.

In ICD-10, the age threshold for the onset of symptoms was 7 years. In the current ICD-11, the criterion is less strict: signs should be evident before the age of 12, which better reflects our current understanding of nervous system development.

So if a person first develops significant inattention, forgetfulness, and organizational difficulties only in their 30s or 40s, we should first look for other possible and more likely causes: anxiety, depression, chronic stress, emotional burnout, or sleep disorders.

Another important point is that cognitive functions are affected in virtually all mental disorders. For example, information-processing speed and attention itself can be more severely impaired in depression than in the early stages of dementia.

So why do some people receive their first diagnosis at 30, 40, or even 50? Because a late diagnosis does not mean late-onset ADHD. A person may have compensated for their difficulties for years through intelligence, parental support, the structure provided by school or university, choosing a suitable profession, calendars, reminders, and the habit of doing everything at the last minute. Then life becomes more complicated. Work, family, children, finances, responsibilities, dozens of simultaneous tasks – and the old coping strategies can no longer handle the load. A person may first see a doctor after the age of 30, even though their ADHD story may have begun in elementary school.

That is why the important question is not only, “What symptoms do you have now?” but also, “When did they begin, and how have they manifested throughout your life?”

With ADHD, we look for a persistent history of symptoms beginning in childhood and appearing in more than one area of life.

And ADHD is not one mandatory set of symptoms that looks the same in everyone.

In ICD-10, the criteria were considerably stricter: a diagnosis of hyperkinetic disorder required a combination of inattention, hyperactivity, and impulsivity.

ICD-11 recognizes that ADHD can present differently: in one person, inattention may predominate; in another, hyperactivity and impulsivity; and in a third, both groups of symptoms may be prominent.

There is a neurobiological basis for this.

ADHD is not simply about being “unable to pull yourself together.” Research links ADHD to differences in the functioning of several interconnected brain systems. These include frontostriatal and frontocerebellar networks involving the prefrontal cortex, basal ganglia, and cerebellum – systems that are important for attention, self-control, and executive functions.

The regulation of dopamine and norepinephrine also plays an important role. These neurotransmitter systems are involved in maintaining attention and motivation, controlling impulses, and organizing goal-directed behavior.

And there is another important point here.

Inattention is more strongly associated with differences in the functioning of frontoparietal attention and executive-control networks, while hyperactivity and impulsivity are associated with frontostriatal systems involved in behavioral inhibition and reward. These systems overlap substantially, but they are not identical.

This is also why it is impossible to diagnose ADHD simply by “looking at the brain.” Despite the neurobiological nature of ADHD, there is currently no biomarker that can be measured or analyzed to establish the diagnosis.

Likewise, tests available online are not sufficient or reliable methods for confirming ADHD.

Standardized tools are used in the diagnostic process. For example, DIVA-5 helps systematically assess ADHD symptoms both in the present and in childhood, while QbTest provides objective measurements of attention, impulsivity, and motor activity.

But neither DIVA-5, nor QbTest, nor any other individual test can establish the diagnosis on its own. The reason is straightforward. A specialist needs to understand the context of the symptoms, assess how they affect a person’s life and, most importantly, rule out other causes that can look very similar.

An ADHD diagnosis is the result of a comprehensive clinical assessment, not the number of boxes checked on a questionnaire.

And this brings us to the next important question. What happens if ADHD is confirmed? How do you get rid of it if ADHD is a developmental disorder?

ADHD can be effectively treated! Although, admittedly, that may sound a little too optimistic. A more accurate way to put it is: ADHD can be effectively managed.

When medication is indicated, it acts on the dopamine and norepinephrine systems and can help improve the regulation of attention, impulsivity, and executive functions.

Put simply, it becomes easier not only to understand what needs to be done, but also to move from intention to action, stay focused on the task, and see it through to completion.

But medication will not teach someone how to use a calendar, plan their week, pause before making an impulsive decision, or break one enormous task into five smaller ones.

That is why treatment is not just about medication. It also includes psychoeducation, environmental modifications, behavioral strategies, and work on time management and organization.

And appropriately selected treatment can significantly support the development of these skills. Does this mean that medication has to be taken for the rest of one’s life?

Not necessarily.

The brain has neuroplasticity, and people are capable of learning and reinforcing more effective ways of organizing their behavior and regulating themselves. This is especially true when periods of better symptom control are used to develop specific skills and habits.

But it is important not to promise the impossible.

We have no grounds to claim that medication “re-trains” the brain to such an extent that ADHD disappears and, after stopping medication, a person will never experience symptoms again. For many people, some symptoms return after medication is discontinued.

At the same time, the skills they have acquired – planning, time management, behavioral control, and a better understanding of their own characteristics – may remain.

So the question should not be: “Do I have to take medication for the rest of my life?”

A much more useful question is: “How much is the treatment helping me now, and do I need medication support at this stage of my life?”

This decision should be reviewed periodically together with a doctor.

And finally, there is one topic that cannot be ignored. I would put it this way:

“My child has ADHD – and I see myself as a child in them.”

Psychiatrists hear this quite often. First, it is precisely this observation within the family that often prompts adults to seek an assessment themselves. More importantly, there is a very solid genetic basis for it.

ADHD is indeed highly heritable: family and twin studies estimate its heritability at approximately 70-80%.

If one parent has ADHD, the likelihood that their child will also have ADHD is substantially higher than in the general population. Estimates vary between studies, but figures of approximately 30-50% are often reported.

This, of course, does not mean that there is a single “ADHD gene” or that a parent will inevitably pass the disorder on to their child. The genetics of ADHD are complex and involve a large number of genetic variants. However, we can say with confidence that genetic testing will play an important role both in assessing ADHD risk and in selecting appropriate treatment.

And one last thing.

Do not diagnose yourself or your loved ones based, so to speak, on TikTok, a superficial online test, or a list of ten symptoms. A proper assessment is not about acquiring yet another label. It is about understanding why things are difficult for you – and what can be done about it.

And if difficulties with attention or hyperactivity have been with you since childhood, occur across different areas of your life, and genuinely interfere with your ability to study, work, build relationships, or manage everyday tasks, that is reason enough to seek a professional assessment.

Dr Eduard Maron, Psychiatrist
Professor at Imperial College London