ADHD in adults: Why symptoms often go unnoticed in childhood and how they show up later 

As a child, Yukta was good at academics and participated in extracurricular activities. She was not the distracted, disruptive child one normally associates with ADHD. “But I did struggle with procrastination, anxiety and emotional dysregulation.” This distinction is at the heart of a crucial question that’s increasingly being asked as more adults are diagnosed with ADHD. Can one develop ADHD as an adult? No. All that happens is that the props that helped the person manage it in younger years may simply have disappeared, triggering behavioural symptoms. As Dr Jyoti Sangle, a Mumbai-based psychiatrist specialising in neurodivergence, says, “Unmasked, unrecognised ADHD during childhood does lead to a lot of behavioural problems and emotional dysregulation in adulthood. This results in personality disorders, relationship issues and substance abuse. Diagnosing ADHD retrospectively is very common indeed.”

A 2025 systematic review in the Journal of Indian Association for Child and Adolescent Mental Health, pooling 24 Indian studies, found community and population-based prevalence ranging from 5.5 per cent in Chandigarh to 23.3 per cent in Punjab, with mid-range estimates of 14 per cent in Delhi-NCR and 15.9 per cent in Ujjain. Across these community studies, the inattentive subtype was consistently dominant — in the Delhi-NCR sample, nearly two-thirds of ADHD cases fell into this more easily missed category. In clinical and substance-use populations, prevalence climbed far higher still, 18% to 62%, where ADHD is often only caught while treating something else entirely.

The ADHD people don’t recognise

The popular image of ADHD is still largely that of a child who cannot sit still in class. But ADHD has three broad presentations: predominantly inattentive, predominantly hyperactive or impulsive, and combined. As people grow older, the outward signs of hyperactivity can become less obvious. Inattention, restlessness, impulsivity and difficulties with executive functioning can remain. For an adult, that can mean chronic procrastination, poor time management, difficulty organising tasks, losing track of things, struggling to start or finish work, or repeatedly pushing themselves into exhaustion.

That was closer to Yukta’s experience than the stereotype. “Burnout happens and then I rest for a bit, recover and the cycle just repeats,” she says. Aishwarya, a 31-year-old doctor, did well academically as a child. Her difficulties became more apparent as the demands of studying increased, particularly while preparing for her NEET undergraduate and postgraduate examinations.

Aishwarya (31)

One reason ADHD goes unnoticed in childhood is because it does not always demand the same kind of self-management as adulthood. The school provides timetables, reminders and fixed deadlines. Parents supervise homework, meals and sleep. Teachers may notice when an assignment is missing. A capable child can compensate for symptoms. “It is only when they grow into adults and see their daily life interrupted and become dysfunctional that they come to us for diagnosis,” says Dr Nimesh Desai, former faculty, NIMHANS, Bengaluru. The National Institute of Mental Health notes that some adults manifest symptoms when they encounter work life challenges, experience stress, serious life events,  hormonal shifts and surrender to a poor diet-sleep-sedentary lifestyle.

What changes with age is not the underlying wiring but its presentation. Hyperactivity,  John Vijaysagar, additional professor at NIMHANS’ Department of Child and Adolescent Psychiatry, notes, “tends to visibly reduce as children become adults but impulsivity and, crucially, emotional regulation, often do not resolve the same way.” Adults frequently develop what look like new struggles but are in fact old ones wearing office clothes: missed deadlines, chronic postponement, difficulty finishing what you start or difficulty starting anything in the first place.

The hidden bias

Gender can also affect who gets noticed. Dr Vijaysagar says awareness has increased around ADHD in girls and women, who may have been overlooked when clinicians and families were looking primarily for hyperactivity.

Access to diagnosis is unequal in other ways too. Yashna Vishwanathan, a teacher at TISS and a development professional and therapist working at the intersection of disability and neurodiversity, points out that an urban, middle-class child may have teachers who raise concerns and families who can pursue assessment. “But A child from a rural or marginalised background may instead be labelled lazy, difficult, uninterested or indisciplined. The result is a generation of adults who may arrive at a diagnosis only after years of compensating,” she says.

When ADHD looks like something else

Sometimes the problem is not that the symptoms were absent. It is that another symptom was louder. Yukta spent years being treated for anxiety. Aishwarya was diagnosed with bipolar depression at 26 and spent three years on medication before being diagnosed with ADHD at 30. She recalls significant physical side effects, including tremors, hair loss and a 12-kg weight gain. Ujjala, now 23, was initially diagnosed with anxiety and depression and later with borderline personality disorder. She eventually began studying ADHD herself and raised the possibility with her psychologist. “After three years of therapy with the same clinical psychologist, I got my ADHD diagnosis,” she says.

Ujjala (23)

ADHD frequently co-occurs with other mental-health conditions, which can complicate assessment and treatment. Dr Vijaysagar cautions against treating every episode of inattention as ADHD. “Stress, sleep difficulties, anxiety, depression, burnout and other conditions can produce similar symptoms. A proper assessment, therefore, involves a developmental and psychiatric history, current functioning and, where possible, information about childhood behaviour and functioning,” he says.

“ADHD frequently overlaps with either hypo or hypersensitivity to different sensory stimuli”, says Dr Vijaysagar. For Aishwarya, it’s hypersensitivity to bright lights. “I use warm lights and calm myself with plants,” she says. Even seating has rules. During a period of acute distress, she recalls fixating on one specific chair at a specific café, refusing any other.  “Sensitivity to sound and lights is very common in ADHD” says Dr Sangle.

For Rohan, darkness was the trigger: “It was like dialling up a sensory overload.” That has faded with age, but noise hasn’t. “Jump scares in horror films do nothing to me. A door slamming shut does,” he says. Traffic has the same effect; constant honking makes his “body tremble” which is why he wears noise-cancelling headphones almost permanently, and why, paradoxically, he needs background noise to fall asleep. For Ujjala, food has to meet exact criteria, “I can’t have very chewy, solid food.” Sleep requires an equally specific environment, one she’s rarely able to find outside her own carefully arranged space.

Rohan (26)

How to manage ADHD?

There is no single strategy for managing adult ADHD. Clinical guidance supports a comprehensive approach that takes into account psychological, behavioural and occupational needs, as well as the person’s preferences and other mental-health conditions. “Medication can be used when symptoms continue to cause significant impairment, while structured approaches like Cognitive Behavioural Therapy (CBT) can help adults develop skills around organisation, planning, attention, procrastination and emotional responses,” says Dr Sangle.

For Yukta, therapy helped her recognise some of the basics she had been neglecting: sleep, nutritious food, exercise and spending time outdoors.
“These do wonders for my mental health,” she says. Aishwarya has learnt to use curiosity and variety to hold her attention. Rohan, who was diagnosed after years of burnout, sleeplessness and social difficulties, has found a personal coping mechanism by starting a board games community in Navi Mumbai.

Dr Shaunak Ajinkya, a psychiatrist at Kokilaben Dhirubhai Ambani Hospital, Mumbai, suggests psychoeducation in the early stages of therapy, where the patient is provided with extensive information about ADHD, including how it manifests and its neurobiological underpinnings. “This helps alleviate some of the patient’s self-criticism. They are reassured that symptoms can be managed effectively with the right tools and strategies,” he says.

The patient is taught to break down large tasks into smaller, more manageable steps. “We use the Pomodoro technique, where the patient works for short intervals with breaks in between, helping them maintain focus and productivity. A daily planner and using a scheduling system helps them manage tasks. Sticky notes and visual cues are recommended at the workspace,” he adds.

Mindfulness and role-playing exercises help curb the patient’s tendency to interrupt conversations and act impulsively in social situations. “The patient is taught to recognise their cognitive distortions, such as ‘all-or-nothing thinking,’ where they view tasks as either perfectly done or complete failures. The patient is taught to consider partial progress as a step forward rather than a failure. Patients are also persuaded to implement a system of rewards, where they allow themselves a small break or treat after completing a difficult task. These strategies make a significant difference. But if the manifestations are severe, then therapies must be complemented with medication,” says Dr Ajinkya.

Sabid (32)

ADHD though is not only a story of difficulty,  “Many people describe living with ADHD as having strengths like curiosity, spontaneity, energy, creative thinking, the ability to hyperfocus on an area of interest. These can be genuine strengths without romanticising ADHD or overlooking the challenges it creates,” says Yashna. But diagnosis can also make acceptance easier. “It made me realise who I am and start accepting myself rather than blaming myself, constantly questioning myself, or searching for answers to every simple and complex act of life or decision. That was healing, or perhaps liberation. At least now I’m aware of where I need to work instead of randomly fishing in the whole sea,” says Sabid, 32, who spent years trying to fit in. Now he can anchor himself.