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Interviewer: Receiving an ADHD diagnosis as an adult can bring some people clarity, but it can also come with unexpected emotional and even cognitive side effects. Today we're going to be diving into some of the potential aftermath of an adult ADHD diagnosis, and some of the feelings and changes that can happen after a diagnosis in adults.

Joining us today to help us understand this better is Braun Tueller, a PAC with Huntsman Mental Health Institute, who treats many patients with ADHD.

The Emotional Impact of an Adult ADHD Diagnosis

Now, Braun, many adults report feelings of, say, depression, and anger when it comes to a diagnosis. What is behind that, and, you know, why do these unexpected things show up?

Braun: To be less professional, I think it's a little bit of almost reverse FOMO, fear of missing out.

Interviewer: Sure.

The Grieving Process

Braun: You know, where you're diagnosed and especially when treatment is successful, that suddenly you're thrown into this place of like, "What have I been doing? You know, what if I had had this when I was in high school and I had been appropriately diagnosed? Maybe I could have been, you know, that 4.0 student. Maybe would that have taken me to a different college? Would that have put me on a different track in life?" And so it sort of generates this existential, like, what if. You know, what if I missed out on something from the past?

Interviewer: So I guess they're like grieving what could have been. Is that kind of what you're explaining?

Braun: Yeah.

Interviewer: Okay. And that can lead to . . .

Braun: Yeah. And in a lot of ways, yeah. And that particular phenomenon is not unique to ADHD.

Interviewer: Oh, really?

Braun: Mm-hmm. I have a lot of patients . . . I probably see this the most with actually my bipolar patients . . .

Interviewer: Oh, interesting.

Braun: . . . who have had years and years of trying different medications and nothing has really worked and they've been in the hospital, or they've had, you know, problems because of mood swings that there is. There's a lot of like, "Man, what if?" Like you said, that grieving process. But yeah, that's a really good way to put it with ADHD.

Anger and Frustration

Interviewer: What about, say, some people experience anger? Is it the same sort of thing? Like, you know, what are they angry at? What is this kind of depression that can kind of come forward from all that?

Braun: So anger is the easiest expression for any negative emotion. You know, I often say that the three hardest things to accurately diagnose and treat in my world are anger or irritability, attention and concentration, low motivation, and low energy because those things can come from so many different things.

So with anger though, in particular, that's sort of the easiest default manifestation of negative. So the perfect example is the person who goes to work, they get ripped apart by their boss, they get in trouble. They come home and they take it out on the family. You know, that's sort of like your quintessential Hollywood, you know, an example of displacement.

Interviewer: Sure.

Braun: But yeah, you know, I think that it's just a manifestation of that grief, that grieving process of like, "Man, why has it taken so long for somebody to accurately diagnose me and treat me with this?"

Managing Emotional Reactions: Therapy, Time, and Conversation

Interviewer: Now what would be some of, say, the steps that could be taken to maybe help manage this, you know, sometimes unexpected consequence of a diagnosis? Is it, you know, more talk therapy? Is there something else involved? Is it time?

Braun: I think that those two things that you just said, you know, some therapy and time. So Utah, in particular, we have sort of an interesting dichotomy between therapy and medications. In Utah, there are a lot more people who pursue medication compared to therapy, specifically for the treatment of ADHD. We lean more towards the medication side of things.

And the recommendation for the best outcomes for ADHD treatment is to pair the two together. You know, there's always a behavioral component to ADHD. So ideally you would have a therapist that you would be able to meet with and they would be able to help you with like, "Okay, you're feeling angry. Let's talk about where that's coming from. What are we going to do with it?"

Interviewer: Sure.

Braun: So, yeah, having a therapist to help the process.

And then it's trite but true, but time heals all wounds. You know, it just depends on the scar the wound leaves behind. But time does help. You know, time does help with things. The further you get away from it, the less the pain is.

But you can certainly accelerate things through processing by talking with people. And it doesn't have to be a therapist. You know, a lot of times you can vent and get that out by talking with loved ones. You know, sometimes the anger . . . I would actually say, in my experience, the majority of anger that people experience is actually towards parents because they say, "Well, man, I lived with mom and dad or grandma and grandpa for, you know, close to two decades. Why did they never recognize that I was having these struggles?" And so just having those conversations and talking about it can go a really long way in providing some peace and resolution.

Cognitive Challenges After an ADHD Diagnosis

Interviewer: Now moving away from the emotional impacts that people can experience, what about these kinds of slips in cognition, in executive function? Like in some of my basic research, I found that people were finding that, you know, before the diagnosis, they were totally fine, went keeping schedules, etc. But then almost ironically, after getting treatment medication-wise or otherwise, now they're not so good at that. What's going on with that? And, you know, what are some of the ways we can maybe manage it?

Braun: So ADHD is a neurodevelopmental disorder, which means that it's present essentially from birth. You know, one of the diagnostic criteria is it has to be present in childhood in some form or fashion. So for somebody who has gone years, if not decades without being diagnosed, they naturally are going to have developed habits and coping mechanisms for their ADHD symptoms. For some people it's hyper organization, you know, setting timers and clocks and, you know, being very rigid that way. For other people, it sort of takes the opposite direction, you know, where they engage in things that satisfy sort of that impulse control, that stimulation seeking.

So everybody is different. But when you are appropriately diagnosed and treated, that throws a new variable into the equation and it can be hard to adapt to. So the example that I usually use is sort of those moving walkways that you see in airports. You know, when you step onto one of those, if you're not expecting it, it takes you a second to sort of adjust your balance and be like, "Oh, okay." And the same thing stepping off of it. You know, you're used to going at a certain speed. Suddenly you step off of it, and it takes you a couple of steps to readjust. And the brain does the same thing when we introduce we'll call them new variables. Whether that's therapy, whether that's medication, it throws the balance off a little bit in regards to coping skills and mechanisms.

So for people who have this lapse in cognition or they sort of have a setback actually in regards to their functioning, it's most likely because they're trying to figure out how to incorporate the new treatment, that hopefully is effective, with their old coping skills. And so it's figuring out a way to blend those two things together to get a good outcome.

Finding Hope and Support in the ADHD Journey

Interviewer: Whether it is kind of an emotional setback or a cognitive setback that comes after an adult diagnosis of ADHD, what do you tell patients who are maybe struggling with those things? And is there hope at the end of the journey?

Braun: There's always hope. There's always hope. So yeah, absolutely, you know, as a provider, I'm letting them know that they're part of the team. And what I mean by that is, you know, a good therapist, a good provider who has made this diagnosis, it's a partnership. You know, they're in this with you. They should be there to help support you and help you get the care that you need.

So I reassure them that they're not alone and that we're going to work through it. And then I also reassure them that they're not alone on the macro scale as well, that there are so many people that experience the same type of thing. You know, one of the beauties of psychiatry is that everybody is unique. And so at the end of the day, everybody's emotion and their emotional experience are unique. But we go through the same steps.

You know, you can talk with other people and meet other people who have had similar experiences and receive support and knowledge, and you get to give support and knowledge. Sort of that pay-it-forward idea that can really be very therapeutic in saying like this is something you've experienced and now you have the ability to help other people or to make sure . . . A good example of ADHD is siblings. I have a lot of people who will say like, "Oh, my gosh, I think that my sibling has this too." And that's sort of how it propagates.

But yeah, it is not abnormal. You know, it's going to pass. And you have the backup and support that you need through your provider and hopefully friends and family.