We’ve all experienced times when our attention is distracted, or we have trouble concentrating on the task at hand. Such occasional experiences do not mean we have ADHD. If there were few or no symptoms in childhood, the attention and concentration problems today are not likely due to ADHD.

Adults who complain of persistent ADHD symptoms, who were not diagnosed in childhood or adolescence, may have been overlooked because they made good grades in school. If homework assignments were rarely completed or turned in, but they did well on tests, the “homework problem” was often overlooked and they made satisfactory grades.

ADHD falls in the broader category of neurodevelopmental disorders which means if symptoms were not present during childhood development, today’s attention and concentration problems are caused by something else. It isn’t necessary to have hyperactivity as a child to be diagnosed with ADHD as an adult.

The most common adult symptoms of ADHD are problems with behavioral and emotional self-management. Making impulsive decisions, being easily distracted by irrelevant thoughts, starting projects without reading or listening to directions, having trouble sustaining attention or concentration on reading or paperwork, and having trouble remaining alert in boring or difficult situations are some of the manifestations of this condition. These symptoms become more difficult to manage as adults because cognitive demands increase as we age and progress in academics and employment can be affected.

There are other conditions that often occur in addition to ADHD that complicate diagnosis such as specific learning disabilities, anxiety, depression, obsessive-compulsive behaviors, and autism spectrum features. Neuropsychological evaluation can clarify the underlying causes of symptoms and lead to treatment recommendations that improve daily functioning in personal, professional, and academic life.

We all have features that make us uniquely different from everyone else—natural abilities or qualities that characterize who we are. Autism is a spectrum or continuum of neurodevelopmental conditions characterized by difficulties in social relationships and communication skills. Individuals with this condition often have unusually strong narrow interests, exhibit repetitive behaviors, and difficulties coping with unexpected change. While the cause of autism spectrum conditions is genetic, environmental factors play a role. There are changes in brain development that occur before and after birth and are usually observable by at least age 2 years.

On the severe end of the spectrum, an individual may have profound learning disabilities and be incapable of independent living. Individuals of normal or higher intellectual abilities may show features of autism without having specific learning disabilities. Autism spectrum is a biomedical condition that may be severe enough to warrant a diagnosis due to the disabling aspects of the condition (e.g. social-communication disability). However, other aspects of autism are simply different areas of strength (e.g., attention to detail, memory for detail, and pattern-recognition or systemizing).

Neurodiversity is a term that captures the concept of autism strengths and weaknesses as being normal, natural variation without needing a “cure.” However, individuals on the autism spectrum may experience anxiety and depression and have difficulty with social-emotional relationships. These difficulties can affect academic, occupational, and emotional functioning. A neuropsychological evaluation can identify cognitive, academic, social and emotional strengths and weaknesses leading to recommendations and treatments that can reduce distress and improve daily functioning in one’s personal, professional, and academic life.

We all have strengths and weaknesses. Some people may be able to clearly express their thoughts when speaking or writing but may not be able to master difficult mathematical concepts. Others may be analytical and easily master complex calculations but have trouble expressing themselves verbally or in writing. Just because you are really good at some aspects of language or calculations but are “average” at others does not mean you have a learning disability. You are normal. However, significant weaknesses in reading, writing, spelling, or mathematical reasoning not due to lack of academic exposure may be symptoms of an underlying specific learning disability (SLD).

There are three specific learning disabilities—reading, written expression, and mathematics. Impairment in reading is also known as dyslexia. This SLD is characterized by difficulty reading words accurately, especially words that are not pronounced phonetically such as “recipe”. You may know the word, and its meaning, when you hear it. However, you may not recognize it in print and read “recipe” as a different word such as “receipt”. As a result, your reading rate is slow and effortful. You may have trouble grasping the meaning of what you are reading and have to read the same passage over and over. Impairment in written expression shows up as problems with spelling accurately, using grammar and punctuation correctly, and having difficulty organizing your thoughts on paper.

People with impairments in mathematics may have trouble mastering fundamental concepts such as the multiplication tables. Inadequate memorization of arithmetic facts leads to problems with accurate or fluent calculations and math reasoning. Difficulty with mathematics reasoning is also known as dyscalculia.

Learning disabilities fall in the broader category of neurodevelopmental disorders, which means if symptoms were not present during childhood development, today’s problems with reading, written expression, or mathematics are caused by something else. SLD often occurs with other neurodevelopmental conditions such as ADHD, autism spectrum disorder (ASD), and communication disorders. It can lead to mood related problems such as depression and anxiety. Neuropsychological evaluation can clarify the underlying causes of symptoms and lead to treatment recommendations that improve daily functioning in one’s personal, professional, and academic life.

Traumatic brain injury (TBI) can be caused by any blow to the head that disrupts brain function in some way. The brain sits inside a hard boney casing (the skull) where it is “floating” in cerebrospinal fluid. Although not all blows to the head result in a TBI, if the brain gets shaken inside the skull micro-injuries may occur that are not visible on brain scans. Some common causes of TBI are blast exposures, falls, motor vehicle accidents, and blunt or penetrating force from bullets or blast fragments.

Concussion is another word for mild TBI (mTBI) and results from a blow to the head—an event that briefly “knocks you out” or makes you feel confused or “see stars.” You do not have to lose consciousness to have a concussion. Although concussion is often associated with athletes, it can happen to anyone. Concussion causes a change in brain chemistry called a “metabolic cascade” that resolves over time.

Concussion may affect physical, emotional, and cognitive abilities.
Physical: headache, sleep disruption, fatigue, dizziness, nausea, light sensitivity.
Cognitive: slow thinking, poor attention and concentration, memory problems.
Emotional: anxiety, depression, irritability.

Although recovery is different for every person and injury, understanding the natural course of recovery is important. Most people can expect to recover fully and return to normal life. Symptoms typically improve within hours to days and resolve completely within weeks. If your symptoms do not improve, further evaluation may be needed. A neuropsychological evaluation can help to clarify and address problems that are impeding recovery.

When a traumatic event happens to you the normal natural response is distress. You may have difficulty getting the images out of your mind. You may be more reactive to sights, sounds and smells that remind you of the event. While these reactions tend to diminish over time, the memories of the trauma will always be with you but the hold they have on you usually lessens. However, if you continue to experience symptoms after a month, you may have gotten “stuck” in some unhelpful beliefs about the trauma and need help to recover.

The way we think about events directly affects how we feel and act. If you are having recurring memories of the event, distressing dreams, flashbacks, and physical and emotional reactions when reminded of the event, or you are avoiding reminders of the event, Posttraumatic Stress Disorder (PTSD) may be the cause. Negative emotions have a powerful effect on thinking and can lead to changes in memory, attention, planning, and problem solving.

A neuropsychological evaluation can clarify if PTSD is responsible for the changes you are having in memory and thinking. Although the experience of the trauma will always be a part of your life, the hold the trauma has on you is treatable. Recovery is possible. Evidence-based manualized treatment can provide positive outcomes. Prolonged Exposure Therapy (PE) has been shown to be especially effective when the main problem is avoiding trauma-related memories, feelings, and situations. Cognitive Processing Therapy (CPT) has shown to be particularly helpful when guilt and shame are the primary problems.

In most of our lives stress, sleep, and mood are so interconnected it may be hard to see where one ends, and another begins. Under stress we produce stress hormones that direct physical and emotional responses. Adrenalin increases arousal, while cortisol suppresses the immune system. When stress becomes chronic these hormones can lead to depression, anxiety, poor memory and thinking.

Stress often leads to erratic sleep patterns that undermine energy and mood which then compounds the stress. Poor sleep can lead to irritability, lack of attention to detail, and problems with concentration and memory that can affect your mood, work performance, and personal relationships.

When you are under chronic stress, it is important to take control of the aspects of your life that you can control. Daily exercise has been shown to relieve stress, enhance mood, and promote better sleep. Find an exercise you enjoy, make an appointment with yourself by putting exercise on your calendar, and stick to it.

Breathe to relax. Something as simple as breathing in through your nose instead of your mouth can make a major change. Breathing in through your nose slows your heart and breath rate and the production of adrenalin and cortisol.

Develop healthy sleep habits. For helpful sleep suggestions try the American Academy of Sleep Medicine’s recommendations.