Symptoms include chronic forgetfulness, difficulty completing tasks and inconsistent concentration: Psychiatrist
PETALING JAYA: Attention deficit hyperactivity disorder (ADHD) in adults is frequently mistaken for stress, burnout or poor time management, leaving many undiagnosed for years, said a psychiatrist.
Dr Shermaine Sim said rising awareness, improved screening tools, greater social media exposure and evolving understanding of ADHD have led more adults to seek assessments for long-standing symptoms that were once dismissed as laziness, poor attitude or stress.
She emphasised that untreated ADHD could contribute to anxiety, depression, behavioural issues, workplace injuries and a higher risk of road crashes.
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“ADHD has always been there. We just were not looking,” she said, adding that the condition may also affect careers, financial management and interpersonal relationships.
However, she stressed that ADHD is not an illness but a condition that can be managed.
A 2023 review found that ADHD is less likely to be diagnosed in females, particularly in childhood, with many women only receiving diagnoses later in life after symptoms were mistaken for anxiety, depression or stress.
Sim, who is attached to The Kuaya, a private mental health centre in Kuala Lumpur, said adult ADHD remains underdiagnosed, adding that global data suggest only a small proportion of adults with the condition are formally diagnosed.
A 2021 global review estimated that persistent adult ADHD affects 2.58% of adults worldwide while symptomatic adult ADHD affects 6.76%. “Without a diagnosis, the general public assumes these adults are simply lazy and problematic.”
Sim said many adults only seek help after years of struggling with disorganisation, missed deadlines, poor time management or repeated burnout without understanding the underlying cause.
She said ADHD in adults does not always present as hyperactivity but may instead appear as chronic forgetfulness, difficulty completing tasks, impulsive decision-making and inconsistent concentration.
Sim added that many adults with ADHD remain highly capable academically and professionally, particularly in areas that strongly interest them.
“They may perform extremely well in high-pressure or stimulating environments while struggling with routine tasks, organisation or consistency,” she said, stressing that those affected may also be at risk of substance use, disrupted sleep and low self-esteem.
She said the key distinction between ADHD and ordinary distraction or burnout lies in its persistence and pattern.
“Stress causes temporary difficulty concentrating. ADHD is there when things are calm.
“In burnout cases, impairment lifts with rest, but ADHD does not. ADHD symptoms affect multiple areas of life, including work, relationships, finances and time management since childhood.”
She said a proper ADHD assessment involves a detailed clinical interview, developmental history, standardised rating scales and screening for related conditions such as anxiety, depression, sleep disorders and thyroid issues.
Private assessments in Malaysia usually range between RM500 and RM1,500 or more, depending on the clinician and whether psychometric testing is included.
“Public hospital psychiatry clinics offer assessments at a fraction of that cost, but waiting times can be long.”
Sim said medication is not always necessary and management may also include cognitive behavioural therapy, ADHD-specific coaching and lifestyle interventions such as sleep and exercise.
“The goal is not to change who someone is. It is to reduce the friction between their brain and the life they want to live.”
She said a diagnosis does not change a person’s personality but helps adults better understand behavioural patterns that may have affected them for years.
“For many people, finally understanding why certain things have always felt harder can be extremely validating.”
She added that many adults spend years developing coping mechanisms to hide symptoms and avoid being perceived as unreliable or lacking commitment.
“The accommodations that help are not complicated. They include flexible working arrangements, clear written instructions, avoiding long meetings and a culture in which people can ask for support without fear.”
