[To protect privacy, the details of this case have been modified, and is a composite of several individuals] A 62 year old male reached out with concerns of having ADHD. He had never been diagnosed before. His expertise was in manufacturing and engineering, being someone who understood much of the equipment needed to make large electronics. He reached out because he had watched several YouTube videos on ADHD and they seemed to be describing him. He was procrastinating, making many small mistakes and falling behind in his work. He was miserable. When we met, he pointed out that these problems had only begun relatively recently, which is usually a sign that the problem is NOT due to ADHD. ADHD begins in childhood, so the explanation had to be due to something else. That's what I told him, too.
However, as we reviewed his school history in more detail, my opinion began to shift. He described inconsistent performance in school. He did well on subjects that he loved and did poorly on those that he did not. He would often get called out for looking out the window too much. He decided not to go to college because he had concluded he would not be able to keep focused. This educational pattern made me think that perhaps he had a challenge with inattention, but maybe not one that was clinically significant.
When we reviewed his work career, it then became really clear why it had taken so many years for him to seek help: he loved his work! He had gone from high school straight onto the manufacturing floor. He was entirely self taught. Over his career, he became one of the people who could fix a problem, no matter where in the process it occurred. He thrived with the daily novelty and he was usually on his feet the entire day. His ADHD symptoms began after he had been forced into a new role, where he was tasked with writing how-to guides and process manuals. He had never enjoyed writing and disliked documenting his work and as a result he was struggling to get it done.
Further detailed evaluation confirmed his diagnosis of ADHD, predominantly inattentive presentation. He was not interested in considering stimulant medication, though it was one of the recommendations. He was also recommended to have a conversation with his manager to pivot back to his earlier role. He solved that problem, too, because he was able to identify someone on his team whom he could meet with and verbally explain his tricks of the trade.
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