A recent study published in the Journal of Attention Disorders sheds light on a significant factor that could delay the diagnosis of attention deficit hyperactivity disorder in adults (ADHD): maladaptive daydreaming. Researchers found that individuals who experience excessive, compulsive fantasizing may unknowingly compensate for or mask their ADHD symptoms, leading to delays in diagnosis.
Maladaptive daydreaming is a behavioral phenomenon characterized by excessive, immersive fantasizing that interferes with daily life. Unlike typical daydreaming, it is compulsive and can consume hours each day, often triggered by stress or negative emotions as a way to escape reality. While it may provide temporary emotional relief, it can lead to significant disruptions in social, academic, and occupational functioning.
ADHD is one of the most common neurodevelopmental conditions, often diagnosed in childhood but persisting into adulthood for many individuals. ADHD is characterized by difficulties with attention, impulsivity, and hyperactivity, which can interfere with various aspects of daily life, including education, employment, and relationships.
As individuals age, the presentation of ADHD symptoms often changes. For example, hyperactivity may diminish, but attentional challenges and executive dysfunction frequently remain, continuing to disrupt an individual’s ability to organize, plan, and manage tasks. Despite its prevalence, ADHD remains underdiagnosed in adults, leaving many individuals without access to the treatment and support that could significantly improve their quality of life.
The delayed diagnosis of ADHD in adults is a growing concern in the field of mental health. The new study was conducted to explore possible factors contributing to delayed ADHD diagnoses in adults.
“As a clinician and researcher working with adults with ADHD, focusing on diagnostic challenges is inevitable,” said study author Ali Kandeğer, an associate professor of psychiatry at Selçuk University and author of the Information Booklet on Attention Deficit Hyperactivity Disorder for Youth and Adults (pdf).
“When designing our studies, we aim to include thought structures (patterns) such as excessive mind wandering and maladaptive daydreaming. Adults are generally better able to describe the functional impairments caused by their thought structures, making these patterns particularly relevant for understanding diagnostic delays and their impact on daily life.”
The study analyzed data from 214 adults diagnosed with ADHD who were treated at the Adult Neurodevelopmental Disorders Clinic at Selçuk University in Türkiye between 2022 and 2024. Participants were divided into two groups: those diagnosed with ADHD during childhood or adolescence (before the age of 18) and those diagnosed in adulthood (18 years or older). The researchers collected detailed sociodemographic, clinical, and diagnostic data, alongside self-reported measures of ADHD symptoms, comorbidities, and maladaptive daydreaming.
Diagnostic evaluations followed the Structured Clinical Interview for DSM-5 Clinician Version, a comprehensive tool for diagnosing mental health conditions. The researchers also employed a range of validated self-report scales, including:
- The Adult ADHD Self-Report Scale to measure ADHD symptom severity.
- The Maladaptive Daydreaming Scale to assess the frequency and severity of maladaptive daydreaming behaviors.
- The Hospital Anxiety and Depression Scale and Childhood Trauma Questionnaire to evaluate comorbid conditions and past experiences of trauma.
Participants completed these assessments over two sessions, with additional self-report data collected via online surveys. Individuals with incomplete forms or severe psychiatric conditions such as psychosis or bipolar disorder were excluded from the study to ensure accurate comparisons.
The researchers found several notable differences between adults diagnosed with ADHD in childhood versus adulthood. Adults diagnosed in adulthood tended to be older and had higher levels of education compared to those diagnosed earlier in life. They also exhibited more severe ADHD symptoms and higher levels of maladaptive daydreaming. Importantly, logistic regression analysis showed that maladaptive daydreaming severity was a significant predictor of receiving an ADHD diagnosis in adulthood, even when controlling for other factors such as age and education.
“When we set out on this study, our goal was to compare the sociodemographic and clinical characteristics of adults diagnosed with ADHD in childhood versus adulthood,” Kandeğer told PsyPost. “Utilizing a comprehensive data recording system, we sought to identify potential clues that might contribute to delayed diagnoses. Given the heterogeneous nature of ADHD, many symptoms and characteristics did not indicate delayed diagnosis.”
“However, what surprised us was that maladaptive daydreaming consistently emerged as a significant indicator of delayed diagnosis, even after controlling for confounding factors. This finding underscores maladaptive daydreaming’s unique role in masking ADHD symptoms and delaying help-seeking behavior.”
Further analyses revealed that in adults diagnosed in adulthood, maladaptive daydreaming was strongly correlated with the severity of ADHD symptoms, the number of comorbid psychiatric disorders, and symptoms of depression and anxiety. This pattern was not observed in individuals diagnosed during childhood or adolescence, suggesting that maladaptive daydreaming might play a unique role in delaying ADHD recognition among adults.
“The study highlights that maladaptive daydreaming can delay ADHD diagnoses until adulthood,” Kandeğer said. “Individuals who engage in excessive daydreaming often find temporary emotional relief but at the cost of functional impairments. Maladaptive daydreaming, by its nature, may mask ADHD symptoms due to reduced activity, decreased impulsivity, and less disruptive behavior during fantasy moments. This masking effect can lead to a delay in ADHD diagnosis until adulthood. Recognizing maladaptive daydreaming as a potential indicator could lead to earlier and more accurate diagnoses of ADHD in adults.”
But the study, like all research, includes some caveats.
“This study was cross-sectional and conducted in a single center, which limits generalizability,” Kandeğer noted. “We relied on self-report measures, which can introduce bias. Additionally, the relatively young age range of our sample (mean age of 23 years) might not reflect older adults with ADHD. Future longitudinal research is needed to confirm these findings.”
“My future goals are to adapt unique thought and behavioral patterns, such as MD, to scientific methodology while investigating novel findings related to the diagnosis and treatment of ADHD in adulthood. Additionally, I am particularly interested in exploring whether MD influences objective neurocognitive tests, which is the next question we aim to address.”
The study, “Could Maladaptive Daydreaming Delay ADHD Diagnosis Until Adulthood? Clinical Characteristics of Adults With ADHD Based on Diagnosis Age,” was authored by Ali Kandeğer, Hasan Ali Güler, Münise Seda Özaltın, Ömer Bayırlı, Hacer Söylemez, Elif Yıldız, and Bengi Semerci.
