A look at “Varied Presentations and Specific Treatment of Adult Attention-deficit Hyperactivity Disorder: Is There a Learning Lesson?” by Madhav Raje, Amaranth Mallik and Vinesh Chandramaniya (2026)
A reminder that ADHD doesn’t always look like the textbook. Sometimes it arrives in disguise, as low mood that won’t lift, insomnia that’s been there since childhood, or relentless rumination. This short Indian case series describes four adults whose ADHD was hiding behind unusual presentations.
What they describe
The authors, psychiatrists working in outpatient clinics across India, selected four cases where ADHD had been missed or complicated by other issues, or where people had only partially recovered from previous treatment. The “disguises” included:
- persistent dysphoria, a low, uneasy mood that didn’t respond to usual treatment;
- lifelong insomnia dating back to childhood;
- obsessive rumination that wouldn’t budge;
- an unusually rigid or intense sense of morality;
- socially inappropriate or “childish” behaviour;
- paraesthesias: tingling or unusual physical sensations.
In each case, recognising the underlying ADHD changed the picture. The authors describe combining ADHD-specific medication, in one case an unusual combination of two ADHD medicines at lower doses, with targeted psychotherapy. They report lasting improvement.
Their key message is that every adult with ADHD is different. Clinicians should consider ADHD when someone has only partially recovered from treatment for another condition, or presents in unexpected ways.
A grain of glitter ✨
The core message, that ADHD can masquerade as other things and be missed, is important and well supported by wider research. But this is a case series of just four people, selected because they were unusual, so we can’t generalise from them, as the authors acknowledge. It’s hard to know whether some of the “uncommon” presentations are truly linked to ADHD or reflect other factors. The medication combination described hasn’t been tested in trials, and it isn’t something anyone should try without their prescriber’s guidance. The framing is firmly medical, focusing on “deficits” and “symptoms”, with little on lived experience or strengths.
Why this matters
If you’ve been treated for depression, anxiety, insomnia or obsessive thoughts and only ever partly improved, it might be worth asking whether ADHD (or another form of neurodivergence) could be part of the picture. A thorough assessment that looks at your whole life story, not just your current symptoms, can sometimes unlock understanding that changes everything.
Some unicorns spend years disguised as ordinary horses, even to themselves. It’s never too late to discover the horn.