Undiagnosed and Misunderstood: The Journey to an Adult ADHD Diagnosis By Dr. Jasmine Kaur

Undiagnosed and Misunderstood: The Journey to an Adult ADHD Diagnosis By Dr. Jasmine Kaur

This is the story of Adam. Throughout his life, he was labeled as moody, impatient, and easily distracted. He struggled to concentrate in school, found it difficult to prioritize tasks, and often felt restless. These traits frustrated him, making even the most mundane moments—like waiting in traffic—feel unbearable. When things didn’t go as planned, he spiraled into stress. His struggles affected his work, strained his personal life, and made him feel like he was constantly falling short. And yet, Adam was smart. He worked hard, earned good grades, and carried a strong work ethic. He faced challenges in relationships but eventually got married, determined to be a better husband, father, and employee. For years, he believed these traits were just part of his personality—until, in his late 40s, he was diagnosed with ADHD (Attention Deficit/Hyperactivity Disorder) 

Adam's experience is not unique. Many chronic medical conditions, particularly mental health disorders, go undiagnosed until later in life. Increased awareness and access to information have helped more individuals recognize symptoms, but systemic barriers still contribute to delayed diagnoses, especially for ADHD. 

Barriers to ADHD Diagnosis in Adults 

Lack of Professional Training 

Historically, mental health professionals received limited training in diagnosing ADHD in adults. A 2014 study found that 90% of adult psychiatrists in the UK were not trained to diagnose ADHD, making it difficult for clinicians to identify and address the condition in adults (The ADHD Centre, 2018). While awareness has increased over the past decade, gaps in physician training continue to affect diagnosis rates. Many adults today belong to a generation that experienced missed diagnoses during childhood and are only now seeking answers. 

Challenges in Diagnostic Criteria 

The criteria for diagnosing ADHD differ between children and adults. According to the DSM, symptoms must have been present before the age of 12. Adults over 16 require five symptoms (instead of six) in either inattention or hyperactivity/impulsivity categories to be diagnosed (National Institute of Mental Health, n.d.). These criteria rely

on retrospective self-reporting, which can be influenced by recall biases and other factors, making diagnosis more challenging (The ADHD Centre, 2018). 

Impact of High IQ and Academic Success 

A significant barrier to ADHD diagnosis is the assumption that high academic achievement negates the presence of ADHD. Children who perform well in school are often overlooked for assessment because their struggles may not manifest as poor grades. However, ADHD symptoms persist beyond academics, affecting organization, emotional regulation, and time management. Many adults with ADHD develop coping mechanisms that mask their challenges, further delaying recognition of the condition. Often, diagnosis occurs only when they recognize similar traits in their children or when professional stress becomes overwhelming (The ADHD Centre, 2018). Additionally, comorbid conditions like sleep disorders, anxiety, or depression can obscure ADHD symptoms, leading to misdiagnosis or incomplete treatment, as clinicians tend to prioritize treating the co-occurring condition (The ADHD Centre, 2018). 

Evolution of Symptoms Over Time 

ADHD symptoms evolve with age. While childhood ADHD is often marked by overt hyperactivity, adults may experience it as inner restlessness rather than physical movement. This subtle shift makes ADHD harder to recognize, contributing to continued underdiagnosis (The ADHD Centre, 2018). Furthermore, internalized shame and stigma prevent many adults from seeking help. Individuals who have faced rejection or criticism for their symptoms may hesitate to pursue a diagnosis due to fear of judgment. 

Gender Disparities in ADHD Diagnosis 

Sex plays a crucial role in the late diagnosis of ADHD. Research shows that 40% of teachers struggle to identify ADHD symptoms in girls, while 85% of teachers and 57% of parents believe girls are more likely to go undiagnosed (Attoe & Climie, 2023). Symptoms of inattention and executive dysfunction in girls often go unnoticed, as they are not perceived as requiring further assessment. This contributes to misdiagnosis and delays in treatment, increasing the risks associated with untreated ADHD (Attoe & Climie, 2023). 

Barriers to Seeking Help 

Several factors influence whether individuals seek an ADHD evaluation. Stigma, self-doubt, difficulty accessing healthcare, and age-related biases often deter adults

from pursuing a diagnosis. Conversely, factors such as mental health literacy, personal responsibility, strong therapeutic relationships, and support from informal networks can encourage individuals to take steps toward proper diagnosis and treatment (Polacsek et al., 2019). 

Consequences of Late Diagnosis 

The difficulty in obtaining a diagnosis and accessing appropriate treatment has significant consequences. Adults with undiagnosed ADHD may experience relationship challenges, difficulties with emotional regulation, increased risk of addiction, and chronic frustration in personal and professional settings (ADD.org, 2024). These consequences may emerge as a sense of loneliness and isolation and may cause other mental health problems like sleep disturbances, anxiety, and depression. Without proper intervention, these struggles can compound over time, impacting overall quality of life. 

Psychological Impact of Late Diagnosis 

Research has suggested that receiving an ADHD diagnosis in adulthood can be both validating and distressing. Many individuals undergo a transition from self-criticism to self-compassion as they begin to understand their lifelong struggles through a new lens. However, adjusting to this new identity can be painful, particularly when considering the years spent mislabeling oneself or being misunderstood by others (Leedham et al., 2019) (Rethink Mental Illness, 2023). The grief and anger associated with the late diagnosis and the countless times one experiences missed opportunities is unfathomable, and some might even reject the late diagnosis as it is too much of an adjustment and identity shift for an individual to accept (Rethink Mental Illness, 2023)(BBC Future, 2024). 

Implications: 

ADHD remains under-researched, particularly in adults, and more comprehensive studies are essential to address this gap. Despite growing awareness, there are still significant challenges in diagnosing adult ADHD, especially given its varied presentation and the evolution of symptoms over time. Research must focus on understanding how ADHD manifests in adults, considering the subtle nature of symptoms like internal restlessness rather than outward hyperactivity. Further studies are needed to explore the diverse experiences of individuals with ADHD, especially those from marginalized groups. Understanding how gender, culture, and other social factors influence diagnosis

and treatment will allow for more equitable care. A deeper focus on the unique barriers faced by different demographic groups will ensure that healthcare systems are more inclusive and can address ADHD in a way that reflects the lived experiences of all individuals. 

The need for improved health policies and greater access to care is critical for addressing the challenges surrounding ADHD diagnosis and treatment. The lack of training in adult ADHD among healthcare professionals continues to hinder early detection, and policies must prioritize enhancing mental health literacy, particularly in primary care and mental health settings. Access to care remains a barrier, especially for those in lower socioeconomic brackets, where financial constraints, insurance limitations, and logistical challenges often delay diagnosis and treatment. Socioeconomic status significantly influences the ability to receive timely and appropriate care, further exacerbating health disparities. Policymakers must work to reduce these barriers, ensuring that ADHD services are accessible and affordable to all, regardless of income or location. Reducing stigma and increasing public awareness will encourage more individuals to seek help, leading to earlier diagnoses and more effective interventions. 

Conclusion 

The bottom line is that ADHD is challenging to diagnose and often leads to late diagnoses in adults. ADHD can present with mild, moderate, or severe symptoms, and its manifestations vary from person to person. Many individuals develop coping mechanisms that allow them to adapt to their symptoms, making it difficult to recognize. Because ADHD symptoms do not always fit neatly into diagnostic criteria, many individuals go undiagnosed for years. However, with greater awareness and increased mental health literacy, it is crucial to recognize potential symptoms in oneself and loved ones and seek appropriate help. Someone’s alcoholism, for example, might not just be a problem but rather a symptom of underlying conditions and years of unnoticed struggles. Increased understanding and timely intervention can significantly improve the quality of life for those with ADHD (ADD.org, n.d.). 

Call to Action 

If you or someone you know may be experiencing symptoms of ADHD, it’s important to seek support. To learn more about ADHD in adults and the condition in general, visit this trusted resource: https://www.cdc.gov/adhd/diagnosis/index.html

References : 

1. The ADHD Centre. (2018). 8 reasons for late ADHD diagnosis among adults. The ADHD Centre. https://www.adhdcentre.co.uk/8-reasons-for-late-adhd-diagnosis-among-adults/ 

2. ADD.org. (2024). Untreated ADHD in adults. ADD.org. https://add.org/untreated-adhd-in-adults/ 

3. Leedham, A., Thompson, A. R., Smith, R., & Freeth, M. (2019). ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1), 135–146. https://doi.org/10.1177/1362361319853442 

4. Polacsek, M., Boardman, G. H., & McCann, T. V. (2019). Help-seeking experiences of older adults with a diagnosis of moderate depression. International Journal of Mental Health Nursing, 28(1), 278–287. https://doi.org/10.1111/inm.12531 

5. Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A systematic review of ADHD in adult women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533 

6. National Institute of Mental Health. (n.d.). ADHD: What you need to know. NIMH. https://www.nimh.nih.gov/health/publications/adhd-what-you-need-to-know 7. Rethink Mental Illness. (2023, July). My late diagnosis of ADHD: Marie’s story. Rethink Mental Illness. https://www.rethink.org/news-and-stories/blogs/2023/07/my-late-diagnosis-of-a dhd-maries-story/ 

8. BBC Future. (2024, October 3). The pros and cons of an adult diagnosis with ADHD. BBC. https://www.bbc.com/future/article/20241003-the-pros-and-cons-of-an-adult-dia gnosis-with-adhd 

9. ADD.org. (n.d.). ADHD DSM-5 criteria. ADD.org. https://add.org/adhd-dsm-5-criteria/