How ADHD Gets Missed Until Adulthood

A former client that I'll never forget was a Fortune 100 CFO who was engaged in their career, had a family they loved at home, and a robust social life. The catch – they didn't feel like they were able to enjoy any of it anymore and were feeling tremendous guilt about it. They came into my office thinking they needed to change their job or that "they just needed tools to help them try a little harder" so that they could figure it out.

The problem with undiagnosed ADHD is that "trying harder" isn't a winning intervention, so it's a battle you will always lose. This person had never gone to therapy and never considered that they may have an executive functioning disorder because they had always experienced success. Even if that success always came with a cost. After agreeing to an assessment, an ADHD diagnosis was clear, and we got to work on a practical plan to stop fighting their brain and start making it work for them.

About half of the people who find their way to me and end up with an ADHD diagnosis aren't seeking me out because they think they have ADHD. They are often seeking me out because they are feeling burned out, overwhelmed, frustrated, or stuck. I often hear it described as "knowing something is off but not being able to put my finger on it."

If this is starting to sound like you, you aren't alone. More than half of people currently diagnosed with ADHD were diagnosed in adulthood^[1]. One of the saddest truths is that people just learn to live with these symptoms for way longer than they need to. The average person spends about 17 years experiencing symptoms before actually getting diagnosed^[2]. It's likely an even larger gap if you are a woman because ADHD is one of many diagnoses that is often overlooked in girls and women.

One of the biggest reasons for this delay in identification and diagnosis is a misunderstanding of what ADHD actually looks like. Many of us who grew up in the 80s/90s/2000s still associate ADHD with the "hyper kid" who can't sit still, is always talking, and is struggling in school. While that is one version of ADHD (hyperactive), the adult clients I most often see often have the more "silent" type of ADHD called inattentive ADHD.

Inattentive ADHD in adults can take a lot of different shapes. It could be the adult who was a straight-A kid even though they always wrote their (A quality) papers the night before they were due.

Sometimes it is the high performer in the office who finds themselves staying in the office or up late every night catching up on work because they spend the working hours price-shopping the car or latest kitchen appliance they've been meticulously researching for the last month or doing anything BUT respond to emails.

This can look like the parent who crushes it at work, keeps the trains running on time at home, but consistently passes out within 5 minutes of lying down at 8pm on the couch to start the episode of The Bachelor (they have already fallen asleep 2 other times earlier this week trying to get through this episode).

These are the people who show up to my office. They show up and mention how they must be "lazy" because "if this stuff was really that important to me, I'd be able to get it done in a timely way." These people are often highly successful and aren't used to not being able to just "figure it out" and have everything work out, even if the process is painful.

An ADHD diagnosis gets overlooked in these circumstances because this person has developed, often unconsciously, behaviors that mask their challenges and often rely on intelligence and fast processing to compensate. As a child, this person is often the "kid we didn't have to worry about" and as an adult they are "the person who can always figure out an answer." Things never *quite* get bad enough to demand real action.

When a client has a unique way of telling their story, I tend to remember them. Here are some of the memorable ways clients with undiagnosed ADHD (or other executive functioning concerns) have presented during our initial consult:

• I feel like I am just not able to stay on top of things anymore, and I'm letting everyone down.

• My partner, my kids, my job, my friends are all important to me – but I just can't seem to find the energy to show up in the way I want.

• This is just a different kind of tired than what I'm used to. From the moment I wake up I'm just moving through sludge and my brain is moving even slower.

• It was fine when I felt like I had the "this is the next life step" playbook, and now that it feels like I've entered the Choose Your Own Adventure part of life, I feel overwhelmed.

• Social interactions feel more draining than they used to. Lately I find myself looking forward to getting to the point in my evening where nobody needs anything from me.

• I often know *exactly* what needs to be done and how to do it, but for whatever reason, I don't. I don't think I'm lazy, but it's the only explanation I can think of.

Inattentive ADHD in high-functioning adults makes everything harder. The frustration shows up in increasingly distressing ways. You may find yourself feeling more anxious or depressed. Your previously healthy conflicts might be turning into uglier fights with your friends and family. You may start finding yourself waking up and just waiting for the moment you get to be left alone. You forget a lot more than you used to. You feel embarrassed when you forget to do the thing you promised, and you get angry at yourself about it later.

What changes after you receive a late-in-life ADHD diagnosis? The most impactful shift is that you understand the challenges and upside of having an ADHD brain. This means that you will finally be able to speak your brain's language and understand how to make it work for you, rather than against you.

You learn how to structure your life in a way that makes sense and allows you to spend more time on your toes than your heels when making decisions. You understand what behavioral strategies are likely to succeed, and why others have failed. You end your day with a little left in your tank, rather than constantly running around with the gas light perpetually on. Things can get easier.

If you think this might be you, reach out.