Adult ADHD diagnosis (late diagnosis, gender bias, masking…)

Nowadays, it seems as if we're all familiar with ADHD and what it entails. In fact,  most likely you have built a very specific image of what ADHD looks like, and it might be similar to a restless child who cannot sit still and gets easily distracted. 

But, did you know that not all children with ADHD will fit that stereotype? Furthermore, did you know that not all individuals with ADHD are children? 

Unfortunately, there are still many misconceptions surrounding ADHD, leaving many people struggling with challenges they don't fully understand.

So, what are those things that we should know about ADHD in adulthood?

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Late diagnosis and gender bias

Despite the importance of diagnosing ADHD on time to provide individuals with the support they might need, many people go through childhood and adolescence without fully understanding their challenges and not ever receiving a diagnosis. Why does this happen?

One of the main reasons of undiagnosed ADHD is related to a gender bias, with females being about twice less likely to be diagnosed compared to their male peers. This means that women are more likely to receive a late diagnosis (if they get one at all!) (1) (2).  

Although there isn't a definitive explanation of why this happens, one of the most common hypotheses refers to the symptom presentation, where females are more likely to have inattentive symptoms only, which are less disruptive and therefore "easier to miss" than those related to hyperactivity or emotional dysregulation. For instance, in school settings, they are less likely to display disruptive behaviors that draw parent's or teacher's attention (1).

Other possible reasons for late ADHD diagnosis include:

• Negligence: Since referrals for ADHD testing in childhood often depend on observations from parents, a missed diagnosis can occur if caregivers are not as involved in the child's life.
  
  
• Lack of awareness: There's still a very narrow idea of what ADHD looks like, so anyone who doesn't fit the stereotype of the restless child is often overlooked. In academic settings, for example, it's common for teachers to attribute the low academic performance of students with ADHD who don't display the typical symptoms to be a result of "just not putting enough effort" (2). 

• Socioeconomic factors: Families with a lower income often have less access to professionals who can assess and provide a diagnosis, while families with a higher income can sometimes use their resources to compensate for symptoms (e.g., with tutoring), masking the need for proper evaluation and treatment (1). 

• High cognitive ability: Individuals with higher ability might mask their difficulties better, delaying diagnosis even though they may still underperform relative to their potential (1). 

• Environmental demands: As people grow older, life demands, such as those linked to educational, occupational, financial, or social environments, become more complex while support systems decline. This means that, for some individuals the struggle with ADHD symptoms only becomes visible when these supports fade, for example, after leaving home or school (3). 

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Is late onset a real thing?

There's still debate around whether ADHD can truly begin in adulthood or not. Although we don't have a definite answer yet, if late onset exists, it could explain why some adults only receive a diagnosis after childhood, since that's when symptoms begin to emerge more clearly and disrupt daily life (1). 

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Dealing with a delayed diagnosis

Most ADHDers are very aware of their challenges. They usually know they're performing below their potential at school or work, struggling to meet deadlines or starting tasks, or having a hard time building meaningful relationships. Without a diagnosis that explains their challenges, these difficulties are experienced as if something is inherently wrong with them. 

Research shows that those who did not get a diagnosis during childhood can experience low self-esteem, harsh self-criticism, shame, and an overall negative perception of themselves. Although receiving a proper diagnosis later in life can help them feel validated, bringing relief and understanding, it may also come with a period of grief based on what life might have been like if they had received a diagnosis and proper support earlier in life (4).  

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Masking: the need to hide your symptoms

You have probably heard of "masking" when referring to neurodivergent conditions. It refers to a social camouflaging strategy where individuals display alternate versions of themselves to hide their symptoms. This is usually done to avoid rejection and the stigma associated with the disorder.

Although masking can sometimes help individuals fit in or avoid negative judgments in certain contexts, research shows that long-term camouflaging of neurodivergent traits can negatively affect quality of life. Instead, experts suggest working toward acceptance of the diagnosis and, if possible, benefiting from the positive effects of getting one, such as validation, relief, and a sense of community and belonging (5). 

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If you think you might have ADHD but weren't diagnosed on time, consider seeking professional assessment to get the support you need!