It was seen. Just not as ADHD.
People who get their diagnosis late were usually not invisible. They had often been in the care system for years, with symptoms that kept getting a different label. The trap is not that no one looked, but that no one added it all up.
The reasons it comes so late
Not one, but a stack of reasons holds the diagnosis back. Together they make up the delay.
A different label
Symptoms are first read as depression, burnout or anxiety. Those diagnoses are often correct in themselves, but the underlying ADHD stays out of view.
The child image
ADHD was long seen as something for hyperactive boys. That a calm adult or older person could have it too did not fit the picture many care providers had.
Masking well
Many people learned to compensate: seeking structure, working hard, putting themselves last. The better the mask, the less visible the symptoms, until the mask breaks.
Women and older people
For these two groups the delay is strongest, each for its own reasons.
♀ Women
The diagnostic criteria were once based on boys. In women, ADHD more often turns inward: dreamy, perfectionist, anxious. Symptoms also fluctuate with hormones (menstruation, pregnancy, menopause) and so get attributed to something else. The masking costs so much energy that it leads to burnout and low mood, and those are what then get the attention.
👴 Older people
Anyone who grew up when ADHD was not yet recognised never got a name for it. Later in life the symptoms get put down to old age, grief or dementia. Sometimes the diagnosis only becomes clear when a fixed structure falls away, for example after the loss of a partner who provided the anchor for years.
Why no one saw the whole
The Zorgfuik pattern in short: there were plenty of clinicians, but each looked at their own piece.
Many separate diagnoses, no one in charge
ADHD on average goes together with three other disorders. Each clinician takes their own part: one the depression, another the anxiety, a third the sleep problems. Each correct on its own. But as long as no one lays all the pieces side by side, the common denominator, ADHD, stays invisible.
Often you are the only one who has seen all the clinicians, and so the only one who can add it all up."With each doctor I told a piece. No one laid the pieces side by side. In the end I did that myself, and only then did the word ADHD come up."
What a good diagnosis involves
ADHD can be reliably established in adults. Not with a brain scan or an online test, but with targeted assessment.
Where this information comes from
Underdiagnosis in women and adults
ADHD in older people is rarely recognised
On average three co-occurring disorders, diagnosis via DIVA
🏎 Need help right now?
If there is immediate danger to yourself or someone else: call 112. Feeling low or having thoughts of suicide? In the Netherlands you can call or chat day and night with 113 via 0800-0113. Outside the Netherlands, contact your local emergency line.