Rediscovering Oneself Following an Adult ADHD Diagnosis
In an era marked by unprecedented access to information, our understanding of ADHD (Attention-Deficit/Hyperactivity Disorder) has transformed. As knowledge about this neurodevelopmental condition has increased, an important shift has occurred, allowing individuals who were once undiagnosed with ADHD to see themselves in a new light. This has resulted in some of my clients considering a potential diagnosis of ADHD when it has not been flagged before. As a clinical psychologist, I have then been able to witness the process of rediscovery following an ADHD diagnosis later in life. I've observed how once shameful or negative life experiences become reframed through a new lens, and how it can provide a powerful sense of validation and increased self-compassion. While a later in life diagnosis can offer newfound understanding, it can also bring about new challenges as people learn to navigate a life with ADHD.
The impact of undiagnosed ADHD as a child:
The experience of growing up with undiagnosed ADHD has a significant impact on all aspects of functioning, mental health, and overall wellbeing. For those with undiagnosed ADHD, they must find ways to overcome the significant difficulties they face with attention, concentration, impulsivity, and/or hyperactivity so they can fulfill their daily responsibilities (i.e., education, relationships). This can lead to the development of ‘masking’ as a way to cope. Masking refers to a process by which people learn to consciously or unconsciously hide or suppress parts of their true selves (e.g., behaviours, traits, or difficulties) to conform to societal expectations and norms. This can manifest in many ways, for example leaning into hyperfocus which can mask symptoms of inattention and hyperactivity. Masking can be both adaptive (helpful) and maladaptive (not so helpful). On the one hand, masking can help people temporarily alleviate some of the challenges associated with their ADHD symptoms. However, on the other hand, masking long-term can create stress, anxiety, and lead to burnout. Prolonged masking may also further delay diagnosis and access to appropriate treatment, as people can become highly adept at concealing their ADHD symptoms.
Another consequence of living with undiagnosed ADHD throughout childhood is the impact that it has on one’s self-esteem. Without knowledge of their condition, there is so much confusion as to why they struggle with seemingly unexplained difficulties compared to their peers. Having to grow up while constantly grappling with the inability to meet societal expectations can become a breeding ground for internalising messages of perceived shortcomings or deficits. The repeated experiences of forgetting details, losing belongings, falling behind in class, being easily distracted, or being labelled as careless or lazy can instil a sense of incompetence and erode self-confidence. Additionally, when others around them fail to understand, invalidate their struggles, or do not provide the support they need to succeed, this only further reinforces the idea that they are somehow flawed or lacking in comparison to their peers. These internalised messages become ingrained in one's self-concept, feeding a continuous cycle of self-criticism and self-punishment and diminished belief in one's abilities, and can lead to the development of beliefs of being inherently flawed or incapable.
The impact of being diagnosed with ADHD as an adult:
Receiving a diagnosis of ADHD as an adult can bring about many positive changes. It can bring about a sense of validation and relief, develop self-awareness and provide a sense of clarity to life experiences and personal challenges. These are further elaborated below:
Validation and Increased Self-Awareness
I have supported some people through an adult ADHD diagnosis and have found this can be an incredibly validating experience for them. It confirms that their struggles are not due to personal flaws or merely a lack of effort, but instead a neurodevelopmental condition. This understanding can help to reframe some of their past struggles and help to build greater self-compassion and self-acceptance, and overtime help to shift negative self-beliefs. With a diagnosis, one can also begin to gain a deeper understanding of the unique ways in which their brain functions, including their personal strengths (e.g., creativity, quick thinking, hyperfocus, multitasking etc.) and weaknesses (e.g., difficulties with organisation, time management, emotion regulation, inattention etc.). This knowledge empowers people to better navigate their condition and learn ways to overcome some of their unique challenges.
Understanding Brain Function
Through diagnosis, people can begin to learn about the role that dopamine plays in their brains functioning, and this can be a game-changer. In people with ADHD, researchers have observed there to be a dysregulation of dopamine in the brain compared to people without ADHD. Dopamine is a neurotransmitter involved in the reward systems in the brain and plays a role in regulating attention and motivation. For people with ADHD this dysregulation of dopamine is thought to be responsible for the difficulties they experience in sustaining attention and self-regulation. Having this understanding of the involvement of dopamine in ADHD can help people make sense of their unique psychological makeup and provide a scientific basis for the challenges they are facing.
Access to Adequate Support:
A further benefit of diagnosis is that a wealth of information about the condition is now available as well as ADHD-targeted supports that can teach new ways of functioning. These ADHD-targeted strategies can help people to better manage their symptoms of ADHD, like inattention and impulsivity, without having to use masking or other unhelpful coping strategies to get by. ADHD supports can also help to empower people to leverage the positive aspects of their ADHD to their advantage.
The ongoing challenges after being diagnosed with ADHD as an adult:
While an adult diagnosis of ADHD can be validating and help people to better understand some of the unique challenges they face, there can still be a lasting impact from being undiagnosed as a child. As discussed earlier, living undiagnosed as a child can have a significant impact on self-esteem and result in the development of negative self-beliefs (e.g., “I am incapable” and “I am lazy” etc.) and masking behaviours to help manage symptoms. These negative self-beliefs and masking behaviours can persist, despite diagnosis, as they have been deeply ingrained and reinforced. This can make them very difficult (but not impossible!) to change. Working towards change involves re-evaluating one’s behaviours and considering 'what is masking and what is me?’, learning new skills to help manage ADHD symptoms, and unlearning some of the unhelpful masking behaviours that were developed to fit societal norms. This will help to uncover a more authentic self over time. Change will also require ongoing challenging of any negative self-beliefs that may have formed when they arise. For example, when struggling to keep on top of life admin an automatic negative thought that could arise is “I’m being lazy”. This is where we can now apply a deeper level of understanding than we had before. We can challenge that thought with our understanding of the unique way that the brain functions with ADHD and the role of dopamine dysregulation in trying to action a task that has little reward. This is why it is harder to action a task that has a lower reward, not because of being lazy.
A further challenge is that an ADHD diagnosis itself doesn’t help one manage the symptoms. While medication management can be very effective for some, it is not for everyone, and doesn’t completely alleviate ADHD symptoms. So, one must learn how to navigate the ongoing challenges in attention, impulsivity, and hyperactivity associated with their condition regardless of any medication management. Working with someone who is specialised in the assessment and treatment of ADHD, can help people sift through the copious amounts of information on ADHD and identify what is most relevant to them, as well teach individualised coping strategies to help empower people to effectively manage their symptoms.
