Adult ADHD

A recap of our 11 August session with Dr Kushil Kaur, Consultant Psychiatrist, and Dr Stephen Jambunathan, Senior Consultant Psychiatrist.

Forty-five minutes, questions submitted anonymously, cameras off. People asked about procrastination, about whether a diagnosis is worth having at all, about perimenopause, and about what ADHD does to a relationship. Here is what came up, and what we said.

Overlap is the rule, not the exception

Almost every question touched something that looks like ADHD but might not be. Difficulty getting started, disorganisation, low motivation: these are also how burnout, anxiety and depression present, and they frequently occur together.

The most useful question is usually about pattern rather than symptom. Does it arrive with stressful periods and lift afterwards? Or has it been the texture of your life in every job, every relationship and every season, including the good ones?

Persistent and lifelong points more towards ADHD. Situational and episodic points elsewhere. But that is a genuinely difficult distinction to draw about yourself, from the inside, which is most of the argument for a proper assessment rather than a self-diagnosis you half believe.

You cannot develop ADHD as an adult. You can absolutely be diagnosed as one.

This distinction caused more confusion than anything else on the night, and it is worth being precise about, because in Malaysia it turns people away from assessment altogether.

ADHD is neurodevelopmental. The diagnostic criteria require that symptoms were present in childhood, so it is true that you do not acquire it at thirty-five. What that does not mean is that an adult cannot be diagnosed. It means the evidence has to reach backwards: what school reports said, what your parents remember, what you were like before you built the systems that now hold everything together.

Plenty of adults were simply never identified as children. That is a failure of recognition, not an absence of the condition, and being told it is "too late" to be assessed confuses the two.

For context, this is not only an individual problem. Malaysia has far fewer psychiatrists per head than comparable upper-middle-income countries, on the order of two per 100,000 people against the four to six per 100,000 those countries typically report in the WHO's Mental Health Atlas. Recognition of adult ADHD here has to be understood against that background.

Why it is missed so much more often in women

ADHD in girls more often shows up as inattention, disorganisation and daydreaming than as visible restlessness, and quiet difficulty is far less likely to prompt a referral than disruptive behaviour.

Research bears this out consistently: girls are referred for assessment less often than boys even when equally or more impaired, and a 2023 systematic review of ADHD in adult women found the same pattern of late recognition and misattribution running through the literature.

Two things compound it. Many girls learn to mask, putting real effort into compensating and appearing fine, which works until demands outgrow the strategies, often at university, in a first serious job, or after a child. And anxiety and depression commonly occur alongside ADHD in women, so those get identified and treated as the whole picture while what sits underneath goes unexamined.

What that tends to look like in clinic is women arriving in their thirties or forties with a long-standing sense of working much harder than everyone around them to produce the same output, and no explanation for it.

What a diagnosis is actually for

Several people asked a version of the same question: is it worth it if I'm managing?

The answer was not really about the diagnosis. It was about what changes when you stop reading your own behaviour as laziness or carelessness, and start building structures that suit how your attention actually works. If getting started is the hard part, you build a starting ritual instead of relying on willpower. One of our team lights the same scented candle before every work session, so the smell itself becomes the cue to begin.

Small, unglamorous, and considerably more effective than deciding to try harder.

This is a general summary of a public education session, not personal medical advice, and it can't stand in for an assessment. If something here sounds like you, the useful next step is to talk it through with a clinician about your own circumstances.

If any of this sounded familiar, an assessment is how you find out properly rather than keep wondering. Book a consultation.