Have you been told you have ADHD, or suspected it yourself, and then found you could not manage to book the assessment, keep the appointment, or fill the prescription?
In this article I explain why ADHD interferes with getting help for ADHD, why it looks like indifference to everyone watching, what it cost one accomplished professional who was not diagnosed until she was fifty-nine, and what actually helps.
There was a filing cabinet in the campus clinic where I trained as a doctoral student in clinical psychology. This was the early 2000s. By the end of my second year, one drawer held ADHD assessments I had written that nobody had come for.
I had been taught to diagnose ADHD. The clinic doors were open to anyone in the city who needed a formal ADHD assessment. In practice, everyone I met with was a university student who was failing their courses and in danger of not completing their degree.
I met with six students that year. The process was the same each time. I assessed them for ADHD and wrote a report documenting my findings. All six received a diagnosis, which is less surprising than it sounds — nobody books a formal ADHD assessment out of curiosity. By the time someone was sitting in front of me, something had already gone badly wrong and the ordinary explanations had run out. The filtering had happened long before anyone reached my office.
I was pleased with the work. Each of those students could now deliver their report to the Disability Services Centre and be given what they needed: a quiet room to write their examinations in, and extra time to complete them. Every student agreed that these accommodations would change everything for them. In the right conditions, they could focus. They could pass their courses. They could earn their degrees.
Why Two Students Never Picked Up Their Reports
At the time, the assessment cost four hundred dollars up front. The report cost another four hundred, payable when the student came to pick it up. Until then, it stayed in the cabinet. The money went to the clinic. I was a trainee, and I was not paid.
I called the students three or four times each across the academic year to ask them to come and pick up their reports. I knew the reports were sitting in that drawer where they could not do the students any good, and I knew what they were worth to them. Every call went the same way. The students were grateful for the reminder. They apologized. They said they would ask their parents for the money and bring in a cheque that week.
Two of the six never came.
It broke my heart. Those two students had not changed their minds, or decided the accommodations weren’t worth pursuing, or found some other way to succeed academically. They wanted the report. They knew precisely what it would buy them. They simply could not organize themselves to walk across campus with a cheque and pick it up.
Two students is not a statistically meaningful finding. But this was the first time I watched the mechanism operate. I have spent the twenty-five years since watching it — in clients who missed appointments that would have helped them and who left prescriptions for ADHD medication unfilled. Those two students taught me what to look for. The years that followed taught me how common this problem is.
That file drawer at the campus clinic taught me more about ADHD than any lecture I attended.
Why ADHD Blocks Its Own Treatment
Here is what those two students demonstrated, and what I have watched people demonstrate ever since.
ADHD obstructs the very act of claiming the remedy for ADHD.
Not ambivalence. Not insufficient motivation — you cannot argue that a student one failed semester away from losing their degree lacks motivation. The impairment and the barrier to treating the impairment are the same impairment. It is a closed loop.
And from the outside, it looks exactly like not caring.
This is the part that does the most damage. Everyone watching draws the obvious conclusion. The parent who paid for the assessment concludes their child is not serious. The spouse concludes it is not a priority. The employer concludes the person is unreliable. And the person with ADHD, who has spent a lifetime being told some version of this, concludes it too — because from where they are standing, the evidence looks the same as it does to everybody else.
How This Looks in a 59-Year-Old Architect
I want to describe a client I will call Beverly, because her situation makes the point more sharply than the students did. Identifying details have been changed.
Beverly was an architect, diagnosed with ADHD at fifty-nine after more than thirty years in the profession. By the time she received the diagnosis she had lost her job and was building a new business, with her savings draining and no other source of income. She had every reason in the world to act, and she knew it.
It took roughly six months to get her onto ADHD medication.
She did not go to her doctor — knowing the medication could help, believing it would help, not going. When she did get there, her physician raised reasonable concerns about possible interactions with medications she was already taking. She needed to go back.
She could not make the second appointment. Not would not — could not. This is what ADHD does. It takes a task that is one phone call long and makes it unreachable.
She was weeks of runway from running out of money, and the two-step task that would have begun to fix it was beyond her.
That is the file cabinet. The same closed loop, twenty-five years later, in an accomplished professional in her late fifties rather than a nineteen-year-old undergraduate. I had watched the mechanism operate as a student. I had described it to myself in exactly those terms. And it still took me longer than it should have to see it in Beverly.
How to Get Help When ADHD Is in the Way
If you recognize yourself here, the gap between what you intend and what you complete is not a character flaw, and it is not evidence about how much you want to accomplish something. It is ADHD itself, operating exactly as it operates.
What I advise people in my office is this. Ask someone close to you to help you.
A closed loop usually has to be broken from the outside. Ask someone in your family, or someone close to you, to help you find a psychologist and make the appointment. Ask them to come with you. Ask them to stay with you through the steps that follow — seeing the physician, obtaining and filling the prescription. And then ask them to keep helping, because the prescription will need refilling, and refilling a prescription is exactly the kind of small deferrable task that ADHD makes hardest. A great many people start medication successfully and then stop taking it three months later after they run out.
Asking someone for help can be the key.
Considering Next Steps
My practice is with accomplished professionals — people who have degrees, credentials, and successful careers. Some have spent decades wondering why the ordinary machinery of getting things done costs them so much more than it appears to cost others. Many have been told for years that they are doing fine.
If that description fits, an assessment for ADHD is worth considering. An assessment in adulthood answers the question properly — not just whether the criteria for ADHD are met, but what else might account for the difficulties, which matters, because anxiety, depression, and long-term exhaustion produce overlapping symptoms and can be present alongside ADHD.
If medication turns out to be part of the picture, that conversation happens with a physician, and a letter from a psychologist gives them something concrete to work from.
If you have been reading this and recognize yourself, you are welcome to get in touch.
Related Articles and Videos
- This companion post follows one architect who was not diagnosed until she was fifty-nine, and explains why grief arrives alongside the relief of a late diagnosis — and why the relief turns out to be the larger of the two.
- The error can also run the other way. This article explains why exhaustion can produce ADHD-like symptoms on screening checklists, and what distinguishes a lifelong pattern of ADHD symptoms from difficulties that appeared only after years of overwork.
- This video explains how severe burnout impairs concentration, memory, and judgment rather than energy alone: How To Recognize Severe Burnout Symptoms.