Diagnosed at 45, then asked to make sense of a life through a public debate that keeps confusing recognition with excess.
I was diagnosed with ADHD in 2018, at the age of 45. In rehab.
That is a rather expensive way to discover that there might have been another explanation worth considering earlier.
I credit the psychiatrist who assessed me there. He listened closely and recognised something I would not even have known to ask about. His experience in addiction care allowed him to consider whether treating my ADHD could help me engage with recovery. In my experience, Ritalin made a crucial difference in those early stages. As I write this, I remain sober.
That is my account of what helped me. It is not a claim that one medication explains recovery or that the same treatment would suit everyone.
When I hear that ADHD is being overdiagnosed, I want to ask what happened to the years before my diagnosis. Where do those years fit in the debate? The school habits, the career decisions, the ways of coping, the explanations I had already accepted about myself?
They do not disappear because more people are now being diagnosed. Yet the public conversation often makes it sound as though the main danger is that adults are discovering ADHD, rather than that some spent decades living with it without knowing what they were trying to manage.
I cannot tell you that ADHD caused everything that brought me to rehab. That would be another tidy story imposed on a complicated life. But it belongs in that history. Finding it at 45 ought to prompt some curiosity about what happened before then.
For some of us, the problem was never an excess of awareness. It was the absence of an explanation we could recognise ourselves in.
Awareness of what, exactly?
There is a difference between having heard of ADHD and understanding how it might appear in your own adult life.
Knowing the name does not necessarily tell you what to make of a mind that wanders while the person sits quietly. It does not explain why you can think deeply about something that interests you, then struggle to return to a task you genuinely want to finish. It does not automatically connect the scattered parts of a life into something worth assessing.
And hearing about ADHD today tells us very little about what a person, their family, their teachers or their clinicians understood thirty years ago.
That time difference matters. Adults diagnosed in their mid-forties are being discussed against today’s level of visibility, as though it had always been available to us. It had not. My diagnosis was late. The life that needed explaining was already well underway.
South Africa also deserves more than a borrowed argument about diagnostic excess elsewhere. Our own adult ADHD guidelines, published in 2017, identified lack of knowledge and funding as barriers to diagnosis and treatment. The specialist interest group behind them had been launched in 2015. This was work being developed locally around the time I finally received my diagnosis.[1]
That does not establish what every South African professional knew. It does establish that the gaps were recognised. We cannot discuss increased awareness honestly while treating the earlier gaps as irrelevant.
The result was visible. The method was not.
School came fairly easily to me. Studying did not.
I disliked revision. The boredom led to avoidance, the avoidance continued until panic arrived, and then I crammed. I relied on what I could retain in the short term. I did not learn a steady, incremental way of studying.
Looking back, I can see how this became a learned way of getting through. If waiting until panic arrived was followed by a workable result, there was little reason to question the method. It had worked again. The marks offered reassurance; the process escaped attention.
That does not mean I learned to have ADHD. It means I developed habits around difficulties I did not yet understand.
School also supplies more of the structure than we sometimes acknowledge: a timetable, regular contact with teachers, smaller deadlines and people who notice whether work has been done. A student can benefit from that structure without recognising how much it is doing.
The teacher matters too. Someone who brings a subject alive can help sustain engagement that the student struggles to generate alone. When teaching becomes less engaging, the difference may appear in the marks well before anyone asks what changed. That is not evidence that an uninspiring teacher causes ADHD. It is a reason to investigate why a student’s performance varies so much with the conditions.
Even the decline in later school years can become a missed opportunity. The student who once did well is expected to recover their former performance. Yet earlier success may tell us more about the fit between the student, the demands and the teaching than about their ability to manage every subsequent situation.
Then comes tertiary education.
The structure changes, and more of the planning moves onto the student. Reading must be organised, distant deadlines broken down, and work resumed without someone checking each stage. Knowing what needs doing and being able to organise its completion become rather different demands.
For a student who has relied on last-minute urgency, the old method may fail as the workload grows. The expectation was success, perhaps even greatness. Instead, there is failure, followed by shame.
A “disastrous year” names the outcome. It offers no explanation.
A 2025 review linked ADHD in university students with poorer academic performance and identified study strategies and executive functioning among the relevant factors.[2] A four-year study likewise found weaker study strategies among students with ADHD and identified executive functioning and academic support among predictors of outcomes.[8] Neither study proves my interpretation of my school habits. They do support asking what the transition demands, rather than assuming that school marks establish readiness for it.
Self-accountability still matters. But handing someone responsibility does not establish that they have the skills or support to carry it.
If we never examine how a student succeeded, we are poorly placed to explain why they later failed.
A career can contain the adaptations
The same problem follows us into work.
A job history records where someone worked. It rarely records why certain roles were tolerable, why others became impossible, or what they quietly built around themselves to keep going.
People make career decisions through opportunity, money, family obligations and circumstance. ADHD is not a complete explanation for those decisions. But it may be part of the explanation: which demands someone can sustain, which settings suit them, where they find enough interest to remain engaged, and what they avoid after repeated difficulties.
Maike Kugler’s 2025 study interviewed 14 employed adults diagnosed with ADHD in adulthood about their careers. Participants described earlier choices and career difficulties in light of undiagnosed ADHD, and diagnosis changed how they understood and approached their working lives.[3] It is a small retrospective qualitative study. It cannot prove that ADHD caused a particular career decision.
It does show why asking about that history matters.
If someone has shaped their working life around what they can manage, the resulting fit may conceal part of the difficulty. We should examine the adaptations before deciding that the absence of an obvious disaster means there was nothing to adapt to.
When expertise becomes a closed door
After my diagnosis, I began recognising possible ADHD symptoms in my son. He was 13 at the time. I looked for an experienced local psychiatrist and arranged an assessment.
An assessment. I was not asking for my diagnosis to be photocopied onto my child.
Before the appointment, I sent an email describing my rehab history, my diagnosis and the reasons for my concern. I wanted to provide background that could inform the conversation.
When I referred to that email in the first session, the response, as I remember it, was: “I only have your word that you were diagnosed with ADHD.”
That sentence chilled me.
A clinician can reasonably ask for confirmation of another clinician’s diagnosis. Records can be requested. A conversation with the treating psychiatrist can be arranged. I understood the response as a statement of doubt, with none of the curiosity I had hoped my account would invite.
The psychiatrist also described my rehab psychiatrist as irresponsible for prescribing Ritalin. The words I remember were: “We don’t give this to active addicts.”
What I heard was a categorical rule being applied to a clinical decision that had helped me. My experience of recovery seemed to have very little standing in the room.
Stimulant prescribing in addiction care requires caution. I do not dispute that. But caution involves assessing a person, the substance use, the medication and the safeguards. It cannot be reduced to the word “addict”. An international consensus published in 2018 supported integrated ADHD and substance-use treatment and discussed stimulant treatment alongside individual assessment of misuse and diversion risk.[5] A later expert consensus likewise rejected a blanket approach to withholding ADHD medication, while recommending risk assessment and generally preferring long-acting stimulants.[7]
Those recommendations do not allow anyone reading this to retrospectively approve my particular prescription. They do show why a categorical dismissal is inadequate.
My son initially received a diagnosis of generalised anxiety disorder, and was later diagnosed with ADHD. That sequence alone does not prove the initial diagnosis was wrong. Anxiety and ADHD can coexist, and assessments can develop as more becomes known.
When ADHD medication was prescribed, the choice was Strattera, or atomoxetine. Given the earlier comments, I wondered whether concern that his medication might be diverted to me had influenced that decision. At the time, my own treatment was already being managed with my psychiatrist.
I cannot establish that diversion was the reason. Atomoxetine can be a legitimate choice, and the prescription alone is not evidence of prejudice. I can describe the suspicion the encounter left me with. It is part of why I now question how much weight a professional’s public expertise should carry when deciding whom to trust with care.
I brought a family history, concerns about my child and an account of treatment that had helped me. I left feeling that my credibility was in question.
That is how mistrust can begin. It does not require a person to arrive opposed to psychiatry. Sometimes they arrive asking for help.
Diagnosed, but still unheard
Diagnosis does not automatically end the struggle to be understood.
Once the label exists, there is still the work of revisiting a life: what was difficult, what was misunderstood, what support might help now, and which old explanations deserve to be questioned.
McGill and colleagues’ 2026 review of 21 studies found that adult diagnosis could bring self-compassion alongside grief, anger and uncertainty. Participants also described barriers, feeling dismissed and uneven support after diagnosis.[4] The research comes largely from high-income settings and cannot simply stand in for South African experience. It nevertheless offers a serious account of questions that a prescription alone cannot resolve.
Lived experience should inform care, including when it unsettles a familiar explanation. Inviting patients to speak has little value if their contribution can only confirm what has already been decided.
Overdiagnosed compared with whom?
Overdiagnosis deserves investigation. So do misdiagnosis, poor assessment and treatment that does not help. A late diagnosis does not make a person exempt from careful evaluation.
But an increase in diagnoses does not, by itself, establish overdiagnosis. And evidence has a scope. A prominent 2021 review found evidence of overdiagnosis and overtreatment in children and adolescents.[6] It was not a study of South Africans first diagnosed in their forties.
When that distinction disappears, a legitimate research question becomes a vague atmosphere of suspicion around anyone arriving late.
The adult who spent decades without an explanation is then asked to defend themselves against a debate that does not necessarily describe their situation. Somehow, the years without recognition become less relevant than the fact that recognition is now more common.
Overdiagnosis in one group and missed diagnosis in another can coexist. We need to identify the people, settings and assessment practices involved. Counting more diagnoses and declaring the matter settled tells us too little.
The psychiatrists who made room for me
I want to be clear about where this leaves me. Psychiatry helped me, and it continues to help me.
The psychiatrist in rehab listened closely enough to reach a diagnosis I had not known was possible. I credit his clinical judgement and his experience with people navigating addiction. He considered treatment in the context of the person before him.
My current psychiatrist still manages my care. She may not describe herself as an ADHD expert, but she listens and respects the knowledge I have built over the years. That knowledge is allowed to become part of our discussion. She brings her professional judgement; I bring the experience of living with the condition and the treatment.
I do not need her to agree with every interpretation I offer. I need room to explain it and for disagreement to engage with what I actually said.
These relationships are why I am unwilling to condemn the profession as a whole. They also give me a basis for expecting better. I know what it feels like when clinical expertise and lived experience are allowed to inform each other.
Being listened to is not a favour. It is part of the work.
What I want from this October
I want ADHD Awareness Month to ask what our awareness actually reaches.
Does it reach the quiet adult whose effort is largely invisible? Does it reach the person whose working life has been shaped around difficulties they never understood? Does it reach the clinician willing to examine a history that complicates the first impression?
For professionals, that means asking about the method as well as the result. It means looking at study habits, career adaptations and the cost of maintaining an appearance of coping. It means giving people room to examine the past without either dismissing their interpretation or making ADHD responsible for everything.
For South Africa, it means discussing access and uneven understanding alongside concerns about diagnostic accuracy. Awareness that cannot lead to an informed assessment or useful support leaves a rather large part of the job unfinished.
And for those of us diagnosed in our mid-forties, it means being allowed to explain what the delay has meant.
Some psychiatrists have already shown me what listening can make possible. This October, how do we make that experience less dependent on which door an adult happens to walk through?
Sources and evidence notes
Schoeman, R., & Liebenberg, R. (2017). The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder. South African Journal of Psychiatry. Used as a historical record of locally recognised assessment and access issues, not a claim about every current clinician or an up-to-date national prevalence estimate.
Pagespetit, È., et al. (2025). ADHD and Academic Performance in College Students: A Systematic Review. Journal of Attention Disorders. University findings do not retrospectively diagnose the author’s school experience. Publisher abstract and PubMed record consulted.
Kugler, M. (2025). Game changer ADHD diagnosis in adulthood: reflections on subjective career success, career crafting and career outcomes. Career Development International. Publisher abstract consulted; full text was not accessible. Fourteen employed adults interviewed. Accounts concern perceived influence and retrospective interpretation, not proof of individual causation.
McGill, L., Jardim-Lalor, I., & O’Connor, C. (2026). A Systematic Review of Lived Experiences of Receiving a Diagnosis of ADHD in Adulthood. Journal of Attention Disorders. Full supplied text consulted. Twenty-one studies; the evidence base is largely from high-income countries and overrepresents women.
Crunelle, C. L., et al. (2018). International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. European Addiction Research. Supports integrated treatment and individual assessment of stimulant risks and benefits; does not establish the appropriateness of an individual historical prescription or show that ADHD medication alone produces sobriety.
Kazda, L., et al. (2021). Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Network Open. Relevant counterevidence with explicit limits on population and transferability.
Young, S., et al. (2023). Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World Journal of Psychiatry. Supports medication consideration following individual risk assessment, generally with long-acting stimulant formulations. It postdates the reported encounter and is not used as proof of a historical breach of clinical standards.
DuPaul, G. J., et al. (2021). Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes. Journal of Clinical Child & Adolescent Psychology. Longitudinal US university evidence on grades, study strategies, executive functioning and support. Does not directly test the author’s account of learned reliance on crisis or teacher engagement; these are interpretive considerations, not demonstrated causal mechanisms.
