09Apr
Illustrative of this trend are findings from a 2019 study that documented a substantial 123 percent escalation in diagnoses of ADHD among adults over a ten-year period. Similarly, another investigation, examining a cohort of 400,000 adults, revealed that the prevalence of autism more than doubled between the years 2011 and 2019.
Furthermore, emerging evidence suggests that the unprecedented circumstances of the global pandemic may have served as a significant catalyst, prompting many adults to finally seek formal diagnostic evaluations. This is supported by the observation of a considerable increase in prescriptions for ADHD medications between 2018 and 2022, a rise particularly prominent among women and adults in the 20 to 39 age bracket.While it is acknowledged that certain enduring mental health conditions, such as bipolar disorder, may indeed not fully manifest until adulthood, the characteristic symptoms of neurodevelopmental conditions like autism and ADHD typically emerge during childhood.
In fact, the widely recognized Diagnostic and Statistical Manual of Mental Disorders (DSM) stipulates that a diagnosis should ideally only be conferred if the relevant symptoms were present within the first decade or so of an individual's life. Despite this criterion, a significant number of adults, even those who, upon reflection, recognize clear indicators of these conditions in their childhood experiences, did not have the possibility of autism or ADHD raised until well beyond their adolescent years.
This raises a critical question: why were their early symptoms often overlooked, minimized in their significance, or simply ignored by those around them?According to Scott Shapiro, a New York City-based psychiatrist specializing in adult ADHD, Cognitive Behavioral Therapy (CBT), and productivity coaching, the transition into the responsibilities and demands of adulthood often acts as the crucial turning point, transforming previously manageable symptoms into challenges that become genuinely overwhelming.
The inherent structure and supportive frameworks typically provided by parents and educators during childhood and adolescence can effectively mitigate or even entirely obscure a child’s academic or social difficulties, frequently extending throughout their high school years.It is important to recognize that symptoms may not only become more apparent with the passage of time but can also, in some instances, actually intensify. For example, initial episodes of bipolar disorder tend to be less severe and more responsive to therapeutic interventions compared to subsequent episodes.
Consequently, if manic episodes occurring in adolescence or young adulthood go untreated, there is a heightened likelihood that later episodes will prove considerably more challenging to manage. This escalating nature of increasingly destructive bipolar symptoms can therefore present a double-edged sword: while these intensifying symptoms can inflict significant disruption on an individual’s life, their very escalation may ultimately be the factor that leads to a life-altering diagnosis.
For women, who are statistically more likely than men to receive a diagnosis of a neurodevelopmental disorder later in life, gender likely plays a significant and multifaceted role. Both autism and ADHD have historically been stereotyped as conditions primarily affecting boys. Statistical data from the Centers for Disease Control and Prevention (CDC) indicates that autism is nearly four times more commonly diagnosed in boys than in girls, and ADHD is nearly twice as common.
This disparity can be partly attributed to the fact that early research on these conditions predominantly focused on male populations, and their symptoms subsequently shaped the prevailing conceptualizations and understanding of these disorders.This issue is not solely a matter of ingrained bias but also one of symptom visibility.
The symptoms that are indeed more frequently observed in boys—such as hyperactivity in ADHD and intense, narrowly focused interests in autism—also tend to be the most readily noticeable by adults in their environment. In contrast, girls often present with more subtle, internalizing symptoms, such as inattentiveness and distractibility in ADHD. Autistic girls, in particular, are more inclined to engage in “masking,” employing compensatory strategies consciously or unconsciously aimed at helping them appear neurotypical. These factors can collectively contribute to their symptoms being more easily missed or dismissed as insignificant.
While feelings of inadequacy are not universally experienced by individuals diagnosed later in life, they are far from uncommon. A research review published in the Journal of Attention Disorders found that women with undiagnosed ADHD reported lower levels of self-esteem and self-efficacy compared to their non-ADHD peers. Conversely, a study in the journal Autism indicated that individuals who received an autism diagnosis during childhood reported higher levels of self-esteem than those diagnosed as adults. Furthermore, significant fluctuations in self-esteem are frequently observed in individuals with untreated bipolar disorder, with self-worth typically reaching its nadir during depressive episodes.
This underlying lack of self-worth, which may originate in childhood but persist well into adulthood, can manifest in ways that, to an external observer, closely resemble symptoms of depression or anxiety. Indeed, J. Russell Ramsay, a clinical psychologist and co-founder of the Adult ADHD Treatment and Research Program at the University of Pennsylvania, notes that it is exceedingly common for adults to initially receive a diagnosis of depression or anxiety before the underlying ADHD, autism, or bipolar disorder is identified. Ramsay emphasizes that these initial diagnoses are not necessarily incorrect. While genuine misdiagnoses can certainly occur, it is also possible for multiple conditions to coexist in an individual.
However, individuals diagnosed later in life often find that the labels of “depression” or “anxiety,” while perhaps partially accurate, provide an incomplete picture of their experiences. Even if mood-related symptoms experience some degree of remission, a significant underlying cause—frequently the feelings of inadequacy and chronic stress stemming from the still-undiagnosed neurodevelopmental disorder—remains obscured and unaddressed.
Consequently, without a clear and conclusive explanation for why so many aspects of daily life feel so inherently challenging, some adults with undiagnosed ADHD, autism, or bipolar disorder may internalize their struggles, leading to cycles of self-criticism and profound shame. Jaynes, a journalist, recounts her experience: “I felt that if I just beat myself up more and more, then I wouldn’t lose valuable things, or be late, or screw something else up.” This pervasive feeling of inadequacy often led her to decline job opportunities she genuinely desired, convinced that she could never work efficiently enough to achieve success.
Research indicates that the majority of newly diagnosed adults share a significant sense of recognition, gratitude for understanding their lifelong struggles, and a profound feeling of relief, at least to some extent. However, feelings of frustration, disappointment at years of misunderstanding, anger at missed opportunities, or sadness for past difficulties may not be far behind. Across several studies specifically examining late diagnoses of autism and ADHD, between 30 and 50 percent of participants reported experiencing negative emotional responses, including regret for lost time and potential, which often occurred concurrently with more positive initial reactions to their diagnosis.
The process of adjusting to a late diagnosis, much like any form of unlearning deeply ingrained patterns, requires time, patience, and self-compassion. However, many late-diagnosed individuals, particularly those who actively engage in therapy or other evidence-based treatment approaches, report that progress in understanding themselves and managing their challenges occurs more quickly than they initially anticipated. The degree to which a diagnosis becomes integrated into one’s sense of identity is also a dynamic process that may naturally evolve over time.
Some individuals who receive a late diagnosis have found that working with a therapist who also shares their diagnosis—an increasingly common practice for therapists to disclose—can be particularly valuable. This may be especially true in the context of autism, where shared lived experience can foster a deeper sense of understanding and validation.
Regardless of whether a therapist identifies as neurodiverse or neurotypical, effective therapeutic approaches for late-diagnosed adults should move beyond a deficit-based perspective. Instead, they should adopt a framework that both acknowledges the genuine challenges these individuals have faced and simultaneously celebrates their often-untapped strengths and unique perspectives. Think positive: “My ADHD brain? I love its creativity, its expansiveness. My autistic brain? I love how fascinated it becomes; it can get lost for hours in research, and it has an unquenchable thirst to understand and know things.”Ultimately, receiving a diagnosis can grant an individual the long-awaited permission to finally shed the masks they may have worn for years and embrace their authentic self. Bulluss poignantly reflects on this transformative impact: “Now, I can focus on making genuine connections with people who enjoy the same things I do, rather than trying to adhere to social expectations I didn’t understand. I can carve out a life that’s Erin-shaped, rather than try to fit a mold that’s not the same shape as me.”
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