I have had the same conversation dozens of times. A patient - usually in their 30s or 40s, often but not always a woman - comes in for something unrelated. And during the consultation, something they describe triggers a question I almost did not ask: had they ever been assessed for ADHD?
The response is almost always some version of: is that not for hyperactive boys who cannot sit still in class?
No. It is not.
ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental condition affecting approximately 3-4% of adults. It presents very differently in adults than in children. It presents very differently in women and girls than in men and boys. And it was dramatically underdiagnosed in African children who grew up in educational systems - both in Africa and in the UK - where children who struggled with attention and organisation were more likely to be labelled as lazy, unfocused, difficult, or not trying hard enough than to be referred for neurological assessment.
The consequence is a generation of African adults who have developed elaborate coping strategies for a brain that works differently, without ever knowing that what they were coping with had a name.
How adult ADHD looks different from the stereotype
The public image of ADHD - a disruptive seven-year-old boy running around the classroom unable to sit still - captures one presentation (ADHD-hyperactive/impulsive type in a child) and misses most others.
Adult ADHD commonly presents as:
Difficulty with task initiation: The inability to begin a task despite knowing exactly how to do it, wanting to do it, and understanding the consequences of not doing it. Not laziness - a genuine neurological difficulty with initiating action on tasks that are not intrinsically stimulating.
Hyperfocus versus complete inability to focus: ADHD is not about inability to focus on anything. It is about inability to regulate focus - to direct attention deliberately to things that are not intrinsically interesting. People with ADHD often hyperfocus intensely on topics that engage them, while finding it near-impossible to begin routine, uninteresting tasks. This paradox confuses people who think ADHD means inability to concentrate on anything.
Time blindness: A disproportionate difficulty perceiving and managing time. Consistently underestimating how long things take. Being late despite genuine intentions not to be. Losing track of time in the middle of tasks.
Working memory difficulties: Information entered into working memory does not stay there reliably. Forgetting what was said mid-sentence. Losing thoughts between thinking them and writing them down. Forgetting tasks that were not written down immediately.
Emotional dysregulation: Intense emotional responses, difficulty modulating emotional reactions, and particularly rejection sensitive dysphoria (RSD) - intense emotional pain in response to perceived criticism or rejection that can be out of proportion to the actual event. RSD is one of the most disabling features of adult ADHD and one of the least discussed.
Inattentive ADHD (the female presentation): Girls and women are significantly more likely than men to have predominantly inattentive ADHD - they are quieter, less disruptive, more likely to be daydreaming. They are dramatically less likely to be referred for assessment. They typically present with anxiety, depression, low self-esteem, and chronic exhaustion from masking (the effort of appearing to function normally).
Why African children were missed
In many African educational contexts, children were assessed on behaviour and results. A child who was well-behaved and bright but consistently underperforming, disorganised, or inattentive was almost certainly going to be told to try harder, study more, and focus. The framework of neurodevelopmental difference was not available.
Girls with inattentive ADHD were particularly invisible. They were not disruptive. They were often described as sweet but vague, or intelligent but not working to potential. In cultures where girls were expected to be obedient and compliant, the quiet girl who daydreamed was not creating a problem for anyone except herself.
The result: adults who grew up hearing they were bright but lazy. Who compensated through enormous effort and intelligence - sometimes reaching high levels of professional achievement - while experiencing privately the exhaustion of a brain working two or three times as hard as their peers to produce the same output.
Case study: Amara, understood at 36
Amara, 36, a solicitor from Ghana based in London, came to see me initially for anxiety and low mood. She described constant overwhelm, difficulty completing work despite very long hours, and a pervasive sense of falling behind.
As we talked, I was struck by how she described her work process. She could read the same paragraph 10 times before it would register. She would sit at her desk for three hours unable to begin a task she knew exactly how to do - then complete it in 45 minutes under deadline pressure. She had elaborate systems (multiple to-do lists, colour-coded calendars, alarms for every task) that took enormous cognitive energy to maintain and still sometimes failed.
She described starting several tasks simultaneously and completing none. Losing her keys, her phone, her train of thought, mid-conversation. Arriving at meetings to find she had forgotten critical information she had known the previous day.
She had never considered ADHD because she had a first-class degree and a successful career. She assumed ADHD meant not achieving.
A private ADHD assessment (NHS waiting times in her area exceeded 3 years; she paid approximately 800 pounds for private assessment) confirmed combined-type ADHD.
She began methylphenidate (Ritalin) at a low dose.
"The first morning I took it," she told me at her next appointment, "I sat at my desk, opened a document I had been avoiding for two weeks, and wrote for three hours without stopping. I cried. I literally cried. I had never known it could be like that. I thought everyone had to fight this hard."
She did not. She just never knew.
Getting diagnosed
NHS pathway: GP referral to adult ADHD service. Current waiting times range from 6 months (rare) to over 4 years (common in London and other major cities). The NHS Right to Choose scheme allows patients in England to access any NICE-approved ADHD service, not just their local one. Psychiatry-UK is a commonly used Right to Choose provider with shorter waiting times. Ask your GP specifically about Right to Choose.
Private assessment: Available within weeks to months. Typically costs 600-1,200 pounds for a full comprehensive assessment. A private diagnosis from a GMC-registered psychiatrist can be shared with your NHS GP for prescription management under a shared care agreement.
Medication: Stimulant medications (methylphenidate and lisdexamfetamine) are first-line and highly effective for ADHD. Non-stimulant alternatives (atomoxetine, guanfacine) exist for people who cannot tolerate stimulants. ADHD medication is not addictive when used as prescribed by someone with ADHD.
Beyond medication: ADHD coaching, CBT adapted for ADHD, and organisational strategies provide meaningful additional benefit alongside medication.
Sources: NICE Clinical Guideline NG87 - ADHD: Diagnosis and Management (2018, updated 2023); Young S et al, BMJ Open 2020 (ADHD presentation in women); Faraone SV et al, Nature Reviews Disease Primers 2021 (ADHD epidemiology and neurobiology); Kooij JJS et al, European Psychiatry 2019 (adult ADHD consensus statement); Barkley RA - Taking Charge of Adult ADHD 2010.
