Adult ADHD Diagnosis: When to Seek Help and What to Expect

Adult ADHD doesn’t always look the way one might expect. In adults that have gone undiagnosed for years, the signs can be subtle. But – with impacts ranging from creating a sense of persistent overwhelm to constant emotional exhaustion – undiagnosed ADHD can shape someone’s work, relationships, and sense of self.

So this month, we spoke with Dr. Francesca Vella, one of our esteemed Consultant Psychiatrists, to explore these nuances. With over a decade of experience supporting adults with complex mental health and neurodevelopmental conditions, Dr. Vella shares her insights on ADHD diagnosis in adults, including what to look out for, how the process works, and why cultural context and compassionate care matter.

What are some of the lesser-known signs of ADHD in adults, particularly in people whose difficulties are often overlooked or misattributed?

“Adult ADHD often presents in ways that can be missed or misunderstood. It might look like chronic burnout, emotional volatility, low self-esteem, feeling constantly overstretched, as well as rejection sensitivity and impulsivity which are both also common. These features can be misattributed to other mental health challenges rather than recognised as manifestations of underlying attentional and executive-functioning challenges associated with ADHD.

Adults with ADHD frequently invest considerable cognitive and emotional effort to meet everyday demands and maintain performance. Over time, this can lead to exhaustion, frustration or diminished self-esteem, particularly when their struggles are misunderstood or invalidated.

Understanding these patterns through the lens of neurodiversity can be profoundly validating. It can open the door to more appropriate support and self-understanding.”

When should someone consider seeking a formal ADHD diagnosis – and what does that process involve?

“It may be time to seek a formal ADHD assessment when attention, motivation, or organisation difficulties begin to cause consistent challenges in daily life. For example, in academic or professional performance, finances, relationships, or emotional wellbeing.

A comprehensive assessment is usually led by an experienced Consultant Psychiatrist and involves:

• A detailed conversation with the client exploring both current and past symptoms.
• Collateral information from someone who knew the individual before the age of 12 – such as a parent, sibling, carer or long-term friend to establish early developmental patterns.
• The use of structured diagnostic tools as well as review of any relevant school or educational reports if available

Because ADHD is a neurodevelopmental condition, understanding how symptoms have evolved across a person’s life is key to reaching an accurate and meaningful diagnosis.

Once identified, ongoing management should take a whole-person approach; combining psychoeducation, behavioural or coaching strategies, practical adjustments at work or home to improve quality of life, and medication were appropriate.”

How do ADHD and burnout interact – and why might neurodivergent adults be more vulnerable to burnout symptoms?

“ADHD and burnout frequently overlap, particularly in high-performing executives that have spent years working harder than most to stay organised, focused, and emotionally regulated. This can gradually deplete energy reserves and lead to emotional and physical exhaustion.

Many neurodivergent adults also experience heightened sensitivity, both emotional and sensory. This can add further strain to already busy lives. An overactive mind that struggles to “switch off,” combined with disrupted sleep, can result in chronic fatigue and difficulties sustaining motivation.

Over time, this persistent state of overdrive can contribute to burnout, emotional dysregulation, and feelings of inadequacy or self-criticism. Recognising this pattern early is important, as the right support can make a really profound difference.”

You’ve led a trial using TMS for OCD – could neuromodulation have a future role in ADHD symptom management too?

“While Transcranial Magnetic Stimulation (TMS) is not currently licensed or recommended for the treatment of ADHD, research is beginning to explore its potential benefits for attention, impulse control, and sleep regulation.

Since ADHD involves altered activity in fronto-striatal brain networks, modulating these circuits through neuromodulation may one day hold therapeutic value. But for now, TMS use in ADHD remains an emerging and experimental area, best considered as an adjunct in carefully selected individuals – particularly those also managing conditions like depression or OCD, for which TMS is already well-established.”

Why is culturally responsive psychiatric care so important in ADHD diagnosis and treatment?

“Culture shapes how people experience, express, and understand their symptoms. The same behaviours that might be recognised as inattentive or impulsive in one setting could be viewed very differently in another.

Being culturally attuned allows clinicians to approach each assessment with genuine curiosity and sensitivity, ensuring symptoms are neither overlooked nor misinterpreted.

Culturally responsive care is about both awareness as well as about seeing the individual in their full context; their upbringing, values, and lived experience. This approach helps foster trust, improves diagnostic accuracy, and allows treatment plans to feel both respectful and relevant, which is vital for long-term engagement and recovery.”

For many adults, seeking an ADHD diagnosis can feel daunting, particularly when their challenges have gone unrecognised for years. But with the right clinical guidance, that process can bring clarity, self-understanding, and a more compassionate path forward.

At Harbor London, our neurodiversity-informed approach ensures every assessment is thoughtful, culturally attuned, and clinically robust. Whether you’re seeking answers for yourself or supporting someone else, we’re here to help.

Contact us for a confidential consultation or learn more about our ADHD and neurodiversity services.