ADHD Diagnosis

Dear Rachel, I recently watched a Four Corners episode on the rise of ADHD diagnoses in Australia and it named what I’d already been noticing — that it feels like everyone I know around the age of 35 and over has been diagnosed lately. The program showed how much the rates vary by postcode, with some inner-city pockets very high and other areas barely diagnosed at all. I don’t want to be dismissive, plenty of people struggled for years before they got answers. But part of me wonders why it’s suddenly everywhere. Are you seeing this in your clinic too? And how do I best support my many friends who now have ADHD?

Dear reader, this issue is certainly getting a lot of attention at the moment. As a health professional I am pleased and relieved to see more awareness of ADHD in girls and women. The Four Corners investigation drew on prescription-fill analysis from UNSW.

Australia has no national ADHD register. So this is a national conversation about a “rise”, built on a proxy measure rather than an actual headcount. The UNSW data shows part of the picture. Not all of it.

The ABS puts adult prevalence at 2.5 per cent. In parts of Fremantle, diagnosis rates among women under 44 have hit eight per cent. More than triple, in under six years. Marrickville and Brunswick look similar. Meanwhile, large parts of the country are what the program called “ADHD deserts”. Many adults who likely meet criteria have never been assessed. Postcode explains a lot of this. But it’s seems to be a story
about access and not true prevalence. Add national medication shortages between 2021 and 2026, which pushed prescribing toward Vyvanse just as it became PBS-listed for adults, and the picture gets messier.

None of that explains why it’s specifically your friends, in their mid-to-late thirties, being diagnosed now. That story is older and it’s backed by data. A 2023 Swedish registry study followed over 17,000 people with ADHD. Women were diagnosed nearly four years later than men – average age 23.5, versus 19.6 for men. This wasn’t because the women weren’t seeking help. Most had years of prior contact with mental health services before anyone considered ADHD.

Part of the reason: the diagnostic criteria were built on the characteristics most commonly associated with hyperactive boys. Research shows that disruptive behaviour is what gets a child referred for assessment. Girls and women present differently. They tend to be less disruptive and more inattentive. They may be highly sensitive and experience intense emotions which they don’t always express. There may be an internal restlessness that isn’t often obvious from the outside. So, they get missed.

What happens instead has a pattern too. A 2024 literature review in the Journal of Child Psychology and Psychiatry found girls with ADHD are frequently misdiagnosed with anxiety or depression first. The symptoms can look similar from the outside. They don’t respond to the same treatment. So the real diagnosis gets delayed further, and the delay itself carries a cost: research links it to worse mental health outcomes, higher rates of self-harm, and academic and relationship challenges that compound over years.

Then there are hormones. Estrogen regulates dopamine directly. So ADHD symptoms intensify, or finally become impossible to keep hidden, at five points: puberty, premenstrual, pregnancy, postpartum and perimenopause. For most women in their mid-to-late thirties, it’s the hormonal shifts of that decade, stacked on motherhood and peak career load, that finally exhaust years of masking and compensating.

This is the piece I speak about often: the challenges associated with ADHD aren’t fixed traits sitting inside a person. It’s what happens when a brain meets an environment that isn’t a good fit and wasn’t built to accommodate it. Many people spend years masking — consciously suppressing the traits that don’t fit, just to get by. Masking has a measurable cost to wellbeing. ADHD didn’t become more common. We just got
better with recognising it and diagnosing it in women.

How to support a friend who’s just been diagnosed:

• Replace open invitations with specific ones. “Let’s catch up soon” creates decision fatigue. Too many open variables. “Coff ee Thursday, 10am, on Smith Street” removes the friction before it starts.
• Send a day-of reminder. A short text an hour before can help for a person who can easily become distracted, experience time blindness or become overwhelmed.
• Ask once what helps. Then do it. Some people want reminders. Others find them stressful. Don’t guess. Ask, note it and try it.
• Don’t take last-minute cancellations personally. Time blindness and sensory overload are real and common in ADHD. A cancelled plan is often a nervous system protecting itself, not a comment on the friendship. Respond with “no worries, next time”. Avoid responding with silence or a guilt trip. Your friends need friends just like you who care enough to ask the questions you have asked.

This article is featured in WellBeing Magazine 224