I Got Trained in Identifying ADHD Without Realizing I Had It

A Psychologist’s Journey to an ADHD Diagnosis in Adulthood

A Psychologist’s Journey to an ADHD Diagnosis in Adulthood

Verywell / Madelyn Goodnight

My name is Amy, and I have a doctoral degree in clinical psychology. I specialize in diagnosing neurodivergence, including ADHD. I did an internship and postdoctoral residency during which I completed hundreds of psychological evaluations, and I have been independently licensed for more than five years. And yet, until about six weeks ago, I didn’t know that I had ADHD.

I have lived with anxiety for as long as I can remember. When I got to college, one of the first things I did was sign up for free therapy through the counseling center on campus, where a graduate student agreed that I was very anxious and exhibited some symptoms of depression. Because my grades were always good, my therapist thought I had high-functioning anxiety that, with support, I could channel into productivity.

Sure, I was a good student, but I panicked every time a professor handed me a syllabus because “It’s so much work!” and I could not conceptualize that it was actually manageable when you considered the length of a semester.

Yeah, I got good grades, but I spent hours staring at blank Word documents before I could bring myself to start a four-page paper that I could finish in a lunch break if I could just write.

And okay, I attended every class, but I almost never retained what the lecture was about. No wonder I was anxious! But I couldn’t have ADHD—I would spend an entire weekend working through weeks of readings and assignments, forgetting to eat lunch. People with ADHD can’t focus like that. Right?

While I was on internship for my doctorate (diagnosing children with ADHD and having no idea why I clicked with them so well or found them so relatable), I reached a point where my anxiety felt like too much. I talked to my primary doctor, who prescribed Sertraline. I knew it was working when I was pulled over a few weeks later because my tail light was out, and I didn’t cry. I definitely felt less anxious.

Yeah, I got good grades, but I spent hours staring at blank Word documents before I could bring myself to start a four-page paper that I could finish in a lunch break if I could just write.

And still, things fell through the cracks. I would completely forget appointments, bounce between tasks without actually finishing any of them, or lose track of time reading or researching and not realizing I had stayed up half of the night. If anything, I was less able to track how long things were taking me or remember little things throughout the day.

If my brain was a house, you can think of ADHD as a shaky foundation. Anxiety is a load-bearing support beam made from lead. Lead is toxic and makes the residents of the house sick in a visible way, so doctors will recommend taking down the lead beam without bothering to check whether that beam is actually holding the house up. We need to address the shaky foundation and put supports in place to make the lead beam unnecessary. No one realized that beam was what was holding me up, and no one was looking around to figure out where it came from.

Let’s go way back. As a child, I was awkward but book smart. I read all the time—I brought a book out to the playground and read through recess. My grades were good, and it was the '90s, so I think everyone assumed that meant I was neurotypical. I rarely got into any kind of trouble, and I had a sibling with more obvious needs. So, a kid with a high GPA who liked to read a lot hardly seemed like a problem.

I did well in school but always felt like I could do better if I just tried harder. My grades were As and Bs, with the occasional C (in my defense, chemistry is awful). Certain things just did not click, but I was technically an honors student, so what did I have to complain about?

I had a tendency to overload myself. In my junior year of high school, my parents had to tell me that I could only take four advanced placement classes. I signed up for AP U.S. History because a teacher said it was the most difficult course in the school. I had a different extracurricular every day of the week (sometimes two or three), including Saturdays.

If my brain was a house, you can think of ADHD as a shaky foundation.

Sometimes I would forget important things. More than once, I would complete an assignment and leave it at home on the day it was due. I always managed to pull something together at the last second, and friends would ask me how I did it. I never had an answer. My brain was in a constant state of chaos, but I looked like I had my s*** together. I was like a duck, looking calm on the surface but kicking like crazy under the water to keep everything going.

Since I was academically strong and involved in so many activities, I got into a good college, where I continued keeping myself busy. Once again, I spent a lot of time wondering why I couldn't just push myself a little farther and pull my grades from good to excellent. But again, who assumes a deficit when you maintain a 3.5 GPA? I got involved with research, teaching, and clinically-adjacent internships, so I was accepted into a doctoral program my senior year.

Graduate school was…well, does anyone really enjoy graduate school? The workload was intense, but I was used to constantly going at that point, and it is still how I function. I got good to great feedback from my practicum supervisors, but my professors thought I was too quiet in the classroom. I felt anxious speaking up because I was afraid my comments were not smart enough to share, or I would mention something we already covered, but I missed it. I found that bringing my laptop to class allowed me to divide my attention, which somehow caused me to retain more of the lectures.

When working with clients diagnosed with ADHD, I wondered about their symptoms. Didn't everyone have trouble paying attention? Didn't everyone forget important things sometimes? I remember telling a friend that, while I found many ADHD symptoms relatable, I doubted the diagnosis applied to me. After all, I was in a doctoral program surrounded by psychologists, and "If I had ADHD, wouldn't someone have mentioned it to me by now?"

I spent my internship and postdoc specializing in diagnosing children with learning disorders, autism, and ADHD. Again, I found some things relatable, but these kids struggled in school. Their grades suffered, and they acted out and disrupted their classes. That wasn't me. (They were also primarily boys, but my thoughts on how gender impacts one's ability to get diagnosed with ADHD are for another article.)

If I had ADHD, wouldn’t someone have mentioned it to me by now?

I got my license, moved to South Dakota, and found myself getting more and more referrals for ADHD evaluations because I happened to be good at them. It is a specialty that found me rather than something I consciously chose to pursue. Working with children, I spent a lot of my day doing play therapy, which involves a lot of movement. My days were broken up between therapy and assessment clients, and the constant novelty was great for my brain.

When psychologists diagnose neurodivergence, we are supposed to identify symptom onset in early childhood. This is because “neurodivergence” refers to brain differences that are present from birth. However, sometimes symptoms are not immediately obvious for a variety of reasons.

“Gifted” children are assumed to be “fine” because they get good grades and excel at school. Anxious children can mask their neurodivergent behaviors. And since diagnoses tend to rely on observable behaviors, inattentive children might not appear to be struggling in an obvious way.

We also learn that, although neurodivergence starts in childhood, it might not be apparent until demands exceed resources. In my practice, I noticed a spike in adult referrals for ADHD assessments starting around April of 2020, when lockdowns and working from home caused many who were previously compensating for their neurodivergence suddenly finding that their old coping skills no longer worked. In other words, COVID-19 was the demand that exceeded many people’s resources.

As my own demands exceeded my resources and I dealt with burnout, I found my clients’ stories more and more relatable. I finally decided to get tested.

“Gifted” children are assumed to be “fine” because they get good grades and excel at school. Anxious children can mask their neurodivergent behaviors. And since diagnoses tend to rely on observable behaviors, inattentive children might not appear to be struggling in an obvious way.

It can be challenging to find referrals for yourself when you are a psychologist. Our ethics code tells us to avoid dual relationships (having both a professional and personal relationship with the same person), and most of the resources for ADHD testing in my area are referral sources to my practice. I was able to find an appointment (the ethics code allows for some dual relationships in circumstances where the dual relationship will not impact the quality of care, and an alternative referral is not available).

I had to wait five months for my appointment, which is actually relatively quick compared to wait times in other parts of the country. After eight hours of testing, ruling out a hearing issue, talking extensively about my life and history, and having my husband share his perspective of my symptoms, it was confirmed: I have attention-deficit/hyperactivity disorder: combined presentation.

I am still figuring some things out, like whether I might have other diagnoses that previously flew under the radar because I am so “high functioning” and what medication might help me thrive. But knowing I have ADHD has allowed me to give myself grace when I forget what time a meeting is or realize I did not text someone back three days ago.

My story is, unfortunately, very common. Many women with ADHD are misdiagnosed or fly under the radar because the research often focuses on the presentations of boys and men. If you think you can tell who has ADHD at a glance, remember that I completed an entire doctorate in clinical psychology, had multiple supervisors who specialized in diagnosing and treating ADHD, and specialized in diagnosing ADHD for years, and no one noticed that I might be part of the population I was serving.

If you think you can tell who has ADHD at a glance, remember that I completed an entire doctorate in clinical psychology, had multiple supervisors who specialized in diagnosing and treating ADHD, and specialized in diagnosing ADHD for years, and no one noticed that I might be part of the population I was serving.

I am currently in the process of interviewing others like me who got diagnosed later in life because I want to write a book that can help undiagnosed neurodivergent folks identify themselves and seek support even if they are “high-functioning.” I hope my readers know they are not alone, and it is never too late to get to know yourself better.

By Amy Marschall, PsyD
Dr. Amy Marschall is a clinical psychologist who works with children and adolescents. She is certified in TF-CBT and telemental health.