Can You Be Undiagnosed With ADHD?

A Forbes Article written by Dr. Nancy Doyle

Research from Sweden has indicated that there is a rising number of adults coming forward for psychiatric reassessment asking to be undiagnosed with ADHD. Given the furore concerning perceptions of over diagnosis, this small but growing number of referrals is of interest. What might be driving it? From a work and careers perspective, there are three important factors to consider.

It’s been about six or seven years since the neurodiversity revolution took hold in workplaces. Starting with tech companies driving Autism at Work programs, and swiftly moving to incorporate ADHD, awareness of neurodivergence has never been higher. However, this has not translated into acceptance, and stigma persists. Awareness can lead to stereotypes, and some ADHDers don’t want to be associated with negative traits such as poor time management or emotional dysregulation. They may feel they have moved on and progressed with their self-development. The cost / benefit ratio of the diagnosis protection versus the vulnerability of disclosure no longer stacks up.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), version five, indicates that for ADHD to be diagnosed, a person should be experiencing significant difficulties in more than one context. This includes education, social life and work. So, context is vital for diagnosis, and some contexts suit ADHDers more than others. For example, what we call ‘distractibility’ in an open plan office is known as ‘ground force awareness’ in military patrols, which rely on high levels of alertness and being attentive to every small noise as a potential danger. The question of whether the ADHD neurotype is only clinically significant in conflicting contexts has not been adequately answered by science. Someone who struggled in school, in their personal life, but then ‘found their niche’ and began to thrive might seek to be undiagnosed as their career progresses. However, they might find a move into desk-based senior roles causes a relapse in struggles.

n recent years, the DSM has gone from prohibiting the diagnosis of ADHD and Autism in the same person, to understanding that the two often co-exist. Indeed, Neuroscientists at Cambridge have found that we cannot tell the difference between neurodivergent brains through imaging. An autistic, dyslexic, ADHD, dyspraxic brain share more characteristics than that which defines them. ADHD is a diagnosis of exclusion, we have to examine complex, adaptive behaviour and then rule out all other possible causes – thyroid disorders, trauma and brain injury, perimenopause, long covid other psychiatric conditions such as Bipolar disorder – all of which might also co-exist. It is complex and requires professional history taking.

Current protocols taking 1 hour online are woefully inadequate for this task. Symptoms are very real, but the causes are many and it is easy to see how the wrong decision could be made. An undiagnosis might actually be a full diagnosis of something else, after new symptoms come to light.

Employers can take a short cut through all this complexity by focusing on everyday, functional performance and addressing it in context, rather than worrying about the accuracy or history of diagnoses. For example, if you have an employee who is highly responsive and engaging, but lacks time management discipline, help them to achieve it. If you have an employee who is creative and strong at analytics but struggles to emotionally self-regulate, support them to learn. These difficulties have been the topic of neurodiversity coaching for decades, and coaching is the only adjustment which has scientific evidence supporting its benefits over time. Coaching, skills workshops, online personal development programs can all be signposted and encouraged as neuroinclusive activities, but critically they will also support people in perimenopause, with long covid and thyroid issues etc.

Focusing on the performance need, not the diagnosis, bypasses the stigma and gets to the root of career success. The neurodiversity movement was about talent, ambition, and allowing neurodivergent people to fulfil their potential. Diagnosed or undiagnosed, disclosure or not, progression was the goal, so facilitating activities which lead to personal growth will always be the right answer.