Adult ADHD is the second most common psychiatric diagnosis in the United States. It has been for decades.
And yet the majority of adults who have it are not being treated. Clinicians who see it walk through their doors every week were never trained to recognize it. The professionals most affected by it are the least likely to seek help — because on paper, everything looks fine.
I sat down with Dr. Russell Ramsay , psychologist, researcher, and author of six books on ADHD — including his newest, Once I Get Started — for a candid conversation about where we are, why we’re still here, and what it’s going to take to actually move the needle. This one was different from the other conversations I’ve had in this series. Two clinicians, decades of combined experience, comparing notes on a field that has frustrated both of us for a long time.
Why are we still writing books about adult ADHD?
It’s a fair question. Dr. Ramsay has written six of them. This is my first on ADHD. And both of us arrived at the same answer independently: because the misinformation hasn’t gotten better. If anything, in the age of TikTok and viral health content, it may have gotten worse.
Dr. Ramsay’s motivation was feeling a duty — his word — to put something accurate and clinically grounded into the world at a moment when ADHD is finally getting significant attention, with new clinical guidelines forthcoming from the American Professional Society of ADHD and Related Disorders. His hope, and mine, is that 2026 and 2027 become the years when the field actually gets on the same page.
My motivation was watching professionals suffer quietly for years. People I genuinely respect — physicians, attorneys, executives — who had been told by equally respected colleagues that they couldn’t possibly have adult ADHD. Who had years of misdiagnosis behind them, or no diagnosis at all. Who felt they couldn’t say anything about their struggles because from the outside, everything looked fine.
That gap between the surface and what’s actually happening underneath — that’s what compelled me to write this book.
The training problem is more serious than most people realize.
Here’s something that doesn’t get said directly enough: most clinicians were never trained to work with adult ADHD. Dr. Ramsay wasn’t. I received roughly one hour of coverage in my residency. Family physicians, psychologists, therapists — the same story, across the board.
And yet adult ADHD is the second most common psychiatric diagnosis in the country. If diabetes were number two and medical schools weren’t covering it, we’d consider that a crisis.
The downstream effect of this training gap is that professionals with ADHD walk into appointments with clinicians who respect them, trust them, and genuinely want to help — and still walk out with the wrong answer. Because the clinician simply doesn’t have the framework to see what’s actually there.
Dr. Ramsay made a point that has stayed with me: some people with ADHD are working twice as hard for half as much just to keep up. They don’t have spare hours to pursue an evaluation. They’re using every available evening and weekend to tread water. The idea of adding an assessment process on top of that feels impossible — which means the people who need support most are often the least positioned to go get it.
What a good diagnostic evaluation actually looks like.
The clinical standard for an ADHD diagnosis is a thorough psychiatric or psychological interview — assessing for symptoms both in the current period and in childhood, because adult ADHD requires childhood onset by definition. This gets augmented by self-report and observer-report measures, because how someone experiences themselves and how the people around them experience them often tells different stories.
Crucially, a good evaluation isn’t just looking for ADHD. It’s actively ruling out other explanations — depression, anxiety, sleep disorders — and understanding what’s actually driving the presentation. ADHD rarely travels alone, and the treatment picture changes depending on what’s accompanying it.
From there, executive function rating scales add nuance that the DSM criteria alone don’t capture. And where available, computerized attention testing can provide an objective data point in a field that has very few of them. As Dr. Ramsay put it, there’s something elegantly simple about sitting in front of a screen for twenty minutes doing one task and seeing what happens. Those twenty minutes, he noted, are genuinely hard — which is itself informative.
Self-mistrust is not a personality trait. It’s a symptom.
This was the thread I found most clinically important in our conversation. Dr. Ramsay has written about self-mistrust as a central belief pattern in adults with ADHD — and it shows up constantly in my practice too.
By age 10, children with ADHD have received roughly 20,000 more negative messages about themselves than their neurotypical peers. That accumulation doesn’t disappear at adulthood. It becomes the inner voice that says: even if I understand what’s happening now, I probably won’t be able to do anything about it. It worked for my kid — but will it work for me?
That doubt is one of the primary reasons parents of newly diagnosed children hesitate to pursue their own evaluations. They’ll spend any amount of time and money getting their child what they need. Getting themselves what they need feels different — less justified, more selfish, somehow less urgent.
Dr. Ramsay’s response to that, and mine, is the same: understanding how your own brain works is one of the highest-return investments you can make — not just for yourself, but for the people around you. The partner. The kids. The team. The quality of presence you can offer when you’re not constantly running on fumes.
The cognitive load of living with unaddressed ADHD.
There’s emerging research now on the fatigue burden of ADHD — the cumulative cost of a brain that is working harder than it needs to in order to reach the same destination. Dr. Ramsay used an analogy I found useful: imagine you need to cross Market Street in Philadelphia. You can take the direct route. Or you can take three right turns, hit more lights, and arrive late. ADHD brains are often taking three right turns — getting there, but at a cost that adds up over decades.
That cost shows up in health. In preventative care appointments missed. In prescriptions not completed. In the quiet erosion of relationships with people who can’t quite articulate why they feel like they’re never getting someone’s full attention.
This is why getting an evaluation — even if you never want to take medication — matters. Because understanding the route your brain is taking is the first step toward finding a more efficient one.
If this conversation resonates — if you’re a professional who has wondered whether there’s something more going on, or a clinician who wants to understand this population better — my book ADHD in Professionals: Embrace Your Brain goes deep on exactly this territory.
Order your copy here: https://www.amazon.com/ADHD-Professionals-Embracing-Your-Brain/dp/B0GZVBDQQH/
📌 Dr. Russell Ramsay’s new book, Once I Get Started: https://www.amazon.com/Once-Get-Started-Program-Intentions/dp/B0FN3M5JVF
📌 CBT for ADHD: cbtforadhd.com
📌 American Professional Society of ADHD and Related Disorders (APSARD): https://apsard.org/
📌 ADHD Self-Report Scale (ASRS screener): https://novopsych.com/assessments/diagnosis/adult-adhd-self-report-scale-asrs/
📌 Constellation PLLC: constellationpllc.com
Are you a clinician who feels undertrained in adult ADHD — or a professional who has experienced the gap firsthand? I’d love to hear your perspective in the comments.
Dr. Jennie Byrne, MD, PhD is a neuroscientist, psychiatrist, and author whose work explores human behavior, mental health, and ADHD in high-achieving adults. In her latest book, “ADHD in Professionals: Embracing Your Brain,” she offers an honest, empowering look at how ADHD shows up in physicians, executives, entrepreneurs, and other professionals—and how they can better understand and work with their brains.
A board-certified psychiatrist with an MD/PhD in neuroscience, Dr. Byrne has built her career at the intersection of clinical care, leadership, and innovation. She is known for her clear, pragmatic voice on topics including ADHD, burnout, stigma, and the future of mental health care.
Dr. Byrne is also a sought-after speaker and thought leader committed to helping professionals navigate mental health with insight, candor, and compassion. Learn more at www.constellationpllc.com.