For as long as I can remember, my brain has always been fizzy, or ‘on’ in a way that never let up; thoughts, ideas and tasks all vying at once for attention in my cerebral cortex. Imagine having so many browser tabs open on your PC that you keep clicking on one, getting distracted by another, and then being so overwhelmed by failing to locate any information at all, you close down the entire system.

But it wasn’t until one day last year, aged 46, that I found myself, both literally and figuratively, on the floor. My system had crashed.

That was the first time the word neurodivergence entered my vocabulary, phrased carefully by my vigilant and wonderful GP. Exploring an assessment in the future could be helpful, she said, as women often become adept at masking those symptoms - until a time such as perimenopause, when it simply becomes too difficult.

She explained that for many women, ADHD can go unnoticed for decades.

We become experts at masking - compensating, over-preparing, pushing through — until a hormonal shift such as declining or fluctuating oestrogen simply makes the neurodivergence impossible to ignore.

Undiagnosed women like me can be high functioning and successful, but the internal toil comes at a severe cost to mental health.

However, as I discovered, attempting to obtain an ADHD assessment in Ireland is easier said than done. Despite the high number of adults with ADHD, it is estimated that only about 1 percent are formally diagnosed. Approximately 5 percent of the population in Ireland is estimated to have the developmental, long-term condition that affects executive function.

Ireland has taken steps forward to support to improve late ADHD diagnosis and support, moving from a position of almost no adult-specific public services to implementing a national clinical programmes introduced in 2022. But access remains a significant issue, as Ken Kilbride, CEO of ADHD Ireland, confirms.

Public waiting lists can stretch to years — in South Dublin alone, the waiting list is nearly four years.

‘About 50 percent of all new referrals into adult HSE mental health services are for ADHD assessment,’ he says. ‘The system is overwhelmed,’ he says, adding that the consequences are far-reaching.

‘We’ve a report from 2018 that estimates how the socio economic cost of undiagnosed adult ADHD in Ireland could be up to €1.8 billion, which includes lost income, reduced tax contributions and increased healthcare costs. And then consider that undiagnosed ADHD comes with higher rates of marital breakdown, higher rates of unemployment, higher rates of substance abuse, anxiety, depression.

‘If 50 percent of people were coming into an emergency department with a heart condition or something like cancer, they would get the services pretty quickly. Yet why aren’t we getting these for ADHD?’ he asks.

Faced with such long waiting lists and private assessments costing up to €2,000, I chose to be assessed via a different route: an online platform in the burgeoning private sector.

I went with Mindpath, who are an online mental health service accredited by the Psychological Society of Ireland and the UK Adult ADHD Network.

The process mainly consists of three steps – an ADHD pre assessment (€9.99), the ADHD assessment itself which involves a clinical evaluation with a psychologist and a 90 minute video call (€549) and a subsequent diagnostic report (€399).

Online assessments like these are becoming more common, though not without debate.

‘In an ideal world, in-person assessments are preferable,’ Kilbride notes.

‘Online, a clinician can only see from the waist up. I’m not a clinician, but the research says there’s much of a muchness – that when online assessment is done properly, it’s just as effective as in-person.’

The bigger issue, he says, is regulation within the private sector. ADHD Ireland as an advocacy and support non-profit, has a list of providers on its website. It does not vet those included in the directory and has no regulatory role, and the oversight of doctors rests with the Irish Medical Council.

‘There’s no ADHD-specific accreditation in Ireland,’ he explains.

‘GPs and psychiatrists need to be listed on the website of the Medical Council of Ireland with the psychiatrist hopefully having ADHD listed as a specialism. There isn’t an official register for Psychologists (Coru, the regulation body for health and social services, is working on it).

‘So we would look for a psychologists to be registered on the Psychology Society of Ireland website and senior enough to be a Chartered Psychologist.

‘So technically none of the companies are regulated also there is no official way to do an ADHD assessment, so means and standards can vary. What you are looking for is a good diagnosis and support.’

In my experience, the assessment process was comprehensive and my diagnosis confirmed what I had suspected. I do indeed have ADHD – the most common form: a combined presentation of inattentive and hyperactive- impulsive symptoms.

Still, having it confirmed felt surreal and strangely emotional, and I’ve now been sitting with my diagnosis for several months.

Processing it, it turns out, is part of the journey. ADHD Ireland even run a webinar on grieving your diagnosis, which says a lot.

‘There are generally two reactions to a late stage diagnosis,’ says Kilbride.

‘One is relief — ‘I’m not broken, there’s an explanation.’ The other is grief: ‘If I’d known earlier, my life might have been different,’’ he says, and I feel both — there’s validation in understanding why my brain works the way it does. But there’s also a quiet mourning- for that child who tried so hard to sit still, the teenager who always doubted herself and the adult who was tormented by such a harsh inner critic for years.

And as it’s thought that ADHD has a genetic component, I’m looking more closely at my own daughters who are aged 9 and 11. It’s deeply concerning that teachers in Ireland have no mandatory initial training in neurodivergence, despite its prevalence.

‘You’re going to have children with ADHD in every classroom,’ says Kilbride, adding that there’s a lot of ground to cover in Ireland when it comes to recognising ADHD in girls in our classrooms.

‘It takes four years training to be a teacher, and up until recently there’s been no basic training in this field — and one in 20 children have ADHD,’ he says, adding that ADHD Ireland have the ADHD Friendly School Programme — a nationwide initiative supporting primary and post-primary schools in creating inclusive environments where students with ADHD can thrive.

‘We will work with a couple of thousand teachers this year, we did a similar number last year. If there’s two teachers in Kerry interested in learning about this we will bring it to them,’ he says.

Treatment typically involves three pathways — medication,

psychotherapy and ADHD coaching. I am working with a psychotherapist on managing some of the emotional fallout of ADHD — I haven’t ventured the psychiatry route yet, but I have taken on board some practical recommendations, of more structured routines and low-clutter, low-distraction work environments.

A designated launch pad for my perpetually mislaid keys and phone; the pomodoro technique to help with focus and procrastination. But one factor underpins everything, as Ledion Musaj, Clinical psychologist and chief clinical officer at Mindpath, explains.

‘Self-awareness is the active ingredient that makes any treatment or any strategy really work,’ says Musaj.

‘Because many people have this idea that this is something which is not a disorder at all, and the diagnosis and breakdown of such offers a logical consistency, in terms of ADHD, how you understand your symptoms and how you understand yourself.

‘So this is mostly a journey towards self understanding — that this is true, and this is something that you have had most of your life. And then there’s an optimal moment to make productive changes.’

This diagnosis hasn’t fixed things overnight. My brain is still fizzy. My house is still chaotic. I’ve been so busy I’ve just about properly read my 54-page report — which given the diagnosis, also makes sense. I still find myself wondering: had I known my brain was wired in a different way, and been supported in that knowledge at an earlier age, what would my life look life today? Would I have made different decisions, chosen another career? Would I inherently be the same person, or would nurturing or treating my impaired executive function from childhood constitute a dramatically altered existence?

I don’t know the answers. What I do know is this — gaining insight into why my brain works the way it does - even in later life - is better than never understanding it at all.

For advice see adhdireland.ie and mindpath.ie