Quick summary: ADHD does not end at childhood, yet many Indonesians reach adulthood without a diagnosis because clinical teaching and some BPJS child development pathways still treat the condition as largely a paediatric issue. A 2020 survey of 1,536 people found poor to very poor ADHD knowledge in 60.4% of medical students, 54.9% of general practitioners, 65.6% of paediatricians and 52.1% of psychologists, while one publicly funded growth and development therapy route stops at age 14. Stronger training, clearer adult assessment routes and earlier recognition would let people who were missed as children obtain an accurate diagnosis and practical support for work, relationships and mental health instead of being mislabelled or left without care.

When people talk about ADHD, the image that often comes to mind is a child. A child who cannot sit still, constantly interrupts or struggles to pay attention in class. But what happens when that child grows up?

ADHD is a neurodevelopmental condition that is usually first diagnosed during childhood, but it can continue into adulthood. Indonesia’s Ministry of Health explicitly acknowledges that some adults have ADHD without ever having been diagnosed, and that symptoms can affect work, home life and relationships.

So ADHD does not come with an expiration date. What can change is how it is recognised as someone gets older.

That raises a question I have started thinking about more seriously: What happens to Indonesians with ADHD after they grow out of the childhood healthcare system? More importantly, what happens to the people who were never recognised as children in the first place?

I was a medical student who didn’t recognise herself

I am a medical graduate, and I learned about ADHD during medical school. I knew that it was a neurodevelopmental condition, and I knew about attention difficulties, hyperactivity and impulsivity. Looking back, though, my understanding of adult ADHD was limited.

I later came across a discussion by an Indonesian psychiatrist that put this gap into words I recognised immediately.

English translation: Psychiatrists working with BPJS may not necessarily understand adult ADHD because those who understand it are still very limited, partly because it is not widely taught in medical education.

I came across this post while researching adult ADHD in Indonesia, and its message immediately resonated with my own experience. What caught my attention even more was her recommendation of Dr Dharmawan Ardi Purnama, who has also spoken publicly about his own experience with ADHD.

Dr Purnama is a psychiatrist who has experienced ADHD since childhood. His personal experience motivated him to pursue psychiatry more deeply, and he has since become a prominent voice in educating the public about ADHD in both children and adults.

In some ways, his journey feels familiar to me. Like him, I am someone with ADHD who wants to understand the condition more deeply, not only to make sense of my own experience, but also to use what I learn to help others.

What I find especially inspiring is that his journey did not stop with understanding his own diagnosis. He went deeper, learning about ADHD through professional training, clinical work and continued study, and then using that knowledge to help other people understand the condition.

As someone with ADHD myself, that means something to me. There is something deeply meaningful about seeing someone who once had to understand their own mind becoming someone who helps others understand theirs.

In a way, it feels like one person with ADHD helping another. We learn more about ourselves, we dig deeper into the condition, and then we use what we learn to make the path a little easier for the people who come after us.

That is the kind of expertise I hope becomes more accessible in Indonesia, not because every clinician needs to specialise in ADHD, but because adults seeking assessment deserve access to professionals who understand how the condition can present across the lifespan.

I don’t want ADHD to become something I merely learn to live with. I want to understand it better, contribute to better recognition, and eventually use what I learn to help others do the same.

I did not recognise myself in what I had learned about ADHD, and I was not diagnosed as a child. Instead, I grew up hearing that I was careless, forgetful, disorganised, too sensitive and sometimes simply difficult.

It was only years later, when I started reading more about ADHD myself, that something clicked. The problems with time, the disorganisation, the difficulty starting tasks that did not interest me, the impulsivity and the way my thoughts seemed to move faster than I could express them all began to look different. The things I had spent years interpreting as personal flaws suddenly seemed to have another possible explanation.

Eventually, I sought a professional assessment and was diagnosed with ADHD as an adult.

Across those experiences, I noticed something that stayed with me. One psychiatrist told me that if these difficulties were occurring in adulthood, they were no longer ADHD and were instead indicative of bipolar disorder.

I found this difficult to reconcile with what I had learned about ADHD and, more importantly, with my own experience. ADHD does not simply cease to be ADHD when someone reaches adulthood. Adult ADHD is recognised as a clinical condition, and assessment of adults who were not diagnosed during childhood is specifically addressed in clinical guidelines.

Bipolar disorder is also a distinct condition. While some symptoms can overlap with ADHD, distinguishing between them requires a proper clinical assessment rather than assuming that ADHD symptoms in an adult must represent bipolar disorder.

My ADHD did not simply become something else because I became an adult.

That made me wonder whether some of the way adult ADHD is understood in Indonesia may still be influenced by an overly childhood-focused view of the condition. If I could go through medical school and still fail to recognise ADHD in myself, how many other Indonesians are reaching adulthood without recognising it either?

The problem is not that doctors don’t know ADHD

I want to be careful here. This is not an argument that Indonesian doctors are incompetent. Medicine is enormous. Medical students cannot learn every condition in equal depth, and clinical practice requires constant learning long after graduation.

But there is a difference between knowing that ADHD exists and understanding how ADHD can present, persist and be assessed in adulthood.

There is evidence that this knowledge gap deserves attention. A 2020 Indonesian study surveyed 1,536 community members and healthcare-related groups, including medical students, general practitioners, paediatricians and psychologists. The researchers found poor-to-very-poor ADHD knowledge among substantial proportions of every group studied: 60.4% of medical students, 54.9% of general practitioners, 65.6% of paediatricians and 52.1% of psychologists. The researchers concluded that further ADHD education should be considered through formal education and other educational channels.

These findings do not mean that Indonesian healthcare professionals know nothing about ADHD. They do suggest something more specific: there is room for better ADHD education.

And when we talk about adult ADHD, that gap matters.

When you finally ask for help

I experienced this personally.

After receiving my ADHD diagnosis, I later moved to another city. I eventually needed documentation confirming my diagnosis for a specific purpose, but I could not simply return to the clinician who had originally assessed me. So I sought another assessment.

I expected to continue from where I had left off. Instead, I felt as though I had to prove the diagnosis all over again.

The doctor questioned whether I had ADHD and asked my mother about my childhood. At one point, I was reminded that ADHD is a neurodevelopmental condition and does not simply appear for the first time in adulthood.

That statement is correct, but there is an important distinction: Not being diagnosed as a child is not the same as not having ADHD as a child.

Adult ADHD assessment specifically has to consider childhood history because the condition is developmental. An adult who was never diagnosed as a child can still be assessed when there is evidence that relevant symptoms began in childhood, persisted and cause significant impairment.

That distinction matters enormously for people like me because some of us were not missed because ADHD was absent. We were missed because nobody recognised it.

“Stop Watching TikTok”

There was another part of that experience that stayed with me.

I was told to stop relying on Instagram and TikTok for information about ADHD and instead look at the page of Dr Dharmawan, a psychiatrist whose work on adult ADHD had also been recommended by the psychologist in the Threads post I had come across.

I understood the concern. Social media is not a diagnostic tool. Watching a video and recognising yourself in a list of ADHD symptoms does not establish that you have ADHD. Indonesia’s Ministry of Health also emphasises that there is no single test that establishes an ADHD diagnosis and that other conditions can produce similar symptoms.

But I wasn’t trying to diagnose myself. I was trying to get assessed.

That made me think about something else. What if social media is not where the problem begins? What if, for some people, it is simply the first place they encounter information that finally gives them a reason to seek professional help?

There is a difference between self-diagnosis and self-recognition. Self-diagnosis says: “I watched this video, therefore I have ADHD.”  Self-recognition says: “I have experienced these difficulties for years. Could this be something I should discuss with a professional?”

The second question should not be discouraged. It should lead to a proper assessment.

So why does 14 matter?

This is where the title of this article comes from.

In Indonesia, 14 is an important age in the pathway for certain child developmental therapy services covered by BPJS Kesehatan. Information about BPJS-covered terapi tumbuh kembang anak (child growth and development therapy) describes an age limit of 14 for children receiving these services. Recent reporting from the Temanggung local government has also described the BPJS developmental-therapy pathway for children with special needs as having a maximum age of 14.

That does not mean that ADHD itself suddenly ends at 14, or that adults with ADHD cannot receive healthcare through BPJS. It means that one particular child-development therapy pathway has an age boundary.

And that made me wonder about what happens beyond it.

A child who has already been recognised and supported for ADHD eventually becomes an adolescent and then an adult. Their needs change, and so does their environment. School becomes university; university becomes employment. Parents become less involved in their daily lives, while responsibilities increase.

For someone who was diagnosed during childhood, there should be a clear transition into appropriate care as they grow older. But what about someone who was never diagnosed as a child?

What happens when they reach adulthood and only then begin to realise that the difficulties they have experienced for years might have an explanation?

That question matters because ADHD can continue into adulthood. Adult ADHD is associated with difficulties that can affect multiple areas of life, while Indonesian Ministry of Health information also recognises that some adults have ADHD without having been diagnosed during childhood.

So perhaps the question is not simply, “What happens after 14?” It is whether we have a clear enough pathway for people with ADHD as they grow up, and for those who were missed when they were children.

If I was missed, who else is being missed?

I was not diagnosed as a child. I was eventually able to recognise the possibility of ADHD and seek professional assessment, but that happened years later.

That makes me wonder how many other Indonesians are reaching adulthood without ever having the opportunity to ask the same question.

If ADHD education among healthcare professionals can still leave room for improvement, then improving recognition cannot depend only on individuals discovering information for themselves. Parents, teachers and healthcare professionals all have a role in recognising persistent difficulties and knowing when further assessment may be appropriate.

The goal is not to diagnose everyone. It is to make sure that people who genuinely need assessment are not missed simply because they were never recognised when they were younger.

Noorharsy Taqillah is a medical graduate from Indonesia preparing for a Master of Public Health in Japan, with interests in mental health and neurodevelopmental conditions. Through her writing she aims to make health and psychology topics more accessible while sharing personal experiences.