Quick summary: Adult ADHD is easy to miss in Indonesia because clinicians draw on two diagnostic systems, ICD-10/PPDGJ-III and DSM-5, which differ on key points such as the age by which symptoms must first appear. Symptoms that overlap with anxiety, depression and other conditions raise the risk of misdiagnosis further, particularly for adults who were never assessed as children and who look nothing like the restless child of popular imagination. Better training, national guidance on adult assessment and more Indonesian research would make diagnoses more accurate, which matters for mental health, access to care and the design of health policy.
For years, an adult may have a perfectly ordinary explanation for why life seems harder for them than for everyone else. Maybe they are forgetful, or they always underestimate how long things will take. They may struggle to start tasks, lose the thread of conversations, misplace important things or feel swamped by responsibilities that other people seem to manage easily. Many spend years calling themselves lazy, careless, disorganised or undisciplined.
Then one day they hear about ADHD, and a question appears: could this explain me? Reaching that question is one thing. Getting a reliable answer is another, and for people who were never assessed as children, adult ADHD often goes unrecognised until much later in life.
In Indonesia, several things can make adult ADHD harder to spot: differences between diagnostic frameworks, symptoms that overlap with other conditions, and gaps in knowledge about how ADHD shows itself after childhood. I have written before about what happens to Indonesians with ADHD once they grow out of childhood services, and this piece picks up a related question. What happens when the person looking for an answer does not quite fit the picture of ADHD that the healthcare system expects to see?
ADHD does not end when childhood does
ADHD is a neurodevelopmental condition. It begins during development, but the way it shows itself can change as a person gets older. The image most people still carry is of a child who cannot sit still, interrupts constantly or struggles to pay attention in class. Adults can look very different. Instead of obvious hyperactivity, an adult may have trouble with organisation, time management, getting started on tasks, sustaining attention, impulsivity and executive functioning, or with keeping on top of responsibilities at work, at university, at home and in relationships.
A 2026 review, Adult ADHD: A Narrative Review of Symptoms, Assessment, and Intervention Strategies, describes ADHD as a condition that persists across the lifespan, even though its outward signs change with age. It also stresses the need to improve how adults are assessed, taking account of their symptoms and the effect those symptoms have on daily functioning.
That creates a real problem. If our mental picture of ADHD is still mainly a restless child in a classroom, an adult who is struggling quietly becomes much easier to overlook. Being missed in childhood does not necessarily mean ADHD was not there. Sometimes it simply means nobody recognised it.
One condition, more than one diagnostic framework
This is where things become more complicated. Mental health practice in Indonesia has long drawn on more than one classification system: the ICD-10, through its Indonesian adaptation PPDGJ-III, and the DSM-5. The two are not identical. An Indonesian review published in 2026 that compares them describes differences in how each conceptualises ADHD, in terminology and classification, in the minimum number of symptoms required, in the age by which symptoms must have begun, and in how far adult ADHD is specifically addressed. Under ICD-10 and PPDGJ-III, symptoms must appear before the age of six, whereas DSM-5 sets the cut-off at 12, and the authors conclude that DSM-5 gives a more comprehensive basis for diagnosing ADHD in adults.
None of this means Indonesian doctors simply pick whichever diagnosis they prefer. It does raise a fair question, though: how consistently are these frameworks applied when an adult comes forward with possible ADHD? For someone looking for an explanation of difficulties that have lasted for years, the technical differences stop being merely technical. They can shape how a clinician reads that person’s developmental history, and whether their symptoms seem to fit the diagnostic picture being considered.
When ADHD looks like something else
There is another problem, which is that ADHD does not exist in a diagnostic vacuum. Some symptoms of adult ADHD overlap with those of anxiety, depression, mood disorders, neurological and other medical conditions, and even the side effects of medication. The same Indonesian review singles out these overlapping conditions as a central part of differential diagnosis. It warns that without a comprehensive assessment the risk of misdiagnosis and underdiagnosis stays high, which can delay treatment and lower quality of life.
This leaves adults who are seeking answers in a difficult position. Someone who finds it hard to concentrate does not automatically have ADHD. The reverse holds too: putting poor concentration down to something else does not automatically rule ADHD out, and ADHD can exist alongside other psychiatric or medical conditions. That is why adult ADHD assessment cannot be reduced to spotting a few familiar symptoms. The question is not only whether this person looks as though they have ADHD. It is also about the history of the symptoms: when they began, how persistent they have been, how much they affect the person’s functioning, and whether another condition explains them better or sits alongside them.
How many people are being missed?
This is where I think the conversation about adult ADHD in Indonesia needs to become bigger than individual diagnosis. How many adults never consider ADHD because they were not diagnosed as children? How many seek help for depression, anxiety or burnout without ADHD ever being raised? How many healthcare professionals have had only limited exposure to adult ADHD, and how many people assume that because nobody spotted it in childhood, ADHD cannot possibly explain what they have lived with ever since?
We cannot answer these questions with any certainty yet, and that is exactly the problem. The same review notes that Indonesian writing on ADHD is still dominated by work on children, and that literature on how adults should be examined and diagnosed in Indonesia remains very limited. We should be careful, then, about turning individual experiences into national statistics. Individual experiences can still point towards questions that deserve proper investigation, though. Mine did.
What would better adult ADHD recognition look like?
The answer is not to diagnose everyone with ADHD, and it is certainly not to swap clinical assessment for symptom checklists on social media. What Indonesia needs is a healthcare environment in which adults with possible ADHD can see clinicians who understand how the condition presents across the lifespan. In practice, that means stronger ADHD teaching in medical and mental health training, clearer clinical guidance, and comprehensive assessment rather than reliance on a single impression. It means keeping ADHD in mind when symptoms overlap with other conditions while still taking differential diagnosis seriously. And it means building more evidence from Indonesia itself, so that clinical practice reflects the population it actually serves. The aim is not more diagnoses for their own sake. It is more accurate ones.
The rulebook is only useful if we know how to use it
Diagnostic systems exist to help clinicians make sense of complicated human experience. When frameworks differ, symptoms overlap and knowledge of adult ADHD remains patchy, the process becomes hard for patients and clinicians alike. The solution is not to abandon diagnostic frameworks, nor to diagnose ourselves through TikTok, and it is certainly not to assume that every adult who struggles to concentrate has ADHD. It is to make sure the people using these frameworks understand how ADHD can present over a lifetime, and have the tools to tell it apart from conditions that look similar.
ADHD does not become a different condition when someone grows up. Sometimes what changes is not the condition at all, but whether we know how to recognise it. If Indonesia wants better outcomes for people with ADHD, one of the first questions worth asking may not be “How many people have ADHD?” but “How many people are we still failing to recognise?”
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.
