Difficult to find providers who actually can properly diagnose it who aren’t overwhelmed. There’s a shortage of mental health providers in the US, and specialists even more so. And many of us were just told our whole lives that we were lazy or had personality defects, so we tend to mask making it difficult to diagnose properly if providers aren’t experienced. Many still only use outward hyperactivity as a valid sign or only diagnose children since there was a long belief that it went away with adulthood, but in reality it’s just usually heavily masked by adults out of necessity.

I think there are a lot of factors.

1. Wealthy Americans often already have access to or utilize services that would help someone with ADHD manage their symptoms regardless of whether they get a diagnosis or not.

2. There are so few affluent Americans left that it’s a significantly small percentage of the population already, meaning though they are more likely to have a diagnosis available to them, they make up a small percentage of people who actually have ADHD.

3. Poor people have less overall knowledge about learning disabilities and Neurodivergences on the whole. They assume that because they also have the same symptoms (which they don’t recognize as symptoms), it’s a matter of laziness, a moral failing, or a lack of work ethic/ability to buckle down).

Also If you’re poor, it’s likely that you may not be evaluated at all (which is part of the reason so many adults are now being evaluated and the percentage of adults who have ADHD has gone up rather steeply).

Also also if you’re poor (especially if you’re a minority) you may not get a diagnosis because there’s a stigma attached to it (nobody want to admit there’s “something wrong” with their kid developmentally).

4. When I was a kid, there was also a lot of assumptions about who could have ADHD (girls “didn’t” get ADHD, it was a boys disease). And ADD was considered a separate thing. If my mother hadn’t worked in the education system it’s likely I and my siblings never would have been tested at all.

5. Support systems in schools are lacking, underfunded, understaffed, and unsupported. Lots of kids fall through the cracks, even when they aren’t neurodivergent.

6. Even less people have access to mental healthcare and for those that do it’s still exorbitantly expensive even with insurance.

7. Without healthcare it’s unlikely that you can get access to medication. ADHD meds are considered narcotics /schedule 2 drugs. Can’t get them without a prescription.

8. Some doctors have a propensity to treat people looking for a diagnosis as addicts looking for a fix. It’s not just doctors (looking at you pharmacists).

Edit:

9. The symptoms a lot of us share are at odds with the way the medical system works, meaning we’re likely to have trouble getting the will to talk to the doctor, have trouble keeping up with appointments and doing tasks that might be required. I was diagnosed as a kid and I still haven’t talked to my doctor about getting further help when I already have a diagnosis.

To be clear, doctors who specialize in this often have a more streamlined process with our symptoms taken into account but just getting to that point where their system can take effect is daunting. The medical care system in this country as a whole works against us.

Many variables at play.

Price shop some independent psychologists in your area, but never mention ADHD.

Go see one and have a laundry list of things you’re struggling with (classic ADHD symptoms), let them do the troubleshooting. Be open to behaviour changes/mitigation strategies.

Part of the challenge is patients have to demonstrate willingness to work on things, and the doc has to document your start point and difficulty improving.

Maybe my experience is out of the norm, but I did some searching online for recommendations of psychologists that do ADHD evaluations. I called the most recommended and was told they had no open appointments but recommended three others that often have availability. I checked those out, chose one, and made an appointment online. They specifically have adult ADHD evaluation as a service they provide with a defined set of appointments and processes. I did an online appointment first, followed by a ton of surveys and questionnaires (it was I think 5 different forms with 30-50 questions each). My wife also did one. I had an in person appointment with some testing over the course of an hour or so, then a follow up to discuss my diagnosis. Of note, it was a few hundred dollars, paid out of our HSA and covered by insurance as mental health services. I didn’t need to “game” anything. I was on time for appointments, honest, and upfront about everything. I discussed why I was looking into this at 30+ years old (I was noticing it interfering with my work and home life more, and through talking to friends and seeing videos online I started to suspect ADHD was a likely explanation for struggles and experiences I’ve had my whole life). Medication never came up during the evaluation, and afterward it only came up in terms of an option for treatment but advised as part of a larger regime of therapy. Psychologists can’t prescribe anything anyways. I do take medication now though it isn’t a stimulant (what OP refers to as pharma speed which is a gross mischaracterization of stimulant medications for ADHD, but it seems they are aware of that and don’t care about continuing to stigmatize ADHD treatments) and both my wife and I have seen a huge difference in my ability to generally function in ways that are healthy, productive, and much more pleasant. I still need to find a therapist though, been meaning to get on that for the last year or so…

For those in the US looking into this, check out psychologists, they are fully equipped and qualified to evaluate and diagnose various types of neurodivergence in people and are easier to get appointments with than most psychiatrists (if you are diagnosed and want to try medication as a treatment option you’ll still need to find a psychiatrist, but that can be easier with a diagnosis in hand). They are generally cheaper since they aren’t medical doctors, and many insurance plans still cover their services. Don’t skip or miss appointments, especially on purpose. It isn’t going to help in a diagnosis and is likely to just make it harder to get help you need and are trying to get. Lock in on that hyper focus and be that person that’s there 20 minutes early (because with an appointment in the afternoon can you really do anything else that day anyways?). Call around, or email, most offices want to help and seem willing to point you to other providers if they can’t help you. Be prepared for a wait though, it’s common to get an appointment 3-6 months out in many areas (more reason not to miss appointments on purpose!).

experiences i’m aware of mainly consist of “doctors that don’t believe you and do nothing to assuage your own concerns about your brain so you have to keep making more appointments and spending more money, or maybe try seeing another doctor who most likely also won’t believe you and do fucking nothing about it but demand more money”