Can Shame Delay an ADHD Diagnosis?

PostedOctober 30, 2025

UpdatedNovember 5, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Shame can play a significant role in delaying or even preventing an ADHD diagnosis, especially in children and adults who have learned to mask their symptoms. For many, shame and stigma can lead to internalising difficulties, making it harder for individuals to seek the help they need. This blog explores how shame affects the recognition of ADHD and how it can contribute to delayed diagnosis.

How Shame Affects Self-Reporting and Parental Recognition

Shame can discourage individuals from fully disclosing their ADHD symptoms, which may delay diagnosis. A 2025 study by Holden & Kobayashi-Wood found that women with undiagnosed ADHD often internalised criticism, leading to underreporting their symptoms in clinical settings. Many participants described years of self-blame and guilt, avoiding discussions about their difficulties to avoid negative judgement from peers and professionals (PMC, 2025).

In children, shame and emotional distress can reduce the likelihood that parents or educators will recognise ADHD symptoms. According to a 2024 study by Dutra et al., children with ADHD often internalise negative feedback and develop early beliefs of defectiveness or failure. This can result in children withdrawing or complying in ways that may be misinterpreted as improvement, thereby delaying referral for diagnosis (Frontiers in Psychology, 2024).

The Role of Rejection Sensitivity and Emotional Masking

Shame, particularly when combined with rejection sensitivity, can cause individuals with ADHD to mask their symptoms. A 2024 study by Knott et al. revealed that girls and women with ADHD often compensate for symptoms to avoid embarrassment or rejection. This emotional masking can delay the diagnostic process by several years, as symptoms are hidden under layers of social fear and self-protection (Australian & New Zealand Journal of Psychiatry, 2024).

Furthermore, emotional dysregulation, which is often seen in ADHD, can confound early ADHD screening efforts. A 2024 study by Marques et al. found that symptoms like irritability and emotional outbursts, which are often mistaken for oppositional traits, can actually be indicative of ADHD. These behaviours, driven by emotional injury, may be misinterpreted as mere oppositional defiance, which delays accurate diagnosis (Frontiers in Psychiatry, 2024).

Clinical Recommendations and the Need for Empathy-Based Assessments

Clinicians should be aware of how shame and emotional distress can impact the diagnostic process. The NICE NG87 guideline recommends that emotional distress and shame be addressed during ADHD assessments to ensure a comprehensive understanding of a person’s struggles. Normalising the discussion of shame and rejection sensitivity, as highlighted by the Royal College of Psychiatrists (2024), can help uncover masked ADHD symptoms and prevent delays in diagnosis (NICE, 2023).

Conclusion

Shame and self-criticism play a significant role in the delayed diagnosis of ADHD, as individuals often mask symptoms to avoid negative judgement. Recognising this dynamic and addressing emotional distress during clinical evaluations can help ensure that individuals receive the correct diagnosis and the necessary support. Understanding the role of shame is key to improving the accuracy and timeliness of ADHD diagnosis, particularly for those who may feel reluctant to disclose their challenges.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.