A conversation I did not plan
I was on the train back from a symposium on mental health, sitting with a psychiatrist I had met that morning. We talked for nearly three hours without a break. Somewhere past the halfway mark, half as a game, I suggested we walk through the ADHD diagnostic criteria together.
She asked a few questions. Then she stopped.
‘This is obvious,’ she said. ‘You have ADHD.’
The verdict surprised only me. I told my wife that evening and she looked genuinely puzzled. ‘You didn’t know?’
Fifty years, read again
Brussels, 1989, at the European School. I scraped through.
Teachers saw a turbulent student who would not settle, with grades that moved without warning. Inside my head there was plenty going on, just rarely about the syllabus. What rescued me each time was a burst of hyperfocus in the last days before an exam.
During my engineering degree I sometimes met a professor for the first time on the day of the exam. People held my attention in a way equations never did, so I started a cultural venture and ran a student association instead. My doctorate in Munich ran on the same rhythm: months of drift, then a decision to finish, then six months at full intensity. I handed it in after three years and one month.
Then came sales at a large corporation. Four days a week on the road suited me. Internal meetings and fixed processes did not.
At thirty-two I started my second company. The third, fourth and fifth followed. There was no master plan. I followed the energy.
What I could not see was the bill. I overextended at every peak and crashed after it. My teams absorbed the volatility. No single failure broke the trust. It wore away through unpredictability. Twice I was broke with a family to support, starting again from nothing.
I mistook adrenaline for sustainability. I managed output, but not energy.
What the diagnosis actually changed
The days afterwards were strange. Relief is not quite the word for it. It felt more like standing in a room you have lived in for fifty years and suddenly seeing where all the furniture came from.
Things I had always filed separately began to line up. The childhood restlessness. School results that never matched the effort. Corporate reviews that praised my ideas and then asked me to start less and finish more. Weeks of clarity followed by flat ones. Working well under meaning and pressure, badly under routine. Saying yes before I had felt the cost.
Decades of what I had read as patchy discipline turned out to be wiring. Today I describe that wiring as a Spiky Profile: a mind with sharp peaks and deep valleys rather than an even line.
Two things changed in how I work.
I stopped trying to fix myself with more structure and started building around the way my energy actually moves. More structure had never worked. I now understand why.
Delegation stopped being a management virtue and became part of the architecture. The people who hold things steady when my attention moves elsewhere are load-bearing.
The personal sense-making then turned into something larger. It led to a research relationship with IESE Business School and to interviews with hundreds of leaders whose minds do not run in straight lines.
What it did not change
Understanding your own wiring brings relief. It also brings a temptation.
In the months after the train journey I caught myself reaching for the diagnosis to explain ordinary lapses. A message I never answered. A commitment I had not kept. One day my wife stopped me mid-sentence and told me, very clearly, to stop hiding behind it.
She was right. Knowing the mechanism behind a broken promise does nothing for the person on the other end of it. Leadership still runs on attention and care.
Clarity about your own mind should deepen accountability. It can never stand in for it.
That is the line I care about most in this whole story.
Why so many senior people find out late
Among the founders and executives I work with, a late diagnosis is closer to the rule than the exception. The research explains it better than any anecdote can.
Strong compensation looks like competence from outside. A study of adults with ADHD who had never been treated found that those with higher IQ showed far fewer measurable deficits in executive function than those with average IQ. Its authors concluded that intelligence can mask the condition and make clinical diagnosis harder (Milioni et al., 2017). A systematic review of fifteen years of research on ADHD and intellectual giftedness reached the same conclusion: high ability tends to delay both diagnosis and treatment (Despature and Galiana, 2023). From outside it reads as discipline. From inside it is constant translation.
Early environments also supply structure you never had to build. School timetables, exam dates, a manager’s deadlines. Russell Barkley’s work frames ADHD as a problem of performance rather than knowledge, which is why external structure placed at the point of performance does so much of the regulating (Barkley, 2012). Senior roles strip that scaffolding away. Nobody sets your deadlines at fifty.
Then the load outgrows the workarounds. Clinicians describe this as a demand and resource imbalance: symptoms stay roughly constant while the demands on capacity climb, so impairment appears at the point where the two cross. Adrenaline and novelty carry a lot of people through their twenties. They carry much less weight alongside a company, a family and twenty decisions a day.
Diagnostic systems add a delay of their own. They look for visible impairment, so a mind that diverges sharply but compensates well stays invisible to them. Quieter, inattentive presentations are noticed later still. Women are more likely to present that way and are referred less often and diagnosed older than men, partly because childhood referral depends on adults noticing disruption rather than distress (Quinn and Madhoo, 2014).
Roughly two thirds of children with ADHD carry it into adult life in full or in part (Faraone et al., 2006). I meet some of them in boardrooms, undiagnosed and highly capable, paying a cost nobody has named yet.
If this is starting to sound familiar
You do not need a diagnosis to start understanding how your own mind operates. You do need a qualified professional to tell you whether it is ADHD.
Ask for a proper assessment with a psychiatrist or a clinical psychologist. An adult assessment looks back at childhood as well as at the present, so old school reports are worth digging out. Mine were not flattering and they were useful.
Observe before you label. Compare a recent good week with a recent bad one, then look hard at what was actually different: what you were working on, who you were with, how much of it was yours to decide.
Tell the people closest to you what you are working out and ask them what they have seen. My wife had seen it for years.
Then use what you learn to design the week and the team around it. Keep owning the impact on the people in it.
Questions I get asked
Can you be diagnosed with ADHD at 50?
Yes. ADHD is diagnosed at any age. Many adults are only identified in their forties or fifties, usually once the coping strategies that worked for decades stop producing results. It requires a full assessment by a psychiatrist or another qualified clinician, including a look back at childhood.
Why do successful leaders get diagnosed so late?
Because the compensation works. High ability and tightly built personal systems hold performance together, while the structure of school and junior roles does part of the regulating. The cost tends to surface when roles become less structured and responsibility grows faster than the workarounds.
Does a late ADHD diagnosis change how you lead?
It changes how you design the work rather than how you think. For me that meant building around energy instead of forcing more structure. It also meant treating delegation as part of the architecture rather than a favour to the team. It should deepen accountability for the impact on other people. It should never excuse it.