When Childhood Ends
How a Paediatric Mind-set Creates a Blind-Spot for Adult ADHD
Why the German autism-in-adulthood study is a cautionary tale for both ASD and ADHD – everywhere!
1. The paper that rang the bell
Lipinski et al. (2021) asked almost 500 German psychotherapists how well they were prepared for autistic adults. Autism scored dead last on every dimension - training hours, factual knowledge, diagnostic experience, clinical confidence.
Three-quarters of clinicians wanted more training; only 15 % had ever taken a course.
The headline looks parochial (“German therapists lack autism know-how”), but the mechanism they exposed is universal:
If a neurodevelopmental condition is framed as a childhood disorder, the adult service pipeline never truly materialises.
2. Swapping the label: does ADHD fare better?
At first glance yes - psychiatrists must prescribe and monitor stimulants, so some ADHD content creeps into residency.
But four structural facts wipe out that advantage:
Net result: ADHD’s “pill advantage” improves prescription literacy - not lived-experience literacy.
3. Why late-diagnosed adults are another species
Years (often decades) of misattribution create a clinical picture alien to paediatric textbooks:
Layered comorbidity – depression, anxiety, substance use and sleep disorders stack up over time. adhdevidence.org
Maladaptive coping loops – perfectionism, over-working, chronic masking, and self-medication become entrenched survival strategies. pmc.ncbi.nlm.nih.gov
Identity shock – qualitative studies describe relief and grief as adults rewrite their personal history around an ADHD lens. pmc.ncbi.nlm.nih.gov
Treating this landscape demands skills in grief work, habit deconstruction, executive-function scaffolding and relational repair - competencies barely touched in child-focused training.
4. Beyond Germany: the global pattern
Germany’s shortfall is therefore the ceiling, not the floor.
Where resources, insurance coverage, and postgraduate pathways are thinner, the gap widens.
5. Reframing the problem – and the fix
Move neurodevelopmental disorders out of the “child” silo.
Mandate adult case exposure during psychology and psychiatry training blocks, with supervised assessments and psychotherapy hours logged.Teach beyond medication.
Core curriculum for adult ADHD should cover masking, shame, perfectionism, relationship dynamics, and executive-function scaffolding - not just titration protocols.Introduce ADHD coaches in the care pathway.
Why? Coaches specialise in day-to-day strategy, behaviour change and accountability, the very gaps most clinicians have no bandwidth for.
How?
Create referral loops: psychiatrist/psychologist ↔ ADHD coach, with shared care plans and release-of-information agreements.
Hold brief, structured case conferences (even quarterly) so medication, therapy goals and coaching tactics stay aligned.
Outcome: Clinicians handle diagnosis, comorbidities and pharma; coaches drive daily implementation and feedback—closing the theory-to-practice gap.
Resource equitable access in LMICs.
Tele-supervision networks and tiered task-shifting (training primary-care clinicians to deliver first-line psychoeducation) can counter specialist scarcity.
Key takeaways
The German autism study exposed a systemic training gap that maps neatly onto ADHD.
Adult ADHD’s apparent “medication familiarity” masks a profound deficit in lived-experience competence, especially for late-diagnosed adults.
Where Germany struggles despite abundant infrastructure, developing nations face a magnified challenge.
Closing the gap demands structural curriculum reform, adult-specific competencies, and global attention to resource-poor settings.