I think I get your point. It's cruel to require Kafkaesque testing and that just makes it not worth it try. But too simple of a test can also misdiagnose.

The chance to be diagnosed with an appropriate gate varies greatly based on where you live and which doctor you can see and more. It can be anything from a 5 minute conversation, to 6 months of inconvenience, to no chance of even existing in your lifetime, to suck it up and don't ask because your career will end.

Therapy, which (at least for me) has focused dually on adhd management strategies that can be very helpful (including, in particular, enhancing relevant social skills related to setting expectations and boundaries) and on identifying and modifying negative self-image issues and counterproductive learned behaviors (e.g. various forms of self-directed hostility that attempt to assert control over a neurophysiological issue).

It’s funny, I went to therapy a lot of times before I found someone I could stick with, and if I were to give my past self a list of what I’ve gotten from therapy, I think I would’ve been unimpressed. Nevertheless, I’ve noticed that I’m more confident and calmer, and it has definitely improved my relationships.

There’s a kind of virtuous cycle that happens where you replace a grumpy mindset where you’re always mad at yourself for not meeting other peoples’ expectations and always mad at other people for making your life hard, with a confident mindset where you understand yourself, are therefore comfortable relating to other people about your abilities and needs, and can focus on putting yourself in situations where you’ll be successful.

If you pair meds with therapy and adjusting your life according to the things you learn about yourself through the lens of the diagnosis your quality of life can increase dramatically (at least it did for me).

I will say how it was life-changing for me getting diagnosed as 39M.

The quick answer:

Understanding neurobiology and the meta-cognition about the why of certain behavioural patterns and experiences is extremely helpful to just calm down and "forgive" myself, and not judge myself so harshly. It's as if I can optimise my life by leaning on my strengths and importantly recognising and dealing with my weaknesses. Just the awareness lets me catch myself getting into patterns, and act on them sometimes, and just let myself be the other times without any guilt. This insight brings peace more than you think. I can now organise my inner dialog and enjoy the diverse thoughts while also being aware of my impact on people in my life.

I was skeptical of the meds myself. I spoke with about 20 people through AHD support groups and group sessions. The drugs are mostly a trial and error affair with side-effects and altered behaviour. My subtle lifestyle changes - keeping one true todo list, always logging down my thoughts and taking comfort in the fact that they are jotted down so that I dont have to keep going down that thought and actually get up and go catch the train etc already gave me the biggest benefits. Then I wanted to see for myself what the drugs could actually do. At the end of it I may choose to take them or not. After 8 months of slow analytical trial and error with a very helpful psychiatrist who understood where I am coming from, I now take a very small dose of Elvanse(Vyvanse) + Guanfacine on some days of the week where I feel like I could use the help. They are not life-changing. They nudge me into being more capable of being me. My wife can notice the regulation the drugs let me have - A win for me. My kid has a better relationship with me than before - A win for me. Could I do without? Sure. But, I choose to have that little support to manage myself to get to who I want to be around my family without losing who I am. To each their own.

Longer background:

Despite reading about and knowing the symptoms of ADHD, and being told by a professional 10 years ago that I should consider getting formally diagnosed, I thought to myself - "Hey, I am smart. I feel happy and satisfied. I dont have any problem. I'm good as I am. I dont need to do anything about it." and promptly kept sweeping any thoughts about it under the proverbial rug.

Until, I started seeing my son develop in front of me. Seeing all those symptoms - impulsivity, hyper-focus on few things and inattentive to most others, emotional regulation issues, extreme reasoning abilities in some areas while being "immature" in other areas. This was me growing up. Being smart and intelligent, but longing to fit in, struggling to deal with the mundane. So, I decided to get diagnosed properly. Basically, I could hide behind my smartness and the ability to manage my symptoms until it just myself in my life, and then my wife, and then my son, but when the second one came along, I couldn't manage anymore and the overwhelm started to show the real patterns.

It takes courage to be honest and vulnerable.

Imagine you spent your whole life crawling, and someone taught you to walk, but for your brain. It's hard to describe.

The medication unlocks your ability to learn the skills you need to cope with the problems you have, and therapy gives you the outside feedback you need to escape your own brain trying its hardest to mess things up and hide the mess.

Imagine if every 10 seconds this guy was in your body taking over your hands for a second or two: https://www.youtube.com/watch?v=GguQu5Iderg

As I said getting a diagnosis varies by region and doctor. A lot. It's practically impossible in some countries. And also depending on region or personal circumstances, it may not be easy to find another doctor or psychiatrist. Also note that in many countries, only a psychiatrist can diagnose it. Even if diagnosed, you might live in a region where most medicine for ADHD is illegal or have a doctor that won't prescribe them. If you just get disbelief after 6 months of waiting, and after another 6 months just get told stimulants are bad, you might give up.

If you search (eg reddit) for ADHD adult diagnosis, it is filled with horror stories. There's even lots of posts of people diagnosed and medicated for 20+ years that move to another country and can't get a prescription. Or you get a prescription, but the pharmacy won't dispense it or insurance won't pay for it. A typical post on these topics also has one or more people responding "I'm in the same place and it was easy" but also has one or more people responding "I'm in the same place and I tried for 3 years before giving up". By the way, it's also common for women to have more trouble getting a diagnosis compared to male siblings and friends with the same symptoms.

Only recently in aus did an adult diagnosis get support from the government PBS scheme. And even then it's because they're letting retroactive childhood diagnoses be considered for the subsidised medication options.

In some countries it's almost impossible (I don't have any direct experience but I've heard tale that in e.g. aus/nz, east asia, south asia, etc people give up before getting diagnosed often), and my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.

In the US, at least, it ranges from difficult to straightforward, but that's not true everywhere