**This episode is general information only and is not medical advice. If any of it applies to you, please talk it through with your own GP or psychiatrist**

Have you ever walked out of a psychiatrist's office more confused than when you walked in? Not sure what just happened, whether you got a diagnosis, what you were supposed to ask, or whether the thing you were terrified of — coming across like you were just there for the stimulants — is exactly what you did. For a lot of women getting an ADHD assessment at 40, the appointment itself is the black box. Nobody tells you the order to see a GP, psychologist and psychiatrist in, what happens if your school reports are gone and your parents have died, why they start you on one medication and not another, or what a drug holiday actually is.

So this week Jane sat a psychiatrist down and asked him to open the box. Dr Brendan Daugherty walks through the whole thing — the pathway, the assessment, how they choose your first medication, and the one thing that makes these appointments go better. Bring the questions you've been too embarrassed to ask.

CHAPTERS

00:00 — Walking out more confused than when you walked in

02:36 — GP, psychologist, psychiatrist — the actual order, and when to skip a step

04:38 — Have the waitlists really improved? A straight answer

05:44 — The two kinds of women who book an assessment — which one are you?

09:50 — 'ADHD is a bit like a shield' — and what's underneath when the medication lifts it

13:19 — 'I'm scared I'll look like I'm drug seeking' — the post Jane sees every week

15:26 — How a psychiatrist spots the woman who's masked her whole life and looks fine

16:56 — No school reports, parents gone — how do you even get diagnosed? (evidence before 12)

19:15 — The squat-rack phone call that diagnosed Jane's ADHD in real time

23:23 — How they actually choose your first medication — first-line vs second-line

25:28 — Long-acting or short-acting, and why it's not one-size-fits-all

26:18 — Drug holidays: why they're prescribed, and why the evidence is weaker than you think

29:34 — What's changing in psychiatry for women — hormones, the cycle, and menopause

What We Cover

• Why so many women walk out of the appointment with no idea what just happened — and the questions nobody tells you to bring
• The actual order to see a GP, psychologist and psychiatrist in, when you can skip a step, and when doubling up is a waste of your money
• The two completely different reasons women book an assessment — and why knowing which one you are changes where you should book
• What Brendan means when he says attention problems aren't always ADHD — the medical and hormonal things a rushed assessment misses
• 'ADHD is a bit like a shield' — the conversation about what surfaces when the medication lifts it, and why Jane went back to short-acting
• The post Jane sees in the Facebook group every single week — 'I'm terrified I'll look like I'm drug seeking' — and exactly how a psychiatrist actually hears that
• How a psychiatrist recognises the woman who's held it all together on the outside and is burnt out underneath
• What happens when you don't have school reports and your parents have died — how the 'evidence before 12' rule actually works in practice
• How they choose which medication to start you on, first-line versus second-line, long-acting versus short — in plain English
• Drug holidays — why they get prescribed, why the evidence is weaker than it sounds, and what that means for your Saturday sport chaos
• What's genuinely changing for women in ADHD care — the hormonal picture, the menstrual cycle, and menopause

Free Resources

Preparing for Diagnosis — for the mum wondering if it's ADHD and what to do next — https://adhdmums.com.au/product/preparing-for-diagnosis/

Paid Resources

Pre-Diagnosis Workbook — the deeper version of 'get clear before you spend the money on an assessment' — https://adhdmums.com.au/product/prediagnosisworkbook/

Related Episodes

How to Get a Diagnosis in Australia (Part 1) — S1 EP7, with Dr Jacinta Thomson — https://adhdmums.com.au/podcast_episode/s1-ep7-how-to-get-a-diagnosis-in-australia-part-1/

ADHD Medication: Stimulants vs Non-Stimulants — S2 EP40, Jane solo — https://adhdmums.com.au/podcast_episode/episode-40-adhd-medication-stimulants-vs-non-stimulants-solo-episode-with-jane-mcfadden/

About the Guest

Dr Brendan Daugherty is a child, adolescent, adult and forensic psychiatrist and a Fellow of the Royal Australian and New Zealand College of Psychiatrists. He's the co-founder of Pandion Health, an Australian telehealth platform providing specialist-led ADHD assessment and ongoing care for adults and children.

You can find Brendan here:

Website: https://www.pandionhealth.com.au

Instagram: @itsdrbrendan (and the clinic, @pandionhealth)

LinkedIn: https://www.linkedin.com/in/brendandaugherty/

📬 Listener Questions & Community

🎙️ Ask a Listener Question (voice)

Voice notes are preferred when possible — hearing your voice helps add context — but you’re very welcome to submit a written question instead.

Send a WhatsApp voice or written on 0403 457 313

Send a SMS voice or written on 0403 457 313

👥 Join the ADHD Mums Facebook Group

👥 Receive the episodes in your inbox

References & Further Reading

On dexamphetamine vs methylphenidate (Brendan's 'a little bit better' point, ~24:24):

Cortese, S. et al. (2018). Comparative efficacy and tolerability of medications for ADHD in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4

On stimulant 'drug holidays' and growth (~26:18):

Drug holidays and the ~2cm growth question are genuinely contested in the literature. The most-cited long-term data is the MTA follow-up (Swanson et al., 2017, Journal of Child Psychology and Psychiatry), which found a small average height reduction associated with consistent stimulant use. Brendan's framing — that it's 'a bit overblown' and the adult evidence for weekend breaks is weak — matches the current consensus.

On combined medication + non-medication treatment (~23:23):

The MTA Cooperative Group studies remain the reference point for Brendan's 'they work best in combination' statement.

[00:00:21] Jane: Have you left thinking, "What was that actually for? What was I supposed to ask? What did I say? Did I get a diagnosis? I have no idea what happened in there." Today's episode is for you. We are asking a psychiatrist to walk us through what actually happens in those appointments, how they diagnose, how they choose the medication that you try first, and how do you get more out of the conversation.

[00:00:51] Jane: Brendan is the co-founder of Pandion Health, an Australian telehealth platform providing specialist-led ADHD assessment and ongoing care for [00:01:00] adults and children. Brendan is currently based in Bali and visits Australia regularly. Welcome to you, Brendan.

[00:01:08] Jane: I am always so excited whenever I get a psychiatrist coming on. So welcome and thank you so much for your time, Brendan. I know how busy psychiatrists are

[00:01:29] Brendan: What kind of brought you into creating the business getting more into that ADHD space.It was a COVID business, so we were generally, initially a general telehealth company, but we had so many referrals for ADHD. I was like, "Wow, what's going on here?" and then it was personally quite interesting to me that we found out slowly over time that a lot of people that work with us had ADHD as well, so it felt like a natural transition.

[00:02:21] Brendan: So it's a personal interest to me as well.

[00:02:36] Jane: when a woman comes to you at 40 and says that she thinks she might have ADHD, what is the best order, do you think, in your opinion, that works between a GP, a psychologist, and a psychiatrist? Because so many people get confused with where to go and in what order

[00:03:08] Brendan: Also, if you have a clinician that you want to see, and you can always ask the GP to refer you to that if they think there's a need for that. Actually, many or some, I should say, GPs, and this is a bit dependent by state, can now do the whole process themselves. but that's still very much a minority, and some people will still want to go see a specialist or see a psychologist.

[00:03:51] Brendan: So that's where I'd start.

[00:04:09] Jane: So I suppose if you're looking for medication and to try it, the psychiatrist would be the better route. Do you think that's right?

[00:04:32] Brendan: But it seems to have been more and more that there's more psychiatrists in the space. Yeah

[00:04:41] Brendan: I do. the story that you used to get is that wait lists were, you know, depending where you were, six months, one year, even two to three years in some public clinics. There are very few public clinics that still do ADHD assessments, but now with, I'd say, more telehealth platforms and more [00:05:00] awareness around ADHD and even a little bit more training, for psychiatrists and psychologists, many more psychiatrists are doing these assessments.

[00:05:25] Jane: Oh, no, I agree. I agree. When we started this podcast, even if you were willing to pay out of pocket, go private, you might still wait a year, 18 months. But I agree, I've seen people get seen for an assessment between one and three, weeks quite often. So I think it's great that there is that more accessibility in the space, that's for sure

[00:06:28] Jane: I think you've made a great point. I have got some resources on my website. I wish I could remember what the name of them were. But, this is just my opinion, I'd love to know what you think. I break down from what I see with women into two categories. One is exactly what you said, "I know that I have this.

[00:07:09] Jane: And I think you've made a great point because when you're booking an assessment, I think you really wanna have a think about which category of those you are in and pick a place or a clinic that is actually gonna cater to that. Is that what you mean?

[00:07:43] Brendan: It might be one of those medical conditions, or it might be, there's, there's a contribution from, say, a little bit of mild depression or anxiety. And if we're just treating the ADHD, then sometimes the full treatment effect is not gonna be found. So like sure, you can, treat ADHD with, [00:08:00] with stimulants and, you know, psychology or coaching.

[00:08:20] Jane: I think you've made a great point because,my-- I feel like the theme to my whole life is like rip sh*t bust. Like I'm just one of those bull at a gate people. And so I was like, "Just get out of my way. I wanna try some medication. My brother's had this for fucking forever, and I've been held back," like I'm right onto it.

[00:09:07] Jane: But I think a really good way of doing it is probably what you said, is to slow down and do a proper assessment from the beginning. That's a really good point

[00:09:39] Brendan: but it's not always sim- easy sailing. I think most people want, the chance to, to get to the next version of themselves, which is clearer, that's behind the clouds. but yeah, it's often just the, it's the start of the story sometimes.

[00:10:01] Jane: there's so much go, getting, impulsivity, excitement, fun, and then when you medicate that heavily, like I was on Vyvanse for a while, once you've removed that shield, it's like there's some sh*t under there that I didn't wanna really find. So I've ended up kind of coming off the Vyvanse and going back on Dex, the short-acting, because I'm like, I kind of like a little bit of ADHD there because it kind of shields me from all of my feelings underneath.

[00:11:01] Brendan: And that's a great shame because it's only through that feeling that you properly develop as a person. Now, I'm not saying we need to feel every feelings. Of course, we all like, like going to the movies and have- having fun and distraction, like, but even moving the dial a little bit allows you to, I would say develop as a person.

[00:11:21] Jane: I think you've made a great point because this podcast was, I think, the first ADHD podcast in Australia, and

[00:11:45] Jane: where we don't wanna survive, we wanna thrive. But there's this place around, yeah, you get diagnosed, yes, you do the stimulants, but then what?

[00:12:08] Brendan: Pretty much. Yeah, and you described it in real time with yourself that you're tinkering. you know, there's this state of distraction is actually quite lovely at times.

[00:12:26] Brendan: there's things that we need to address, there's things we need to do, and if we're always getting distracted, it's, it's challenging. So you're moving the dial all the way here. It's quite uncomfortable to face our real self. And then, we don't always need to do that, so you've found a nice balance where you can, you know, you can zone in when you need to.

[00:13:06] Brendan: There's obviously side effects, but it allows them to engage in a, in, in their education and, and their socialization in a way that far outweighs, in most cases,the side effects of the medication.

[00:13:19] Jane: One of the posts that I see in the Facebook group all the time, and it's just the best, right? And it's basically a woman will say, "Hi, I'm going in for my ADHD assessment. I've been waiting six months for this appointment. I've listened to every single podcast episode.

[00:13:58] Jane: And it-- I just see it all the [00:14:00] time, and I don't even know what the answer is

[00:14:06] Jane: and it, it speaks to the guilt that women are feeling around ADHD still. It's like they're still feeling stigmatized around it, so it's a real shame. But like, if someone came to me and said that, I'd think, " Wow, you know, they've really thought about this.

[00:14:37] Brendan: So if someone has four kids with ADHD, it's pretty, pretty common for the parents to have it as well. it's not like I'm gonna say, This is clearly someone that's just seen these, these miracle drugs and, and they want them." it's someone that's actually likelier to have ADHD than the rest of the population.

[00:15:14] Brendan: Is there a relationship problem? Is there difficulty at work? What is the thing that's the functioning issue? I would really start there after the, after the other background, because those things are real issues and they deserve treatment

[00:15:52] Jane: How would you as a psychiatrist recognize that when sometimes these women are really good at coming across as fine?

[00:16:27] Brendan: Then, though some of those, exist in the normal realm of experience, absolutely those are really hardcore signs of ADHD. and psychiatrists know that, masking is a really, you know, really common feature of ADHD, particularly in women. So I think it's extremely natural and common story to hear.

[00:16:56] Jane: Okay. Uh, here we go. I put out into the Facebook group [00:17:00] that you were coming in. This is from Jennifer. She said she was 49 when she got assessed, and she says, "My psychiatrist interviewed my mum. Nothing cl- nothing like confirming you had symptoms prior to 12." When a woman comes to you, and let's say she's 45 or 49 and her parents can't remember, she doesn't have school reports, like how do you actually make a diagnosis? I see so many women saying, "My reports are missing. My parents have died." Like, but then sometimes I see women saying, "I couldn't get medication or assessment because I didn't have that."

[00:17:51] Brendan: And so if it's in an adult, we typically look for, you know, like a, a parent or, having school [00:18:00] reports, or potentially and a sibling, or a friend even that knew that person before the age of 12.

[00:18:23] Brendan: there are, depending on how strictly you, meet the criteria, sometimes it's difficult to get the PBS medication, uh, without that collateral information. But, for many people, that's not such an issue. Essentially, in most cases, there's ways around it, but you will still find that some psychiatrists, very strictly, adhere to that diagnostic criteria and are concerned of the ramifications of, say, taking someone at their word and then finding out later that it wasn't the case. I think most people or most psychiatrists are fairly pragmatic, and in the cases where there's not this collateral information, they [00:19:00] will take a good history,and use the rating forms to, to establish that criteria.

[00:19:14] Brendan: Yeah.

[00:19:16] Jane: when I went to get mine, I didn't have any school reports my parents had passed away. I rang up the office first because I thought the same thing. I thought, "If I pay all of the money and then I don't have the things that I need, I'm gonna be really devastated.

[00:19:37] Brendan: So they said, "Okay, we're gonna call your husband at the appointment possibly. Like, can you get him prepped?" So anyway, we have the appointment and then they say, "Yes, we need to speak to your husband now." So I put the psychiatrist on hold, I thought, but actually I hadn't put him on hold. I called my husband, who was at the gym, and he was doing squats, so he sounded like he was gonna have a heart attack.

[00:20:03] Jane: didn't realize the psychiatrist could hear us, and so we started arguing on, "I told you it was 10 o'clock." He goes, "No, you told me it was 12 o'clock." And then we had this big argument about what time it was, and I didn't realize he could hear all of it. Then I said to my husband, "Look, just act cool because I'm gonna put him on now." And then I put the psychiatrist on and he goes, "Look, I have to tell you, I wasn't on hold. I've heard the whole exchange and I don't need to hear anything else.

[00:20:32] Jane: we..."

[00:20:39] Jane: heard ADHD play out like full, full time." So I know what you mean. It's,

[00:20:57] Jane: Absolutely. Yeah. I [00:21:00] mean, like, there's several parts of the, the diagnosis, the moving parts. There's like the evidence before 12, there's the also seeing the symptoms in multiple different domains, and that's where the husband typically would fit in. And there's obviously satisfying the inattention or, hyperactive impulsive criteria, and then also checking that it's not something else, right?

[00:21:27] Jane: We're gonna go back to another topic that comes up all the time in the Facebook group, I see a lot of women post and say things like, "I've started the stimulant, however, now I have all of these sensory issues. I can't stand noise. I need all this routine. I'm really feeling withdrawn." And they list out all of these, traits. Then they say, "Maybe I'm autistic or is it my PTSD? I don't know what to do.

[00:22:03] Brendan: Look, the simple answer to that is go back and talk about that with your clinician, like your psychiatrist, because as you said, it can mean a whole lot of things. It could actually be a side effect of the medication. For some people, it's actually at the end of the day when the medication wears off, they have a rebound, you know, in, in sort of lay terms, all the dopamine is used up, the medications help them, and then it stops working, and then they get their symptoms twice as bad at the end of the day.

[00:23:00] Brendan: So I would always say, like we said before, that the medications are really just the start of the journey, and often they need a lot of tweaking, so it's really important not to just give it up and say, "Oh, the medications aren't for me." Perhaps they're not, and perhaps at some stage you choose not to be on them,but also there's so many other factors to take into consideration that's absolutely best done, you know, with a specialist

[00:23:23] Jane: how do you decide which medication to start someone on? Does everyone start on Ritalin or do you look at the overall picture? How does that work?

[00:23:48] Brendan: But the non-medication treatments, I'm sure the audience is quite aware, but there's things like psychology, there's coaching, there's lifestyle modifications, there's, different environmental changes, to start off with. [00:24:00] But if we're just talking about medications, basically there's first-line treatments and second-line treatments.

[00:24:24] Brendan: So, if there isn't, you know, what we'd call a contraindication for those medications, like a safety issue, around those medications, then we'd, you'd always wanna start with the first line because they just typ-typically work so much better than the second-line medications. And there is, in terms of, like, the differences between, say, Ritalin and amphetamines, there is a small bit of evidence that dexamphetamine is just, it's a little bit, uh, better, uh, if you have a look at the big studies.

[00:25:13] Brendan: If it's not the right medication, like it has side effects, then, uh, you'd typically try the other one. So you'd try, you'd try Ritalin or one of the long-acting forms there, uh, after that, which is, Ritalin LA or Concerta And then if those aren't working or they're not right for you, then you try the second-line medications.

[00:25:46] Brendan: Some people end up on just the short-acting, which depending on the formulation is typically works for about four to six hours. And in the long-acting, again, depending on the formulation, more like eight to 12 hours. For some people it's great. Like I [00:26:00] think in general the long-acting is great because you take it once in the morning and then you don't need to think about it for the rest of the day.

[00:26:18] Jane: Perfect. this question I see all the time in the Facebook group. It's from Peta: "Why do some psychiatrists say to try having two days a week off your medication? I feel like I'm finally getting some help for the five days, and then on the Saturday, particularly with kids' sport, I then feel like I have to not take the medication on Saturday and Sunday.

[00:26:39] Brendan: Typically this, this direction is given because,concerns over tolerance. So meaning that theoretically these are drugs of addiction, and once you take it at a certain dose and your body gets used to it, then it doesn't work as well, so you need to take more. The theory goes that if you have a couple of days off, your receptors recalibrate and that you don't need to [00:27:00] keep taking more and more and more.

[00:27:22] Brendan: And if you have these drug holidays, two days off on the weekend, then you will potentially eat a lot more and, and sleep better, and that means that you don't have as much growth issues. But of course, Peta's not worried about that, I don't think, 'cause, she's much older than that. Actually, in reality, if someone came to me and they didn't want to do it the holiday,I wouldn't worry about it.

[00:28:05] Jane: Okay. I actually didn't realize that was the reason. So even if you wanted to do the drug holiday, you could just pick two days yourself where you needed less functioning if you were worried about tolerance. I think it's like the psychiatrist might have said it in like a rule way, or the patient's heard it as this is the rule. Like on weekends, don't take it. But That's not what you're saying at all. if you've got a really busy day with Saturday at sport and you've gotta have everything ready, not a good idea on a Saturday to go without medication

[00:28:42] or specialist before making any changes to your medication

[00:28:55] Jane: Yeah, a bit more like whatever it is for you, like liveliness or impulsiveness or [00:29:00] whatever. So some people really like to have those days off. But in those people that don't, then in general, absolutely just take it every day you need it.

[00:29:27] Brendan: And afterwards when my hubby pointed it out, I was like, "Oh my God, that is so right." But, I didn't notice it at the time. It's like the parent version of you would've appreciated that, but the, the kid version would not. Yeah.

[00:29:50] Brendan: Absolutely. I mean, first of all, just the amount of information out there is allowing a lot more people to be self-educated and women to know that this is [00:30:00] a condition that may be affecting them and to get assessed for it. And so the stigma around it and the, you know, the education around it is causing a lot more women to get diagnoses or get assessments to start off.

[00:30:33] Brendan: So around attention can fluctuate during the menstrual cycle. Obviously, it tends to be worse towards the latter part. And then also at menopause, typically that can see a shift in concentration, typically a, you know, worsened ability to concentrate as well. So these factors and, most clinicians are aware of this now, and that may result in a, shifting of treatment throughout the month or a change, at menopause.

[00:31:14] Jane: Wow. so if there was women listening that really wants a full assessment, maybe they've been diagnosed with other things previously, they're not sure what's what.

[00:31:27] Brendan: Well, we always do a holistic approach, and if someone points out that they have differences over the, their cycle or at a certain stage of life, then that's absolutely taken into account. And where we need a deeper dive, sometimes we will ask for, say, a psychologist to do a deeper dive into the cognitive symptoms.

[00:32:06] Brendan: And, and there's this option too to, to do shared care with GPs as well. So sometimes, you know, like we've talked about, do the initial diagnosis, then the GP does sort of the ongoing, uh, care for a period of time, and then something might come up, so they realize that, you know, menopause comes up and, and their functioning becomes worse again, then they might re-refer to our psychiatrists, for an overall assessment.

[00:32:37] Jane: Great. Great. Well, that was Brendan from Pandion Health. I'm gonna leave all of his details into the show notes. If anyone would like to hear more from Brendan, please send me in listener questions, via email or into the ADHD Mum's phone, and I can always ask Brendan to return. Brendan's like, "Oh my God, no, I didn't offer," but I've just offered.

[00:32:58] Jane: Brendan's like, "Hide. [00:33:00] Run." we get so little psychiatrists and medical professionals to come on board and talk on the podcast, I assume probably because you guys are so busy.

[00:33:17] Brendan: Absolute pleasure. It was great to have this conversation and yeah, I really hope that the people that need more help or or assistance can feel empowered to do so. 'Cause at the end of the day, that's what it's all about.