Episode 82 – ADHD or PTSD? Why So Many Women Are Misdiagnosed with Amanda Moses

Jane McFadden:
Hello and welcome to ADHD Mums. Today we have an episode about ADHD or is it PTSD? Why so many women are misdiagnosed between the two? And I do not know enough information about this, so I have brought on an amazing guest, Amanda Moses. I’m going to put in all of her information in the show notes if you’d like to follow her on Instagram.

I love the way that she so passionately talks about the misinformation out there. I love that, and that’s what really drew me to your Instagram account, Amanda.

Amanda Moses:
Oh, thank you, Jane. There are so many podcasts and information out there that is incorrect, and I find it quite grating. So I love it when you go through research and stuff that is not quite right, because I’m like so drawn in as soon as you post. I think it’s my role as an educator because I work in the space of supervising and training other psychologists.

Like my platform really is about education, and though my audience tends to be mostly allied health professionals, I can see why it also draws in just general community members because I think that we do see a lot of information online and it can be hard to understand sometimes, like how much of this is true or factual or how much of this is just based on opinion or I don’t know, some kind of media sensation at the moment.

Jane McFadden:
Oh, I agree and I think that’s why I love a lot of your content. If you haven’t checked out Amanda’s Instagram, I’m going to put the links in the show notes. So Amanda, for anybody who doesn’t know you, do you want to give us a couple of points about who you are?

Amanda Moses:
So I’m a senior psychologist. I’m also a PhD candidate researching autism identification, and I’m also a proud ADHD mum of three little kids as well. So I’ve been working as a psychologist for a really long time now, and in my clinical practice, I focus specifically on assessing and diagnosing really highly masked and more complex presentations of autism and ADHD.

But outside of that, predominantly my work really is in training, mentoring, and supervising psychologists. So I think my passion area is really with neurodivergence and neuroaffirming practice and really trying to make sure that our health professionals are getting appropriately educated on this so that we can better serve our community members.

Jane McFadden:
Oh, absolutely. And if there’s anybody out there who has been turned away by a practitioner and still feels that there’s something that they would like to have their child assessed for or themselves—myself and my children were only picked up by a very experienced autism and ADHD clinical psychologist on the Sunshine Coast who would probably be quite similar in education and passion level to you. That’s all she does—highly masked presentations.

If there’s anybody out there that has been turned away, I always encourage them to go to a clinical psychologist.

Amanda Moses:
I agree, Jane. And look, I should just emphasise that being endorsed as a clinical psych or an educational and developmental psych doesn’t necessarily provide someone the qualifications to assess and diagnose autism and ADHD. Typically, psychologists will get that specialised training once they’re already registered. That’s not something we learn at university, which is crazy. We probably do one lecture on autism throughout our degrees.

We don’t learn enough about it. So I think that what people don’t realise is that while there are many health professionals trained to do diagnostic assessments, not enough clinicians are actually trained to understand less stereotyped presentations of autism and ADHD—those who tend to have high masking presentations—and certainly doing it also from an affirming point of view.

So I agree with you that if you still feel like there’s something going on and you’ve been assessed but it didn’t feel like it captured you, I’ve actually had to reassess clients and looked at their old reports and thought, wow, there was so much missed here. And they did end up being autistic ADHD. So don’t let that deter you if you still feel strongly about the fact that you could potentially be neurodivergent. You really need to find the right clinician.

Jane McFadden:
Yeah, and I think you’ve made a great point because I did some training with Esther Fadook—I don’t know how you say her last name.

Amanda Moses:
She’s my colleague and friend as well.

Jane McFadden:
Yeah! Well, she’s a registered psychologist and I loved her training. So you’re right—when I say clinical psychologist, I really mean anybody with lived experience who’s done that high-level training. I think you’ve made a great point. I don’t mean that registered psychologists can’t do it because they’re incredible.

Amanda Moses:
Yeah, and look, I understand you didn’t mean it from that perspective. I think that it’s so helpful for the community to know that difference too, because you would see a title and assume, ‘Oh, clinical—they must know more, they must be better.’ But actually, you’d probably be best served by trying to find a psychologist who works with highly internalised, high-masking presentations, who’s neuroaffirming, and perhaps even has lived experience as well. There are a lot of lived-experience clinicians out there that I think do a really great job.

Jane McFadden:
Oh, I completely agree. Okay, let’s move on. I actually could do a whole podcast just on that subject, but I’m going to force myself to move on.

ADHD and PTSD. Now it’s interesting what we just talked about, because one of the other reasons that I always encourage people in our Facebook group to go and seek another assessment from a psychologist—one of the ones we just spoke about—is because of the amount of misdiagnosis that a lot of women have been through by the time they get to this path. Myself included. I’ve been diagnosed with so many things. I would actually just love to know what is real and what was not.

So when we talk about ADHD and PTSD, where is the overlap, do you think?

Amanda Moses:
I think it’s a tricky one because this question comes up a lot in professional settings. So if the health professionals are confused, I can’t imagine how much community members must be confused about it, right?

Some of this is in part to blame because of people like Gabor Maté and others who have come out in more recent years trying to claim that ADHD is just a trauma response—when we, in fact, know that could not be further from the truth. Unfortunately, those types of sentiments have filtered into professional settings.

Now I’ve observed, as someone who trains and supervises psychologists, that even psychologists seem genuinely confused. They’re like, ‘I don’t know how to distinguish between this. I don’t know if I can even diagnose ADHD if trauma is present.’

So I do a lot of work training in this space. And I think that some of the things people tend to be confused about are around attentional differences.

We know that an ADHDer will struggle with attentional regulation—and that may be true too of somebody who’s experienced trauma. We know that that kind of brain fog an ADHDer experiences may be confused with dissociation, as we might see in somebody who’s experienced trauma, as well as things like emotional regulation differences, impulsivity, hyperactivity.

So there are these elements that seemingly overlap, but there are really clear distinctions between them and what is what.

Jane McFadden:
So then, how would someone of your level of experience start to even tease them apart if you had somebody in front of you?

Amanda Moses:
Yeah, so most of my work is with really complex clients, and I’d say the vast majority have experienced trauma and are now questioning neurodivergence as well.

So yes, that is my role—trying to work out, okay, so we might have PTSD here as well as potentially ADHD and autism. How do I capture this whole experience?

I like to remind clinicians it doesn’t necessarily need to be about exclusion—like, is it PTSD or ADHD—but rather, is it potentially both?

What we do know from the research is that those who are autistic and ADHD are more likely and more susceptible to experiencing trauma, perhaps because of their vulnerability to it and because of the way they process traumatic events.

So we see a higher incidence of trauma in this population, meaning that I really like to emphasise to people that most of the time it’s going to be both.

It’s not about saying we need to rule out trauma to understand if it’s ADHD, because many ADHDers have trauma.

You need to understand what it looks like when an ADHDer has trauma versus when it’s just somebody with trauma who’s not also an ADHDer.

For me, I usually start with trying to predate traits—say, okay, so if the trauma started when they were eight, is there any evidence or self-reports of traits that started prior to that time? Because that would indicate the likelihood of neurodivergence with trauma.

But more often than not, it’s never that easy.

I often have clients who experienced trauma in that developmental period, meaning that I can’t predate it—and that’s okay, because then what I’m looking for is how those traits manifest throughout their life.

If we’re coming back to some of those things people get confused about, like attentional differences—what I expect to see with an ADHDer is this pattern of attention that is typically characterised by being very attentive to tasks or activities they find subjectively interesting or rewarding, versus someone with PTSD who won’t necessarily have that discrepancy.

Their attention isn’t regulated based on reward or motivation—it’s usually driven by fear, hypervigilance, anxiety. It’s about not feeling safe and having to stay on high alert for potential threats in the environment.

Because they’re on high alert, they’re not able to regulate their attention to what’s happening in the moment—and that looks really different.

Of course, if they have both ADHD and trauma, I’ll see a pattern of both. I’ll be able to distinguish between the times their attention wasn’t regulated because they were on high alert versus the times it occurs without psychological distress—when it’s purely about motivation and reward.

Those aren’t things I should see with someone with PTSD. It should typically occur in the context of hypervigilance.

Jane McFadden:
Well, Amanda, I think what we’ve seen in your response is the difference between a passionate psychologist, very highly educated and well-developed professionally, versus a lot of practitioners out there.

For example, I’ve had a couple of women write to me recently who have been to see psychiatrists who all had the same response: ‘Let’s rule out the trauma first.’

They won’t even let the poor woman try ADHD medication. They keep holding it over them, and every time they go to the appointment, they still don’t get the medication they want to try.

This trauma process can go on for two years, and they still never get access to try medication. So I think the way that you’ve answered that question just shows the difference so clearly.

Amanda Moses:
Yeah, and to me, it’s so clear as well. That’s why I do so much work educating and training, because I want that to be clear to other professionals too.

I’ve heard that sentiment so often where psychologists tell me, ‘I heard I’m not allowed to diagnose ADHD if trauma might be there. I have to rule that out first.’

And I’m like, no—nowhere in our scientific literature does it say you need to do that. Our DSM doesn’t even state that.

When we diagnose, certain conditions do require exclusion before you can make the diagnosis—but ADHD isn’t one of them.

It baffles me where this rumour came from and why so many people believe it when it’s not grounded in scientific evidence or even our diagnostic manual.

If you’re an ADHDer who’s experienced trauma and your psychiatrist is only focusing on trauma, they’re going to miss the big picture—because neurodivergence and your neurotype are the most fundamental parts of how your brain works and how you experience life.

If I disregard that and try to treat someone without understanding how they process information or experience the world, I’m going to provide very ineffective treatments.

We need to understand someone’s neurotype as the most fundamental aspect of them—it shapes how I provide therapy and treatment.

Jane McFadden:
Yes. And you know, this is one of the trickiest parts. I feel like I’m a little front-line with it—having all these women message me, sending DMs, posting in the Facebook group.

It’s tricky because I had already been diagnosed by a psychologist by the time I got to a psychiatrist, so I presented very textbook because I knew what they were looking for. I just wanted to try medication.

But when women are getting ready for an appointment, they want to be diagnosed properly—they want to be confident in that assessment. But then I also say, be careful with trauma—because if you bring that up, depending on the psychiatrist, you could end up on a merry-go-round for years and not get access to medication.

Some of these women don’t have thousands of dollars to spend on different appointments, so they’ve got so much riding on this one thing. They don’t know whether to be completely honest and risk being held back or just present one thing to try the medication. It’s so tricky.

Amanda Moses:
It is really tricky—and personally upsetting for me because I see this a lot as well. It’s so expensive to get an assessment or even a psychiatry appointment.

I’m not devaluing any of the work clinicians do, but I’m aware it costs a lot of money. And it upsets me to see so many people being let down by health professionals.

This idea that you have to rule out trauma to diagnose ADHD isn’t grounded in anything, and it bothers me that people are paying thousands and going in circles for years without getting proper care.

We actually have research showing the harm caused by misdiagnosis and missed diagnoses for both autism and ADHD.

When I looked at the research, it’s clear—people diagnosed later with autism or ADHD tend to have more complex mental health problems, higher rates of suicidal ideation, suicidality, and co-occurring conditions.

Those diagnosed earlier, particularly with autism, tend to have lower levels of comorbidities.

So early diagnosis actually becomes a protective factor for mental health and wellbeing. But too often, people get about ten different labels before the correct one—ADHD or autism—and it’s just really disappointing.

Jane McFadden:
Well, I think it’s people like yourself, and you know, Mari Carmen and Esther Fedorkins, and the lady from the Neurodivergent Women—

Amanda Moses:
Monique Mitchelson.

Jane McFadden:
Yes, Monique Mitchelson! There are so many psychologists out there doing that training, and that’s so important because that’s how we’ll see change.

So if we take a step back—with women, for example, or just people—if they have ADHD, they’re going to be more likely to experience trauma. Do you think this is part of the pathway of being misdiagnosed?

Amanda Moses:
Partly, yes, I think so. But I think there are other factors too.

If we’re talking about women and those assigned female at birth specifically, I presented on this last year at the Big ADHD Conference in Australia.

Basically, the topic was: why are women and AFAB people getting late diagnosed and missed?

A lot of it comes down to the criteria for ADHD. When it was written originally, the sample size was mostly young boys—70 to 90%.

So what’s happened is that screening tools and measures are heavily based on young boys’ presentations. It wasn’t until the DSM-IV—about the last 20 years—that they realised ADHD could persist into adulthood.

Before that, the assumption was that ADHD was a childhood problem you grew out of.

But research has shown bias at every step of the process—teachers, parents, GPs—all are more likely to identify boys. Even when a young girl shows the same level of symptoms, she’s less likely to be flagged.

Even if she gets referred, she’s less likely to be diagnosed. And even if diagnosed, she’s less likely to be offered medication.

So there’s bias and discrimination at every level.

Also, girls and AFAB people may have slightly different presentations—their hyperactivity is often more verbal or mental restlessness rather than physical.

They might have more internalised traits and not fit the stereotype. That in itself forms another barrier.

Jane McFadden:
Oh, absolutely. I think you’ve said that really well. If you happen to find the research article, send it through and I can put it into the show notes.

Amanda Moses:
I made a document about it, so I’ll send it to you.

Jane McFadden:
Yeah! Some people like to read—or is that just me?

If we talk about RSD, rejection sensitivity dysphoria—most of the audience will know what that is—but people with PTSD also have deep emotional wounds. How would you tell the difference?

Amanda Moses:
I think the answer lies in what the trigger is. With PTSD, it’s not always rejection or criticism-specific. Their emotional wounds are linked to their trauma narrative—abuse, neglect, or other experiences.

For example, someone who experienced neglect may have low self-worth, which we also see in ADHDers.

For an ADHDer, RSD is still a relatively new concept—it doesn’t yet have strong research backing. What I’ll share is based on clinical observation.

I think ADHDers resonate with it for a reason—it means something. I’ve been trying to understand how it fits with ADHD.

I hypothesise two things: first, it’s about lived experience. ADHDers often internalise messages like ‘lazy,’ ‘unorganised,’ ‘not trying hard enough.’

This starts in childhood. They may receive more criticism in school, setting them up to be more sensitive to rejection later.

Secondly, it relates to executive functioning. ADHD is primarily about executive functioning differences—particularly inhibitory control, which regulates impulses and emotions.

So when ADHDers experience emotional dysregulation or big emotional reactions, it’s because that executive functioning system struggles to regulate impulses.

That can lead to disproportionate emotional reactions to perceived rejection or criticism.

So for me, RSD makes sense within that framework—it’s both lived experience and neurological regulation differences.

Jane McFadden:
Okay, you are so interesting, Amanda. I’d love to talk to you for hours. But let’s continue on.

So let’s say someone is diagnosed with PTSD but actually has ADHD—or both. How does this impact treatment, and why is it such a problem?

Amanda Moses:
I think the problem is that when trauma is present and ADHD isn’t accounted for, you’re probably going to have a traumatised person with significantly worse executive functioning than someone without ADHD.

As an ADHDer, your executive functioning is already challenging, and stress or mental health issues make it worse.

If I assume someone just has trauma and treat that without acknowledging ADHD, I’m missing a big piece.

I’m unlikely to assist them fully. Trauma treatments won’t necessarily harm, but if I fail to account for ADHD and its impact, treatment may feel ineffective or stagnant.

Clients may feel stuck because a huge part of their picture is being missed.

Jane McFadden:
Exactly. That’s one perspective—if the ADHD is missed. But on the other side, if someone with PTSD is misdiagnosed with ADHD and given stimulant medication, how would that affect them?

Amanda Moses:
First, I want to be clear—the media has done a great job convincing people that this happens a lot and we should worry, but research doesn’t support that.

What we actually see is the opposite—people being misdiagnosed with trauma or personality disorders when ADHD is the true explanation.

There isn’t strong evidence of people being misdiagnosed with ADHD when it’s actually trauma.

If it did happen, I can’t say for sure what the implications would be. Stimulant medication is usually short-acting—Ritalin lasts about three hours, Vyvanse about twelve.

So any effect would be temporary. My concern is more about missing ADHD than misdiagnosing it, because these medications clear from the system quickly.

Jane McFadden:
Oh, I completely agree. And we know they’re safe, right? They’re safe for kids, safe for adults—it’s your choice whether to medicate, but they’re well-regulated.

Amanda Moses:
I agree. Which is why I don’t understand why some practitioners won’t let someone try a short-acting stimulant and see if it helps, rather than holding it back.

Jane McFadden:
I haven’t heard anyone say they tried ADHD medication and it didn’t work because they didn’t have ADHD. The media says it happens—I haven’t seen it.

Amanda Moses:
I haven’t either, and I haven’t read any research showing it. A lot of it is fearmongering, and it harms real ADHDers who need medication.

It creates mistrust, where people doubt their own diagnosis or professionals second-guess it. It’s unnecessary and damaging.

Jane McFadden:
I agree. And I think holding the medication back creates more of an underground, dangerous market out of desperation.

Amanda Moses:
Absolutely.

Jane McFadden:
Okay, so let’s say a woman has both ADHD and PTSD—what would an effective treatment plan look like?

Amanda Moses:
An effective plan would look at both together. You don’t need to treat one before the other, because ADHD shapes how someone experiences every moment of their day—you can’t ignore it.

So if the person chooses to medicate, they’d take ADHD medication or try other management strategies while also addressing trauma, such as through EMDR, which is evidence-based.

It’s important for the therapist to understand that this is ADHD as trauma—not just trauma alone.

Executive functioning differences, how they engage in therapy, how they process information—all need to be supported.

A trauma-informed approach must accommodate their neurotype to set them up for success.

Jane McFadden:
You’ve said that really well. You’ve got a great way of making complex things sound simple.

Okay, last big question before takeaways. I hear the ‘trauma-informed’ buzzword thrown around—but how many people really understand what that means? What does it mean for someone with ADHD, and how do we find a professional that is trauma-informed?

Amanda Moses:
Trauma-informed care is about creating environments and support that actively recognise and respect the impact trauma has on someone—without causing further harm.

For ADHD women, that might mean working with professionals who understand that living with undiagnosed or late-diagnosed ADHD often brings layers of trauma—chronic invalidation, stigma, struggles with self-worth.

Trauma-informed care should be gentle, validating, respectful, and collaborative. It centres the person’s experience.

For me, that means treating my client as an equal expert. They’re the expert of themselves—I bring expertise in psychology and neurodivergence, and together we collaborate.

Finding professionals who understand both trauma and ADHD means looking for those who explicitly describe their practice as trauma-informed and neurodiversity-affirming.

Good professionals are transparent about their expertise. Referrals from trusted community members or support groups can help too.

And don’t be afraid to ask direct questions—ask about their experience with trauma-informed approaches and ADHD. A professional who answers openly without defensiveness shows genuine understanding.

You’re about to invest a lot of money—you deserve to ask these questions and get a respectful, informed answer.

Jane McFadden:
I love the way you said that. And I think your answer should also apply to paediatricians for our children.

As a parent, I’m an expert on my child, and they’re the expert on paediatrics—it’s 50/50.

You don’t need to be subservient to a practitioner because we know our kids. If that practitioner says, ‘You listen, I know best,’ that may not be the right person for you.

Amanda Moses:
I agree. We should be collaborative and respect each other’s expertise. Even as a mum—who knows your child better than you?

But it’s okay to take advice and meet halfway. Don’t lose yourself in the process. A good clinician brings their expertise but also expects you to bring yours.

Jane McFadden:
I love that. Okay, we’re finishing up, Amanda—which is sad for me—but we will do that.

So, what would be an important message that you’d love ADHD mums to know about ADHD and PTSD?

Amanda Moses:
The most important message is—it’s often not about ADHD or PTSD, but ADHD and PTSD.

For many women, especially mothers, the experience of living with undiagnosed or misunderstood ADHD can itself be traumatic.

ADHD brings daily stresses that accumulate over time, creating an environment where trauma symptoms can flourish—and trauma can amplify the severity of executive dysfunction.

Recognising that both can coexist allows for a gentler, more holistic approach to support and healing, and helps you advocate more effectively for yourself and your children.

Jane McFadden:
Oh, perfect. I think there’ll be a lot of people who’ll want to follow you or explore your work. Where’s the best place for people to find you or your resources?

Amanda Moses:
You can find me at amandamosespsychology.com.au. I have psychoeducational resources there for community members and health professionals, lots of free content, and my Instagram is @amandamosespsychology.

I share education and knowledge there—very happy to connect with anyone.

Jane McFadden:
Beautiful. Well, thank you so much for your time, Amanda. That has been really interesting. This is one of the big topics that I haven’t been able to get anybody to come on and talk about yet, so this is going to be really well received.

Amanda Moses:
You’re welcome. Thanks for having me.

Jane McFadden:
The key message here is—you are not alone. Thank you for listening. If you enjoyed this episode, follow us on Instagram or join our ADHD Mums Podcast Facebook community. Everything you do matters and helps spread the word about what neurodiversity in females looks like.