Difficult to find providers who actually can properly diagnose it who aren’t overwhelmed. And many of us were just told our whole lives that we were lazy or had personality defects, so we tend to mask making it difficult to diagnose properly if providers aren’t experienced. Many still only use outward hyperactivity as a valid sign or only diagnose children since there was a long belief that it went away with adulthood, but in reality it’s just usually heavily masked by adults out of necessity.