Question: Thanks for doing an AMA! Appreciate your time. 
  
  What do you think are the main factors for someone to fly under the radar for so long with ADHD? Is it a supportive family and childhood upbringing? Do we know what genes are involved etc? 
  
  Also I'm a female that presents more overtly hyperactive than a lot of other females I know with ADHD who are more the day dreamer type, do we know what contributes to presentation types? 
  
  Also, the DSM doesn't include criteria around emotional regulation despite it being quite commonplace given than ADHD is an executive function disorder, what do studies say about emotional regulation and ADHD and when do you suspect it will be included in a DSM (incl. the politics involved)?
Answer: When ADHD is not noticed until later in life it is typically because the patient had been protected by having protective social, emotional or intellectual resources such as a supportive family, an outstanding school or just being very intelligent.  This "scaffolding" supports them for a while but collapses under the weight of the challenges that occur in adulthood.
  
  We don't know what contributes to the presentation types.  
  
  Emotional regulation is a complex topic.  Perhaps I'll do an AMA on it.   In the meanwhile, see:  [https://pubmed.ncbi.nlm.nih.gov/29624671/](https://pubmed.ncbi.nlm.nih.gov/29624671/)   Email me at [svfaraone@upstate.edu](mailto:svfaraone@upstate.edu) for a copy.
content: Q: Thanks for doing an AMA! Appreciate your time. 
  
  What do you think are the main factors for someone to fly under the radar for so long with ADHD? Is it a supportive family and childhood upbringing? Do we know what genes are involved etc? 
  
  Also I'm a female that presents more overtly hyperactive than a lot of other females I know with ADHD who are more the day dreamer type, do we know what contributes to presentation types? 
  
  Also, the DSM doesn't include criteria around emotional regulation despite it being quite commonplace given than ADHD is an executive function disorder, what do studies say about emotional regulation and ADHD and when do you suspect it will be included in a DSM (incl. the politics involved)?
   Ans: When ADHD is not noticed until later in life it is typically because the patient had been protected by having protective social, emotional or intellectual resources such as a supportive family, an outstanding school or just being very intelligent.  This "scaffolding" supports them for a while but collapses under the weight of the challenges that occur in adulthood.
  
  We don't know what contributes to the presentation types.  
  
  Emotional regulation is a complex topic.  Perhaps I'll do an AMA on it.   In the meanwhile, see:  [https://pubmed.ncbi.nlm.nih.gov/29624671/](https://pubmed.ncbi.nlm.nih.gov/29624671/)   Email me at [svfaraone@upstate.edu](mailto:svfaraone@upstate.edu) for a copy.