As someone who did get diagnosed: It took me _five_ attempts to get all the way to an appointment with a psychiatrist (inability to find a suitable psychiatrist, lost referrals, missed appointments etc). Navigating the medical establishment with untreated ADHD is hell. Now I've got treatment for it, I could do it easily, but it's really hard to overstate just how non-functional you can end up.
Because the symptoms are easily faked, I needed a significant range of retrospective evidence - quotes from school report cards, interviews with my parents - which I had to arrange prior to assessment. If I hadn't been able to produce those, I likely would not have been able to get treatment.
It felt like a really strong coffee. It did not really help as I could just focus intensely on the wrong things for hours then crash. The comedown was not fun. The side effects were not fun. The benefits were questionable.
Above all, my lifestyle is built around ADHD. My work is structured to accomodate my quirks. I was happier riding the waves as there were almost no consequences for doing so.
Perhaps another type of medication would have worked better, but no medication at all is good enough.
One thing I appreciated is that they titrated the medication safely. I hear that American doctors start people with a much stronger dose. German doctors seem more moderate, and more willing to try therapy first.
Your mileage may vary.
I do know that therapy and medication made it night and day for her. She immediately dropped all caffeine. Her sleep and general mood was so much better and she wad way less flakey. She doesn't dismiss therapy although I know she hasn't gone every week for a while not and mostly goes when she's feeling like she needs it. Medication was a trip and error, but she's much happier with this steady state.
I think in America you should still be able to get access to meds fast. But trying to chase local doctors means all the slowness that comes from a local economy (you really want an ADHD specialist because of stigma.) I would be trying to find telehealth options if they're there. I do agree with you about the behavioral approaches. The best option IMO is pharmaceutical. Stimulants are ~70-80% effective for people with ADHD.
You should _really_ consider therapy in addition to any medication. The meds will be amazing for a month and then useful for a year. After that you're going to have to make a decision about how you want to continue treatment. Keep bumping the dose and adjust to the side effects or 'typical therapy'. By then, that therapy is going to be much harder to apply to your life than it would have been in the first few months when you started the meds.
In the UK, for me, diagnosis wasn't too hard via BUPA - my phsychiatrist seeing me for my other mental health problems recommended me and it was relatively quick to get an ADHD diagnosis; now, however, I am stuck - there's a UK shorage of medication so my psychiatrist is unwilling to proscribe for a new patient whilst existing ones aren't getting what they need. Until that gets unblocked I'm in limbo; additionally BUPA do not cover any ADHD costs (except the diagnosis) - after that you're on your own and you either need to self-fund or go via the NHS; the NHS won't "just" prescibe; for me they want that to come from the psychiatrist and they'll then pick up the medication part of it - but see above about BUPA not funding ADHD costs.
If you go NHS all the way then you'll be on long waiting lists and, presumably, some sort of post-code lottery as to your experience.
I'm willing to self-fund to get to the point where the NHS will take over (and apparently that's a dice-roll too; my GP says he will prescribe once the shrink gets me on a stable dose, but not before - apparently some GPs refuse and require that you go via the NHS for everything, so you're on long waiting lists again); but am currently unable to progress due to the shortage of medication, as mentioned. I am also expecting relatively large bills as I will need to self fund both the psychiatrist and the initial medication prior to the NHS picking it up.
Anecdotally (reading ADHD forums on reddit) experiences in the US sound much more random.
Expect to pay between £700 - £1500 (initial consultation, titration fees). Then the ongoing medication costs.
Honestly I am torn on this issue, I don't think we should have a nation filled with amphetamine users, but right now I'm a self funded founder and I can't justify this cost. So I have no choice but to self medicate with medication I have procured myself through alternative means...
The whole thing feels scammy in the UK
The NHS ADHD waiting list in my region was over 6 years but using RTC, I was diagnosed in around 6 months with no extra cost and prescriptions costing the NHS standard. Places like ADHD360 and PsychiatryUK focus on high throughput / low cost so the amount of time and qualifications of the practitioners won't match hand-picking a private psychologist but you can't argue with the cost.