You are not Broken. You are wired differently.
Take what helps, skip what doesn’t, and remember you don’t have to do this alone.

The Appointment Page

Paired worksheet. When They Say You Are Too Young and Too Capable

Danielle Ralston, Master ADHD Coach, MSW, ADHD-CCSP

The framework in three sentences. The Double Dismissal is two refusals that hold each other up: too young for perimenopause, too capable for ADHD or autism, with each one used to rule out the other. Both refusals are predictable, which means both can be answered before they arrive. Fill this in, print the last page, and take that one sheet in.

1. What changed, and when

The three things that started around the same time.

What changed, not how it feels. “I cannot follow a recipe” beats “brain fog.”

Roughly when did it start? A month is enough.

What changed in your life in the two months before that?

2. What you already tried

The result, not the intention. This is the part that stops the conversation being about effort.

What you tried	How long	What actually happened

3. The two things you are asking for

Two. Not eight. An appointment that ends without a named request ends without a decision.

Request one

Request two

4. The lines that close the exits

Tick the ones you expect to need. Say them in your own words.

If the answer is that you are too young

“I know the usual timeline starts around forty-five. There is population data showing severe perimenopausal symptoms peak about ten years earlier in women with ADHD, in the thirty-five to thirty-nine band. That is why I am raising it now rather than waiting.”

If the answer is that your bloods were normal

“My understanding is that the 2025 European guidance says blood testing is not needed to diagnose perimenopause over forty-five. Can we treat the symptom picture rather than wait on a number?”

If the answer is that you are managing well

“I did manage. That took a system I no longer have, and the cost of running it is what I am here about. Coping is not the same as not needing support.”

The close, every time

“So the two things I am asking for today are ______ and ______. If either is a no, could you write in the notes what the reason was, so I have it for next time?”

5. Your letter

For when the appointment is short, or when speaking under pressure is the part that goes wrong. Fill the brackets, send it ahead or hand it over at the start.

Dear Dr ____________,

I am writing ahead of my appointment on ____________ so we can use the time well.

Since roughly ____________ I have had ____________, ____________ and ____________. Before that period the main change in my life was ____________. I have tried ____________, for ____________, and the result was ____________.

I am aware I am ______. I understand the standard perimenopause timeline begins later, and I am raising it now because population data indicates severe perimenopausal symptoms peak around a decade earlier in women with ADHD.

I am asking for two things at this appointment: ____________ and ____________.

If either is not appropriate, I would be grateful if the reason could be recorded in my notes.

Thank you, ____________, ____________, ____________

6. After

What was said, and what was agreed.

Write it in the car park while it is still accurate. This becomes the timeline for the next appointment.

Worth saying out loud. No script makes a clinician assess you. Women in this position describe being disbelieved as the norm rather than the exception, and a well-prepared appointment does not fix a system-level problem. What it does is remove the reasons that are easiest to reach for. If three attempts have gone the same way, that is information about the practice, not about you.