When Your Brain is Already Translating: ADHD, Bilingualism and Finding Support in Sydney

You already know what you need to do: book the appointment, find the right person, fill in the form, make the phone call, follow up on the email you meant to answer three weeks ago.

You've probably known for months. The knowing was never the hard part.

For many adults with ADHD, the difficult part is everything that sits between I should do this and it's done. Now add another language — perhaps your second, third or fourth — and a healthcare system full of referrals, rebates, acronyms and unfamiliar rules.

Suddenly, getting help becomes another thing requiring the exact executive functioning you're trying to get help with.

At Syné, we hold onto a simple idea: accessing therapy should feel as easy and familiar as getting your morning coffee. For someone living with ADHD, that isn't just a nice sentiment; it's a design principle. Fewer hoops, fewer forms and fewer reasons to put it off until next Monday.

We also believe in being honest with you. Navigating ADHD care in Australia isn't always that simple, particularly if English isn't your first language or you don't have access to Medicare.

This article is for the people somewhere in the middle: living with ADHD or wondering whether they might have it, waiting for an assessment, navigating Australia in another language, or simply trying to work out what support is available.

It's not just about finding the word

When we talk about ADHD and bilingualism, it's easy to assume the difficulty is vocabulary. You forget a word, pause, reach for the translation and eventually find it. That happens, of course, but language is doing far more work in the background than we tend to notice.

A conversation in your second language can ask your brain to listen, interpret, hold onto meaning, formulate a response and work out how to say it, all while the conversation keeps moving. When attention, working memory and task-switching are already things you have to work harder to regulate, that extra processing can feel like having too many tabs open at once.

You can run them all; it just takes more energy.

You might notice it in meetings, when you understood the question and knew what you wanted to say, but by the time you've assembled the response the conversation has moved somewhere else. It can be the 3pm wall after a full day of listening, interpreting, responding and self-monitoring, or losing the end of your own sentence somewhere between knowing what you meant and finding the words to say it.

Then there's the emotional side of language, which can be harder to explain. There's a difference between being fluent in English and feeling entirely like yourself in English.

You might work in English all day, run meetings in it, make friends in it, crack jokes in it and argue with your internet provider in it, only to have someone ask how you feel and discover that the language you've been speaking all day suddenly doesn't quite have the right words.

Therapy asks for a different kind of fluency. For some bilingual people, the words closest to fear, shame, anger or grief are still the ones they first learned to express those feelings in. Add ADHD — when holding onto a thought, regulating an emotion or finding the right words under pressure may already take more effort — and explaining what's happening inside can become another task entirely. You know what you mean; you just can't always get it out in quite the same shape.

When Your Inner Monologue Gets Crowded

There can also be a surprising amount of self-monitoring happening underneath all of this. Living with ADHD can come with its own quiet commentary: don't interrupt, pay attention, remember what they just said, don't lose your point. Living in a second language can bring another: did I understand that correctly, was that the right word, did that sound rude, did they understand me? 

When the two overlap, a lot of energy can go into simply trying to look like you're keeping up. Sometimes you're not just translating the conversation; you're translating yourself while trying to stay in it.

Importantly, none of this means your English isn't “good enough”. The research on bilingualism and ADHD is still developing, and the findings aren't completely consistent. Some studies have found differences in executive functioning, others have found possible advantages in areas such as working memory, and broader reviews haven't found convincing evidence that bilingualism itself makes ADHD better or worse.

What we can say is that being bilingual doesn't cause ADHD, and it doesn't erase it either. It may simply change how you experience some of the demands placed on your attention.

Sometimes, having an explanation for that matters. Without one, it's very easy for difficulty to become something more personal: maybe my English isn't good enough; maybe I'm bad at communicating; maybe I'm lazy; maybe everyone else can cope with this and I just can't.

ADHD already attracts an uncomfortable amount of moral language — careless, disorganised, unreliable, too much, not trying hard enough. When you're also navigating life in another language or culture, it can become even harder to work out what belongs to language, what belongs to attention, what belongs to overwhelm, and what was never a character flaw in the first place.

Sometimes what looks like a language problem may be an attention problem. Sometimes it's both. Either way, shame rarely makes either one easier.

Then there's the Australian healthcare system

There's a particular irony in asking someone who may struggle with executive function to navigate a system that requires quite a lot of it. Find a GP, make the appointment, remember the appointment, explain what's happening, get the referral, find a psychiatrist, compare fees, join a waitlist, follow up, work out what Medicare covers, work out what your visa covers, and keep the paperwork somewhere you'll actually find it again.

For someone navigating all of that in their second language, there's another layer again.

ADHD is common, but accessing ADHD care can still be surprisingly complicated. Private assessments can cost hundreds — sometimes thousands — of dollars, waiting periods vary enormously, and Medicare rebates don't necessarily cover the full cost. Depending on your visa, insurance and residency status, Medicare may not be available to you at all.

Then come the terms: referral, Mental Health Treatment Plan, gap fee, OSHC, Reciprocal Health Care Agreement, endorsed prescriber. Not exactly calming language when you're already overwhelmed.

Australian ADHD care, translated into human

• Referral: A letter from your GP allowing you to see a specialist. You'll generally need one for a psychiatrist consultation to attract a Medicare rebate.

  Mental Health Treatment Plan: A plan prepared by your GP that can give eligible Medicare holders access to partly rebated psychology sessions. International students may also need one depending on their OSHC policy.

• Bulk-billed: The provider accepts the Medicare rebate as the full payment, meaning you don't pay a gap. This only applies if you're Medicare-eligible.

• Medicare: Australia's public health insurance system. Eligibility depends on citizenship, residency and certain visa or reciprocal healthcare arrangements.

• OSHC: Overseas Student Health Cover. Most international students are required to have it. It isn't the same as Medicare, and coverage varies between insurers and policies.

• Reciprocal Health Care Agreement: Australia has limited healthcare agreements with a small number of countries. These don't necessarily give you the same access as a Medicare-eligible Australian resident.

• Gap fee: The amount left over after any Medicare or insurance rebate is applied.

• Endorsed or continuation prescriber: In NSW, certain GPs can now play a greater role in ongoing ADHD medication management, with further changes to GP assessment and prescribing being introduced.

If your eyes glazed over halfway through that list, you're not alone.

What if you don't have Medicare?

If you're living in Australia temporarily — perhaps on a student, working holiday, 482 or 485 visa — your pathway may look different. For international students, OSHC is generally the starting point. What it covers varies, so it's worth checking before you book rather than discovering the gap afterwards.

For other temporary visa holders, eligibility depends on your circumstances, and Services Australia is the safest place to confirm your exact Medicare status. Before booking an ADHD assessment, it's also worth asking exactly what the quoted fee includes. Is it just the initial assessment, or does it also include a written report and follow-up appointments?

If you were diagnosed overseas, bring your records with you. In NSW, continuation prescribing requires an established diagnosis and stable response to medication, although individual clinicians may differ in what overseas documentation they accept. The important thing is not to assume you have no options simply because you don't have a Medicare card.

ADHD care in NSW is changing

There are changes underway that may make parts of the process easier. Since September 2025, authorised GPs in NSW have been able to continue prescribing stimulant ADHD medication for eligible people who have already been diagnosed and are stable on treatment.

More GPs are also being trained to assess, diagnose and initiate treatment, and NSW Health has announced plans for up to 2,500 subsidised GP ADHD assessments from early 2027, prioritising people experiencing financial stress.

It's progress, but it's worth keeping expectations grounded. Demand for ADHD assessment remains significant, and not every detail — including how some initiatives will apply to people without Medicare — is clear yet. If you're unsure, ask your GP rather than ruling yourself in or out.

No diagnosis. No referral. No Medicare card.

This is where Syné works a little differently. You don't need to arrive with paperwork proving why you're struggling, and you don't need an ADHD diagnosis, GP referral, Mental Health Treatment Plan or Medicare card.

You choose a time and show up — at our Sydney CBD space, five minutes from Wynyard Station, or online from wherever you are — and we begin with what's actually happening in your life.

That might be constantly losing things, procrastinating until something becomes an emergency, feeling exhausted from masking all day, or building an elaborate system of alarms, notes and reminders and somehow still forgetting the thing. You might not know whether it's ADHD at all, and that's okay too.

You don't need the perfect explanation for why work feels harder than it should, or to know whether the procrastination, overwhelm, forgetfulness or exhaustion you're experiencing is ADHD. If English isn't your first language, you also don't need to translate your entire inner world perfectly before we can begin. Sometimes therapy starts much more simply: this keeps happening, I don't really understand why, and I'd like things to feel a little easier.

That's enough to start with.

We're equally clear about what we don't do. Syné doesn't provide formal ADHD diagnoses or prescribe medication. If you're seeking either, you'll need an appropriately qualified medical professional or assessor. Therapy and coaching aren't replacements for that process, but they can give you somewhere to begin while you're navigating it.

Meet Maria

For Maria Herguedas Irazu, this work is both professional and personal. Maria is an accredited psychotherapist and ADHD coach with Master's degrees in Counselling and Psychotherapy and in Sexology, alongside Gottman Method training for couples work. She's also a native Spanish speaker living and working in Sydney with ADHD herself.

So when a client says they knew exactly what they wanted to say in Spanish but couldn't quite find themselves in the English version, there's a particular kind of understanding there.

Maria's work is practical, relaxed and multi-modal. Rather than asking every person to fit into one therapeutic framework, she draws from different approaches depending on what that person actually needs. Sometimes that means understanding the emotional patterns underneath what's happening; sometimes it means building systems that make Tuesday morning slightly less chaotic. Often, it's both.

Sessions with Maria can be in Spanish, English, or move naturally between the two. A feeling might arrive more easily in Spanish while a story is easier to tell in English, and sometimes there simply isn't a perfect translation. You don't have to choose one version of yourself before you walk through the door.

There's something particularly fitting about that at Syné. Our name comes from the Ancient Greek sophrosyne, a word associated with soundness of mind, balance and inner harmony. Fittingly, there isn't one perfect English translation.

Maybe that's part of the point. Not everything we experience fits neatly into one word, one language or one diagnosis. Sometimes we need a little more room to understand what's happening beneath all of them. You don't need to translate yourself perfectly here.

Ancient wisdom, for modern minds.

You don't need a diagnosis to want life to feel easier

Not everyone is looking for a label. Sometimes you just want to stop losing your keys, finish the email before it becomes A Whole Thing, make it through a meeting without spending half of it mentally rehearsing what you're going to say, or build a routine that survives longer than four days. Maybe you simply want to understand why something that looks incredibly simple from the outside can feel strangely impossible from the inside.

Those are valid things to want support with.

Research into ADHD coaching is still developing, but studies suggest that structured coaching and skills-based approaches may improve executive functioning, ADHD symptoms and everyday functioning. CBT also has a growing evidence base for adults with ADHD, particularly around functioning, emotional regulation and quality of life.

Most of that research has involved people with a formal diagnosis, so we shouldn't pretend we know exactly how those findings translate to people without one. What we can say is that you don't need to wait for a piece of paper before you're allowed to start understanding yourself better. Assessment, coaching and therapy can be different parts of the same picture.

While you're figuring it out

If you're waiting for an assessment — or still deciding whether you even want one — there are some practical things that can make the process a little easier.

Ask your GP about the options available to you, particularly in NSW where ADHD prescribing and assessment pathways are changing. If English isn't your first language, ask an assessor how language is considered during the assessment and whether any additional support is available. Check your Medicare, OSHC or private insurance cover before booking so you understand what you'll actually pay.

It can also help to write down examples before an appointment rather than expecting yourself to remember everything in the room. Think about what happens at work, at home, with appointments, money, relationships or deadlines, and write those examples in whichever language they arrive in. If you were diagnosed or treated overseas, keep copies of your reports and prescriptions.

And wherever you can, get things out of your head. Use the calendar alerts, the lists, the notes stuck somewhere impossible to ignore, the body doubling and whatever other systems genuinely make your life easier. Your brain doesn't receive extra points for remembering unaided.

Most importantly, don't confuse fluency with intelligence. Taking longer to find a sentence in your second language says nothing about the complexity of the thought behind it.

These are general ideas rather than medical, legal or immigration advice.

Until then, you can still get started...

You don't need to have the perfect explanation, know whether it's ADHD or understand every part of the Australian healthcare system before you're allowed to ask for support. And you certainly don't need to translate your entire inner world into perfect English before someone can help you make sense of it.

Whether you're waiting for an assessment, navigating life without Medicare, wondering whether ADHD explains some of what you've been experiencing, or simply tired of translating yourself all day, you're welcome here.

Start with a free 15-minute discovery session with Maria. No diagnosis or referral required.

[Book a free 15-minute discovery session with Maria →]

Terapia y coaching para el TDAH en español en Sydney

¿Vives en Australia, tienes TDAH — o te preguntas si podrías tenerlo — y el inglés no es tu primer idioma?

Maria Herguedas Irazu es psicoterapeuta acreditada y coach de TDAH en Syné Collective. Ofrece sesiones en español, inglés o una combinación de ambos, de forma presencial en Sydney CBD y online. No necesitas diagnóstico, derivación ni tarjeta Medicare para empezar terapia o coaching con Syné.

Preguntas frecuentes

• ¿Puedo recibir apoyo para el TDAH en Australia sin Medicare? Sí. Aunque Medicare solo está disponible para personas elegibles, puedes acceder de forma privada a terapia, coaching y evaluaciones. En Syné no necesitas Medicare ni una derivación para reservar.

• ¿Necesito un diagnóstico de TDAH para empezar con Maria? No. Puedes trabajar con Maria sin un diagnóstico formal.

• ¿Maria puede diagnosticar el TDAH? No. Syné no realiza diagnósticos formales ni prescribe medicación. Maria puede apoyarte antes, durante o después de un proceso de evaluación.

• ¿Puedo hacer las sesiones completamente en español? Sí. Maria ofrece sesiones en español, inglés o una combinación de ambos.

• ¿Cuánto cuesta una sesión?Las sesiones individuales cuestan $150 y las sesiones de pareja $220.

• ¿Dónde está Syné Collective? Level 12, 347 Kent St, Sydney NSW 2000, a unos cinco minutos a pie de Wynyard Station.

• Busco terapia en español. ¿Necesito tener TDAH para atenderme con Maria? Para nada. El TDAH es solo una de las áreas de especialización de Maria. Como psicoterapeuta, trabaja con una amplia variedad de dificultades emocionales y psicológicas, como ansiedad, depresión, estrés, duelo y pérdida, sexualidad, intimidad, relaciones de pareja y mucho más.

FAQs

• Can I get ADHD support in Australia without Medicare? Yes. Private therapy, ADHD coaching and assessment services can be accessed without Medicare. Syné doesn't require Medicare, a GP referral or a Mental Health Treatment Plan to book.

• Do I need an ADHD diagnosis to start with Maria? No. You can begin therapy or coaching without a formal diagnosis.

• Can Maria diagnose ADHD? No. Syné doesn't provide formal ADHD diagnosis or prescribe medication. Maria can support you before, during or after the assessment process.

• Why can using a second language feel particularly exhausting with ADHD? Real-time communication can involve listening, interpreting, holding information in mind and preparing a response simultaneously. For someone already managing attention and working-memory demands, that additional processing can feel particularly tiring.

• Can I see a Spanish-speaking therapist for ADHD in Sydney? Yes. Maria Herguedas Irazu is a native Spanish-speaking psychotherapist and ADHD coach at Syné Collective in Sydney CBD. Sessions are available in Spanish, English or a mix of both, in person or online. You don't need an ADHD diagnosis, GP referral or Medicare card to book with Syné.

• Can I have therapy in Spanish even if I speak fluent English? Yes. Speaking fluent English doesn't necessarily mean it's the language that feels most natural when talking about emotions, relationships or difficult experiences. With Maria, you can use Spanish, English or move between both during a session.

• What's the difference between ADHD coaching and therapy? Coaching tends to focus on practical strategies, systems and goals for everyday life. Therapy can explore emotions, relationships and deeper patterns alongside practical tools. Maria works across both.

• How much does a session cost? $150 for individual sessions and $220 for couples.

• Can international students get an ADHD assessment in Australia? Yes. The pathway and costs depend on your OSHC policy and provider. Check your cover before booking.

• Does Maria offer ADHD coaching and therapy in Spanish? Yes. Sessions can be in Spanish, English or a mix of both.

• I am looking for Spanish therapy. Do I need to have ADHD to see Maria? Not at all. ADHD is just one area of Maria's expertise, however, Maria is a talented psychotherapists with capability managing a range of psychological or emotional challenges like Anxiety, Depression, Stress, Grief, Loss, Sex, Intimacy, Relationships and more.

• Where is Syné Collective? Level 12, 347 Kent St, Sydney NSW 2000, approximately five minutes' walk from Wynyard Station.

  
  

This article provides general information only and isn't medical, legal, financial or immigration advice. Medicare eligibility, visa arrangements and NSW ADHD pathways can change, so confirm current information with Services Australia, the Department of Home Affairs, your insurer or your GP.