What is ADHD

ADHD stands for Attention Deficit Hyperactivity Disorder; it is a neurodevelopmental condition that affects emotional regulation, organisation, attention and executive functioning. It is also linked to poor impulse control. All these symptoms are incredibly challenging, and lead to a whole host of issues as people try to manage them and their associated consequences. 

Under current DSM-5-TR criteria, ADHD is organised into predominantly inattentive, predominantly hyperactive-impulsive and combined presentation. The term ADD (Attention Deficit Disorder) is still used but no longer a formal diagnosis. What was historically referred to as ADD now usually falls under ADHD, predominantly inattentive presentation (American Psychiatric Association 2022).

How does it show up in clinical settings?

ADHD is not just a childhood issue; symptoms span into adulthood and may present differently throughout an individual’s life. I often find in my clinic that adults present with chronic overwhelm, burnout, anxiety, low self -esteem and relationship difficulties. All of these can be associated with (but are not exclusive to) an ADHD diagnosis, however, clients are often, prior to therapy, unaware of the link. 

Clients may arrive for therapy frustrated at never quite fulfilling potential, some present with a deep sense of shame linked to relationship difficulties that arise as a consequence of impulsive behaviour, whereas others are struggling to understand perpetual cycles of stress and burnout which can often be a symptom of masking.

ADHD can also present slightly differently in children and adults, for example it is often associated with hyperactivity in children whereas in adults, traits might appear more subtly in the form of procrastination, difficulties with time management or organisational challenges. 

Indeed, many adults seek support for stress before gaining an ADHD diagnosis. 

Persistent patterns 

ADHD is associated with persistent patterns of behaviours such as inattention, hyperactivity and impulsivity that interfere with functioning or development. Understanding persistent is important here because we all experience these behaviours at some point in our lives

Like many psychological symptoms, people with ADHD can see variations in their behaviour depending on external factors such as stress, their environment and hormones. 

Receiving a formal diagnosis

For many people, a formal diagnosis of ADHD can be extremely helpful. There is a profound sense of validation, and it can be liberating for clients to explore the shame of labels such as “lazy” or “too much”, whilst understanding the behaviour can be attributed to something more tangible.

A formal diagnosis often opens the door to more support, greater understanding and, over time, a sense of relief from an acute sense of self blame. People also begin to see their own strengths and attributes and sometimes describe diagnosis as providing a framework that helps to explain past and current experiences. 

However, a diagnosis can bring challenges too, A sense of loss at missed opportunities that were never pursued due to self-doubt, or anger towards others who failed to spot the ADHD or provide the relevant support when needed. 

Despite the pain that can be associated with diagnosis, the overall outcome is often a positive one, providing essential opportunities to understand via access to psycho education, and to heal with positive therapeutic support and intervention. 

Diagnosis can shine the spotlight on positive attributes associated with ADHD too. For example, individuals with ADHD describe experiencing periods of intense concentration, called hyperfocus, where they become deeply absorbed in tasks that are particularly interesting or rewarding. This enables productivity and can often enhance creativity; and whilst it might sometimes make it more challenging to divert attention from one thing to another, it can also be a strength when channelled effectively.

What does the ADHD assessment involve?

Because there is so much cross over between symptoms of ADHD and patterns of behaviours found in all of us occasionally, it can be difficult to diagnose. ADHD shares symptoms with other mental health conditions; difficulty concentrating, mood swings and feeling restless can be associated with conditions such as Generalised Anxiety Disorder and Bipolar disorder, which is why a thorough assessment by a qualified practitioner is so important (National Institute for Health and Care Excellence 2018). 

As noted earlier, the importance is understanding the severity of the symptoms and their persistence in everyday life. This means a diagnosis can only be made by understanding a detailed history of behaviour, exploring the range of symptoms that were evident in childhood and assessing the persistence and severity of these symptoms across a variety of settings in everyday life. 

A qualified practitioner relies on gathering a whole host of information, using interviews, questionnaires and ratings scales that they then rely on to make a formal diagnosis. It is essential for the practitioner to rule out other causes of behaviour too, hence why such a detailed understanding of current and historical behaviours is essential. 

How to manage the challenges of ADHD 

Alongside a formal diagnosis and the opportunity to process the variety of feelings that might arise as a consequence, therapy provides the individual with practical tools for managing the day to day challenges of living with ADHD. These might include struggling to maintain routines, forgetting or losing items on a regular basis, difficulty regulating emotions or disruptions to sleep which result in low energy, and subsequent mood. I often hear clients talk about the intense conflict they feel when they are aware of what they “should” be doing but are consistently unable to see it through to the end.

For clients in these perpetual cycles, it can be transformative to have access to psychoeducation, helping them to understand how their brain works, lowering self-criticism and increasing self-awareness. I also find it is incredibly helpful for clients to have access to specific behavioural techniques, teaching them how to break tasks down into bitesize manageable chunks. To encourage them to set reminders and stick to structured routines that don’t feel overwhelming. Clients also learn how to ensure they manage their environment, reducing distractions that can seem magnified to someone with ADHD.

Medication is sometimes prescribed to help manage symptoms, however a greater understanding, acceptance and awareness of how the ADHD brain receives and processes information is a huge part of helping clients manage day to day challenges. Effective therapeutic work focuses on symptom management, but also on rebuilding self-understanding and developing self-compassion.

ADHD and awareness

It is hard to deny there is a lot more understanding and awareness of ADHD in society than there once was, even a few years ago. This has led to a substantial rise in the amount of people both seeking and receiving diagnosis. An increase which has, in turn, fuelled debate about whether there is a rise in cases of ADHD or simply more awareness. 

Greater knowledge and understanding in society and in wider professional circles, has undoubtedly given people the confidence they need to seek a diagnosis. There is also a reduction in the negative perception and stigma associated with an ADHD diagnosis, with more empathy towards those suffering with symptoms and an urge to understand the origins rather than blame the person. 

However, society can also oversimplify the condition and so professional diagnosis with a qualified practitioner is essential. It is imperative not to attribute all the symptoms associated with ADHD to the condition itself, as many of us experience these behaviours to some degree at various times in our life. 

Overall, I believe greater understanding around ADHD has provided further relief for many. Treating ADHD with compassion, awareness, practical coping strategies and relational support is proving hugely successful. 

Please contact me for further information if you are seeking further information on ADHD. I offer clinical assessments as well as therapy for adults who have been diagnosed or think they might be living with this complex condition. 

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787

National Institute for Health and Care Excellence. (2018). Attention deficit hyperactivity disorder: Diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87