ADHD: rethinking our relationship with difference

ADHD is a recognised neurodevelopmental condition. For many people, it can bring very real difficulties with attention, impulsivity, organisation and everyday life. But receiving an ADHD diagnosis in adulthood can raise questions that go beyond symptoms or strategies.

It can offer a different lens through which someone begins to understand themselves: not in isolation, but as a person who has spent a lifetime functioning within particular environments, relationships and expectations.

The person hasn't changed, but perhaps their understanding of themselves can change. This raises a wider question that interests me as a counsellor: What is our relationship with difference?

Difference doesn't exist in isolation

Human beings differ enormously. We differ in attention, temperament, emotional intensity, sociability, motivation, sensory experience and the ways in which we learn and organise ourselves.

Someone can experience genuine difficulty and impairment associated with ADHD while also recognising that the environment in which they are expected to function can make those difficulties more or less significant.

At school, children are expected to concentrate, remember instructions, regulate their behaviour, organise their work and complete tasks within particular timescales. Many of those expectations follow us into adulthood: appointments, paperwork, emails, meetings, deadlines, punctuality and competing demands.

The existence of expectations isn't necessarily the problem. Schools, workplaces and societies need structures in order to function. Perhaps the more useful question is how rigid those structures need to be, and whether reasonable differences in how people function should be accommodated.

Someone may struggle considerably in an environment requiring prolonged concentration, meticulous administration and constant organisation, yet function very differently somewhere more practical, stimulating, flexible or autonomous.

The person hasn't suddenly become 'more' or 'less' neurodivergent. What has changed is the relationship between how they function and what their environment asks of them. That doesn't mean changing the environment makes ADHD disappear. Some people experience significant difficulties even within supportive environments, but context still matters.

When judgement becomes internalised

Long before receiving an ADHD diagnosis, someone may already have developed a story about the kind of person they are.

Perhaps at school they were the child who was regularly told to pay attention, stop talking or remember what they had been asked to do. Their reports might have said they were capable of more “if only they applied themselves.”

Later, the situations change. It might be forgetting an appointment they genuinely intended to keep, struggling to begin something until the deadline is almost upon them, or enthusiastically starting projects that somehow never quite get finished.

Perhaps a partner interprets forgetfulness as not listening. At work, difficulty keeping on top of paperwork might be seen as carelessness, even though the same person may be highly capable when dealing with practical problems or situations requiring quick thinking.

They may look at other people apparently managing everyday life and quietly wonder why things that seem straightforward for everyone else require so much effort from them.

They might become meticulous about checking things because they don't trust themselves to remember. They might rely on pressure to get started, work late to catch up, avoid situations in which they expect to struggle, or put enormous effort into appearing as though they are managing perfectly well.

These ways of managing don't appear from nowhere. They can develop through repeatedly finding things difficult and needing to find a way through. And when the reason for that struggle isn't understood, judgement can easily become part of the explanation.

Over time, what began as other people's frustration, criticism, or expectations can become part of how someone understands themselves. This is where I think an important distinction can sometimes be missed.

ADHD is a neurodevelopmental condition, but years of struggling to meet expectations can leave their own psychological mark. ADHD may not have been created by those experiences, but the shame might have been.

Receiving a diagnosis in adulthood

Now imagine receiving an ADHD diagnosis at 30, 40, 50 or even later. Perhaps you've spent much of your life finding ways to manage. You worked harder where you needed to, found ways around things that were difficult and adapted because, at the time, there seemed to be little alternative.

Some of those adaptations may have become so familiar that they no longer felt like adaptations at all. They were simply what you did to get through school, hold down a job, maintain relationships or keep everyday life moving.

A diagnosis doesn't remove the struggle that was there, but it can change your perspective on how much of the adapting you had been doing. Things you once assumed were simply what you needed to do to keep up may begin to look different. Not because they were unnecessary, but because you can now see the effort involved in continually trying to function in ways that didn't always come naturally to you.

And perhaps, for the first time, there is room to wonder whether all of that adapting should always have been yours to do. What might have been different if the people and environments around you had understood you better? What if support had sometimes meant changing the circumstances rather than always expecting you to find another way to manage them?

Those questions don't offer simple answers. Nor do they undo the life someone has already lived. They can bring relief, anger and sometimes a sense of grief as past experiences are reconsidered from a position that wasn't available at the time.

More than a diagnosis

There is another complexity. After spending years without an explanation, finally having one can understandably become compelling. Was that ADHD? Is this ADHD? Was that why I struggled there? Is this part of my personality, or is it ADHD? 

Diagnosis can provide a framework through which previously confusing experiences begin to make sense. But perhaps another task follows: finding a way to integrate that understanding without allowing a diagnosis to explain everything about who you are.

The movement doesn't have to be from: "There is something wrong with me." to: "Everything about me is ADHD." There may be another possibility: This tells me something important about how I experience and respond to the world, but it doesn't tell me everything about who I am.

Where counselling might help

This is where counselling following an adult ADHD diagnosis can involve considerably more than finding strategies for organisation or managing symptoms.

The Power Threat Meaning Framework, developed by psychologists Lucy Johnstone, Mary Boyle and colleagues, offers one useful way of thinking about this. Rather than asking “What is wrong with you?”, it invites us to consider what has happened in someone's life, how power and expectations may have shaped their experiences, what those experiences have meant to them, and how they have learned to respond.

That doesn't mean using someone's history to explain away ADHD. Instead, it allows us to become curious about the life that developed around their difference. What happened when they struggled to meet expectations? How did other people respond? What did they eventually come to believe about themselves? What did they learn to do to cope? And which of those beliefs or adaptations still serve them now?

Counselling doesn't need to dispute the diagnosis, nor does it reduce every difficulty to ADHD. It can create space for someone to explore what the diagnosis means within the wider context of their life, and perhaps reconsider some of the conclusions they have reached about themselves along the way.

Rethinking our relationship with difference

Perhaps this is why conversations about ADHD need room for both difference and disorder rather than requiring us to choose between them.

ADHD can involve genuine difficulty and impairment. Recognising the role of environment doesn't take that away. Neither does recognising ADHD as a neurodevelopmental condition mean that every difficulty should be located entirely within the person.

An ADHD diagnosis doesn't tell someone who they are. It offers one way of understanding how they experience and respond to the world and, perhaps, an opportunity to look again at the relationship between themselves and the world they have been trying to navigate.

We also learn something about ourselves from the way the world responds to us. For someone receiving an ADHD diagnosis later in life, understanding ADHD may therefore be only part of the process. There may also be a need to look again at what years of struggling, adapting and being judged have come to mean about who they are.

The diagnosis does not change the person, or the life already lived. But it may allow some of that life to be understood differently, with more room to distinguish between the difficulties ADHD brought, the adaptations those difficulties demanded, and the judgements that became attached to them.