ADHD

What is ADHD?

ADHD is a neurological difference is defined by a pattern of inattention and/or hyperactivity-impulsivity. With symptoms typically showing up in childhood, those with ADHD often struggle to concentrate for long periods of time. While the condition is more commonly diagnosed in younger people, more people are receiving a diagnosis of ADHD in adulthood.

In this video, counsellor and psychotherapist Val Teller explains more about adult ADHD. 

ADHD can make everyday tasks more challenging, largely due to difficulty with attention, impulse control, or hyperactivity, which can lead to trouble focusing, being on time, organisation, and emotional regulation. These tend to be noticed at an early age, often becoming more noticeable when a child’s circumstances change (for example, if there is a change in school). Sometimes the diagnosis isn’t made, and therefore learning to manage symptoms can be difficult.

Types of ADHD

There are three types of ADHD:

• predominantly inattentive presentation
• predominantly hyperactive-impulsive
• combined hyperactive-impulsive and inattentive (when six or more signs are present, from either the inattentiveness category or the hyperactivity and impulsiveness category). This is the most common type of ADHD seen by doctors.

Signs of ADHD

There are two categories of ADHD symptoms: inattentiveness, and hyperactivity and impulsiveness. Most people will have a mix of the two, but this isn’t always the case. The lists below describe some of the common symptoms seen in children and teenagers.

Inattentiveness

Common signs of inattentiveness include:

• short attention span, easily distracted
• making mistakes
• often losing things/forgetful
• struggle to focus on tasks that take a long time
• appearing unable to listen/carry out instructions
• jumping from one task to another
• finding organising tasks difficult

Hyperactivity and impulsiveness

Common signs of hyperactivity and impulsiveness include:

• difficulty sitting still
• constant fidgeting
• unable to concentrate on tasks
• excessive talking
• excessive physical movement
• interrupting other people’s conversations
• little sense of risk or danger
• difficulty waiting their turn

In environments like schools, where young people are expected to sit quietly for long periods of time concentrating on tasks, it’s easy to see why those with ADHD struggle. Receiving a diagnosis and getting the right support can help make school and other social experiences easier.

Sometimes, young people with ADHD may have other conditions or neurological differences alongside ADHD. These can include anxiety disorders, depression, sleep problems, epilepsy, Tourette’s, learning difficulties and autism. If you think that you may be experiencing these or may be neurodivergent in another way you have not yet been diagnosed with, speaking with your doctor can help you access an assessment and find out more about the support available.

As a child, I did not look like what most people picture as a kid with ADHD. I was shy and quiet. In school, I would daydream, only partially listening to my second-grade teacher drone on about long division.

- Read Liz’s story.

Signs of adult ADHD

Symptoms in adults are less defined as currently, there is less research on adults with ADHD. Rather than developing at a later age, it’s believed that the condition will always have been present in childhood, as it is thought the genes you inherit from your parents are a significant factor in developing ADHD. Symptoms may then have been missed, or they may have been diagnosed, but symptoms have persisted into adulthood. As explained by the NHS, symptoms of ADHD usually start before age 12.   

ADHD tends to affect adults in a different way, and the symptoms are often much more subtle. Some symptoms that may be seen in adults include:

• lack of attention to detail
• starting new tasks before finishing existing ones
• poor organisational skills
• difficulty focusing and prioritising
• often losing/misplacing things
• often forgetting things
• restlessness
• often interrupting other people's conversations
• mood swings and irritability
• difficulty coping with stress
• impatience
• risky behaviour

Symptoms of ADHD can be both external, observable behaviours, as well as more internal, often invisible challenges. These can include:

• Executive dysfunction - Refers to difficulties with cognitive skills that help you to plan, organise, prioritise, and regulate behaviour to achieve goals. This can mean that managing your time, staying focused, and adapting to change can all feel challenging. You may also have difficulty holding on to information while performing tasks, or remembering instructions. Overall, this can lead to tasks taking longer, missed deadlines, trouble focusing on one task, and trouble breaking tasks down into manageable steps. 
• Time blindness - Refers to difficulty perceiving and managing how time passes. This can mean that planning, organising, and completing tasks on time is challenging, as you may under or overestimate how long tasks will take, you may struggle to stick to schedules, and may lose track of time, particularly when you are doing something you enjoy.
• Emotional dysregulation - Refers to difficulty managing and responding to emotions, which can result in more intense, prolonged, or disproportionate emotional reactions such as overwhelming feelings of sadness, extreme anxiety, or sudden anger.

Symptoms can present differently in men and women. Men may be more likely to have a more external presentation (e.g. hyperactivity, inattentiveness, or impulsivity), where women may have more internalised, less noticeable symptoms (e.g. difficulty with executive functions, emotional regulation, or cognitive challenges). Research published in 2020 revealed that women with ADHD may have greater difficulty with working memory and impulse control. However, it is important to note that, currently, diagnostic criteria does not take gender into account.

Women with ADHD may be more likely to experience decreased self-esteem, have more difficulty with relationships with others, and have an increased likelihood of anxiety. Women with ADHD may also be more likely to socially mask, meaning that they may try and hide or change behaviours to be more socially acceptable or appear neurotypical. Over time, this can lead to burnout, feelings of exhaustion, and may make receiving a diagnosis more challenging. 

Just like children and teenagers, adults with ADHD can develop other conditions. In adults, these often include personality disorders, bipolar disorder and obsessive-compulsive disorder.

Causes of ADHD

The cause of ADHD is not yet fully understood. A combination of factors is thought to contribute. Genetics is considered a significant factor, specifically, the genes you inherit from your parents. There doesn’t appear to be a single genetic fault at play, however, so the way ADHD is inherited is likely to be complex.

Research has also shown that differences in the brain could contribute to ADHD. In brain scans, those with the condition are seen to have smaller areas in certain parts of the brain. Certain groups have also been suggested as being at higher risk of developing ADHD. This includes those who were born prematurely (or those with a low birth weight), those with epilepsy and those with brain damage.  

Getting an ADHD diagnosis

If you suspect your child has ADHD, a diagnosis can help ensure you get the right support for them. Your first step should be to see your GP. While they cannot formally diagnose ADHD, they will be able to refer you to a specialist if they feel it’s necessary.

They may initially suggest a period of ‘watchful waiting’ - a certain amount of time (usually 10 weeks) to keep an eye on symptoms and see if they improve. They may also suggest ADHD-focused parent training or education programmes. This is no reflection on your parenting, instead, it aims to help you learn more about ADHD and how you can support your child. If your child’s behaviour doesn’t improve and you and your doctor agree it’s affecting everyday life, they should refer you to a specialist for assessment.

If you’re an adult and you think you have ADHD, your doctor will talk to you about your symptoms and may refer you for an assessment if you meet the following criteria:

• You were not diagnosed with ADHD as a child, but your symptoms started then and have never gone away.
• Your symptoms can’t be explained by another mental health condition.
• Your symptoms are affecting everyday life.

Counselling for ADHD

Many people of all ages with ADHD carry trauma from feeling repeatedly misunderstood, criticised, or pathologised, whether that be in a home or school setting. Lasting feelings of shame, anxiety, and low self-worth can persist, as it can be common for many to be labelled as ‘lazy’ or ‘difficult’. Working with a therapist can help you to unpack these experiences and feelings, to better understand your emotions and how your experiences may have influenced you, as well as to better understand emotional reactivity and feelings of self-doubt that may have developed over time. 

Therapy offers a safe, supportive space where you can learn how to better understand how your brain works, develop strategies to deal with your individual challenges and needs, as well as explore who you are and unpack how your experiences have influenced you. Therapy can not only help you to manage things that may challenge you, but can also help you to improve your emotional well-being, thrive in your relationships, and find ways to improve your day-to-day life. 

Treatment of ADHD symptoms may involve medication, therapy, or a combination of the two. The NHS requires an ADHD specialist to start and monitor ADHD medications.

Several different therapy options can be helpful for those with ADHD. These can also help with additional difficulties, such as anxiety. Some therapies that may be suggested are:

Cognitive behavioural therapy (CBT)

CBT is a type of talking therapy that helps you manage problems by looking to change the way you think and behave. This can be useful if there are certain situations you/your child find difficult. CBT is also a great way to help with any associated anxiety.

Training and education

If your child has been diagnosed with ADHD, your doctor may recommend certain education and training programmes for both you and your child. These could include:

• Psychoeducation - This encourages you/your child to talk about ADHD and its effects. The aim here is to help people understand what their diagnosis means and how they can learn to cope with the symptoms.
• Parent training and education programmes - These programmes look to help parents of children with ADHD learn different ways of talking, playing and working with their child to improve attention and behaviour.
• Social skills training - Using role-play, social skills training aims to help those with ADHD understand social situations better. 

Medication

Various types of medication can be used to treat symptoms of ADHD. While these should not be seen as a ‘cure’ – ADHD is a neurological difference, meaning it stems from differences in the brain – they can help those with ADHD concentrate better, feel calmer and be more able to practise new skills.

For more information on the types of medication that may be prescribed to help with symptoms, the NHS explains more about how medicines can help adults as well as children and young people. 

Our job as counsellors is to help our ADHD clients recognise what is working for them and see how they can move forward with this.

- Counsellor S. Spinger in ‘What is it like to live with ADHD?.

What should I be looking for in a therapist?

There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to help someone with ADHD. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice for parents who have children with ADHD about the recommended treatments:

• If your child is old enough to go to school, they should not usually be offered medication first.
• You should be offered a place on a course to help parents with their child's behaviour. Sometimes it is helpful if your child also attends a course of group treatment, which may be a psychological therapy such as cognitive behavioural therapy (CBT) or social skills training.
• If your child is a teenager, one-to-one psychological therapy for them may be an option, instead of a course for both of you.
• If your child has a learning disability as well as ADHD, you should be given the choice of group or one-to-one sessions for you and your child.
• If the treatment so far has not helped, your child should be offered medication. This should be alongside other support and treatment, including courses for parents and children. Medication may also be offered if you and your child would prefer not to attend a course for parents or have psychological treatment.

Read the full NICE guidelines: Attention deficit hyperactivity disorder.

Counsellors helping people with ADHD may have to adjust the way they work, therefore, it may be worth seeking a professional who has had experience in this area. 

Starting therapy can be daunting, but finding the right therapist can make the process feel less intimidating. Things to keep in mind when searching for a therapist include considering their qualifications, which therapeutic approach they use, and what their specialisms are. In order for therapy to work best for you, you need to feel safe and comfortable with your therapist. Asking questions, determining what you hope to get out of therapy, trying different approaches, and even assessing if you feel compatible with your therapist can all help you to find the right therapist for you.  

Further help

• ADHD UK
• ADHD Foundation
• The National Attention Deficit Disorder Information and Support Service (ADDISS)