Understanding Adult ADHD: Beyond the Myths

I must confess, I grew up in an era that saw ADHD as little more than ‘the naughty boy’ syndrome. For years, ADHD was reduced to a single story — a restless young boy who couldn’t sit still, behave, or follow the rules. The general assumption at the time was simple: these children were undisciplined, or the product of poor parenting, and all they needed was a firm hand to set them straight.

Looking back now, I can see how limiting and, frankly, damaging that view was — and sadly, still is in many places. This misunderstanding causes real harm. Children are unfairly labelled as ‘naughty’, ‘lazy’, or ‘disruptive’. These labels don’t just fade away; they stick. They shape self-esteem, relationships, academic performance, mental health, and how people see themselves well into adulthood.

Thankfully, our understanding of ADHD has moved forward. Advances in genetic testing, brain imaging, and a vast body of research have taught us that ADHD is far more than being a bit distracted or full of energy. It’s about real and often life-impacting difficulties with attention, impulse control, emotional regulation, and executive functioning. We now recognise ADHD as a lifelong condition, influenced by a complex mix of biology, environment, and social context.

ADHD doesn’t look the same for everyone meaning it can be confusing and misleading. It often presents differently in girls and young women, meaning many go undiagnosed or are misdiagnosed with other mental health conditions instead. We also now know that ADHD doesn't simply disappear in adulthood — a common misconception from the past. In fact, it frequently persists and often overlaps with other challenges such as anxiety, trauma, learning difficulties, and mood disorders — all of which were, for far too long, overlooked. And yet, despite all we've learned, misunderstandings remain common — in the media, schools, healthcare settings, and even in the very assessment and diagnosis process.

ADHD remains a controversial topic. Some still question whether it exists at all, and more recently, it’s been dubbed the ‘trendy’ diagnosis. Social media is flooded with ADHD content, and there has been a sharp rise in people seeking or self-diagnosing with ADHD. This surge has understandably sparked scepticism, and there are valid concerns about the quality of some assessments. Unfortunately, assessments vary hugely — some are superficial, rushed, or carried out by people who aren’t properly qualified to diagnose. This can lead to people being underdiagnosed, overdiagnosed, misdiagnosed, or left with reports that don’t meet the necessary standards to access the help they need.

In my work with children, young people, and adults living with ADHD, I’ve seen first-hand how deeply it can affect daily life. But I’ve also witnessed — time and again — the creativity, determination, and resilience that so often accompany ADHD.

This blog is a long one, but for good reason. ADHD is complex, often misunderstood, and deserves proper attention. My aim is twofold: to offer information and hope to those wondering if ADHD could explain some of their struggles, and to support those who already have a diagnosis but are left thinking, what now? I also hope this creates a space where people with ADHD can feel seen, understood, and validated. And for those less familiar with ADHD, I hope it offers fresh insight and perhaps even a shift in perspective. You can’t do this justice in just a few paragraphs — it takes time. So grab a cuppa and settle in for a read — that is, if you can sit still and pay attention long enough!

In this blog, I’d love to take you through how our understanding of ADHD has evolved — its history, the stigma that still lingers today, and the real challenges of getting a proper diagnosis. And for those who, like me, love the science behind mental health, I’ll also share what we now know about the ADHD brain — leaving me in no doubt whatsoever about its reality.

Whether you’re a parent, a professional, or someone trying to make sense of ADHD in your own life, I hope this helps you see the bigger picture and why it’s so important that we approach ADHD with compassion, curiosity, and good-quality information.

A Brief History of ADHD

Although many people think of ADHD as a relatively new diagnosis, descriptions of behaviours we now associate with ADHD have been around for centuries. As early as the late 1700s, medical texts and literature described children and adults who struggled with inattention, impulsivity, and restlessness. In 1798, Scottish physician Sir Alexander Crichton wrote about individuals with a "mental restlessness" who had difficulty sustaining attention—an early description that sounds strikingly familiar today.

In the early to mid-20th century, the condition was commonly referred to as "minimal brain dysfunction" (MBD). This term reflected a belief at the time that children who were inattentive and hyperactive likely had subtle, undetectable brain injuries. MBD became a catch-all label for a variety of learning and behavioural difficulties, but it lacked clear diagnostic criteria and scientific consensus.

It wasn't until the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 that the term attention deficit disorder (ADD) was introduced. This marked a shift towards recognising attention difficulties, not just hyperactivity. A few years later, the revised DSM-III (DSM-III-R) replaced ADD with the now-familiar term attention deficit hyperactivity disorder (ADHD), acknowledging the interplay of both inattention and hyperactivity-impulsivity.

However, for much of its history, ADHD was seen primarily as a disorder affecting young hyperactive boys, and the diagnostic criteria were shaped around these observations. As a result, countless individuals, especially girls, women, and those without overt hyperactivity, were often overlooked, misdiagnosed, or misunderstood. It wasn’t until the late 1990s and early 2000s that awareness grew regarding the diverse ways ADHD can present across age groups, genders, and cultures.

Understanding the Core Features of ADHD

ADHD is often misunderstood as just being "hyper" or "distracted", but it’s much more complex. In fact, ADHD is made up of three key elements: inattention, hyperactivity, and impulsivity. Importantly, you don’t have to experience all of these to have ADHD as some people mainly struggle with attention, others with hyperactivity and impulsivity, and some experience a mix of all three.  Lets have a look at what we mean by those terms.

Inattention: The Challenge of Regulating Attention

When we talk about “inattention,” people often assume it means someone with ADHD can’t pay attention but it’s not about lacking attention, it’s about difficulty regulating and controlling attention. People with ADHD can struggle to direct, sustain, or shift their focus depending on the situation.

Have you ever sat down to write an email, only to realise 20 minutes later that you’ve wandered off into scrolling, staring into space, or wondering about something random like whether cats recognise our faces? That’s hypoattention — when attention slips away even though you know you should be focused. Tasks that are repetitive, uninteresting, or low stimulation like admin, reading dense documents, or house chores often feel like trying to grip a slippery bar of soap. The attention just won’t "stick," no matter how important the task might be.  In fact, sometimes the more important the task, the harder it can be to get started. I often hear people rule themselves out of having ADHD because they tell me ''they can pay attention for hours so they cant have it''. Can they?

On the flip side of hypoattention, people with ADHD can also experience hyperattention, sometimes called hyperfocus. This is when attention gets locked onto something so tightly that it becomes hard to disengage. Have you ever started reorganising your bookshelf or getting into a creative project, only to look up and realise hours have passed, you’ve forgotten to eat, and the to-do list is untouched? That’s hyperattention. It usually happens when something feels stimulating, novel, or emotionally rewarding — even if it wasn’t meant to be a priority.

So it’s not a simple matter of not being able to focus, it’s that the brain struggles to control when to focus, how long to sustain it, and when to switch it off.

Hyperactivity: The Need to Move, Fidget, or Just Do Something

Hyperactivity can be obvious, but it isn’t always. Some people are indeed physically restless constantly moving, tapping, pacing, twiddling with their hair, or talking. Have you ever found yourself standing up mid-conversation without even realising it, or unable to resist getting up and down repeatedly during a meeting making excuses to go to the toilet or to make a drink?

For others, especially adults, hyperactivity is more subtle. It might be an internal sense of restlessness — that constant feeling of needing to move, be productive, or just a feeling to do something, even when you’re sitting still. Clients often describe it as like carrying a motor inside them that doesn’t easily turn off.  Some people call this anxiety!!!

Hyperactivity can also show up mentally. Ever experienced racing thoughts, a buzzing mind that skips from idea to idea, or feeling like you’re always multitasking even when you don’t want to be? When you start to try and figure something out, but your brain gives you five other thoughts before you can even get started.  That too is part of hyperactivity.

Impulsivity: Acting First, Thinking Later

Impulsivity is when actions, words, or decisions seem to bypass the brain's usual “pause” button. Have you ever blurted something out mid-conversation and thought, Why did I just say that? Or made a snap decision booking a spontaneous trip, buying something you didn’t plan to and maybe can’t afford to, or quitting a job — only to later realise you hadn’t fully thought it through?  Do you find yourself finishing people’s sentences and butting in with the urge to speak before you forget what you have in mind?

Impulsivity can also affect emotional responses. Have you ever reacted strongly in the heat of the moment, later wishing you’d had more time to process before responding? This is another way impulsivity shows up — not because someone doesn't care, but because the brain struggles to delay reactions.

ADHD Is Highly Individual

Not everyone with ADHD will experience all three elements, and even when they do, they may show up differently depending on age, gender, personality, and life circumstances. For example:

• Some people may feel hyperactive on the inside but rarely show it outwardly.

• Others may rarely hyperfocus, while some find themselves “stuck” on specific tasks regularly.

• Some may be impulsive in social situations but highly cautious when it comes to money.

This is why ADHD can be so confusing and unless you work with an experienced practitioner it might get overlooked or misdiagnosed.  It’s also why there are different recognised types (presentations) of ADHD.

The Three Presentations of ADHD (According to DSM-5-TR)

If you have an assessment and receive a diagnosis you should also be told what type you have:

1. ADHD, Predominantly Inattentive Presentation

People with this presentation mainly experience difficulties with focus, organisation, and sustained attention, without significant hyperactivity.

2. ADHD, Predominantly Hyperactive-Impulsive Presentation

Here, hyperactivity and impulsivity are more prominent, with fewer obvious attention difficulties.

3. ADHD, Combined Presentation

This is when someone shows a significant combination of inattentive, hyperactive, and impulsive traits.

How ADHD Changes from Childhood to Adulthood

ADHD can be first noticed in childhood, but it doesn’t disappear just because someone grows up. What does often change is how it shows up. The core challenges with attention, hyperactivity, and impulsivity usually continue, but they can evolve as life demands, responsibilities, and environments change. This is why very often it doesn't come to be a problem until adulthood.

Childhood ADHD

In children, ADHD is often most visible through hyperactivity and impulsivity. These are the kids who might:

• Constantly fidget, run, or climb.

• Struggle to sit still in class.

• Blurt out answers, interrupt others, or struggle with waiting their turn.

• Lose or forget things (coats, homework, lunchboxes).

• Daydream frequently or zone out during lessons.

• Avoid homework because it feels overwhelming or boring, even if they want to do well.

• Seem to be behaving poorly or become the class clown

The school environment tends to highlight these behaviours, as children are expected to sit still, pay attention, and follow instructions for long periods, tasks that are especially challenging for those with ADHD. What can often be missed are the children who learn to mask and to just behave as expected even though internally their minds might be really struggling. This can lead to well-behaved children in school that then come home with emotionally charged outburst at home where it is safe to do so and parents frustrated with schools who simply aren't seeing what they see.

Teenage Years

In adolescence, some hyperactivity may soften or shift or quite often get worse in different ways. Teenagers might not be climbing the furniture anymore, but they might:

• Pace around during conversations.

• Prefer moving tasks or physical activity over sitting still.

• Feel a strong internal restlessness (“I have to get out of here”).

• Still struggle with attention, organisation, and impulsivity leading to last-minute cramming, impulsive social choices, or emotional outbursts.

• Struggle with emotion regulation

The teenage years also bring more independence, meaning that problems with time management, planning, and emotional regulation can become more noticeable. The pressure to manage schoolwork, friendships, and growing responsibilities without adult scaffolding often reveals areas where executive functioning is still developing.

Adult ADHD

By adulthood ADHD can show up in a couple of ways that often seem so different it doesn’t seem like the same condition.  For instant one person might be 'overly' organised as they know that without having a place for everything, having strict routines, using endless to do lists, and putting everything in their calendars, that they would struggle to manage. Their lives can become quite rigid. We can see high levels of perfectionism and often high flying careers where individuals work longer and harder than those around them as if driven to succeed. 

On the other hand, we can see someone so disorganised, their bills aren’t paid even if they have the money to do so, they struggle to care for themselves and others around them, and are often struggling with other mental health conditions, worn down by years of struggle and mental exhaustion.

By adulthood, hyperactivity in ADHD often becomes less about obvious physical restlessness and more about what’s happening internally. Many adults with ADHD still experience a strong sense of restlessness, but instead of climbing on furniture or constantly moving, it might feel like their mind is racing. Thoughts jump quickly from one idea to the next, often making it difficult to “switch off” and leading many to mistake this for anxiety. This mental hyperactivity can be exhausting, creating a constant background buzz that’s hard to escape.

In day-to-day life, this often looks like constant multitasking — even when it’s not helpful. People with ADHD may find themselves starting several things at once but struggling to complete them, or switching tasks impulsively without even noticing. For some this means getting loads done, for others it means being so overwhelmed that nothing gets done.

Physical signs are still common too. Adults might fidget, tap their foot, play with objects, or feel uncomfortable sitting still for long periods, such as in meetings or lectures. Some people instinctively gravitate towards fast-paced, high-pressure environments without fully realising that they are, in part, meeting the brain’s craving for stimulation.

Impulsivity in adults can also take many forms. It may show up in everyday decisions — like impulse spending, taking on commitments without thinking them through, or even quitting jobs suddenly without a plan. In conversations, it might lead to blurting things out or sending an email too quickly, only to regret it moments later. Emotionally, adults with ADHD may struggle to regulate their feelings, leading to reacting too quickly in arguments or feeling emotionally overwhelmed and flooded. In some cases, people may turn to substances like alcohol or drugs, sometimes as an unconscious attempt to manage these intense internal states. In other cases it can lead to great success as entrepreneurs who dive in to things without second guessing themselves.

Many 'high-flyers' rule themselves out from having ADHD because of how well they appear to be doing in life. In the past, having a university degree or a successful career was often seen as evidence against ADHD, based on the outdated belief that someone with ADHD couldn’t possibly achieve academically but we now know that many people with ADHD are intellectually gifted and high achievers, often at the expense of their mental health, wellbeing, and immense personal effort behind the scenes.

Many adults with ADHD describe chronic overwhelm. They may cope by masking (hiding or compensating for difficulties) or by developing routines that work well but it often comes at the cost of extra mental effort, leading to fatigue and stress.  An ADHD brain will literally do two, three or even four times the work of someone who doesn’t have ADHD.

The Neurology of ADHD: What the Brain Tells Us

ADHD is not a behavioural problem rooted in poor discipline or motivation—it's a neurodevelopmental condition, meaning its roots lie in the structure and function of the brain. While we’re still learning, neuroimaging and neuroscience research have given us a much clearer picture of what’s happening under the surface. I often talk about how I like to be evidence based and here is a brief summary of what we know so far.

1. Brain Structure Differences

Several brain regions in people with ADHD can differ in size or development compared to neurotypical individuals:

• Prefrontal Cortex: Often referred to as the “CEO of the brain,” the prefrontal cortex is central to executive functions like planning, organisation, decision-making, attention, and impulse control. In ADHD, this region can be underactive or delayed in development.

• Basal Ganglia: Involved in motor control and behaviour regulation, this area also plays a role in reward processing. Abnormalities here may contribute to difficulties with motivation and regulating responses.

• Cerebellum: Once thought to be primarily responsible for movement, the cerebellum is now known to support attention, timing, and cognitive flexibility. Many individuals with ADHD show reduced volume in this region.

• Corpus Callosum: This thick band of fibres connects the two hemispheres of the brain and allows them to communicate effectively. Some studies suggest it functions differently in people with ADHD, which may affect integration of information.

2. Neurotransmitter Dysregulation

ADHD is strongly influenced by disruptions in the brain's neurochemical systems. The way neurons communicate via neurotransmitters has a profound effect on attention, impulse control, emotion regulation, motivation, and sleep. The key neurotransmitters most strongly implicated in ADHD are:

• Dopamine: Often referred to as the brain’s “reward chemical,” dopamine helps with attention, motivation, and pleasure. People with ADHD typically have lower levels of dopamine activity, which may explain the tendency to seek stimulation or novelty and struggle with delayed gratification.

• Norepinephrine (noradrenaline): This neurotransmitter is involved in alertness, arousal, and focus. Like dopamine, norepinephrine signalling tends to be dysregulated in ADHD, contributing to difficulties with sustaining attention and managing impulses.

• Glutamate: Glutamate is the most abundant excitatory neurotransmitter in the brain, essential for learning, memory, and cognition. Studies suggest abnormal glutamate levels in various brain regions in people with ADHD. Both excess and deficiency can be problematic with high glutamate potentially contributing to hyperactivity and impulsivity and low glutamate in certain areas potentially impairing focus and executive function.

• GABA (Gamma-Aminobutyric Acid): GABA is the primary inhibitory neurotransmitter. It helps calm neural activity, regulate mood, and control impulses. People with ADHD may have lower GABA activity, especially in the prefrontal cortex. This might lead to increased impulsivity, difficulty calming the mind, and heightened emotional reactivity.

• Melatonin: Melatonin is a hormone (not technically a neurotransmitter but often discussed in similar terms) that governs the sleep-wake cycle (circadian rhythm). Many individuals with ADHD experience delayed melatonin production, leading to difficulty falling asleep and disrupted sleep patterns.  Sleep problems can worsen ADHD symptoms like inattention and emotional dysregulation.

ADHD isn’t caused by a single neurotransmitter problem—it’s the result of a complex interplay between multiple neurochemical systems. Disruptions in dopamine and norepinephrine are the best understood and most directly targeted by current medications.  Stimulant medications like methylphenidate and amphetamines work by increasing the availability of these neurotransmitters, which is why they can be so effective.

3. Impaired Executive Functioning

Executive functioning refers to a set of cognitive skills that include working memory, flexible thinking, emotional regulation, self-monitoring, and impulse control. These functions can be impaired in people with ADHD, leading to real-world challenges like disorganisation, time blindness, forgetfulness, difficulty following through on tasks, and emotional reactivity.

4. Default Mode Network (DMN) Disruption

The Default Mode Network is a network of brain regions that activates when we're at rest or daydreaming. In ADHD, there appears to be poor regulation between the DMN and task-positive networks (which activate during focus). This difficulty in “switching off” the DMN may explain lapses in attention and drifting off during tasks. It may also explain that why when you try to relax and it should quieten down it doesn't and your brain just keeps going.

These biological foundations affect how individuals with ADHD experience attention, emotion, motivation, and behaviour. Understanding these neurological underpinnings helps shift the narrative from blame and moral judgement to empathy and evidence-based care.

What ADHD Can Look Like at Work

ADHD doesn’t only show up in classrooms or childhood reports for many adults, it is most painfully obvious in the workplace. Yet, because most people still associate ADHD with hyperactive schoolchildren, its impact on working life is often misunderstood or missed altogether. Many adults with ADHD quietly struggle to keep up with the demands of modern work, often blaming themselves without realising there's a neurological explanation.

One of the most common challenges is difficulty with organisation and time management. People with ADHD might have the best intentions but struggle to prioritise, plan, and follow through. The classic “to-do list” often ends up either overwhelming or abandoned. Deadlines seem far away until they suddenly feel like an emergency. Tasks may pile up, emails go unanswered, and important details get lost, not due to laziness, but because executive functioning skills like planning, remembering, and sequencing are genuinely impaired.

Procrastination and perfectionism often walk hand-in-hand for employees with ADHD. It’s not that they don’t care often, they care deeply but getting started can feel like wading through mud. Some may avoid tasks until the very last moment, relying on adrenaline to kick their brain into action. Others may hyperfocus on making one small part of a project “perfect,” while losing track of the bigger picture or running out of time.

Then there’s emotional dysregulation, which can be one of the lesser-known but equally impactful parts of ADHD at work. Criticism may feel crushing. A minor mistake might spiral into feelings of failure or shame. Conversely, praise can lead to bursts of excitement and enthusiasm that aren’t always sustainable. Mood fluctuations and frustration especially when trying hard and still feeling behind can take a toll on confidence and wellbeing.

Many people with ADHD also experience inconsistency. On some days, they might seem like the most productive person in the office, delivering innovative ideas, working at full throttle, and surprising even themselves with their creativity. On other days, tasks that seemed simple may feel impossible. This inconsistency can lead to feeling unreliable or being perceived by others as disorganised, when in reality, it’s the unpredictable nature of ADHD symptoms at play.

It’s also important to mention masking. Many adults, especially women, have learned to hide their difficulties, often working twice as hard to appear “together.” This might look like staying late, over-preparing for meetings, or micromanaging themselves, but behind the scenes, it can be mentally and emotionally exhausting.

Of course, it’s not all negative. Many people with ADHD also bring strengths to the workplace, often without realising they are related to their neurodivergence. Creative problem-solving, outside-the-box thinking, enthusiasm, adaptability, and the ability to hyperfocus on meaningful tasks can all be incredibly valuable. However, without support or understanding, these strengths can easily be overshadowed by stress, burnout, or chronic self-doubt.

ADHD and interpersonal functioning

ADHD can have a profound impact on relationships—whether romantic, familial, social, or professional. One of the often misunderstood aspects of ADHD is how deeply it can affect emotional regulation and communication. Many people with ADHD experience Rejection Sensitive Dysphoria (RSD), a heightened emotional sensitivity that can cause intense distress in response to perceived criticism, rejection, or disapproval. This can lead to emotional withdrawal, defensiveness, or conflict in close relationships even when no harm was intended.

Everyday interactions can also be affected by the executive functioning difficulties that come with ADHD. Forgetting to reply to messages, missing important dates, or struggling to follow through on plans can all unintentionally send the message that someone doesn’t care, when in reality they may feel deeply overwhelmed, disorganised, or even ashamed. Over time, this can erode trust and connection if not understood or supported appropriately.

Comorbid mood conditions, such as anxiety or depression, are also common in ADHD and can add additional layers of complexity to relationships. A person may withdraw, become irritable, or experience emotional highs and lows that are hard for partners, friends, or family members to navigate.

It’s also important to acknowledge the impact on self-esteem. Many people with ADHD grow up feeling they’re "too much," "too messy," or constantly falling short of expectations. These internalised beliefs can affect how they show up in relationships sometimes leading to people-pleasing, emotional overcompensation, or fear of intimacy.

Despite these challenges, relationships can thrive when ADHD is understood and supported. Open communication, self-awareness, and accommodations (like reminders, clear plans, or emotional check-ins) can make a huge difference. It’s not about "fixing" someone with ADHD it’s about creating a shared understanding and making space for neurodiversity within our human connections.

ADHD in Girls and Women: The Invisible Struggle 

One of the most significant gaps in ADHD research and diagnosis has been the underrepresentation of girls and women. Girls are more likely to exhibit inattentive symptoms rather than the disruptive hyperactive traits more commonly seen in boys and any hyperactivity and impulsivity tends to be mental rather than physical. As a result, they are often overlooked, misdiagnosed, or diagnosed much later in life—sometimes not until adulthood. I have even diagnosed a woman in her 60's recently and she shared this now allowed her to make sense of her entire life through a different and kinder lens. Many women grow up internalising their struggles, experiencing anxiety, low self-esteem, and feeling 'different' without understanding why.

One of the most concerning patterns in the mental health world is how women with undiagnosed ADHD are frequently mislabelled with other conditions such as anxiety or depression and particularly Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder (EUPD).  Why does this happen?

ADHD and BPD/EUPD can share some surface-level traits — emotional dysregulation, impulsivity, difficulty with relationships, and mood swings. But what’s often missed is what’s underneath those behaviours.  When a woman presents in distress, perhaps overwhelmed, tearful, impulsive, emotionally reactive, she may be quickly labelled as “too much” or “unstable” and referred for personality assessments rather than properly screened for ADHD.

In reality, many women with ADHD have been living with years of internalised shame, burnout, and chronic invalidation. This emotional build-up can look like “mood instability” or “personality disorder traits,” when what’s really going on is a neurodevelopmental condition that’s gone unrecognised and unsupported.

Instead of being seen as struggling with attention regulation, executive functioning, or sensory sensitivity, women are too often framed as overreacting, being dramatic, or emotionally unstable.  And once a label like BPD/EUPD is attached, it can be hard to shake even if it doesn’t fully fit.  That’s a common thing I hear when doing assessments that women have been given a BPD/EUPD diagnosis (often very quickly) but the person just knows it doesn’t fit them.

Being misdiagnosed can delay proper support by years or even decades and can lead to feelings of shame and stigma, a loss of trust in professionals, and lowered self-esteem.  Many women describe a kind of identity crisis wondering which parts of them are real and which are symptoms and grieving the years they spent misunderstanding themselves.

Why Are More People Being Diagnosed Now?

There’s been a dramatic rise in ADHD diagnoses over the past few years, especially among adults, women, and people from marginalised communities. For some, this shift is seen as overdue recognition — finally, the world is catching up. For others, it sparks concern: Are we overdiagnosing ADHD? Is this just another mental health trend? The reality is far more complex. We’re not just seeing more people being diagnosed we’re seeing how our understanding of ADHD is finally expanding beyond outdated stereotypes.

We Know More Now Than Ever Before

What’s changed? First and foremost, science. We now have decades of research and neuroimaging data that simply didn’t exist before. ADHD is no longer thought of as just a behavioural issue or a childhood phase. Brain scans show differences in structure and function, especially in areas related to attention, impulse control, and emotional regulation. It’s not about someone “not trying hard enough” it’s about how their brain is wired.

Now we know ADHD can look very different in adults: difficulty with focus, managing time, emotional overwhelm, procrastination, and mental fatigue. These aren’t new symptoms they’re just newly recognised.

The Impact of COVID: When Coping Strategies Disappeared

One of the biggest (and least talked about) catalysts for the surge in ADHD diagnoses was the COVID-19 pandemic. Before lockdowns, many people were unknowingly relying on external structures to function — the office, school schedules, daily routines, social cues, and deadlines. These systems acted as scaffolding, compensating for internal difficulties.

When that scaffolding was suddenly stripped away, people who had always been “just about coping” found themselves floundering. Basic tasks became overwhelming. Focus vanished. Emotions ran high. It wasn’t just pandemic stress — it was the absence of the systems they’d unknowingly depended on for years. For many, this was the moment things clicked: Maybe this isn’t just anxiety or burnout. Maybe there’s something else going on. And for a significant number, that “something else” was ADHD.

When Life Transitions Reveal ADHD

For many people, ADHD doesn't become obvious until something shifts — a big life change, a new responsibility, or a sudden loss of structure. These moments often act like a spotlight, revealing the challenges that were previously hidden or managed in subtle ways.

Transitions like starting university, changing jobs, becoming a parent, or moving out can be the first time someone truly struggles to keep things together and for some, it’s the point when they’re finally diagnosed.

“I used to be fine — what’s changed?”

A common story I hear is: “I got through school fine,” or “I’ve always been a bit disorganised, but I managed.” And then — suddenly — things fall apart. The strategies that used to help (parental reminders, structured school days, a helpful partner, a supportive manager) drop away, and the cracks start to show when deadlines are looming, and bills are stacking up.

Many people with ADHD have unknowingly built coping strategies over time — relying on adrenaline, pressure, or late-night cramming to get things done. Others may develop what’s often called a “functional mask” — a collection of tricks, routines, or sheer force of will that keeps life on track (on the surface, at least).

Transitions take away the structures that were quietly scaffolding your executive functioning. When that external support disappears, and life becomes more complex, the brain’s difficulties with attention, planning, motivation, and regulation can suddenly feel unmanageable.

It’s incredibly common for people, especially women and adults, to receive a diagnosis during or after one of these transition points. Not because the ADHD has just “started,” but because it’s the first time life demands have outpaced the brain’s unrecognised needs.

So Are We Overdiagnosing?

It’s a fair question. The explosion of online content, self-diagnosis trends, and rapid private assessments has raised concerns. ADHD is now being discussed more openly than ever before, and not all sources are reliable. In some cases, people are receiving diagnoses based on brief questionnaires without a full clinical picture. There’s a risk of oversimplifying complex psychological challenges — and of mislabelling stress, trauma, or burnout as ADHD when it may not be.

To receive an ADHD diagnosis, it shouldn't be enough to simply relate to some of the common traits as many people experience occasional inattention, restlessness, or impulsivity. For a formal diagnosis, you must meet the recognised diagnostic criteria (such as those outlined in the DSM-5-TR or ICD-11) and show evidence of significant impairment in daily functioning. Sadly many people think that ticking the criteria box means that they meet a disorder level and not just that of having significant traits.

Not everyone who identifies with aspects of ADHD will meet the full threshold for diagnosis and that’s okay. The purpose of assessment is not just to label, but to understand whether the pattern of difficulties is part of a broader neurodevelopmental condition that would benefit from specific support.

Or is it still under diagnosed?

That said, the more pressing issue may actually be underdiagnosis.  Despite the growing awareness, many people still go undiagnosed for years or even decades. And those with co-occurring conditions like anxiety, depression, or autism often have their ADHD symptoms misattributed or masked entirely.  Many of the people who come to see me with lifelong 'anxiety', depression, or other mental health diagnosis, that seemingly cant be treated actually have undiagnosed ADHD instead of, or indeed as well as. Having ADHD doesn't rule out other difficulties.

Both overdiagnosis and underdiagnosis can exist at the same time. We need thoughtful, thorough assessments that go beyond tick-box exercises. We need clinicians who understand how ADHD shows up across genders, ages, cultures, and co-occurring conditions. And we need to create space for curiosity not judgement about what’s really going on beneath the surface of someone’s struggles.

Yes, more people are being diagnosed with ADHD than ever before. But maybe that’s not because it’s suddenly everywhere, maybe we’re just finally paying attention.

Challenges in ADHD Assessment and Diagnosis

So how do you get a proper ADHD assessment?  Well a good assessment requires a thorough clinical evaluation, which includes developmental history, behavioural observations, standardised questionnaires, and input from multiple sources (e.g., parents, teachers, partners) if possible. Unfortunately, in the quest for efficiency, some assessments today are delivered in under an hour, based solely on self-report, or conducted without any collateral information. These practices not only risk misdiagnosis but can also undermine legitimate diagnoses.

Additionally, ADHD shares overlapping symptoms with other conditions such as anxiety, depression, trauma, and autism. Without careful evaluation, individuals can be wrongly labelled or have co-existing conditions missed altogether. Clinicians conducting assessments need training not only in how to ask questions on a questionnaire and tick a box, but they need full training in neurodevelopmental disorders, experience with differential diagnosis, and knowledge of ADHD across the lifespan. This includes recognising how ADHD presents differently in women, adults, and across cultures.

Diagnosis used to be made only by psychiatrists or psychologists but now other professions, not always trained in other neurodevelopmental or mental health conditions are being used within diagnostic services.  I want to make clear that some of these clinicians are excellent, having worked within mental health services for many years with great understanding and expertise.  Sadly, many are not. Some people train just to do assessments of ADHD, without further mental health training, but if you don't fully understand all of the other co-existing conditions how can you properly rule them in or out of the diagnosis. That is why it is my belief we are potentially using clinicians without the right training and support to assess and diagnose. What is harder to digest is that most people wouldn't know to what level their clinician is trained when they set out to go through the assessment process.

ADHD is a nuanced condition requiring nuanced understanding.

Cheap Assessments and Meaningless Reports 

Many people turn to private assessments due to long NHS waiting lists, often waiting years for an appointment. I have heard of waiting lists up to seven years in some areas for adult assessments and that shows the increased demand not being met. 

Many people report that they hope to get the assessment and then move to the NHS for their treatment options. However, not all private assessments are accepted by NHS services. Some NHS trusts have clear criteria around the type of clinician who must perform the assessment (e.g., a psychiatrist or psychologist registered with the appropriate governing body), the tools used, and the structure of the report. Assessments not meeting these standards may be rejected, leaving clients in limbo even though they have paid for an assessment.

The mental health marketplace has seen an explosion of low-cost ADHD assessments, often advertised online and carried out with minimal clinical oversight. While accessible services are vital, these assessments can be problematic. This leaves clients confused, invalidated, or holding reports that are not recognised by their GP, the NHS, or workplace accommodations.  There are some fabulous assessment centres out there, there are also some not so good ones, and the point is how do you know the difference until its too late.  I think the adage of it seems to cheap and too good it probably is. 

A good assessment requires pre-screening, informant discussions and questionnaires, a background history taking, an interview which usually takes between 1.5-2 hours on top of the history taking, it might involve a computerised task, and then an individual report to meet standards.  That can’t be rushed and paying for a clinicians time should reflect this.

This is why it is imperative to work with clinicians who are extensively trained, can offer a referral to ongoing care and treatment, and whose reports meet NICE and AQAS standards. Whilst I understand the urgency for assessment and diagnosis, surely the correct diagnosis is better than a quick and cheap one?

The Downside of Self-Diagnosis and Misinformation on Social Media

While the rise in ADHD awareness is long overdue and, in many ways, empowering, it has also brought with it some unintended problems particularly in the age of social media. TikTok, Instagram, YouTube, and Reddit are flooded with content about ADHD, often created by people who genuinely want to help others. Many share relatable anecdotes, symptom lists, and “signs you might have ADHD” videos that resonate with millions. But with this flood of information comes a serious challenge: not all of it is accurate, or clinically sound.  I often hear phrases like ‘well we are all on the spectrum (ADHD/ASD) aren’t we?  No we are not.

One of the biggest concerns is the growing trend of self-diagnosis. For many, recognising themselves in ADHD content online is the first step toward finally seeking help and that’s important. However, some people stop there. Without a formal assessment, there’s a risk of oversimplifying complex emotional, psychological, or even physical health issues. Difficulties with attention, focus, or emotional regulation are not exclusive to ADHD. Trauma, anxiety, depression, grief, burnout, sleep disorders, and even thyroid problems (to name just a few) can mimic ADHD symptoms. Without a thorough clinical assessment, people may end up attributing their struggles to ADHD, when the root cause could be something else entirely that could require and benefit from other treatment.

Another issue is the oversimplification and cherry-picking of symptoms. Social media often condenses ADHD into quirky soundbites: "If you forget where you put your keys, you might have ADHD," or "If you can hyperfocus on your favourite hobby, you must have it." While these experiences may be familiar to people with ADHD, they are also common human experiences. Occasional forgetfulness, procrastination, or feeling overwhelmed are part of life for many — especially in a world that is overstimulating, demanding, and increasingly shaped by technology. ADHD is not defined by isolated moments; it is defined by pervasive, persistent, and functionally impairing patterns of behaviour and experience across multiple areas of life.

The other downside is that misinformation can create unrealistic expectations about what ADHD is and how it should be treated. Quick-fix videos suggesting that a diagnosis alone will unlock productivity, creativity, or instant self-understanding can be misleading. ADHD management often involves a complex process of understanding yourself, adjusting habits, sometimes exploring medication, therapy, or coaching — and, importantly, recognising and accommodating your own neurodivergence. It isn’t just about having a lightbulb moment and suddenly becoming organised and focused.

What’s more, social media algorithms reward content that is emotionally charged, relatable, and simplified. Nuanced, evidence-based information doesn’t always go viral. This means people often encounter repeated, surface-level, and sometimes exaggerated portrayals of ADHD, reinforcing a narrow view of what it is and leads to cynicism in the non-believers.

That being said, I don’t think the solution is to dismiss social media altogether — far from it. For many, online spaces have offered validation, reduced shame, and encouraged people to seek support when they might never have done so otherwise. The key is to approach it critically. Self-reflection is valuable, but self-diagnosis should ideally lead to seeking a professional assessment, not replace it. ADHD, like all neurodevelopmental conditions, deserves the depth and careful consideration that comes from a full, thoughtful evaluation.

Treating ADHD: More Than Just Medication

When it comes to ADHD treatment, there is no one-size-fits-all approach — and that’s a good thing. Effective treatment usually involves a combination of medical and non-medical strategies tailored to the individual’s needs.

For many, medication can be a helpful tool. Stimulant medications such as methylphenidate (e.g., Ritalin, Concerta) or lisdexamfetamine (e.g., Elvanse) are often prescribed and have strong evidence supporting their effectiveness. They work by enhancing attention, reducing impulsivity, and helping regulate emotions. For some, non-stimulant medications like atomoxetine may be considered, especially when stimulants aren’t suitable. Medication isn’t a magic fix, it doesn’t eliminate ADHD, but for many people, it creates enough stability to make other strategies more effective.

Equally important are non-medical interventions, which can make a significant difference in daily life. Psychoeducation is often the starting point, helping people understand how ADHD shows up in their lives, why certain tasks are difficult, and how their brain works differently. Knowledge alone can be incredibly validating and empowering.

Many people benefit from therapy, which can be adapted specifically for ADHD. Therapy helps individuals address patterns of negative thinking, develop coping strategies, and manage emotional dysregulation, which is often overlooked in ADHD.

Others find ADHD coaching valuable working practically on skills like time management, organisation, planning, and reducing procrastination. Coaching tends to focus on day-to-day challenges, offering practical tools and accountability.

In addition, occupational therapy or workplace adjustments can be crucial, particularly for adults. Support might include using planners, setting up external reminders, breaking tasks into manageable steps, or developing routines that fit the person’s strengths and challenges.

Many people also benefit from peer support whether through support groups, online communities, or connecting with others who understand ADHD from lived experience. Sharing strategies, successes, and frustrations with others who “get it” can be a powerful source of encouragement.

The most effective treatment plans can combine medication (where appropriate) with these non-medical supports, creating a more sustainable and holistic approach to managing ADHD. Treatment isn’t just about reducing symptoms it’s about helping individuals build confidence, improve functioning, and feel more in control of their lives.

The Positives of Having ADHD: Creativity, Drive, and the Power to Break the Rules

So far we have looked at the potential difficulties of ADHD, but it can come with a surprising set of strengths, particularly when it's harnessed in the right environments. Far from being just a clinical diagnosis, ADHD is also linked to innovation, resilience, and even entrepreneurial genius. People with ADHD often display characteristics that are extremely valuable, both professionally and personally. Here are some of the superpowers commonly found among those with ADHD:

1. Creativity and Out-of-the-Box Thinking

• ADHD brains are often wired for divergent thinking — the ability to generate multiple solutions to a single problem.

• Many artists, writers, inventors, and designers with ADHD credit their imagination and ability to see things differently as a key part of their success.

2. Hyperfocus (When It Matters Most)

• While people with ADHD often struggle with sustaining attention on boring or repetitive tasks, they can exhibit hyperfocus when working on something they are passionate about.

• This intense, immersive focus is what allows them to build, create, and innovate at an exceptional level.

3. Risk-Taking and Fearlessness

• Many people with ADHD are natural risk-takers. This trait is incredibly valuable in fields like entrepreneurship, where stepping into the unknown is essential.

• Willingness to try new things, even if they seem unconventional, often leads to breakthroughs.

4. High Energy and Drive

• The restlessness that sometimes causes difficulty in traditional school or office environments can actually be a source of drive and stamina.

• Many people with ADHD are able to outwork others when they are motivated, thanks to their energy and enthusiasm.

5. Resilience

• ADHD often forces people to adapt and find creative ways to cope from a young age. This builds a kind of toughness and persistence that is invaluable later in life.

ADHD and Entrepreneurship

Entrepreneurship seems almost tailor-made for the ADHD mind. Why? Because running your own business is unpredictable, creative, and requires constant problem-solving. The freedom to follow multiple ideas, adapt quickly, and pursue passion-driven projects aligns naturally with ADHD traits. In fact, studies have found that adults with ADHD are more likely to start businesses than those without it.

While ADHD does present challenges, it can also be a wellspring of talent, innovation, and originality. The key is recognising and harnessing these traits rather than trying to fit into a one-size-fits-all mould. People with ADHD often have a unique ability to see the world differently and that difference is exactly what leads to greatness.

Famous People with ADHD Who Changed the Game

Many of the world’s most successful creatives, business leaders, and innovators attribute part of their success to the very traits associated with ADHD. ADHD is common among highly successful individuals who defied convention and did things their own way. Here are just a few:

Richard Branson – Founder of Virgin Group

Branson is open about having ADHD and dyslexia. He often talks about how his creativity, risk-taking, and people skills have been key to building his multi-billion-dollar empire.

Simone Biles – Olympic Gold Medalist

Biles, one of the most decorated gymnasts in history, has spoken publicly about having ADHD. Her ability to hyperfocus, persevere, and manage immense pressure is an inspiration to millions.

David Neeleman – Founder of JetBlue Airways

Neeleman credits his ADHD for his entrepreneurial success. He believes that his ADHD helped him think creatively and innovate in the airline industry.

Will.i.am – Musician and Entrepreneur

The Black Eyed Peas frontman has spoken openly about his ADHD, describing how it fuels his creative process and pushes him to continually innovate.

Michael Phelps – The Most Decorated Olympian of All Time

Diagnosed with ADHD at a young age, Phelps used swimming as an outlet for his energy and focus. His incredible achievements in the pool are partly thanks to his relentless drive and intensity.

ADHD IS Real — and Misunderstood

I hope this weeks blog has offered some new insight into ADHD, Id like to dare to think that it may have changed a few minds on what it is and what it isn't. Despite lingering stigma, ADHD is not a fad, a moral or intellectual failing, or a simple case of being disorganised. It is a legitimate neurodevelopmental condition that affects millions of people across their lifespan. We've come a long way in understanding ADHD, but we’re still in the middle of that journey. The next steps involve not only increasing access to diagnosis but ensuring that diagnosis is accurate, thoughtful, and inclusive.

By raising awareness, demanding higher standards of assessment, and advocating for informed, compassionate care, we can create a system that truly sees, understands, and supports people with ADHD, not just as a diagnosis, but as individuals who deserve dignity, opportunity, and understanding.

How I Can Help: Compassionate, Evidence-Based ADHD Assessment and Support

It’s important to remember that ADHD is not just about challenges — it’s about difference. And with the right understanding and support, people with ADHD can lead meaningful, successful, and fulfilling lives. So if you’ve found yourself recognising ADHD traits in your own life, or if someone has suggested you might explore it, you can try an online screening tools like the ASRS (Adult ADHD Self-Report Scale). It’s freely available and can be a helpful starting point for self-reflection.

You can even try it here:  https://add.org/adhd-test/

However, and this is crucial — screening is only step one. A positive screening result doesn’t mean you definitely have ADHD, just as a negative result doesn’t entirely rule it out. Some people score low in the ratings but that is because they have built strategies to compensate, hence the need for an experienced clinician to see through that. Please know that you don’t have to navigate this process alone.

As a Clinical Psychologist with specialist training in the assessment and treatment of neurodevelopmental conditions, including ADHD, I bring vast experience that goes beyond just ticking boxes. ADHD is not simply a checklist diagnosis, and my approach reflects this. I take time to carefully consider your personal history, the nuances of your experiences, and the impact of other possible factors like anxiety, trauma, or sensory processing differences.

I also have a deep understanding of how ADHD shows up across different stages of life, in women and girls, and in people with complex presentations. Many clients come to me after feeling unseen, misunderstood, and even misdiagnosed in other settings which is why I am committed to offering a respectful, collaborative, and evidence-based service.

I also help with work place adjustments and I can even offer training and education to your workplace so they can fully understand how to benefit from a neurodevelopmental workforce. You are awesome and adjustments can make life even better.

If you would like to book an assessment or just make an enquiry, then as always feel free to get in touch. As always until next time

Carla