What exactly is Adult ADHD?
Attention-Deficit/Hyperactivity Disorder ADHD is a neurodevelopmental condition that affects both children and adults.
It is, by all accounts, a truly terrible name, which has contributed to a major misunderstanding of its presentation.
The first name for ADHD was actually “Hyperkinetic Reaction of Childhood” and it wasn’t until the early 21st century that it was widely acknowledged that ADHD could persist into adulthood.
For decades, it was simply referred to as ADD (and if you’re a Gen-Xer or Boomer, you probably still call it that) and the vast majority of people given diagnoses were children (specifically, hyperactive boys).
ADHD is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity (and a lot of other traits!) that can interfere with daily functioning and quality of life.
There is much more to ADHD than indicated in the DSM (the book that providers use to diagnose), especially regarding how it presents differently in children vs. adults and in different genders.
Inattention
ADHD is NOT about lack of attention…it’s about difficulty regulating attention. It’s hard to pay attention to one thing when you’re paying attention to everything. “Daydreamer” and “head in the clouds” are common descriptors for this type, which is the most common type for women/girls. Anxiety often accompanies this type. Symptoms are easily “masked,”meaning you’ve learned how to compensate or “fake it.” It can be exhausting and lonely since your challenges are often invisible to others.
Hyperactivity
This type is the classic stereotype of ADHD. It’s actually more complicated and tends to present differently in adults . Think of it as a restless or hyperactive mind, with or without the urge to physically move your body. I call it the “spin cycle.” You may not be literally running in circles, but your mind is in overdrive, sprinting from one thought or feeling to the next. Hyperactive ADHDers often have more physical energy than others and find themselves exercising compulsively or constantly cleaning up. They’ve likely been told to “calm down” or “relax!” and sometimes they worry that they’re “too much.”
Impulsivity
Similar to hyperactivity, we think of impulsivity more in children (and especially teens) than adults, but many adults experience low impulse control. Impulsivity is closely tied to emotional regulation in ADHD, so you may experience frequent mood swings and big feelings that appear out of proportion to the situation. Many ADHDers struggle with impulsivity when it comes to spending money (ubiquitous credit card use and online shopping doesn’t help) and using substances (ADHDers are up to 2.5x more likely to develop a substance use disorder).
Considering the DSM requirement that “symptoms were present prior to age 12,” one of the most common questions of those questioning if they have ADHD is: “What if I didn’t have it in childhood?”
In my experience, many people realize over time (with the help of therapy and/or coaching) that they likely did have symptoms as a child but they:
developed compensatory strategies (like doubling checking test answers, making to-do lists, taking frequent breaks)
benefited from scaffolding (parents/teachers setting up a predictable routine and breaking down learning into chunks)
it wasn’t until experiencing a major life event in adulthood (such as living alone for the first time, moving in with a partner, becoming a parent) that their symptoms became more obvious and started to affect their mood, behavior, and/or overall wellbeing.
For our work together, it will be helpful to reflect on what was (and what was not) helpful to you as a child and adolescent.
Think about your relationship to structure (love it or hate it?), routine (do you prefer predictability or spontaneity?), expectations (do you set them too low, too high, or just right?), and accountability (do you prefer someone checking in or total independence?).
The Unseen + Lesser Known ⏰ Traits of ADHD 💤
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Note: Emotion Regulation is very closely related to executive functioning (and included with EFs on this page) but it's also a highly overlooked trait of ADHD and one of the most important pieces of the puzzle.
Here are some examples of what it looks like in ADHDers:
Emotional Impulsivity: React quickly and intensely to emotional triggers without fully processing your feelings. Reactions can look and feel out of proportion to the situation.
Low Frustration Tolerance: Easily frustrated and may appear inpatient or irritable. It can be hard to self-soothe or divert your attention from the source of distress, causing you to stay angry or anxious longer than expected.
Overwhelm: When you mind becomes flooded with information and emotions, and it's too much to process (this can lead to shut down or "ADHD paralysis").
Procrastination: Putting things off until the last minute because you can't manage the negative thoughts and emotions associated with the task. (While procrastination is also a time management and self-control issue, feelings such as anxiety, boredom, self-doubt, and frustration can make it difficult to take action).
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Rejection Sensitivity: Many ADHDers experience hypersensitivity to perceived rejection or criticism.
Rejection Sensitive Dysphoria (RSD): People with RSD feel rejection intensely and describe experiencing extreme emotional pain when they feel misunderstood, rejected, or criticized (even when these situations are minor or unintended).
Emotional Cost of Hypersensitivity: Can lead to feelings of shame, intense frustration, or sadness, often triggering emotional outbursts or withdrawal. RSD is thought to stem from the emotional dysregulation common in ADHD, and it can significantly impact self-esteem, relationships, and overall emotional well-being.
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Perfectionism as a Coping Mechanism: Some ADHDers may develop perfectionist tendencies as a way to cope with feelings of inadequacy or to compensate for their challenges with focus, organization, and productivity. The desire to "get things just right" can serve as a way to counterbalance perceived deficits in performance.
When Perfectionism Leads to Procrastination: ADHDers may delay starting or finishing tasks due to a fear of not meeting their high standards. This cycle of avoidance, fueled by the anxiety of "perfect" expectations, can further exacerbate ADHD-related difficulties with time management and task completion.
Emotional Toll of Perfectionism: May result in emotional distress, such as frustration, self-criticism, and feelings of failure. When perfectionist goals aren't met, individuals may feel deeply discouraged, which can damage self-esteem and worsen emotional dysregulation, creating a cycle of negative emotions.
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A Highly Sensitive Person (HSP) is someone who has an increased sensitivity to sensory input, emotions, and environmental stimuli.
Many, if not most, ADHDers experience hypersensitivity, which can lead to becoming easily overwhelmed or overstimulated.
Strengths associated with hypersensitivity: greater empathy, creativity, and intuition
Challenges include a tendency to experience stress, fatigue, or emotional burnout in demanding situations.
Sensory differences: HSPs tend to be deeply affected by bright lights, loud noises, strong smells, or chaotic environments.
Emotionally sensitive: HSPs are highly sensitive to emotions—both their own and those of others—and may feel things more intensely than the average person.
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Demand Avoidance: Many people with ADHD are resistant to demands and expectations. You may avoid tasks or situations perceived as challenging, stressful, or undesirable. The avoidance typically stems from anxiety, stress, or a fear of failure, and often fluctuates depending on the person’s mood, energy level, or perceived difficulty of the task.
Pathological Demand Avoidance or Persistent Drive for Autonomy (PDA): A more extreme and pervasive pattern of behavior, characterized by an intense and persistent avoidance of everyday demands. This avoidance often extends to even basic tasks, such as personal care or engaging in social interactions.
In PDA, the avoidance is driven by an overwhelming need to feel in control, often coupled with extreme anxiety about being directed by others. Unlike typical demand avoidance, the resistance is often excessive, irrational, and difficult to manage through conventional methods.
PDA is widely considered to be a subtype of autism spectrum disorder (ASD), yet it's possible to have characteristics of PDA as an allistic person (not on the autism spectrum).
In short, demand avoidance is more common and situational, while PDA is a more pervasive and extreme form of avoidance, often rooted in the need for control and linked to anxiety.
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Time blindness is when it's hard to feel or understand how much time is passing. It's tricky to estimate how long things take or to notice that time is slipping away.
You may see time as either “now” or “later." Your orientation to time is the present and the future seems very distant.
Because you have difficulty accurately estimating how long a task will take you, you usually think you have more time than you do (and you're known as that friend who is always late).
IRL example: It’s like when you're playing your favorite game and you think only a few minutes have gone by, but actually, it's been an hour.
Challenges include:
Being on time
Planning your day
Getting things done before a deadline
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Difficulty Falling Asleep (Insomnia): People with ADHD frequently experience insomnia due to hyperactivity and racing thoughts. Their brains may have trouble "shutting down" at bedtime, leading to prolonged periods of wakefulness as they struggle to relax and unwind.
Restless Sleep: ADHD can contribute to more restless or fragmented sleep. Hyperactivity can persist during the night, causing frequent awakenings, tossing and turning, or trouble staying asleep. This restless sleep leads to poor sleep quality overall.
Delayed Sleep Phase Syndrome: Many individuals with ADHD experience a delayed sleep phase, meaning their body’s internal clock is shifted later. They may feel wide awake late into the night and prefer to stay up late, which leads to difficulty waking up in the morning.
Other Sleep Disorders: ADHD is associated with a higher likelihood of sleep disorders such as sleep apnea and restless leg syndrome.
Consistency/Routine: People with ADHD might have inconsistent sleep schedules or struggle with establishing a regular bedtime routine.
Sleep issues can worsen ADHD symptoms, creating a challenging cycle of fatigue and cognitive impairment.
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High Co-Occurrence: Adults with ADHD are significantly more likely to develop substance use disorders (SUDs) compared to the general population, particularly involving alcohol, cannabis, and stimulants.
Self-Medication: Many individuals with ADHD may turn to substances as a way to manage symptoms like impulsivity, restlessness, and difficulty concentrating, leading to patterns of self-medication and increased risk of addiction.
Treatment Challenges: Managing ADHD in adults with co-occurring substance use often requires an integrated approach, combining behavioral therapy with careful use of medications like non-stimulants or controlled stimulants to avoid exacerbating substance use
📆 Executive Function Skills 📚 Most Impacted by ADHD
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Name: Inhibition
AKA: Self-Control or Self-Restraint
Function: The ability to stop and think before acting, resisting impulsive behaviors or distractions.
Explain Like I’m Five: It's like having a stop sign in your brain that helps you control your actions, words, and thoughts.
IRL Example: Imagine you’re in class and someone says something funny—you might want to laugh really loud or yell out a joke, but inhibition control helps you stop and think, 'Is this the right time to do that?' It’s the part of your brain that helps you pause, make better choices, and not act on every impulse right away.
Impact of ADHD: Individuals with ADHD often struggle to pause before reacting, leading to impulsivity, interrupting others, or acting without considering consequences.
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Name: Emotional Regulation
AKA: Self-Regulation or Self-Control
Function: The ability to manage and regulate emotions appropriately in various situations.
Explain Like I’m Five: Like having a remote control for your feelings–you can turn them up or down so you stay in control and not your feelings.
IRL Example: Imagine you're really angry because someone bumped into you. Instead of yelling or getting upset right away, emotional regulation helps you stop, take a deep breath, and choose how to react calmly.
Impact of ADHD: Emotional dysregulation is common, resulting in intense emotional reactions, mood swings, and difficulty calming down after feeling upset or frustrated. Greater executive function capacity has been linked to better emotion regulation, and conversely, poor executive function is linked to difficulty regulating emotions.
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Name: Non-Verbal Working Memory
AKA: Visual-Spatial Memory
Function: Occurs when someone visualizes something and holds it in their 'mind's eye.' It can help you process the past or think about the future (specifically, what the future looks like).
Explain Like I'm Five: Like having a "picture memory" in your brain that helps you remember things you see (like the color of a house or a landmark when you're driving around town).
IRL Example: When you visualize scenes from the past, like where you left your keys when you realize they're missing.
Impact of ADHD: People with ADHD may struggle to keep visual information in mind.
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Name: Verbal Working Memory
AKA: Short-term Memory
Function: The ability to temporarily store and manipulate information (specifically related to language and words) in your mind for short periods, such as remembering a phone number or following multi-step instructions.
Explain Like I’m Five: It’s kind of like a post-it note in your brain where you hold info for a short time.
IRL Example: It helps you remember a phone number long enough to repeat it in your head and get to a pen to write it down.
Impact of ADHD: People with ADHD may struggle to keep auditory information in mind while working on it because they have less room in their “cognitive workspace.”
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Name: Cognitive Flexibility
AKA: Cognitive Shifting
Function: The ability to adapt your thinking and behavior in response to changing situations, new information, or unexpected challenges. It allows you to think of new ideas, try different solutions, or change your plans when something unexpected happens–and it helps you stay calm and adjust when things don’t go as planned.
Explain Like I’m Five: Like being able to switch gears in your brain when something changes. Imagine you’re playing a game, and suddenly the rules change—you have to quickly figure out how to play the new way without getting stuck on the old rules.
IRL Example: Multitasking and problem solving are both related to cognitive flexibility. For example, imagine you’re in a work meeting and you receive a call that your child is sick at school--you have to quickly switch gears and come up with a solution in short order.
Impact of ADHD: ADHDers may become rigid in their thinking, have trouble adjusting to changes, and struggle to "shift gears" mentally when something unexpected happens. Cognitive rigidity is the other end of the spectrum and commonly experienced by neurodivergent individuals.
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Name: Task Initiation
Function: The ability to start tasks promptly, rather than procrastinating or avoiding them. It’s that little push in your brain that helps you begin a job or task, even if it’s something you don’t feel like doing at first.
Explain Like I’m Five: When you start doing something right away instead of putting it off. It’s like when you have homework to do—task initiation is what helps you sit down, open your notebook, and start working instead of waiting until the last minute or getting distracted.
IRL Example: There are endless examples of initiating tasks. Think about your morning routine…are there certain tasks that you do immediately and others that you tend to delay or avoid?
Impact of ADHD: It’s very common for people with ADHD to procrastinate or have difficulty starting tasks, especially those that are uninteresting, challenging, or overwhelming. ADHDers tend to conflate motivation and task initiation (“I can’t seem to get motivated [to do a task]”) but task initiation (ability)--not motivation (desire)--is often the challenge.
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Name: Planning and Prioritization
Function: Planning is the ability to see the big picture and to develop a set of steps to complete a task or accomplish a goal. Prioritizing involves being able to make decisions about what’s important to focus on and what’s not important.
Explain Like I’m Five: It’s like making a to-do list for your brain. When you have a lot of things to do, planning helps you figure out the steps you need to take to get everything done. Prioritizing is deciding which things are most important and should be done first.
IRL Example: If your child comes home from school and has homework and chores to do and they want to play outside, they’ll need to organize what’s most important and/or urgent in order to plan for everything they want to do.
Impact of ADHD: ADHDers often have difficulty setting priorities, breaking down tasks, and keeping track of deadlines or belongings–all of which can lead to missed appointments, incomplete tasks, or messy environments.
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Name: Organization
Function: The ability to create and maintain systems to keep track of information or materials in an orderly and efficient manner.
Explain Like I’m Five: It’s keeping your things in order so you can find and use them easily. Imagine you have a messy room with toys, books, and clothes all over the place—when you need to find something, it’s hard because everything is scattered. But if you keep your room tidy, with toys on shelves and clothes in drawers, it’s easier to find what you need.
IRL Example: When your desk is covered with papers and unnecessary items, the disorganized clutter can make it hard to focus and find what you need when you need it.
Impact of ADHD: It's easy to get distracted or overwhelmed by clutter, whether it’s physical (like a messy room) or mental (like keeping track of tasks). This can lead to forgetting important things, losing items, or having trouble following through on plans.
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Name: Metacognition
AKA: Self-Awareness or Self-Directed Attention
Function: The ability to think about and evaluate your own thinking.
Explain Like I’m Five: It's like being the boss of your brain.
IRL Example: When solving a math problem, it's when you stop and ask yourself, 'Wait, did I read the directions?' or 'Is there a better way to solve this?' It’s like checking in on your brain to make sure you're on the right track and figuring out how to learn better.
Impact of ADHD: Those with ADHD often have reduced self-awareness of their behavior, making it harder to reflect on past actions, learn from mistakes, or adjust strategies for future tasks.
WWhat’s GOOD about having ADHD?
Lots of things! In fact, several of our so-called “symptoms” can be considered gifts, depending on one’s mindset and situation. ADHDers tend to be passionate, creative, adventurous, outside-of-the-box thinkers. The ability to hyperfocus, especially on areas of deep interest, can lead to exceptional levels of productivity and innovation.
Additionally, many people with ADHD have loads of energy and a spontaneous nature, making them enthusiastic collaborators and inspiring leaders.
Moreover, the heightened sensitivity and empathy that often accompany ADHD can also lead to strong interpersonal connections and a deep understanding of others’ perspectives.
