As adult ADHD is becoming more and more prevalent, it is important that we know how to recognize it and understand how ADHD might manifest in adults in ways that differ from children
Historically, we have thought of ADHD as primarily a diagnosis given to children who are exhibiting behavioral problems in the classroom. With this increase in prevalence of adult ADHD, we also see that the way we think about and view ADHD changes.
I have been testing adults for ADHD for the past two years. I also work with many adults who are struggling with ADHD symptoms in therapy. I have always been curious about ADHD as someone who identifies strongly with this diagnosis. I am eager and excited to see the ways in which our conceptualizations and treatment of this diagnosis evolve and change in the field as we learn more about adult ADHD. In this article, I will share some patterns and commonalities I’ve noticed when testing adults and working with adults in therapy who have ADHD.
Impulsive Spending
Impulsive spending is one major way I’ve seen ADHD show-up for adults, especially in therapy with clients working to behaviorally treat their ADHD symptoms. Oftentimes, ADHD makes boredom almost intolerable and one behavioral treatment for ADHD is working on increasing tolerance for boredom and rest. Impulsive spending is one way I’ve seen my clients deal with boredom in a way that is not helpful to them. I also work with clients on finding other ways to meet their needs for a dopamine hit that don’t have negative consequences such as going on a walk or working on a creative project when feeling the urge to engage in impulsive spending.
Case Example: June, a therapy client, told me that they are struggling immensely with impulsive spending via online shopping during their downtime between appointments at work. June would often find that they didn’t know how to manage their unstructured time, especially when it was less than an hour between work appointments, and would automatically jump on their phone and start browsing the web, inevitably buying things they didn’t need. In counseling, we worked on identifying June’s values around spending and discovered that impulsive spending is in direct conflict with June’s value of minimizing consumption for the good of the planet. We created a plan for helping June engage in some conscious decision making processes instead of automatically grabbing their phone and going on “autopilot” while web browsing. Through this treatment plan, June was able to increase confidence in themself and reduce anxiety that resulted from their impulsive tendencies and acting against their values.
Feeling Burned out at Work
Many of my clients express feeling chronic burnout at work. Many of the tasks and expectations associated with a full time job are extremely challenging for someone with ADHD. Strict deadlines, inflexible work schedules, and task organization are all skills that adults with ADHD struggle immensely with. I try to normalize these struggles with my clients and support them in advocating for their needs at work. While there is a lot that is outside my clients’ control when it comes to unrealistic time and energy expectations at work, there are ways they can work to set boundaries and reduce workload when possible. I also find that ADHD testing is a helpful tool in negotiating accommodations at work for many adults.
Sleep Difficulties
One hallmark of adult ADHD is chronic sleep difficulties, often extending back to childhood. Because individuals with ADHD often struggle with slowing down and may often have a “noisy brain” initiating and sustaining sleep can be incredibly difficult. I have been shocked at the frequency with which my adult ADHD’ers report comorbid sleeping problems. In therapy, I often work with people on psychoeducation around sleep hygiene, the importance of having a routine around sleep as well as helping people identify and maintain their ideal sleep schedule.
Relationship Problems
My adult ADHD clients will often report a myriad of relationship difficulties associated with their symptoms. Specifically, I often hear that people are struggling to stay present in conversations and listen to what others are saying without either interjecting in a way that is off-putting or tuning out to the conversation completely. This struggle often seems like a difficulty with focus and inability to control what the brain is latching on to at any given moment. Helping adults to train their ability to pay attention, identify common distractors and develop strategies for being a more active and engaged listener is a very important part of treatment for these folks.
Difficulty with listening and auditory attention is a chronic struggle for me in my personal life. It is ironic that I went into the field of counseling considering my difficulties with listening and obnoxious tendency to interject during conversations with others. I have really had to work to train myself to be a more present, engaged and active listener. Fortunately for my clients, there are cheaper ways to learn these strategies than getting a PhD in counseling psychology…
ADHD testing can also help identify what kind of stimuli a person can be prone to. For example, when testing for ADHD, I am able to assess my clients and identify if they are more sensitive to auditory, visual or a combination of auditory and visual distractors. Having this information can really help inform a behavioral treatment plan for ADHD symptom management.
Case Example: Andy told me tearfully during his initial appointment that he feels like he is not able to be present with his kids. He said, for example, his son would try to show him a drawing he made at school and Andy would sometimes be so hyper focused on whatever task he was doing after work that he wouldn’t even remember his son coming over to talk to him. Andy would often go into the garage after a long work day and tinker around with his motorcycle as a way to blow off steam. He realized that while this behavior helped him to deal with work-related stress, it was preventing him from showing-up for his family.
Andy identified that being a present father is an important value to him and not paying attention to his kids after a long work day because of becoming swept up in a hobby is causing him immense feelings of guilt and shame. Andy said he has always generally struggled with being a good listener and that his wife will often get angry with him for forgetting to do things she asked him to do around the house. Through therapy and ADHD testing, Andy was able to begin behavioral training around improving his listening skills as well as get support at work to reduce his workload, which reduced his stress, and ultimately freed up more energy for him to be present with his family.
Feeling like a Failure
One of the most common statements I hear from adults I’m treating or testing who have ADHD is, “I feel like a failure.” Most people have felt this way about themselves their whole lives. They will say, “I always just thought I was stupid or lazy.” Every time I hear someone say these words, it strikes a deep chord in my heart. I am aware that we grew-up in systems that were not created for neurodivergent folks. These systems are often hard for those who are not on the spectrum of neurodivergence, and they continue to have unreasonable expectations of people. For example, the 40 hour work week or sitting at a desk for 8 hours per day is often torture for someone who is living with ADHD, but when you have debt, bills to pay and people relying on you for financial support, what choice does someone who is living with ADHD have but to suffer the consequences of these arbitrary and infuriatingly unrealistic expectations set up by employers and academic institutions?
I often work with clients on finding fault with the systems they live and work in rather than within themselves. Very few people I work with fall into the definition of someone who isn’t willing to put their best into work, relationships and improving their ability to get through day-to-day tasks that are challenging for them. I often find the adults living with ADHD I work with are very hard workers, are dedicated to what they care about and are passionate people. These are not people who are “lazy” or “failures.” In fact, the opposite is true. Part of holding these systems accountable for harmful and unrealistic expectations of people is the intention of creating change on a larger scale that will benefit everyone. Research continues to demonstrate that the mental and physical health, not to mention longevity, of individuals living in cultures with more favorable work-life balance, vacation time and free healthcare far surpasses that of those living in the United States. At what point are we going to collectively demand these changes for the good of everyone?
If you are an adult who is living with ADHD or suspected ADHD, there is hope in being able to find support through counseling with a counselor who is familiar with the way ADHD impacts adults. I speak with many clients who do not want to rely solely on medication to treat their symptoms, and finding behavioral ways of managing what they are struggling with becomes an extremely important part of treatment. The first step is being aware of how ADHD symptoms uniquely impact adults and can cause problems for people with a heavy load of responsibilities to manage. Feel free to email me if you are interested in scheduling an initial appointment for ADHD testing and/or therapy at drchelseatwisscounseling@gmail.com.
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