ADHD Therapy for Adults

Understanding ADHD in Adults

ADHD (Attention-Deficit/Hyperactivity Disorder) in adults often looks very different from the stereotypical image of a hyperactive child who can't sit still. Adult ADHD is complex, nuanced, and frequently misunderstood—even by people who have it.

The Three Types of ADHD

ADHD presents in three primary patterns, and understanding which one applies to you (or if you have a combination) is important for developing effective strategies.

Inattentive Type (formerly called ADD): This type involves difficulty sustaining attention, being easily distracted, struggling with organization and follow-through, appearing forgetful or spacey, and having trouble with time management and prioritization. People with inattentive ADHD often seem to be daydreaming or not listening, but internally they're dealing with racing thoughts or hyperfocus on something other than what they're supposed to be doing.

Hyperactive-Impulsive Type: This type involves physical restlessness and difficulty sitting still, talking excessively or interrupting others, acting impulsively without thinking through consequences, feeling internally restless even when appearing calm, and struggling to wait their turn or delay gratification. Adults with this type might fidget constantly, feel driven by a motor, or make impulsive decisions about spending, relationships, or career changes.

Combined Type: This is the most common presentation in adults, involving symptoms from both inattentive and hyperactive-impulsive categories. The specific mix and severity of symptoms varies greatly from person to person and can even fluctuate within the same person depending on stress, sleep, and other factors.

How ADHD Shows Up in Adult Life

Adult ADHD manifests differently than childhood ADHD. Physical hyperactivity often decreases with age, replaced by internal restlessness. The demands of adult life—jobs, relationships, managing a household—expose executive function deficits that might have been less obvious in the structured environment of school or with parental support.

Common ways ADHD affects adult life include chronic procrastination followed by panic-driven productivity, difficulty with routine tasks like laundry or dishes while hyperfocusing on interesting projects for hours, time blindness leading to constant lateness or underestimating how long things take, emotional dysregulation with intense reactions to minor frustrations, rejection sensitivity and taking criticism very personally, difficulty making and keeping friends due to forgetting to respond or maintain contact, and impulsive spending or decision-making that creates financial or relationship problems.

Who Benefits from ADHD Therapy

ADHD therapy helps adults who have been diagnosed with ADHD as well as those who suspect they might have it and are struggling with symptoms.

• You were diagnosed with ADHD as a child and still struggle as an adult
• You suspect you have ADHD but were never formally evaluated or diagnosed
• You're on ADHD medication but still need help with strategies and skills
• You struggle with executive function tasks like planning, organizing, or completing projects
• You experience emotional dysregulation, intense emotions, or rejection sensitivity
• Your relationships are affected by ADHD symptoms like forgetfulness or impulsivity
• You're struggling at work due to difficulty focusing, meeting deadlines, or staying organized
• You've developed coping mechanisms that no longer work or are exhausting to maintain
• You deal with chronic shame or low self-esteem from years of feeling "less than"
• You have co-occurring conditions like anxiety or depression alongside ADHD
• You're a woman who was missed for diagnosis because your ADHD doesn't fit stereotypes
• You're high-functioning but completely exhausted from the effort it takes

ADHD therapy isn't a replacement for medication if you need it, but it provides essential skills and strategies that medication alone can't address. Many people benefit most from a combination of both.

The Hidden Struggle: ADHD in Women and Girls

ADHD in women is chronically underdiagnosed and misunderstood. Many women don't get diagnosed until adulthood, after years of struggling and being told they just need to "try harder" or that they're "too sensitive."

Why Women Are Missed

The diagnostic criteria for ADHD were developed primarily by studying hyperactive boys. Women and girls are more likely to have inattentive-type ADHD, which is less disruptive and more easily overlooked. Girls are often socialized to mask their symptoms, developing coping strategies that hide their struggles until the demands of adult life become overwhelming.

Women with ADHD might appear to have it together on the outside while burning out internally. They might be high achievers who spend enormous energy compensating for executive function challenges. Or they might struggle with chronic underachievement despite high intelligence, labeled as "not living up to their potential."

How ADHD Presents Differently in Women

Women with ADHD often experience internal hyperactivity (racing thoughts, mental restlessness) rather than physical hyperactivity. They struggle with emotional regulation and may be dismissed as "overly emotional" or "hormonal." They develop perfectionism as a coping mechanism, leading to anxiety and burnout. They experience intense rejection sensitivity that affects relationships deeply. Hormonal changes during the menstrual cycle, pregnancy, or menopause can dramatically affect ADHD symptoms.

Many women are misdiagnosed with anxiety or depression when ADHD is the underlying issue—though these conditions often co-occur with ADHD. Therapy that understands how ADHD specifically affects women is crucial for developing effective strategies and addressing the shame many women carry from years of being told their struggles are their fault.

ADHD and Emotional Regulation: The Hidden Symptom

While not officially part of the diagnostic criteria, emotional dysregulation is one of the most challenging aspects of ADHD for many adults. Your emotions might feel more intense, come on more quickly, and be harder to manage than they seem to be for others.

Rejection Sensitive Dysphoria (RSD)

RSD is an extreme emotional sensitivity to perceived rejection or criticism. Even minor feedback can feel devastating. You might avoid situations where rejection is possible, leading to procrastination on important tasks or avoidance of relationships. You might people-please excessively to avoid any hint of disapproval. Or you might react with intense anger or defensiveness when feeling criticized, even when none was intended.

RSD is one of the most painful aspects of ADHD but also one of the least discussed. Therapy helps you recognize RSD when it happens, develop strategies to manage the intense emotional reactions, and challenge the catastrophic thinking that often accompanies it.

Mood Swings and Emotional Intensity

ADHD affects the brain's ability to regulate emotions. You might go from calm to furious in seconds over something minor, feel overwhelmed by emotions that seem disproportionate to the situation, struggle to calm down once upset, or experience mood shifts that others find confusing or difficult.

This isn't about being "dramatic" or "oversensitive"—it's neurological. Your brain processes and regulates emotions differently. Therapy provides tools for emotional regulation that work with ADHD, not against it.

Executive Function Challenges: When Your Brain Won't Cooperate

Executive function is like your brain's management system—it handles planning, organizing, prioritizing, initiating tasks, and following through. ADHD significantly impacts these functions, creating challenges that others often misinterpret as laziness or lack of motivation.

The Knowing-Doing Gap

One of the most frustrating aspects of ADHD is knowing exactly what you need to do but being unable to make yourself do it. It's not about not caring or being lazy—it's about the gap between intention and execution that executive dysfunction creates. You know you should start that project, but you literally can't make yourself begin. You know the dishes need washing, but the task feels impossibly overwhelming.

This creates intense shame. Others (and maybe you yourself) think "if you know what to do, just do it!" But with ADHD, knowing isn't enough. Your brain needs specific supports and strategies to bridge that gap.

Time Blindness

Time blindness is the inability to accurately sense the passage of time or estimate how long tasks will take. You might think five minutes have passed when it's been an hour, or that a project will take 30 minutes when it actually takes three hours. This leads to chronic lateness, missed deadlines, and the stress of always feeling behind.

Therapy helps you develop external systems to manage time since your internal sense isn't reliable. This might include timers, visual schedules, time-blocking, or other accommodations that work with your brain's limitations.

Task Initiation and Completion

Starting tasks is often harder than doing them. Once you get going, you might be fine—but that initial activation energy feels impossibly high. Similarly, you might start many things but struggle to finish them, leaving a trail of half-completed projects that increase your sense of failure.

Understanding the neurology behind these struggles removes the moral judgment. You're not lazy or uncommitted—your brain's executive function system needs specific strategies and supports to initiate and complete tasks effectively.

ADHD and Relationships: The Connection Challenges

ADHD significantly affects relationships, often in painful ways. You might struggle with maintaining friendships, navigating romantic partnerships, or communicating effectively with family members.

Common Relationship Challenges

Forgetting important dates, plans, or conversations can make partners or friends feel unimportant, even though your forgetfulness has nothing to do with how much you care. Zoning out during conversations or interrupting can be perceived as rudeness or lack of interest. Emotional dysregulation might lead to intense reactions that damage relationships. Time blindness causes lateness that frustrates others. Hyperfocus on interests might mean neglecting relationship needs.

Partners often misinterpret ADHD symptoms as lack of care or effort, leading to resentment and conflict. Friends might drift away when you repeatedly forget to respond to texts or miss gatherings. Family might not understand why you struggle with things that seem easy to them.

How Therapy Helps

ADHD therapy addresses relationship challenges by helping you develop communication strategies, create systems for remembering important information, learn to recognize and manage emotional reactions, understand your attachment patterns (ADHD often affects attachment), and build relationships with people who understand and accept your neurodivergence.

We may also work with your partner in couples sessions if relationship dynamics are significantly affected by ADHD. Learn more about our couples counseling services.

ADHD and Co-Occurring Conditions

ADHD rarely exists in isolation. Most adults with ADHD have at least one co-occurring condition, and addressing both is essential for effective support.

Anxiety

Anxiety and ADHD frequently co-occur, sometimes making it hard to distinguish which symptoms come from which condition. The constant stress of struggling with executive function, chronic lateness, and unfinished tasks creates anxiety. Stimulant medications can sometimes worsen anxiety. Therapy addresses both conditions, using approaches like ACT that help you take action even with anxiety present. Learn more about ACT therapy for anxiety and ADHD.

Depression

Chronic feelings of failure, shame about ADHD struggles, and exhaustion from trying so hard just to function can lead to depression. Additionally, ADHD affects dopamine regulation, which also plays a role in depression. Therapy addresses both the neurological aspects and the emotional impact of living with unmanaged ADHD.

Trauma

Many adults with ADHD have trauma from years of being misunderstood, criticized, or punished for symptoms they couldn't control. School experiences, family dynamics, or relationship failures can create lasting wounds. Trauma-informed therapy helps process these experiences while building new, more compassionate narratives about yourself.

Approaches Used in ADHD Therapy

ADHD therapy integrates multiple evidence-based approaches tailored to your specific needs and challenges.

Learn more about all the therapeutic approaches we integrate in ADHD counseling.

Frequently Asked Questions About ADHD Therapy

Do I need an ADHD diagnosis to start therapy?

No. If you suspect you have ADHD and are struggling with symptoms, therapy can help whether you have a formal diagnosis or not. We can also discuss evaluation options if diagnosis is something you're interested in pursuing.

Can therapy cure ADHD?

ADHD is a lifelong neurological difference, not something that can be "cured." However, therapy can dramatically improve how you manage symptoms, develop effective strategies, and create a life that works for your brain. Many people find that with the right support and strategies, ADHD becomes much less disabling.

I'm already on ADHD medication. Do I still need therapy?

Medication and therapy address different aspects of ADHD. Medication helps with neurological symptoms like focus and impulse control. Therapy helps you develop skills, create systems, process emotions, and address the psychological impact of living with ADHD. Most people benefit from both.

How long does ADHD therapy take?

It varies based on your needs and goals. Some people work intensively for a few months to develop core strategies and skills. Others benefit from longer-term support as they navigate different life stages and challenges. ADHD therapy is often more open-ended than therapy for other conditions because ADHD is a chronic condition that may require ongoing support.

Will you diagnose me with ADHD?

As a therapist, I can provide information about whether your symptoms are consistent with ADHD and refer you for formal evaluation if appropriate. Formal ADHD diagnosis typically requires comprehensive psychological or neuropsychological testing. However, therapy can help with ADHD symptoms whether you pursue formal diagnosis or not.

What if my ADHD doesn't look like what I see in the media?

Media portrayals of ADHD are often stereotypical and limited. ADHD presents differently in different people, especially in adults and in women. If you struggle with executive function, emotional regulation, time management, or other ADHD symptoms, therapy can help regardless of whether your presentation fits stereotypes.

Can ADHD therapy help with work performance?

Absolutely. Work challenges are one of the primary reasons adults seek ADHD therapy. We'll address time management, organization, task initiation, meeting deadlines, managing workplace relationships, and advocating for accommodations if needed. Many people see significant improvement in work performance with the right strategies and supports.