The Reality of ADHD
There are a lot of misconceptions about what Attention-Deficit Hyperactivity (ADHD) actually is. ADHD isn’t just about getting distracted. ADHD is a regulation and neurodevelopmental disorder, which is a kind of mental health condition. People with ADHD can have difficulty regulating their attention, emotions, behavior, etc. People with ADHD actually can pay attention, they just have difficulty controlling what they attend to. People with ADHD struggle with executive function, which includes memory, starting tasks, planning, emotion regulation, organization, and resisting acting on impulses.
ADHD Symptoms: What They Are and Why They Matter
There are three presentations of ADHD: Inattentive type, Hyperactive type and Combined type. The Inattentive presentation is characterized by:
1. Person makes careless mistakes
2. Experiences difficulty to sustain attention (inattentive symptoms)
3. Appears to not listen when spoken to directly
4. Does not follow through on instructions
5. Does not complete tasks
6. Difficulty with organization and time management
7. Reluctance to engage in tasks that require sustained effort
8. Tendency to lose objects
9. Easily distracted
10. Forgetful (American Psychiatric Association, 2022).
The Hyperactive presentation is characterized by:
1. Impulsive behavior
2. Tendency to fidget
3. Appears restlessness
4. Struggles to be quiet during activities
5. Struggles to sit still
6. Talks excessively
7. Blurts out or interrupts others and
8. Difficulty waiting (American Psychiatric Association, 2022).
Someone has Combined presentation if they meet criteria for both the Inattentive and Hyperactive presentations.
Understanding the different presentations is important, as some people mistakenly think that ADHD is just hyperactivity and bouncing off the walls. They do not realize that inattentiveness is also part of ADHD. This misconception has led to an underdiagnosis of ADHD. Women often have the inattentive presentation, meaning women often go undiagnosed or misdiagnosed (Peterson, 2025).
As a teen therapist, parents often talk to me about their child’s struggles with organization, including bedrooms, lockers, and backpacks being a mess. They also share that their teen has missing assignments or may have poor grades. Other teens might forget to do their chores.
Adults with ADHD talk about having a hard time starting and completing tasks at work, getting fixated on activities, being late places, and having trouble holding themselves accountable.
The Brain Behind ADHD
People with ADHD have smaller prefrontal cortexes and lower activity in the prefrontal cortex compared to people
without ADHD, which affects planning and impulse control (Peterson, 2025). They also have thinner gray matter in the frontal lobes, which affects organization and focus. The basal ganglia are smaller in those with ADHD, which impacts motor control and habits. The neurotransmitter, dopamine, is involved in ADHD as well, such that, dopamine levels are lower. This makes it difficult to get motivated and sustain focus (Peterson, 2025). Additionally, ADHD individuals have lower levels of norepinephrine, making regulating stress and attention difficult, and it can cause low mood, sleep issues and anxiety (Pertzsch, 2025). ADHD folks can also have lower levels of serotonin, which can cause hyperactivity. There are differences in GABA for ADHD people, making sensory input confusing and overwhelming and causing challenges with concentration and memory (Pertzsch, 2025).
Differentiating ADHD from Other Conditions
Getting distracted is normal and does not necessarily mean that you have ADHD. However, if your symptoms are persisting for over six months, started before the age of 12 and are impairing functioning in multiple areas of life (such as school and social settings) then it is possible that ADHD might be present. A doctor, nurse practitioner, or psychologist can screen you for ADHD. A psychologist can complete a psychological or neuropsychological evaluation.
ADHD often co-occurs with other conditions or mental health disorders. Common co-occurring conditions are Mood disorders, Anxiety, Depression, Bipolar Disorder, Substance Use Disorders, Posttraumatic Stress Disorder, Autism Spectrum Disorder, learning disabilities, Tic Disorders, and Sleep Disorders (Peterson, 2025). Another co-occurring condition is Social Anxiety Disorder, which could in part be related to Rejection Sensitivity Dysphoria that is common in ADHD (Saline, 2022).
Treatment Approaches and Strategies
First and foremost, individuals can learn strategies and skills to help improve executive functioning challenges. A professional called an ADHD coach or a therapist with a specialization in ADHD can build a treatment plan and help an individual learn and build these skills. Here are some strategies to try:
- Body doubling is where you work alongside someone with tasks that you have had difficulty initiating. A therapist or other support person could be a body double for you (Peterson, 2025).
- Mindfulness Mindfulness means being in the present moment without judgment. Mindfulness practices can include yoga, deep breathing, body scan, etc, though people can also be mindful in an informal way of everyday activities (Bertin, 2022). As therapists, we often hear people who have ADHD state that they cannot do mindfulness. It may be challenging to learn as a person with ADHD, so having help (ADHD coach, therapist, mindfulness teacher) in the beginning is recommended.
- Accountability Tivers (2022) suggests that accountability from others can be a way to help with follow through and task completion. He gives examples, such as sending photos of completed tasks to someone you’ve chosen to help keep you accountable. Another option is to send a text of your intention (eg. I will leave work at 5pm. I will call you when I leave work. If I don’t call you by 5:15, please call me).
- Getting a team of people to help An example of this is if there is a task that is really difficult for you to complete, such as cleaning, you could hire a cleaning person to clean your home at a frequency that works for you (Nowell, 2022).
- List Create a list of tasks that need to get done with specific deadlines. Specific deadlines help create a sense of urgency and overcome challenges with different perceptions of time that is common in ADHD folks. A list also helps with challenges with working memory (Peterson, 2025).
- Calendar People can take the list a step further and schedule items from your to do list on a calendar at a specific day and time. Regularly check your calendar to see what is scheduled to do that day (Nowell, 2022).
- Lifestyle changes: Getting enough sleep, exercising, and eating enough protein are also ways to manage ADHD symptoms (Nowell, 2022).
With these different strategies there is trial and error, as different strategies work for different people (similar to medications and everything else!).
Medications are one prong of treatment for individuals with ADHD. Medications such as Adderall, Ritilan, Concerta can be prescribed by a doctor or Psychiatrist. It may take some trial and error to find the right medication and right dose for you.
People with ADHD can also receive accommodations at work or school. In school this might be a 504 plan or an individualized education plan. Accommodations could include extended time on tests, extensions on assignments, and preferential seating, etc. Parents can work with the school to establish a 504 plan or individualized education plan. It is helpful to work with a neuropsychologist or specialized therapist to get recommendations for accommodations as accommodations impact all people differently and can sometimes have unintended consequences.
For adults in the workforce, the Job Accommodation Network can give you ideas of accommodations to advocate for in your workplace. You can talk with your employer about what accommodations will be best for you. Employers are required to provide reasonable accommodations in the workplace as part of the Americans with Disabilities Act (ADA).
ADHD Across the Lifespan
ADHD can change across the life span. Peterson (2025) states that adults are less likely to present with the hyperactive presentation of ADHD. ADHD symptoms can be more prominent during life transitions, as it becomes more difficult to manage symptoms during those times (Peterson, 2025). Hormonal changes can also affect the way that ADHD manifests. When estrogen is lower, ADHD symptoms worsen. This can happen at certain times in the menstrual cycle for people who are menstruating and estrogen levels begin to decline at perimenopause (Peterson, 2025).
Conclusion
If you think you or your child might have ADHD, get a diagnosis from your primary care physician, nurse practitioner, or through a psychological evaluation or neuropsychological evaluation. Once diagnosed, there are treatment options such as medications and then working with a therapist who understands ADHD can help.
Blog written by Sentier therapist, Andrea Schroeder, MS, LPC, LPCC.
Sources:
About Attention Deficit/Hyperactivity Disorder (ADHD). (n.d.). Job Accommodation Network. Retrieved May 2, 2025, from https://askjan.org/disabilities/Attention-Deficit-Hyperactivity-Disorder-AD-HD.cfm
American Psychiatric Association: Desk Reference to the Diagnostic Criteria from DSM-5-TR. Washington, DC, American Psychiatric Association, 2022.
Bertin, M (2022). Mindfulness-Based Strategies for Overcoming Complex ADHD in Youth and Families [Conference Presentation]. ADHD Certification Course: What’s New & What’s Next in Supporting Neurodiverse Clients. Online.
Nowell, D. (2022) ADHD, Neurodiversity, and Clinical Practice [Conference Presentation]. ADHD Certification Course: What’s New & What’s Next in Supporting Neurodiverse Clients. Online.
Peterson, L. (2025, April 29). Spotting ADHD Workshop for Providers [Workshop]. Online.
Pertzsch, K. (2025, May 1). Distracted and Disordered: Understanding the Overlap Between
ADHD and Eating Disorders [Workshop]. Online.
Saline, S. (2022). ADHD, Social Anxiety and Rejection Sensitivity Moving Beyond Hello [Conference Presentation]. ADHD Certification Course: What’s New & What’s Next in Supporting Neurodiverse Clients. Online.
Tivers, E. (2022). Effectively Keep ADHD Clients On-Time & On-Task Step-by-Step Guide to Building Accountability Relationships [Conference Presentation]. ADHD Certification Course: What’s New & What’s Next in Supporting Neurodiverse Clients. Online.
