Specialty: ADHD
What is ADHD?
My definition of ADHD is a culmination of reviewing research and medical information on this diagnosis from various experts, and my lived professional and personal experiences while working as a psychotherapist. ADHD or Attention-Deficit/Hyperactivity Disorder is within the umbrella of neurodiversity or a neurological level of difference in overall baseline perception and experiences of external information. ADHD specifically involves dopamine and norepinephrine pathing and this being a primary factor with challenges involving motivation and productivity that cause significant issues in daily functioning.
How is ADHD diagnosed and treated?
ADHD is typically diagnosed through a comprehensive neuropsych that tests specific neurological functioning. Neuropsychs are conducted by licensed psychologists that have received specific training to conduct these structured assessments. Diagnosing can also be through a Master's level clinician or any other mental healthcare provider that has a license to independently practice that may start as a self-screening followed by qualitative interviews and phenomological experiences with the client over the course of therapy to support or adjust the diagnosis.
Due to the biological makeup of ADHD, symptoms are typically required to be present in childhood although there has been an increase in adult diagnosis even with limited concrete information available from childhood. This said, there are many cases when symptoms are present but may not have been recognized potentially due to lack of ADHD symptom awareness from caregivers and educators or due to other co-occurring issues that may obscure these symptoms ranging from anxiety, depression, aggressive behavior, or challenging environmental issues with family and peers taking the focus away or even Giftedness or exceptional abilities compensating for struggles with ADHD. In these cases, clients or patients may not receive a diagnosis until these are resolved or differentiated which may not occur until adulthood. Through therapy, adults may reprocess experiences in childhood with consideration of their ADHD symptoms.
You may notice someone with ADHD having extended or unpredictable periods of time with decreased or increased motivation and productivity that is in consistent conflict of what is required of them in their work and responsibilities leading to common labels of "lazy", "unambitious", "self-centered", and "undisciplined". Adding to this misunderstanding, they may have uncommon motivation and productivity or the ability to "hyperfocus" on activities or projects they personally enjoy due to their differences in dopamine and norepinephrine pathing. To support them in these extended or unpredictable states involving motivation and productivity that lead to difficulty following through and completing tasks, people with ADHD may require medication to regulate, extra assistance or understanding from professors, bosses, family members, friends with deadlines and time management, and/or acceptance of significant changes in lifestyle that allow for their natural shifts and states.
A person considered predominantly hyperactive type may be more sensitive to external, tactile information while those with predominantly inattentive type may be more focused inward with their internal experiences. I sometimes consider inattentive type, internal hyperactivity. Inattentive types may be those who may overdo activities that require less physical exertion that allow them to channel their internal hyperactivity rather than push past it. This may involve many hours playing video games, scrolling online, or deep in personal reflections or daydreams. Those with hyperactive type may have difficulty sitting for extended periods of time, need a certain amount of physical activity daily to "expel excess energy" or have careers that implement the physical which allows them to go with their hyperactive state. All these activities must be considered detrimental to basic daily functioning and following through such as difficulties with maintaining their homes, jobs, and relationships to where it harms their health and wellbeing to be considered a disorder.
As mentioned throughout this section, treatment can be a combination of therapy to support awareness needed to make lifestyle, social, and environmental changes as well as exploring medication options with an outside medication provider.
Links with more information:
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
ADHD Self-Report Scale
ADHD Self-Report Scale with Hyperactive vs Inattentive
Wender Utah Rating Scale for ADHD
Resources for ADHD
Like many conditions, ADHD comes from an inseparable blend of nature and nurture. I often recommend Scattered Minds by Gabor Maté, which explores how trauma and early environment can influence the development and expression of ADHD.
While upbringing and context matter, I’ve found that the most effective treatment for ADHD usually combines behavioral and lifestyle changes with medication. Medication often addresses the neurological or biological components more directly, while therapy supports changes at a more conscious level with self-nurturing and co-creating changes in relationships and environmental factors.
With starting medication, I recommend working with a psychiatrist, MD who specializes in ADHD, a psychotherapist (such as myself) for longer-term and more nuanced support, and, if possible, neuropsych testing with a psychologist for a more detailed ADHD or cognitive functioning assessment. A neuropsych is not required for diagnosing and medication, but is best practice to recommend especially for those who are concerned about other co-occurring neurological issues. You can learn more about ADHD diagnosing in the More Information section of my site.
At this time, I don’t have specific neuropsychologists I refer to directly. However, many well-reviewed providers can be found online. Those who do not accept insurance or accept private-pay only often have more availability. If you're using insurance, I recommend contacting your insurer directly to explore your options. As with therapists, the quality and focus of training and clinical experience of neuropsych professionals can vary which can affect results.
For medication access, I've learned of success connecting with providers with Circle Medical or Zocdoc since appointments are often quick and accessible which works well with therapy that allows more room to process medication effects. Other online psychiatry services include Done. and Talkiatry. These can be useful, especially in areas like Austin, TX, where local psychiatric providers are limited and may not specialize in ADHD, which can impact the range of medication options offered.
If you're preparing for a medication consult and want to go in well-informed, I recommend Russell A. Barkley, PhD’s work including the comprehensive Attention Deficit Hyperactivity Disorder, A Handbook for Diagnosis and Treatment, along with relevant episodes from Huberman Lab, which explore the neuroscience behind attention and executive functioning.
Behaviorally, many people, myself included find body doubling to be a highly effective tool. I first recommend cultivating or joining an online or in-person community you can feel safe to vulnerable with and have honest conversations. If this is not available or convenient enough with your needs, there are platforms like Focusmate, Focused Space, and Caveday on demand.
And of course with some awareness of its limits with confidentiality and capabilities as a tool, there is ChatGPT and other AIs or LLMs with a memory system as another way to support accountability with behavioral changes.
Therapy is highly recommended as a place to check-in with the use and effectiveness of non-human and therefore, non-discerning tools, and to explore how to adjust the use of them to better align with the way you naturally work.