Neurodiversity and Mental Health: ADHD

This blog explores some examples of the interplay between neurodiversity in the form of ADHD and mental health, shedding light on the unique challenges and opportunities individuals with ADHD may face. 

Defining Neurodiversity 

Neurodiversity, a term coined by sociologist Judy Singer in the late 1990s, challenges the notion that neurological differences are abnormal or undesirable. Instead, it emphasizes the diversity of the human brain and acknowledges conditions such as autism, ADHD, dyslexia, and others as natural variations of the human experience. Recognizing neurodiversity involves reframing these conditions not as disorders to be fixed but as differences to be understood. 

Many of these conditions can be experienced along a spectrum, and many people will benefit from evidence-based treatment to address at least some of the aspects of their condition. Some people experience symptoms to the level of disability. And some people view at least some of their differences as positive and uniquely helpful. 

The experience of neurodiverse individuals in their communities can be significantly improved when they are appropriately supported by people and systems. Support can include help-seeking accurate diagnosis and treatment when needed. Mental health treatment providers should consider the intersection of ADHD and other psychiatric disorders carefully to develop comprehensive and effective treatment plans. 

ADHD and Co-Occurring Disorders 

An adult affected by ADHD is up to six times more likely to also have depression than an adult without ADHD (CHADD, The Double Whammy of ADHD and Depression). About half of adults with ADHD also have an anxiety disorder, and some research points to a comorbidity as high as 20 percent for ADHD and bipolar disorder. 

Treatment programs that consider the intersection of these conditions can help adults find strategies and solutions that meet their unique needs. 

Adult ADHD Diagnostic Challenges 

Neurodivergent individuals often face diagnostic challenges as their symptoms may overlap with other mental health disorders. Distinguishing between neurodivergent traits and symptoms of other mental health disorders requires a nuanced understanding from clinicians. Normed, evidence-based assessments completed by the patient as well as structured interviews with the individual and their history and current experience and interviews with family members can be helpful in developing a full and accurate diagnosis. 

For example, in adolescents especially, ADHD can present similar to some symptoms of oppositional defiant disorder (ODD) or conduct disorder. Many symptoms of ADHD overlap with the presentation of bipolar disorder, especially bipolar II disorder. A small percentage of individuals with ADHD experience psychosis, which typically is a symptom of a thought disorder like schizophrenia. 

ADHD may also mask co-occurring cognitive disorders like learning and intellectual disabilities. Psychological testing can help determine what other diagnoses are present and what other interventions may be needed. For example, if a student is performing well in math, but is having trouble with reading comprehension, psychological testing may be indicated to evaluate for dyslexia or another learning disorder. 

Given the ability of ADHD to mimic and mask other mental health issues, an accurate and complete diagnosis from a qualified professional is crucial for an effective long-term strategy to reduce and manage symptoms. 

Diagnosing ADHD in Adults 

There are two main types of ADHD: inattention and hyperactivity-impulsivity. 

To meet the criteria for inattentive ADHD, adults and older adolescents must exhibit at least five of these symptoms, and they must be present for at least six months. Diagnostic criteria also consider whether symptoms occur in different settings and without the influence of other disorders or substances and whether they cause disability. The symptoms:  

• often fails to give close attention to detail, makes careless mistakes 
• has trouble sustaining attention 
• does not seem to listen when spoken to directly 

• does not follow through on instructions or does not complete assignments, chores, or other responsibilities 
• difficulty organizing tasks and managing time 
• has trouble starting tasks/ reluctant to do unpleasant or tedious tasks 
• is often easily distracted by external stimuli or unrelated thoughts 
• is often forgetful in everyday activities  

For hyperactivity-impulsivity, adults must exhibit five or more of these as well:  

• fidgeting, squirming in their seat, tapping hands or feet 
• trouble sitting still in situations where remaining seated is expected  
• feeling restless 
• often “on the go,” acting as if driven by a motor,  
• talking excessively,  
• blurting out answers, interrupting,  
• trouble waiting their turn,  
• being intrusive and lacking boundaries.  

Often, there is a tendency to primarily look at school performance and academic records when diagnosing ADHD. Unfortunately, the result of that practice is that people who are higher-functioning or who have a lot of effective support and who perform well in those areas can go undiagnosed. But they’re still struggling. 

Misconceptions about Adult ADHD  

ADHD is Only a Problem at School 

Too often ADHD is not depicted realistically and is envisioned as an issue only affecting school or work performance. In reality, ADHD symptoms can affect all areas of life. While the inattention symptoms that impact school and job performance are more well-known, the hyperactive and impulsive symptoms, which are less talked about, can have a major impact on an individual’s ability to socialize appropriately and form positive peer relationships.  

In addition to what we call “executive functioning,” ADHD often affects the parts of the brain that aid in emotion regulation. It can be harder for people with ADHD – particularly young people – to access their rational problem-solving skills in emotional situations. Struggles with emotion regulation can impact social relationships and other areas. 

People with ADHD can even be more prone to injuries or more susceptible to accidents. This can present as children who are impulsive and get on their bikes and go outside to do something on a whim and don’t think about the consequences. In adults, a person with untreated ADHD may have trouble overcoming distractions sufficiently to drive a car safely. 

People with ADHD Can’t Focus 

The brains of people with ADHD often are more susceptible and responsive to external stimuli relative to internal stimuli, as compared to those without ADHD. Without medications or learned skills, that response to the environment can create challenges with focus and time management. 

Many people have a misconception that ADHD prevents an individual from focusing in all situations. Individuals with ADHD can and actually will spend a lot of time on things that engage their brains in a rewarding way. However, tasks that don’t engage their brains often cannot compete with other stimuli in the environment for attention. A lot of “adulting” – financial planning, organizing work to meet deadlines, responding to emails – doesn’t typically engage anyone’s brain in a rewarding way. To complete these kinds of tasks, individuals with ADHD need to learn skills and tools to overcome the external stimuli begging for the brain’s attention. 

All Aspects of ADHD are Negative 

Some people with ADHD find that they benefit from some of the aspects of the condition. Some tend to be more creative or more willing to take risks. Others find that the ability to “hyperfocus” on a topic or task of interest contributes to their success. Some aspects, like being more spontaneous, being more talkative, etc., can contribute to social interactions in positive ways. 

Treatment for Adults with ADHD and Co-Occurring Disorders 

From a clinical standpoint, understanding the intersection of neurodiversity and mental health is crucial for providing effective and inclusive care. Mental health professionals need to adopt a person-centered approach that considers the unique strengths, challenges, and coping mechanisms of neurodivergent individuals. 

Many adults with ADHD “grow out of” some of the hyperactivity symptoms they experienced in childhood or find effective medications to reduce hyperactivity. Adults with ADHD often report more difficulty with inattention symptoms – which we would categorize generally as executive functioning difficulties – which may be more difficult to treat with medication. 

Therefore, neurodivergent adults need support and education on creating structure and daily routines, strategies to manage distractions, and tools and tricks for completing tasks. While adults with depression and anxiety may also struggle with executive functioning, their symptoms may be more episodic and may respond better to medications. 

Struggling to apply skills in a particular setting may contribute to depression or anxiety for someone with ADHD. Further, some medications that treat ADHD may be contraindicated for individuals also diagnosed with bipolar disorder or a psychotic disorder. 

Skyland Trail’s adult treatment program curriculum, which is largely based on evidence-based medication management and CBT and DBT skills acquisition, can help neurodivergent individuals with complex needs find a path forward that takes multiple challenges into account.  

ADHD and Sleep 

Sleep hygiene is paramount. Any person who is not getting enough sleep or who has an unhealthy sleep schedule is going to be more susceptible to not focusing or functioning well. Inadequate sleep also can contribute to symptoms of depression, mania, and anxiety as well. Many adults with ADHD and other mental health disorders have trouble falling asleep and/or staying asleep.  

Some research suggests that people with ADHD have a slightly different diurnal rhythm than other adults. They may have a harder time waking up in the morning and tend to experience their peak productivity hours later in the day. 

Neurodiversity-Informed Perspectives 

Clinicians should embrace neurodiversity-informed therapies that celebrate neurodivergent strengths and help individuals navigate societal expectations. This includes interventions focused on developing coping strategies, social skills, and self-advocacy. 

On a social level, addressing the intersectionality of neurodiversity and mental health involves dismantling stigmas and fostering environments that promote inclusivity and understanding. 

Educational institutions play a pivotal role in supporting neurodivergent individuals. Implementing inclusive teaching methods, providing reasonable accommodations, and fostering a culture of acceptance can create a more supportive learning environment. 

Employers should prioritize creating neurodiverse-friendly workplaces. This includes offering flexible work arrangements when possible, providing sensory-friendly spaces, and promoting neurodiversity awareness to cultivate a more inclusive professional atmosphere. 

Community Support 

Building strong community support networks is essential. This involves destigmatizing neurodivergent conditions, fostering empathy, and creating spaces where individuals can share experiences, resources, and strategies for navigating societal challenges. 

Understanding the intersectionality of neurodiversity and mental health requires a collaborative effort from both clinical and social perspectives. Embracing neurodiversity involves challenging preconceived notions, adopting inclusive practices, and fostering environments that celebrate the diverse ways in which individuals experience and navigate the world. By addressing this intersectionality, we can move towards a more compassionate and inclusive society that values and supports the mental well-being of all its members.