I recall being a psychiatrist in the early 2000s; ADHD in therapy was just beginning to enter clinical conversations. Some psychiatrists rejected the idea of neurodiversity, while others saw an opportunity to move toward something clinically important. Over time, more mental health professionals recognized how ADHD symptoms can profoundly shape treatment outcomes. Today, recognizing ADHD in therapy is not a niche skill, it is a practical clinical competency that helps therapists reduce shame, improve follow-through, and tailor interventions to how a client’s brain and nervous system actually function. Below are five reasons why every therapist should understand ADHD in therapy.
When clients seek an ADHD diagnosis, there is often a sense of urgency to reach a decision as quickly as possible. In contrast, therapists have the unique opportunity to truly get to know their clients over time, how they think, feel, plan, remember, relate, and recover from setbacks. This is one of the core reasons ADHD in therapy matters: the therapeutic relationship offers a longitudinal view that can clarify patterns that short assessments may miss.
Research by Drechsler et al. (2020) shows that building long-term relationships in clinical settings leads to a more nuanced understanding of diagnoses compared to short assessment sessions. Ultimately, considering a diagnosis in this context stems from a genuine understanding of the client, not simply trying to label them.
You are not diagnosing in-session. You are widening the clinical hypothesis so the treatment plan actually fits the person.
It is crucial to recognize that many therapeutic interventions can get caught in a “therapeutic loop” when neurodiverse issues like ADHD go unidentified. Research by Leahy and Holland (2020) highlights that when ADHD goes unrecognized, it can lead to persistent challenges in treating conditions like depression and anxiety. Individuals with ADHD often experience heightened emotional reactivity and may misinterpret incoming information. Continuing therapy without addressing these vital underlying struggles can meaningfully hinder a client’s progress.
Shaw et al. (2014) pointed out that emotional dysregulation is a significant feature of ADHD, profoundly affecting therapeutic outcomes, often appearing as “insight without change,” repeated unfinished homework, high self-criticism, and emotional overload. When ADHD in therapy goes unaddressed, even the most evidence-based approaches may repeatedly stall.
Recent findings by Stern et al. (2022) show that when symptom severity warrants medication, it can open a “therapeutic window,” making psychological interventions more effective and accessible. Often, this can provide a sense of safety that helps individuals explore their inner selves without feeling too overwhelmed.
“I understand why I keep doing this.”
Too many steps. Too much noise.
“I knew and still failed.”
The antidote is scaffolding: fewer steps, visible structure, and compassionate accountability, not more insight alone.
Many people with ADHD carry years of criticism, masking, and perfectionism. They may overwork, miss deadlines anyway, and ultimately conclude they are fundamentally flawed. Barkley (2018) highlights the profound negative effects of untreated ADHD on self-esteem and self-concept. Academic struggles can seem overwhelming despite genuine effort, leading to overwork, fear of failure, and deeply internalized shame.
Research by Adamou et al. (2021) noted that appropriate treatment, including medication when clinically indicated, can reduce feelings of shame and worthlessness in adults with ADHD. Compassion-focused strategies are particularly effective for this population, as described by Gilbert and Kirby (2019), helping clients build a compassionate self-understanding that addresses these long-standing struggles rather than reinforcing them.
“If I cared enough, I would just do it.”
“My executive function is overloaded. I need fewer steps and better external supports.”
With ADHD in therapy, reframes like this reduce shame and meaningfully increase treatment traction over time.
When medications are helpful, they often ease feelings of overwhelm, allowing clients to engage more fully in the therapeutic process. This support helps clients access calmness, clarity, perspective, and courage inner resources that can be far more difficult to reach without it. Their internal resources become more reachable in this state. Research by Stern et al. (2022) describes how medication can open a “therapeutic window,” making psychological interventions in ADHD therapy more effective and accessible.
Meta-analyses by Cortese et al. (2018) show that pharmacological treatment can significantly enhance both therapeutic engagement and outcomes. Medication is not a cure and is not right for everyone, it is one evidence-supported option within a broader, coordinated care plan. See also: CDC and NIMH treatment guidelines.
The therapeutic window is the zone where a client has enough internal steadiness to reflect, learn, and apply skills. Outside this window, therapy may feel too overwhelming or too emotionally distant to be useful.
What it feels like: “My mind is racing. I can’t think straight.”
Therapy move: stabilize first – grounding, pacing, one micro-step.
What it feels like: “I can pause and choose what to do next.”
Therapy move: practice skills, build routines, translate insight into action.
When people grow up in environments marked by trauma during childhood, it is vital to take the time to figure out whether their struggles come from those traumatic experiences, from ADHD, or from both. Understanding the interplay can help therapists differentiate between procrastination rooted in executive-function friction and dissociation rooted in a trauma response. It can also clarify anxious behaviors linked to a heightened nervous system from trauma, versus the feelings of urgency and impatience that arise from sympathetic overdrive in ADHD. These experiences often feel remarkably similar, making them clinically difficult to tell apart.
Research by Stein et al. (2023) provides clinical guidelines to help distinguish ADHD from trauma responses, as there can be significant overlap in symptoms. A comprehensive NIH/PMC review of the ADHD and PTSD relationship confirms that comorbidity is common, both can co-occur, interact, and complicate treatment planning when only one is considered.
Many clients have both. In ADHD in therapy, begin with curiosity and collaboration: “What happened in your body right before it became hard to start?”
Recognizing ADHD in therapy does not require every therapist to become a diagnostician. Consider a formal evaluation when functional impairment is persistent, cross-situational, and not fully explained by the current treatment response. Referral does not end the therapeutic work, it improves diagnostic clarity while therapy continues to support regulation, behavior change, and self-compassion.
The goal is not to turn every therapist into an ADHD specialist overnight. The goal is to make ADHD in therapy more workable, so clients feel genuinely seen and treatment becomes meaningfully more effective.
As a psychiatrist and therapist, I have come to see that recognizing ADHD in therapy, in all its forms, is crucial for ensuring a positive prognosis. Research by Young et al. (2020) shows that therapy approaches informed by ADHD awareness lead to significantly better outcomes compared to standard methods. It is essential for all of us to continually expand our knowledge on this topic, so that our clients benefit from the insight of a well-informed therapist and can avoid falling into avoidable therapeutic loops.
Clinically, this means moving slowly enough to understand the person, not just the symptom label. Better precision means better alliance, better adherence, and better prognosis.
Whether you are a therapist seeking to better support clients navigating ADHD, or a person who suspects ADHD may be shaping your experience in therapy, professional support can provide the clarity and tools to move forward.
Common questions therapists and clients ask about ADHD in therapy.
A: Look for patterns across time and settings: inconsistent follow-through despite genuine motivation, time blindness, working-memory strain, and emotional spikes followed by shame. ADHD in therapy benefits enormously from scaffolding smaller steps, external reminders, and compassionate accountability, which often improves traction when standard approaches have stalled.
A: Yes. Both can involve inattention, emotional dysregulation, impulsive responding, and avoidance. Careful assessment explores onset, triggers, dissociation, and cross-situational patterns, while recognizing that both may coexist. The NIH/PMC comorbidity review provides useful clinical context on how frequently the two overlap.
A: No. For many clients, combined care works best. Medication may reduce symptom burden and open the therapeutic window, while ADHD in therapy builds durable self-management skills, emotional regulation, and self-compassion. Neither approach is sufficient alone for lasting, meaningful change.
A: Start with the CDC treatment overview and the NIMH ADHD resource, then discuss options with a qualified clinician. The NICE guideline NG87 is also an excellent evidence-based reference for clinicians.
Last reviewed: February 2026
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org.