Understanding Neurodiversity-Affirming ADHD Therapy

Embracing Your Unique Mind

Living with ADHD is hard enough, finding the right therapy practice to help you with your adult ADHD shouldn’t be. For far too long, traditional therapy models have focused on helping individuals with ADHD conform to neurotypical standards. But what if therapy didn’t ask you to change who you are? What if, instead, it validated your unique brain and empowered you to thrive on your terms? That’s the foundation of neurodiversity-affirming ADHD therapy; a strengths-based, trauma-informed, compassionate approach that embraces ADHD as a natural variation in human thinking rather than a disorder to be "fixed”. It rejects these unhelpful narratives and instead offers acceptance, validation, and practical tools designed specifically for the ADHD brain. Your therapist should embrace your neurodivergence with respect, understanding, inclusion and collaboration because therapy is designed to help you grow, heal and discover your true authentic self. Our amazing ADHD brains operate in a very different and beautiful way and this is something to be celebrated. So what are some of the things you can look for when you searching for support? I got you. Let’s get into it.

Finding a Neurodiversity-Affirming Therapist

Not all therapists are trained in ADHD, understand the complexities of neurodivergence and it’s co-existing conditions that tag along. So, it’s essential to find an ADHD specialist; someone who has experience with ADHD and has a neurodiversity-affirming lens. I know it’s hard to find that unicorn therapist, but a specialist can offer customized strategies that work with your unique ADHD brain and not against it. You have already gone SO long in life feeling like you were born on another planet, therapy shouldn’t be one more place you feel misunderstood. Your ADHD therapist will help you navigate those feelings, normalize your experience and remind you that ADHD is a real neurodevelopment condition, and not a personal failing. You will know you’re in the right place if you feel supported, understood and validated.

Accommodating ADHD, Not Masking It

An ADHD specialist will design therapy to fit your unique way of thinking, rather than trying to make you fit into neurotypical structures. ADHD therapy can offer strategies that feel flexible and enhance motivation in way that feels more natural. You can also ask about accommodations, or adjustments that remove barriers to therapy and ensure you have equal access and opportunity in the therapy room. Some examples of neurodiversity accommodations might include: breaks, sensory adjustments, flexible interaction options, ability to go off camera during virtual sessions, reducing pressure to maintain eye contact, appointment reminders (lots of them), and any other supports you can can think of that with help you feel successful. A really good time to ask about all of this stuff (specialties, neurodiversity-affirming practices, accommodations etc) is in the initial consultation or even in your first visit.

Cultivating A Sensory Friendly Space

A sensory-friendly therapy space will minimize distractions and reduce sensory overload during your therapy sessions, allowing you to focus on your therapy. Let’s be real, most therapist office spaces are designed to be calming but here’s a few pro tips to consider even if you are doing therapy virtually from the comfort of your own home. Strategies for improving your sensory regulation experience during therapy might include: opting for adjustable and/or natural lighting, minimizing background noise, exploring the rainbow of sound, using noise cancelling headphones, accommodations around strong or irritating scents, having fidget toys handy and choosing seating that is neurodivergent friendly. I like to give clients “permission” to stand up, move around, wiggle, pace or do whatever feels right during our visits.

Celebrating Your Strengths

While it’s true that most people don’t come into therapy when everything is good, it doesn’t mean that the focus of therapy has to be on what’s difficult. Therapy can help you build on your natural talents, enhance your personal growth, leverage your creativity for problem-solving, harness your hyperfocus, improve your communication, develop new thinking patterns and funnel your energy towards your goals. By focusing on what you can do and what makes you unique, you can thrive with ADHD rather than struggle against it.

Feeling Comfortable Enough to Unmask

Masking is social strategy or coping skill that allows you to hide your ADHD symptoms in efforts to “blend in” and conform to neurotypical standards; all in attempts to “fly below the radar”, avoid stigma and social consequences associated with being neurodivergent. Masking might look like…maintaining eye contact in conversations (when you don’t want to), giving verbal or non-verbal cues you’re listening (when you’re not), suppressing your urge to fidget or bottling up your emotions so you’re not unfairly labeled as “to much” or “to sensitive”. Gross, I strongly dislike those terms. Masking is exhausting, isolating and harmful; we know that masking can lead to depression, anxiety and other mental health issues. Unmasking is the process of gradually revealing and accepting your ADHD symptoms instead of hiding them. Scary, I know. Maybe you have been masking for so long that you don’t even know what it feels like to unmask and live more authentically. Neurodiverersity-Affirming ADHD therapy offers a safe-space to explore yourself, understand your unique needs and genuinely be yourself. This is really powerful and liberating stuff.

Thriving, Not Just Surviving, with ADHD

Neurodiversity-Affirming ADHD therapy isn’t about "fixing" you—it’s about equipping you with the tools, mindset, and self-acceptance to thrive. By embracing your neurodivergence and working with a therapist who understands and affirms your ADHD experience, you can build a life that honors your unique strengths and needs.

ADHD Symptoms in Adult Women

7 Unique Ways Symptoms of ADHD Manifest in Women

Attention Deficit Hyperactivity Disorder (ADHD) is widely undiagnosed, misdiagnosed and dismissed in women. There are many factors that contribute to inadequate treatment for women with ADHD; and as a female therapist living with ADHD, I can confidently say…none of them are okay. Women deserve better. There’s so many reasons why ADHD is missed in the clinical picture for women; I can probably do an entire blog on this topic (and hey maybe I will). Factors include: symptoms types, inadequate research, internalized symptoms, provider bias, lack or training, stigma, stereotypes, societal expectations, gender roles, camouflaging and fluctuations in hormones. Although the symptoms for ADHD are diagnostically the same between men and women, the presentation and ways in which they manifest differ. So lets dive in.

Inattention

Women often struggle with predominantly inattention symptoms of ADHD, and they can be subtle; daydreaming, zoning out, not paying attention and procrastinating to name a few. Inattention symptoms of ADHD are often missed by educators, physicians, therapists and parents. It’s much easier to catch ADHD in the boy who is climbing the bookshelves, than the girl in the back looking out the window and twirling her hair. Inattention symptoms unfairly get labeled as some sort of negative character flaw such as being lazy, flaky or spacey. These stigmatizing labels are harmful to self-esteem, self-confidence and further perpetuate stigma. To complicate it even more, women learn societal expectations early on and become expert camouflagers, hiding and repressing their ADHD symptoms, which we now know leads to further mood issues such as depression and anxiety.

Internalized Hyperactivity

Women may be more likely to experience internalized hyperactivity that manifests as racing thoughts, internal restlessness, body tension, anxiety, picking, difficulty relaxing, mental exhaustion and fatigue. As a young girl, I was very talkative and thus frequently moved around the classroom for for disrupting my peers. Every parent-teacher conference was the same…”she talks to much”. As an adult, the chatter has largely been trapped inside. Reasons for this? Societal expectations, camouflaging, stereotypes and stigma contributing to internalized symptoms. Internalized symptoms might also include mood symptoms; and all of this contributes to the difficulty of early detection of ADHD in women.

Hypersensitivity

Women with ADHD tend to experience more central nervous system hypersensitivities compared to men with ADHD. These hypersensitivities may include sensory processing issues, chronic overwhelm, over-stimulation (fight/flight) and sensory overload. Examples might include: uncomfortable clothing materials, scratchy tags, loud music, loud chewing (misophonia), bright or un=natural lights (think fluorescent lighting), crowded spaces and strong smells like perfumes. Theses sensitivities might contribute to somatic complaints, headaches, migraines, stomach aches, nausea, dizziness, sleep disorders and Inflammatory conditions. Women with ADHD get unfairly labeled as being to “sensitive”. Hypersensitivities can make women feel overwhelmed by the world they are living in.

Perfectionism

Perfectionism is a common experience for women with ADHD. Perfectionism might stem from several places including: overcompensation, rigid or concrete thinking styles, fear of criticism, rejection sensitive dysphoria (we will come back to this one later), low self-esteem, gender roles, societal expectations and more. Perfectionism is unhealthy, maladaptive and leads women to extreme exhaustion, defensiveness, unrealistic expectations, negative comparisons of themselves and unattainable personal standards. Sounds tiring right?!

Comorbidity

ADHD rarely travels alone and women with ADHD appear to be more susceptible to comorbid conditions than their male counterparts. What is comorbidity anyways? Comorbidity refers to the co-existence of multiple mental health or physical conditions occurring at the same time. Women are susceptible to co-occurring conditions that include: depression, anxiety, addiction, migraines, sleep disorders and more. The presence of these other conditions can make for a complex diagnostic picture and is in part why ADHD might fly below the radar unseen for many years. Meanwhile women are struggling with the consequences of a missed diagnosis.

Emotional Dysregulation

You know what I’m talking about…nuclear meltdowns, outbursts, fits of rage, tantrums and tears. Emotional regulation is an executive function and a core symptom of ADHD. Hormonal fluctuations and low estrogen across the lifespan complicates the ADHD picture. Symptoms like irritability, mood swings and difficulty concentrating are sometimes attributed to PMDD or other mental health disorders when really…all signs point to ADHD.

Rejection Sensitive Dysphoria

Your are not going to find Rejection Sensitive Dysphoria (RSD) in the diagnostic criteria of the DSM-5, but this symptom has gained a lot of traction over the last several years and deserves to be recognized here. RSD is an intense response to both real or perceived rejection, criticism or failure. Symptoms of RSD include intense feelings of shame, guilt, fear, low self-esteem and difficulty regulating emotions. RSD can result in hours of distress, spiraling, ruminating. RSD causes functional impairment in day-to-day activities, relationships, work environments and sometimes leads to further isolation or avoidance and perpetuates comorbid conditions (see above).

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ADHD Therapy: What is it and how does it work.

9 Key Components of ADHD Therapy

If you have ADHD and have been in therapy before, you might have noticed your therapist addressing everything but your adult ADHD. In fact, your ADHD has been pushed so far back that it’s not even on the “back burner” anymore. Sure, you are still discussing your “other issues” like underlying depression, anxiety and why your relationships are burning to the ground, but you still can’t ignore the feeling that you are not getting to the root of your problems. The unfortunate truth is that there is a BIG gap in clinical care for adults struggling with ADHD and a generalist therapist may not have the experience or confidence in diagnosing and treating ADHD. There’s not doubt that it’s difficult to find that unicorn therapist who really understand the complexities of neurodivergence, executive function and it’s co-existing conditions. My first pro-tip for you is…find a therapist who specializes in ADHD and provides neurodiversity affirming care. It’s essential. Most therapists offer a free consultation where you can ask a few questions, gauge if your a good fit and find out more about their experience and approach to ADHD.

So what is ADHD therapy anyways? ADHD therapy is generally and integrative approach that focuses on education, executive functioning, cognitive behavioral therapy, mindfulness, coping skills, medications, lifestyle changes, coaching, treatment of co-existing conditions and more. So let’s break it down.

Education

Let’s be real. A lot of things have changed over the years in the world of ADHD and neurodivergence. Following ADHD testing and evaluation, I like to start the ADHD therapy journey with education because it helps you understand the neurobiology of ADHD, learn about the parts of the brain impacted by ADHD and gain insight into your symptoms and why you struggle with certain things. The education piece of therapy should not be ignored; it helps put the puzzle pieces together, make sense of your experiences, examines the role of stigma, combats years of isolation and validates years of feeling misunderstood. You’re not on Mars alone!

Executive Functioning

We’ve all heard the buzz word…executive function. So what does that mean really? Well, executive function refers to a set of cognitive processes in the pre-frontal cortex of the brain…and this is the part of the brain specifically impacted by ADHD. Executive functioning skills include planning, prioritizing, task initiation, organization, impulse control, emotional regulation, flexible thinking and self-monitoring. Sound familiar? Executive functioning is directly related to procrastination, or why you have difficulty getting started on things and why you lost your keys for the third time today. These skills are impaired due to ADHD and frequently cause distress in various domains of life. The focus of ADHD therapy is to identify areas of distress or impairment and develop goals to improve day-to-day functioning struggles.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an evidenced based-treatment frequently used to treat ADHD, depression, anxiety, addiction, sleep and more. CBT helps increase awareness of unhelpful thinking that contributes to mood issues and inevitably interferes with completing tasks and getting things done. One major goal of the CBT-ADHD model is to help you think more adaptively and decrease the frequency of those anxiety and/or shame spirals. CBT also helps you tackle core beliefs, that constant nagging feeling that you are not good enough or that you’re a failing at life. CBT helps you gain control of your thoughts, improve your self-confidence and expand your self-compassion so you can navigate life with more ease.

Mindfulness

Hear me out! Mindfulness therapy is thought to help ADHD by thickening your prefrontal cortex…the parts of your brain responsible for executive functioning. Mindfulness practices can help enhance focus, improve attention, reduce stress, promote relaxation and help you manage your emotions. Mindfulness therapy also contributes to increased levels of dopamine in the brain, which we know is in short supply in ADHD humans.

Coping Skills

ADHD therapy should provide you with a robust tool-box of coping skills to manage ADHD and it’s co-existing conditions. Because you followed my pro-tip of finding a therapist who specializes in ADHD, the skills you learn should be practical and neurodivergent friendly. Learning skills that are tailored to your ADHD brain and that are neurodiversity affirming sets you up for success and helps you feel supported and understood. The things that work for your neuro-typical peers may not work for you. A therapist that does not understand neuro-diversity may offer you strategies that will not work for you.

Medications

Stimulant medications are the number one treatment for ADHD; they are generally considered safe, accessible and are well tolerated by most people. Stimulant medications increase levels of serotonin, norepinephrine and dopamine in the brain. There are a lot of options out there now-a-days so if one isn’t the right fit, try again. I should probably mention here that stigma, stimulant shortages and side effects can interfere with finding a successful treatment option. It’s important to work closely with your provider to find something that works for you. Sometimes the side effects of a stimulant medication outweigh the benefits but don’t worry there are alternative options for treating ADHD such as psychotherapy and lifestyle changes.

Lifestyle Changes

Recent research has shown that ADHD impacts life expectancy by up to 13 years. Yikes! Symptoms of ADHD such as impulsivity, inattention and difficulty sticking with routines often need to be addressed in ADHD therapy. Contributing factors to shortened life expectancy in ADHD adults include poor diet, addiction, risky behaviors, lack of exercise and more. ADHD therapy helps you focus on lifestyle changes and creating new healthy routines that mitigate these risks and improve life expectancy outcomes. Cognitive Behavioral Therapy (CBT) can also be useful in this area because it addresses maladaptive thoughts, feelings and behaviors regarding lifestyle choices so that you can think more adaptively and make progress towards healthy change.

Coaching

ADHD therapy often involves coaching around executive functioning skills, organization strategies, time-management strategies, lifestyle changes and managing distractibility. Most ADHD therapists are open to addressing the psychological and emotional aspects of ADHD alongside the the practical approach or providing skills and strategies. Although it’s nice if you can get both of these services in one place, it may not always be practical. If you are significantly struggling with other co-existing conditions such as as depression, anxiety or addiction; it might make sense to split these services so that your therapist can focus solely on addressing and treating the underlying mental health concerns.

Treatment of Co-Existing Conditions

The reality is that ADHD rarely travels alone. In fact approximately 80% of adult humans diagnosed with ADHD also have a co-existing condition and 50% of individuals with ADHD have a 3rd coexisting condition. The biggest culprits include: anxiety, depression and addiction. ADHD therapy frequently involves treatment for these other conditions especially if they are co-morbid.

“ADHD touches every piece of your life, it’s a whole-person condition.”

— Trina Mauchmar, LCSW