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Nancy Fingerhood, LSW
Counselor, Insight Clinical Counseling and Wellness, LLC

Attention deficit hyperactivity disorder (ADHD) is a neurobiological disorder that affects executive functioning portion of the brain (located mainly in the front part of the brain). When executive functioning is impaired, it can be difficult to prioritize and initiate tasks, sustain our attention, manage time, and regulate emotions. When people think of ADHD, they often picture a young excessively energetic child in school unable to pay attention to the teacher. Some also believe that children may outgrow ADHD. However, research shows that ADHD symptoms persist for 60 percent of adults. In adults, the symptoms can look different from those in children, and the severity can fluctuate depending on life stressors.

The hyperactivity type of ADHD is not as prevalent in adults. Most adults with this diagnosis have the ADHD Inattentive type, formerly called Attention Deficit Disorder (ADD). Many assume they have outgrown ADHD because they are no longer presenting as hyperactive or impulsive, but do express other symptoms such as procrastination, “zoning out,” and disorganization. ADHD can interfere with home life, financial management, relationships, and in work settings.

Procrastination is a common behavior of ADHD and is often thought to stem from difficulties with organization, low motivation, and distractibility. However, an overlooked cause of procrastination is perfectionism. After years of being criticized for not being “good enough,” people with ADHD may fear imperfections. A perfectionist mindset can stop a person from initiating a task since the belief is often: if it’s not going to be perfect, why bother doing it in the first place? Not starting the task is a way to avoid fears of failure or rejection.

While stimulant medications like Ritalin and Adderall and non-stimulants such as Strattera are effective in managing symptoms, not everyone wants to start with the medication route. Talk therapy with a mental health professional can be an effective and goal-oriented method to address ADHD-related challenges. A therapist introduces strategies to compensate for executive function deficits and change negative thought patterns.

Strategies to assist with executive functioning include:

• Keeping a calendar for appointments with specific dates in a highly visible area
• Keeping a task list for things that need to be done but not necessarily on a certain day Crossing off a task after doing it will give you a burst of the feel-good neurochemical dopamine
• Breaking down tasks into smaller steps to avoid feeling overwhelmed
• Practicing mindfulness as stress can exacerbate ADHD symptoms
• Entering tasks into an Eisenhower Matrix, which is a decision-making framework that helps prioritize tasks
• After doing something you do not find enjoyable, reward yourself by doing a preferred task

A mental health professional can work with clients with ADHD to explore self-judgements and personal strengths. Perfectionism creates almost impossible standards that lead to burnout and anxious thoughts. Self-compassion is one of the antidotes to having perfectionistic expectations. A therapist can guide you to uncover the root cause of unhelpful self-beliefs.

A combination of education about ADHD, practical skills, and exploration of unhealthy self-dialogues can have a positive impact on ADHD symptoms. Seeing a therapist may also assist with any co-occurring conditions that emerge from the challenges of having ADHD, such as anxiety or depression. Medications are also a viable option in conjunction with therapy. ADHD is a complex disorder that affects individuals in a unique way. With proper guidance from a mental health professional, you can navigate life’s challenges and enhance your quality of life.

Sibley, M. H., Arnold, L. E., Swanson, J. M., Hechtman, L. T., Kennedy, T. M., … Owens, E. (2022). Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry, 179(2), 142-151.  https://doi.org/10.1176/appi.ajp.2021.21010032