Out On The Couch

October is ADHD Awareness Month—in contemporary media, ADHD is often presented as affecting mostly children, and more specifically  mostly young white boys (and we could do a whole separate blog about how cissexism, misogyny, and racism impact the diagnosis and treatment of ADHD).

ADHD continues into adulthood, and studies show that it is highly prevalent across race and gender.  What’s more, misdiagnosis or late diagnosis of ADHD can have far reaching effects on individuals, including substance abuse, depression, and trauma.

ADHD Affirmative Therapy

While ADHD may or may not be a primary focus of treatment, ADHD can impact all aspects of everyday life, and when your clients (or colleagues) demonstrate harmful habits or actions that may be connected to their ADHD, they may react with shame or frustration. Affirmative therapists don’t just affirm LGBTQIA+ identities, but also think affirmatively about neurodivergence. Learning how to support people with ADHD can improve your therapeutic relationships with clients, and your work relationships.

Consider Adjusting Your Scheduling Processes

Maintaining a schedule is key to managing a clinical workload—and no-shows can greatly impact your ability to do your job. However, the tools of time management that we are expected to learn as children can be extremely difficult to manage for people with ADHD. Time blindness is a common symptom of ADHD, and it can be an extreme source of frustration and shame. Perhaps most importantly: it’s not a sign of laziness or lack of care.

Most clinics have moved beyond giving you a paper appointment card and instead send appointment confirmation via email or text message. But considering most people’s inboxes, that update may get lost as quickly as a piece of paper shoved in someone’s pocket. Consider setting up text reminders if you don’t already—and remember that a reminder 24 hours hours in advance might not be enough. While neurotypical patients may feel like a reminder one or two hours before is overkill, it might be the nudge your ADHD client needs to ensure that they can make it on time. (Many reminder systems allow users to opt in to multiple options, which can let each user choose what’s best for them.)

In addition, consider adding a little bit of flexibility to your no-show and late-cancellation policies. You probably can’t make it a free-for-all, but offering an occasional reprieve or a “free pass” may help a client who would otherwise struggle to come back to appointments after “getting in trouble” for missing an appointment.

ADHD Awareness: Be Flexible 

There are lots of treatments out there for ADHD, and as a result, it can be easy to encourage ADHDers to pursue or maintain medical treatment. For many, medication can be a lifesaver that they can’t imagine doing without. But for others, medication may have inconsistent effectiveness, or unwanted side effects. In some situations, availability may impact access. Perhaps most importantly, remember that ADHD medication cannot repair years of struggling with neurotypical expectations for communication, attention, and organization—even with medication, someone with ADHD may continue to struggle in the same ways, just at a lesser scale.

ADHD Awareness: Communicate

This seems obvious, but … talk to people in your life with ADHD! Ideally, talk to them before there is a serious problem. An important aspect of this is to remember that it’s not your job to “fix” their ADHD. No matter how “together” they may seem from the outside, very few people with ADHD are going to move through the world in the same way that neurotypical people do, even if they have a successful treatment system. But it can also be extremely difficult to move away from neurotypical methods—and nearly every ADHDer has a stack of barely used planners in various styles to prove it.

You may find that your clients and coworkers are struggling with something totally invisible to you that is related to their ADHD. It may be a never ending pile of laundry that is getting in the way (figuratively or literally) of other attempts at organization, side effects from medication resulting in brain fog, or a brand new hobby that they are hyperfocusing on to the detriment of other things, but you’ll never know without talking about it.

Working Together

Communicating also gives you an opportunity to ask them what they need from you. For example, difficulty in focusing can make a 50-minute therapy session feel overwhelming to an ADHDer, and what works for one may not work for another. Something as simple as starting the session with a couple minutes of writing notes may help an ADHDer identify things that they will otherwise forget before they get a chance to mention them. Do you have a coworker who is always struggling to get to their first appointment on time? Something as simple as making sure you make a pot of coffee when you get in could make a big difference.

This ADHD Awareness Month, we encourage you to think about how some of the processes and practices that you take for granted could be made more accessible to ADHDers and other neurodivergent populations!

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