The Adult Autism & ADHD Practice’s Approach to ADHD
Introduction
To celebrate our new name (The Adult Autism and ADHD Practice) and now offering standalone ADHD assessments / collaborative identifications, our first blog is going to be all about ADHD!
We have actually been offering combined Autistic and ADHD identification since 2024. During this time, it has been joyful to see so many clients who we supported through their Autistic identification return to us to explore ADHD, as well as new clients exploring AuDHD experience with us. We are looking forward to now giving clients a choice of working with us for exploration of ADHD experience alone if they want it!
We believe passionately that no ADHDer needs to spend their lives trying to meet neurotypical standards and recognise that ADHD functioning (or flourishing) is not just about you, but the relationship between you and your environment. We don’t just know this because of our professional knowledge, we also have lived experience: our clinical manager is ADHD, as are several of our management team (and/or Autistic) as are many of our psychologists.
The blog will cover:
What we mean by a neurodiversity affirmative approach
How we understand ADHD within the neurodiversity paradigm
Hyperfocus and hypofocus
How we approach collaborative identification
Language Note: Unlike the Autistic community, there is not clear consensus in the ADHD community about the preferred language to use when talking about or naming ADHD. Describing yourself as an ADHDer is common, and many others call themselves AuDHD if they are Autistic and ADHD. We have chosen to use ADHDer but this may change over time in line with community preferences.
A Neurodiversity Affirmative Approach: Difference not Disorder
We work within a neurodiversity-affirmative approach to collaboratively identify ADHD. We use the term ‘collaborative identification’ rather than ‘assessment’ because ‘assessment’ comes from the medical model and conveys a sense of the professional alone having the power to ‘decide’ if someone is ADHD. We work with people to explore their neurology together and approach sessions as an opportunity to collaboratively think whether someone’s ways of being aligns with ADHD experience. It is not our decision: we work with you to find the best explanation for your experiences.
We have written elsewhere about the Neurodiversity Paradigm and what it means to work within a neurodiversity affirmative approach but to summarise, the Neurodiversity Paradigm is based on a social justice approach (the Neurodiversity Movement) viewing the way that the way neurodivergent people (e.g., Autistic, ADHDer, dyslexic) experience and interact with the world as part of natural diversity. This way of working views being ADHD as a different way of experiencing the world, not a ‘disorder’ or ‘condition’ (how ADHD is described within a medical model). Walker (2021) explains how the medical model is based on the Pathology Paradigm. ADHDers often share similar thinking styles, emotional responses, and physical experiences, even though these can vary greatly from person to person.
Currently, there is not a widely accepted or well-known different name for ADHD. Nick Walker has suggested ‘Kinetic Cognitive Style’. Kinetic refers to movement and energy. KCS has been suggested as a neutral alternative because it explains how factors such as interest and urgency drive this thinking style and the need for movement in both our brains and our bodies. This isn’t widely used, however, so for now we are using ‘ADHD’ neutrally as a placeholder.
A Neurodiversity Affirmative Approach to ADHD
We understand ADHD in terms of attention that can change and is based on interest and driven by urgency, novelty, and capacity. It is a divergent thinking style, one profile of diverse cognitive styles. It is a misnomer to see ADHD as a ‘deficit’ of attention: we know that ADHDers typically have an abundance of attention: their attention is just much more driven by interest, curiosity, and personal relevance and novelty than non-ADHDers.
Sonny Jane Wise (Lived Experience Educator) reframes ADHD in terms of:
Experiences of non-linear attention which is driven by personal interest, values, urgency, novelty, and capacity.
Differences in time perception – inner clock different to linear time.
Internal and/or external hyperactivity, e.g., racing thoughts, increased need for movement.
Differences in sensory processing and filtering.
Increased need for movement for regulation, sensory input, self-expression, engagement and learning.
Communication differences in voice tone, eye contact, verbal processing, interest- and connection-based conversation style.
An ADHDer’s attention is strongest when a task is engaging, meaningful, or stimulating to the person. When the task is personally relevant, rewarding, time-sensitive, new or exciting, ADHDers often experience hyperfocus. For example, some of the authors of this blog (and books on adult and child Autistic identification) are ADHDers and have first-hand experience of how hyperfocus can facilitate intense focus on writing and creativity.
It is important to acknowledge, however, that this does not mean that ADHDers cannot struggle in this world set up with neurotypical expectations or that challenges arising from our neurology cannot have significant negative consequences on many ADHD people’s lives.
The importance of context
Understanding ADHD within a neurodiversity affirmative framework is not just about viewing traits as strengths. Context and environment are vital when understanding a person’s attentional style and whether this is a strength or a challenge in that specific situation. An ADHDer may focus intensely on (i.e., pay very close attention to) a topic they are interested in, but appear ‘unfocused’ when asked to complete a task that they have no interest in, or are bored by. Processing information and making decisions really quickly (‘impulsivity’) can be extremely helpful for generating lots of ideas and giving the motivation to try them out, but might be less helpful when that person wants to actually ‘do the doing’ of the tasks (often considered by ADHDers to be the more boring parts of the overall plan). Issues can also arise when there is a mismatch between what ADHD attention looks like and neurotypical expectations and norms (e.g. that our bodies should be still when paying attention, or when there are very specific timescales for tasks to be completed in). Understanding ADHD in a neurodiversity affirmative way means the psychologist and person coming to us working together to understand whether their experience is a strength or a challenge, depending on the specific context, and how to maximise strengths and find ways to help with challenges.
What is hyperfocus?
Hyperfocus is something that is familiar to many ADHDers. It means ‘being in the zone.’ It is a deep, prolonged intense concentration in which the person is completely immersed in the task at hand, time can become timeless, and they can be extremely productive and creative. Most of the time, we can easily enter hyperfocus / a monotropic state for something that we feel passionate about, but find it extremely difficult to get going and focus on a boring task. For example, dealing with household bills or filling in forms can be excruciating to even start, but if something is a topic of passion, spending hours researching it deeply and not being able to “switch off” is enjoyable. Hyperfocus on a work project can make a person highly productive, but at the cost of attending to other needs, such as rest and nutrition. It might be that the same person becomes ‘stuck’ in hyperfocusing on an activity (e.g., playing a video game) and cannot exit that attention tunnel to complete tasks they actually need to. Once the hyperfocus ends, it can feel exhausting. Despite hyperfocus being such a key part of ADHD experience, it isn’t well-reflected in current diagnostic criteria.
What is hypofocus?
Current ADHD diagnostic criteria focus on hypofocus, for example, in terms of ‘distractibility’, ‘forgetfulness’, ‘difficulty completing tasks’. Given ADHDers’ attention thrives in stimulating environment, it makes sense that giving sustained attention to tasks that are not intrinsically stimulating is not an ADHD strength. Focusing only on what ADHDers find it hard to focus on gives a misleading view of their attention and what it actually means to be ADHD.
Compensatory strategies
Many ADHDers have developed a ‘system’ or workarounds for things that they find difficult. ADHDers are often creative, innovative problem-solvers which supports them in coming up with these effective compensatory strategies. Compensatory strategies are techniques or methods that help individuals manage challenges by using their strengths or adapting their environment. They might be scaffolds that the person does themselves (e.g., setting alarms; having a ‘system’), something someone else does for them (e.g., a partner helping by being the one to start the task first), or environmental adaptation (e.g., finding a job role that matches their attentional and processing style). We always ask people about their ‘compensatory strategies’, and what would happen if these were not in place because these strategies can be very adept at effectively ‘masking’ an area of support need. It might also become exhausting over time. Sometimes compensatory strategies work really well in one context, but when the person is in a different situation where they can’t use their strategies, they can really struggle.
Why Seek Formal ADHD Identification?
We fully support self-identification! However, we also recognise that some people do wish to explore a formal ADHD identification. This might be for a variety of reasons, for example:
Providing a new way for them to understand their way of being in and experiencing the world, which can support self-compassion and understanding for areas in which life can be difficult when ADHD neurology is misunderstood.
Some people may have previously been given unhelpful labels (e.g., being 'lazy', someone who 'just doesn't listen' etc.) or mental health diagnoses which they do not feel matches how they feel about themselves and their experiences or struggles.
Formal identification of ADHD can make it clear that a person requires reasonable adjustments under equality legislation.
Some people find it helpful when applying for disability benefits to have a formal identification (we recognize it is everyone’s individual choice to identify as disabled or not, and that many ADHDers do need financial and other supports).
What to Expect in the Formal Identification Process (with The Adult Autism & ADHD Practice)
Current diagnostic criteria (which as part of our work, we actively advocate for change around) reflects only a narrow part of ADHD experience. We explore someone’s experiences in full, including hyperfocus, variable attention, experiences of time, use of substances, sleep and navigating a neurotypical world. We do not expect people to share their experiences in a linear way (i.e. starting at the start and going in a straight line to the end). The ways in which people share information with us in sessions gives us a valuable insight into their attentional and processing styles and we want people to communicate according to their preference. We want to get to know the real you and how you communicate! We don’t expect people to ‘edit’ their personal communication style: we value ‘tangential’ conversation/information sharing.
We ask you to complete an intake form online before we meet to gather information about you and how you experience the world. This can be completed over a period of time as you can save and come back to it. Many of our clients have expressed that they feel anxious that they won’t be able to get out everything that they want to verbally during their video sessions. Sending this information to your psychologist in writing means that you can give all the information you want to give, in the way you want to give it. However, some people prefer to talk things through instead of filling in the form, and we are happy to support this.
We ask about your experiences paying attention when something is really interesting to you, and about your experience of intensity of attention, pacing and movement differences. We encourage people to think of examples across different areas of their lives, for example, during education, at work, in home life/chores, social settings, hobbies and interests, and relationships. We also explore any compensatory strategies you might use, and how things are for you if you can’t or don’t use those strategies.
We also have a form for a supporter to complete if you would like them to (e.g., parent/carer, friend, partner, someone who knew you as a child) but we recognise that there are many reasons why people might prefer not to involve someone else, and this is perfectly valid.
Our collaborative identifications are conducted over 3 separate sessions, and there is a free post identification support session also included in the price, whihch will be taolored to your identified neurology (e.g. ADHD or AuDHD).
Our paperwork is accepted across the NHS, HSE and other official organisations. However, it must be noted that should you wish to explore medication, you would need to access this from a psychiatrist as this is not something we offer at this time.
If you would like to make a booking for ADHD identification click BOOK NOW
For further information, check out our FAQs or email us at info@adultautism.ie.
For a very detailed look at how we approach our Autistic identification process (which includes a great deal of information about what it means to be neurodiversity affirmative) you can also read this book.
Authors:
Dr Charlotte Kerr (she/her), Chartered Senior Clinical Psychologist, The Adult Autism & ADHD Practice
Dr Anna Day (she/they), Co Principal Clinical Psychologist, The Adult Autism & ADHD Practice
Davida Hartman (she/her), Adjunct Professor UCD School of Psychology, Chartered Co Principal Psychologist and Clinical Director of The Children’s Clinic, Dublin. Clinical Director of The Adult Autism & ADHD Practice
