ADHD in adults — where to begin?

How it can show up in adults

Executive functions are the processes behind planning, organisation, working memory, impulse control and shifting attention. When they are weakened, it can show up as: difficulty concentrating and finishing tasks, procrastination, trouble with time management, impulsivity, racing thoughts, and emotional dysregulation — strong, rapid mood swings. A heightened sensitivity to rejection and criticism is also common (described as RSD, rejection sensitive dysphoria).

Why it often goes unrecognised

Many people spend years not knowing that their difficulties share a common thread. They learn to compensate for them and come to see themselves as lazy or disorganised. In reality, their brain simply works differently and needs tailored strategies, not more willpower. ADHD also often co-occurs with anxiety or low mood (comorbidity), which further blurs the picture. What is more, ADHD is often misdiagnosed as another condition — most commonly depression, anxiety disorders, bipolar disorder, or personality disorders (for example the borderline type). Because the symptoms overlap — mood swings, impulsivity, difficulty concentrating and unstable emotions — the correct diagnosis is sometimes only made after years.

A neurobiological perspective

In the mainstream scientific understanding, ADHD is a neurodevelopmental condition with a strong biological and hereditary basis — twin studies point to its high heritability. It is associated with differences in attention and executive-function networks (including the prefrontal cortex) and in dopamine and noradrenaline signalling, as well as with a somewhat delayed maturation of certain brain regions. This is one reason why appropriately chosen medication, acting on these systems, can be effective. In this view, ADHD is not a character flaw or a matter of laziness — it is a different way for the brain to work.

A developmental perspective (Gabor Maté)

It is worth knowing a broader view proposed by the physician Gabor Maté in his book Scattered Minds. In his view, ADHD is not solely a matter of genes but the result of a sensitive temperament interacting with the early environment — especially the level of stress and the quality of early attachment relationships. Maté emphasises that a child's brain develops in relationship and that its circuits are shaped by the emotional environment (neuroplasticity). In this framing, symptoms are often an early way of coping with overwhelm — tuning out an excess of stimuli. He stresses compassion rather than blame, and that supportive conditions can foster change at any age.

This is one of several perspectives; it complements, and partly differs from, the mainstream model, which strongly emphasises the neurobiological and hereditary basis. So treat it as an inspiring viewpoint rather than the only truth; a real diagnosis and support plan are best established with a specialist.

Where to begin — the path to diagnosis

With observation and a conversation. It helps to notice in which situations the difficulties are greatest and how they affect your life. The next step is an assessment with a specialist: a full diagnosis is made by a qualified doctor or psychologist, usually based on a structured interview, questionnaires and classification criteria (DSM-5, ICD-11), including developmental history. For many people a diagnosis is a relief — it brings order to the picture and opens the way to effective support.

Forms of support

Support is often multi-pronged. Psychologically, this may include psychoeducation, skills training and compensatory strategies (planning, breaking tasks into smaller steps, reminders, designing your environment), work on emotional regulation and elements of cognitive-behavioural therapy. Coaching and everyday organisational support can also help. For many people, combining lifestyle changes, psychological support and adjusted nutrition already brings satisfying results. Because of possible side effects, medication is better regarded as a last resort, used when other forms of support prove insufficient; the decision is always made by a doctor, weighing benefits and risks, while psychological support can run alongside it. Self-acceptance is central: learning to see yourself with kindness and to use your strengths.

This is an informational text, not a diagnosis. If you suspect you have ADHD, please consult a specialist. If you are in crisis, please seek urgent support — you do not have to cope alone.

Sources and further reading

• American Psychological Association — Guidelines for the Practice of Telepsychology