Understanding ADHD:
Evidence-based psychoeducation to help you understand Attention Deficit Hyperactivity Disorder, what it is, how it presents, and what support looks like.
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by difficulties regulating attention, hyperactivity, and/or impulsivity that can impact daily functioning. It is one of the most thoroughly researched neurodevelopmental conditions in clinical psychology, and yet it remains widely misunderstood.
ADHD is not a deficit of attention in the traditional sense, rather, it reflects a difference in how the brain regulates attention, motivation, and executive functioning. People with ADHD can often hyperfocus intensely on tasks they find engaging, whilst struggling considerably with tasks that feel repetitive, unstimulating, or externally imposed.
The Three Presentations of ADHD
According to the DSM-5 and ICD-11, ADHD presents in three distinct ways. Understanding which presentation applies to you or your child is an important first step in accessing the right support.
Predominantly Inattentive
Difficulty sustaining attention, frequent mind-wandering, losing items, forgetting daily tasks, struggling to follow through on instructions, and being easily distracted. Often missed in childhood, particularly in girls and women.
Predominantly Hyperactive-Impulsive
Restlessness, difficulty staying seated, talking excessively, interrupting others, acting without thinking, and a sense of internal urgency. More commonly recognised in boys, but present across all genders.
Combined Presentation
Meets criteria for both inattentive and hyperactive-impulsive symptoms. This is the most commonly diagnosed presentation in clinical settings and can vary in intensity across different life contexts.
How ADHD Affects the Brain: The Executive Function Model
Clinical psychologists understand ADHD primarily through the lens of executive functioning, a set of higher-order cognitive skills managed largely by the prefrontal cortex. These include:
- Working memory — holding and manipulating information in mind in the short term
- Cognitive flexibility — shifting attention between tasks or adapting to change
- Inhibitory control — suppressing impulsive responses and irrelevant distractions
- Planning and organisation — breaking goals into steps and following through
- Emotional regulation — managing frustration, rejection sensitivity, and emotional reactivity
- Time perception — accurately sensing the passage of time and managing deadlines
In ADHD, these systems are not absent, they are context-dependent. This is why someone with ADHD may perform brilliantly in high-interest or high-pressure situations, yet struggle significantly with routine or low-stimulation tasks. This variability is often mistaken for laziness or lack of effort, which can be profoundly damaging to self-esteem.
ADHD in Women and Girls: The Hidden Presentation
ADHD has historically been under-diagnosed in women and girls, largely because early research was conducted almost exclusively on young boys with hyperactive presentations. Clinical understanding has evolved significantly, and it is now recognised that ADHD in females often presents quite differently.
Girls and women with ADHD are more likely to:
- Present with the inattentive subtype, which is less disruptive and therefore less likely to prompt a referral
- Engage in masking, using significant cognitive and social effort to appear neurotypical, often at great personal cost
- Internalise difficulties, leading to anxiety, low self-esteem, and self-criticism rather than externalised behavioural problems
- Be diagnosed later in life, often following a major life transition such as starting university, becoming a parent, or reaching perimenopause
- Experience their symptoms as a personal failing rather than a neurological difference
Hormonal fluctuations across the menstrual cycle, pregnancy, and menopause can significantly worsen ADHD symptoms, a factor that remains under-researched but is increasingly acknowledged in clinical practice.
The Emotional Experience of ADHD
One of the most under-discussed aspects of ADHD is its emotional dimension. While diagnostic criteria focus on attention and hyperactivity, the emotional experience of living with ADHD can be profound and pervasive.
Individuals with ADHD frequently describe:
- Intense frustration at the gap between their intentions and their actions
- Shame and self-blame accumulated over years of being told they are “not trying hard enough”
- Grief upon receiving a late diagnosis: mourning the years spent struggling without understanding why
- A sense of being “too much”: too loud, too emotional, too disorganised — for the world around them
- Paradoxical feelings of both boredom and overwhelm, sometimes simultaneously
- Difficulty with emotional regulation that affects relationships, work, and self-concept
From a clinical perspective, these emotional experiences are not separate from ADHD, they are central to it. Effective psychological support addresses both the neurological underpinnings and the emotional consequences of living with a brain that works differently in a world not designed for it.
How ADHD is Assessed
A comprehensive ADHD assessment conducted by a clinical psychologist goes well beyond a simple symptom checklist. At Reframe Psychology, our assessments are thorough, evidence-based, and take the whole person into account.
A full assessment typically includes:
- Clinical interview: a detailed exploration of developmental history, current difficulties, and life context
- Standardised rating scales: validated psychometric tools such as the Conners Adult ADHD Rating Scales (CAARS)
- Collateral information: where appropriate, gathering information from parents, partners, or teachers to understand cross-context presentation
- Cognitive assessment: when recommended, an evaluation of working memory, processing speed, and executive function profiles
- Differential diagnosis, carefully ruling out other conditions that may explain symptoms, including anxiety, trauma, sleep disorders, and thyroid dysfunction
- Feedback session: a dedicated appointment to discuss findings, formulation, and recommendations in plain language
Following the assessment, you will receive a comprehensive written report suitable for sharing with your GP, employer, educational institution, or other healthcare providers. Where indicated, we will provide a referral for medication through our prescribing partners.
Evidence-Based Treatments for ADHD
Not everyone with ADHD needs or want therapy, but for those who want to manage ADHD through therapy, the evidence base supports a multimodal approach, combining psychological, behavioural, (and where appropriate, pharmacological interventions) for the best outcomes.
Strengths and the Neurodiversity Perspective
A clinical psychologist’s role is not only to identify difficulties — it is to understand the whole person. ADHD, like all neurodevelopmental differences, brings with it a unique profile of strengths alongside challenges.
Many individuals with ADHD describe remarkable capacities for:
- Hyperfocus — the ability to immerse deeply in areas of genuine interest, often producing high-quality, creative work
- Divergent thinking — generating novel ideas, making unexpected connections, and thinking outside conventional frameworks
- High energy and enthusiasm — when engaged, individuals with ADHD can bring extraordinary drive and passion
- Empathy and emotional sensitivity — a heightened awareness of others’ emotional states, often making them compassionate and perceptive
- Crisis performance — many people with ADHD describe performing exceptionally well under pressure, when adrenaline provides the neurological activation their brain needs
At Reframe Psychology, we hold a neurodiversity-affirming stance. This means we work with you to understand your ADHD not as a disorder to be fixed, but as a different way of being that requires the right environment, strategies, and support to thrive.
Whether you are seeking an ADHD assessment for yourself or your child, or looking for psychological support following a diagnosis, our team is here to help. Book a free 15-minute introductory call to discuss your needs with no obligation.