• Emma Mahony was diagnosed with ADHD as an adult 

  • Here she explains the role therapy played in her diagnosis and in learning to understanding her condition and how it fits into her life

  • We have therapists and counsellors who specialise in ADHD on the welldoing.org directory – find yours here

ADHD is often difficult to diagnose in the usual therapeutic situations, because the intensity of a therapist’s room means the attention deficit doesn’t always show up. The sufferer might be so engaged and focused in the exchange, that he or she doesn’t seem capable of distraction at all, and so even those who have been able to afford therapy might not have hit upon the source of their difficulty.

The quiet of the therapist’s room, the one-on-one attention, the lack of distracting factors – these influences can all help mask the usual distractibility and inattention. That’s why the teacher at the coalface of the classroom environment (for a child), or partner or boss (for an adult) is an important person to listen to – because they see it daily. Even therapists of adult ADHD sufferers have to be specialists, or must know what to look for, to recognise it in their client’s lives; for example, the over-talkativeness won’t necessarily be obvious where the client is encouraged to talk and the psychotherapist paid to listen.

Wherever you are in the world, the full ADHD assessment is a specialist examination, consisting of a structured interview (such as the DIVA 5.0, or from the Diagnostic and Statistical Manual of Mental Disorders [DSM] edition 5) administered by a trained mental health professional, such as an ADHD nurse or a psychiatrist. In addition to the client describing his or her symptoms, a family member will be interviewed to confirm them. This process usually takes a minimum of 1-2 hours and is followed up by a report confirming or excluding the diagnosis. On the NHS in the UK, it will take considerably longer as there will be multiple screenings with an ADHD nurse before you finally get to meet the ADHD psychiatrist.

"Adult ADHD is far more complex to diagnose than childhood ADHD because there may be a number of underlying issues going on, and the symptoms of ADHD can be seen in a number of other diagnoses," explains psychiatrist Dr Judith Mohring. "Poor memory and concentration is common in depression and anxiety, for example. Unstable mood can be a sign of a personality problem or mood disorder, and difficulties with day-to-day functioning are common in almost all mental health conditions to a greater or lesser extent." The first interview and screening is so that the psychiatrist can rule out another diagnosis first that would better explain the symptoms. So far so complex.

Why therapy has been invaluable to me

Where the therapist really comes into their own, is when the ADHD is diagnosed and they are on hand for weekly counselling sessions to both go back to where the ADHD has shown up in the lifetime of the midlife diagnosed, or coach them to make progress in their lives going forward. This weekly check-in, once a sufferer can overcome any sense of shame or stigma in needing it (and, of course, can afford it) is transformational. In my recent book, within the chapter on therapy, I begin with a quote from the author and neuropsychologist Dr Sam Goldstein, who writes: ”I strongly urge my professional readers to continue advocating for the important role of including psychotherapy in the treatment of ADHD across the lifespan” [my italics].

This might seem like a life sentence for some, after all most use psychotherapy as a tool to get themselves through a rough patch in their life, not as wagon wheels to keep the cart rolling along. However, that is exactly what it seems to do for an ADHDer. There is something about the pressure, the deadline, the constancy of the therapist in the ADHDer’s life, which I, for one, have found to be vital for keeping me in check. In fact, when my therapist last announced a couple of weeks leave in the summer, I immediately booked a flight abroad, organised a business party, and did a few other pandemically-ill-advised numbers, just because I could. I knew I wouldn’t have to answer to her for a couple of weeks, so the mouse went off playing. I have another school-friend who has ADHD who lied to her therapist about her cocaine habit – and yet continued her sessions for many months. No doubt the therapist knew something was up.

Therapy is a good thing in the life of an ADHDer, and for me it keeps me on the straight and narrow.

However, if reflection is one half of therapy’s use to the ADHDer, then coaching is the other half. When I retrained as a secondary school teacher with the Now Teach organisation, I was open about my ADHD to employers, and had my hourly weekly therapist session written into my “learning support plan” so it could be ringfenced outside of school hours for emotional support. I really needed it to get through this major career change from journalism to teaching. It was invaluable. Until I revisited some of my own off-the-rails behaviour as a teenager during these sessions, and transformed some of my own feelings of imposter syndrome by being back in the one place I vowed I would never return to, I was unable to step into my teacher identity authentically. It took a good year of these sessions and working towards my newly qualified teacher status to get my confidence going, but as my confidence increased so did my projection of myself as a competent professional. Therapy helped me get there. My therapist had my back.

While not everyone might want to change their life after diagnosis, I would still suggest giving therapy a go anyway. If you have lived with ADHD undiagnosed for much of your adult life, you will definitely have a lot of life experience to explore. Just don’t bother lying about it like my friend. It makes it an expensive habit in more ways than one.

Better Late Than Never: Understand, Survive and Thrive – Midlife ADHD Diagnosis by Emma Mahony is published by Trigger Publishing

Further reading

My journey with therapy and chronic depression

Counselling offered me the compassion I desperately needed

Before therapy I was selfish

9 ways counselling can change your life for the better

Relationship therapy saved our marriage