Why ADHD Is Often Missed in Adults
Adult ADHD is frequently overlooked or misattributed, particularly when someone appears articulate, insightful, or outwardly “high functioning”.
Instead, difficulties may be framed primarily as:
anxiety
depression
trauma
low self-esteem
These experiences are often very real — but ADHD may be the underlying neurodevelopmental difference shaping how they are experienced.
When ADHD isn’t recognised:
therapy can move too quickly
insight may be prioritised over regulation
emotional responses may be misread as resistance
clients may feel they are “failing therapy”
In reality, the therapy may not be aligned with how their nervous system works.
ADHD, Trauma, and the Nervous System
ADHD is associated with differences in emotional regulation and heightened sensitivity to stress.
When trauma — particularly developmental or relational trauma — is also present, the nervous system can remain in a prolonged state of alert.
This can mean:
therapy feels overwhelming rather than containing
shutdown or avoidance occurs
emotional reactions escalate quickly
trust takes longer to establish
In these situations, pushing insight or cognitive work without adequate safety can feel destabilising rather than helpful.
When ADHD Is Recognised, Therapy Outcomes Improve
Research and clinical evidence consistently show that therapy outcomes improve when ADHD is recognised and the therapeutic approach adapts accordingly.
Importantly, this does not require abandoning established therapy models.
It requires changing how therapy is delivered.
When ADHD is accounted for:
pacing becomes more intentional
regulation comes before exploration
safety and predictability are prioritised
shame is reduced rather than reinforced
The same therapeutic frameworks can be used — but delivered in a way that fits the client’s nervous system.
ADHD Therapy Is Not One-Size-Fits-All
This isn’t about lowering therapeutic standards or avoiding challenge.
It’s about clinical responsiveness.
Effective therapy has always involved adaptation.
ADHD simply makes the need for that adaptation more visible.
When therapy hasn’t helped someone in the past, it’s worth asking not:
“Why didn’t they engage?”
But instead:
“What wasn’t accounted for?”
A Final Thought
If therapy hasn’t worked for you before, it doesn’t mean you failed.
Often, it means the therapy wasn’t designed with your nervous system in mind.
With ADHD, how therapy is delivered matters.
Call to Action (choose one or use both)
For Clients
If you’re an adult with ADHD — diagnosed or exploring — and therapy hasn’t felt helpful in the past, you’re not alone.
I offer ADHD-affirming psychotherapy for adults, both online and in person in Limerick, with a focus on pacing, safety, and understanding how ADHD shapes mental health.
👉 Learn more or book a session:
robertrackley.ie
For Professionals
If you’re a therapist or mental health professional looking to deepen your understanding of ADHD in adult therapy, I also deliver CPD-accredited training on neurodivergence in the therapy room.
👉 Explore training and courses:
robertrackley.ie/training
