Attention-deficit hyperactivity disorder (ADHD) is a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a form of neurodivergence. This mental health condition is often characterized by inattentiveness, hyperactivity, and a different way of thinking and seeing the world.
Although ADHD was previously considered a mental illness primarily seen in young boys, we now understand that it can affect anyone of any age, background, race, or gender. More adults than ever are starting to seek an ADHD diagnosis and support, and many people have joined the neurodivergent movement to discuss how brain differences are not a disease that can be cured.
Treating ADHD often involves a combination of medication and therapy. If you’re a therapist or mental health professional who works with children, adolescents, or adults with ADHD, it may benefit you to look at new research on this condition, how to treat it, and how to be mindful of neurodivergence. There are a few ways you can make your space safer and more welcoming for neurodivergent clients with ADHD, which we’ll be discussing in this article.
What Is ADHD?
Attention-deficit hyperactivity disorder is a mental health condition. Within the diagnostic category of ADHD, there are three subtypes of the condition, including the following:
- Primarily Inattentive ADHD (ADHD-PI): ADHD-PI is a condition marked by inattentive symptoms like a lack of focus, difficulty forming thoughts, and forgetfulness. This type does not involve hyperactivity symptoms.
- Primarily Hyperactive And Impulsive ADHD (ADHD-HI): ADHD-HI is a condition characterized by hyperactivity, extreme energy, difficulty staying still, impulsivity, and increased movement. This type does not include symptoms of inattentiveness.
- Combined Type ADHD: Combined type ADHD is a condition distinguished by a combination of hyperactivity and inattentive symptoms. This subtype is the most common type of ADHD.
In previous diagnostic manuals, ADHD was paired with attention deficit disorder (ADD). However, ADD is no longer a diagnostic label and has been replaced by the primarily inattentive subtype label. In addition, in the DSM-4, ADHD was classified as “Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence.” However, it was moved to the “Neurodevelopmental Disorders” category in the DSM-5.
The Diagnostic Criteria For ADHD
ADHD is diagnosed when clients meet the criteria for one of the three subtypes of the condition.
With ADHD-PI, the diagnostic criteria involve six or more of the following symptoms that have persisted for at least six months:
- Difficulty giving attention to details
- Difficulty sustaining attention on tasks or play activities
- Not seeming to listen when spoken to directly
- Difficulty organizing tasks and activities
- Avoidance or dislike of tasks that require mental effort
- Losing items often
- Forgetfulness in daily activities
- Becoming easily distracted by external stimuli
- Difficulty performing tasks like cleaning or schoolwork
With ADHD-HI, the diagnostic criteria involve six or more of the following symptoms that have persisted for at least six months:
- Frequent fidgeting or stimming behaviors
- Running, climbing, moving around, or switching positions when inappropriate
- Difficulty sitting still
- Difficulty taking part in leisure activities quietly
- Impulsive behavior
- Talking excessively, loudly, or often
- Blurting out an answer before a question has been completed
- Difficulty waiting for one’s turn
- Frequently interrupting others
Someone may be diagnosed with combined-type ADHD if they have symptoms from both categories. In addition, for any ADHD diagnosis, symptoms must have been present before 12 years of age, and there must be evidence that the symptoms interfere with social, professional, or educational functioning. Finally, symptoms must not be explained by substance use, another mental health condition, or a medical illness.
What Is Neurodivergence?
According to the American Psychological Association (APA), neurodivergence is “a concept that regards individuals with differences in brain function and behavioral traits as part of normal variation in the human population.” Although it may be used to describe multiple conditions, it is most frequently used to refer to differences in neuro-ability. Therefore, it tends to be associated with conditions such as ADHD, dyslexia, and autism spectrum disorder (ASD).
Some people with ADHD identify as neurodivergent. These individuals may see ADHD as an integral part of who they are and their identity rather than a disability or disorder that needs to be cured. Others may disagree with the label of neurodivergence for themselves, believing their ADHD is a disability or condition separate from their identity. Both opinions are valid, and it can be essential for therapists and mental health professionals to respect how clients want to identify in this area.
How To Be Welcoming To Neurodivergence And ADHD-Informed As A Therapist
Even if you are not a specialist in ADHD, there are ways you can work to welcome those with ADHD and neurodivergent identities during sessions, including the following.
- Have Fidgets Available In Session
Although not all people with ADHD have hyperactive symptoms, the condition has been associated with “stimming,” meaning behaviors someone partakes in to connect with their senses and environment for self-regulation. People with ADHD often report being able to focus on treatment more effectively when they are able to stim freely.
Having a box of fidget items that clients can use, including adults, allows clients to keep their hands occupied during sessions, which may help them focus on the topic they’re sharing. In addition, clients without ADHD may also use these objects to cope, as some clients with anxiety may find them comforting,
A few popular fidget items to include in your basket include the following:
- “Pop-its” or bubble pop fidgets
- Fidget spinners
- Stuffed animals
- Puzzles, like a Rubik’s cube
- Finger traps
- Lotion
- Stress balls
- Squishes
- A notepad for doodling
- Infinity cubes
- Mazes
- Tangles
- Magnets
If you work with children, be sure to choose toys made for kids that cannot be accidentally ingested.
- Buy Comfy And Diverse Office Furniture
Designing your office with clients in mind may be beneficial if you work with neurodivergent clients. A cluttered office could be overwhelming to some individuals with ADHD. Using monotone but bright and happy colors may be a more appropriate option. For example, you might have a bright orange couch, white rug, and red wall décor but keep your office clean and tidy. Orange is often associated with happiness and excitement, so it can be a cheerful color for sessions. Blue or green hues can be helpful if you want a calmer office environment.
In addition to the colors you choose, consider having more than one way for clients to sit in session and allow them to choose where and how they want to sit. For example, you might buy a large couch, an armchair, and a rug. Clients can sit or lie on the couch, lean back in the chair, or sit on the rug. Make sure all furniture is comfortable and easy to move around on without injury, especially if you work with children with ADHD.
- Be Patient
People with ADHD may process information differently in session and struggle with following a singular topic of conversation. Instead of becoming frustrated, kindly and patiently remind the client of the goals they’ve brought up in session. You might also help them list out the topics they discussed in therapy and let them know which ones you want to focus on next time.
If your client struggles with hyperactivity and talks loudly or quickly or moves around the room, remain patient as you explore their therapeutic goals. If they are excitedly sharing information they’re proud of or talking about a topic they love, try not to interrupt or tell them to stop, as doing so may lead to a sense of rejection sensitivity for the client. If they are opening up about something they love, it could be a sign they are comfortable with you. Rejecting this way of sharing information could be harmful to the treatment process.
- Don’t Invalidate One’s Diagnosis Or Identity
At times, you may have clients previously diagnosed with a condition who are coming to you for treatment for the first time. Others may self-diagnose or identify as neurodivergent. It can be vital to support and validate these clients in their experiences.
Try not to use biases based on outdated studies or opinions of ADHD. For example, if your client is an adult woman of color, it may be unhelpful to doubt their identity solely because many past studies on ADHD have only been done on white male children. Instead, learn about how ADHD has impacted their life and use this information to help future clients who might be diverse in their presentation, too.
- Use Varied And Unique Approaches
Traditional talk therapy without any breaks, activities, or interactive tools may not be engaging for someone with ADHD. Sitting in a room without pause for an hour talking about challenging subjects and being expected to remain on the topic at hand may seem difficult to this individual. Instead, consider offering various techniques in session to help clients manage ADHD.
People with ADHD may enjoy therapy games, worksheets, coloring, fidgets, roleplay, art therapy, creating music, and many other forms of interactive therapy. If you have supplies, use them to your advantage while discussing the client’s goals for therapy. Let the conversation flow naturally and try to reduce expectations of what you believe therapy “should” look like. Therapy is for the client’s benefit, so tailoring it to their needs can be vital.
- Learn About Comorbid Conditions
ADHD is commonly comorbid with several other mental health conditions, including but not limited to the following:
- Depression
- Social anxiety disorder
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Autism spectrum disorder (ASD)
- Dyslexia
- Dyscalculia
- Other learning disabilities
Being aware of how these conditions can overlap and impact clients’ everyday lives can ensure you provide care for all symptoms and concerns. In addition, understanding that many people with ADHD are autistic can be beneficial. According to studies, 50% to 70% of autistic people also have ADHD.
How To Receive Neurodivergence And ADHD Training As A Therapist
Therapists and mental healthcare providers can receive comprehensive training in treating ADHD and neurodivergence from several sources. Some people may choose to learn about these skills from their continued education units (CEUs). Others might choose to go through a course to learn from other experts on the subject.
Getting a certification in ADHD treatment, symptoms, and behavior may be difficult, as there is no “official” ADHD treatment certification. However, you can also specialize in treating this condition and other neurodevelopmental conditions through your university if they have a program or specialized courses related to these conditions.
Exploring ADHD And Neurodivergence With Online Therapy
If you’re a therapist who wants to learn more about ADHD, or you think you could be neurodivergent yourself, it could be helpful to connect with a professional through an online therapy platform like BetterHelp. BetterHelp has thousands of licensed providers who each specialize in different areas. You can connect with someone who understands conditions like ADHD and has special training in neurodivergence.
Not only can they help you grow in your understanding of these concepts, but they can also assist you with any mental health concerns you might be facing. All of this can be done conveniently from the comfort of your own home through video chats, phone calls, or an in-app messaging feature.
The Efficacy Of Online Therapy For ADHD
Research has found that online therapy can be equally as effective as face-to-face therapy. In one review, researchers assessed the effectiveness of web-based interventions delivered to kids and young people with neurodevelopmental conditions such as ADHD and ASD. In the majority of the trials, researchers discovered that web-based interventions were effective in improving condition-specific outcomes and reducing comorbid psychological symptoms. They concluded that online interventions are efficacious in reducing symptoms associated with each of these conditions and could be beneficial for assisting neurodivergent individuals.
Takeaway
ADHD is a complex mental health condition and can also be considered a form of neurodiversity, depending on how an individual chooses to identify. Understanding how to treat ADHD can be essential to providing quality care to anyone of any age who comes through your practice. If you want to learn more about ADHD, consider signing up for ADHD continuing education courses or looking into further studies on this topic. Speaking to an online provider who understands ADHD and neurodivergence could be another option for streamlining your educational pursuits.
