Adult ADHD · Psychology and support

Self understanding and supported change in adult ADHD

The effects of years of criticism, and how practical systems, support and kinder self-talk can help rebuild confidence.

Nisha Bal · Founder & Principal OT
Updated 11 October 2026

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Sleep, movement and food can look straightforward on paper. Doing it, making changes, is a different ball game. A person may understand every recommendation and still struggle to use it. In my clinical work, I want to understand the life in which the recommendation has landed: what the person expects of themselves, what they have already tried, and what happens inside them when another attempt goes wrong. Those psychological conditions belong in treatment from the beginning.

Many adults with ADHD have been labelled long before their difficulties were understood. Dumb, stupid, lazy. Repeated criticism can turn a difficulty with starting, remembering or organising into a general conclusion about the self. Eventually the person may supply the criticism without anybody else having to say it. A missed appointment becomes evidence that they cannot be trusted. A difficult form becomes evidence that they are unintelligent. The practical difficulty remains, and now approaching it also means approaching a familiar judgement.

Research is giving this experience a clearer account. Recent interviews with adults studying in Ireland described other people's dismissive attitudes becoming part of their own view of themselves, sometimes leading to withdrawal. Australian student interviews described inadequacy, compensating through excessive effort and difficulty practising self-compassion. These accounts matter because they help explain why advice can be heard as another demand to prove one's worth. In the consulting room, that history can be present even when the person says very little about it.

This is part of what I mean when I say that therapy involves undoing the work. We examine the conclusions formed through misunderstanding, repeated failure and exclusion. We ask what a particular event actually demonstrates. Having difficulty getting started demonstrates a difficulty getting started. It may tell us about task size, emotional response, executive demands, fatigue or the support available. The conclusion that it reveals a defective person needs a separate examination. Sometimes painful experiences and trauma also require attention in their own right.

A diagnosis can be good news because it allows a different reading of a life. Someone can be capable and intelligent while needing help to organise time, begin a low-interest task or return after interruption. The square peg in a round hole captures something useful about that mismatch. Recognition may bring relief, anger or grief about the years spent trying to force a fit. Therapy gives those responses room while helping the person work out what recognition makes possible now.

The diagnosis is not an excuse to leave costly habits unexamined. It gives us a more accurate starting point for changing them. Accepting divergence means becoming specific about the functions that need support. Keeping a plan in mind, estimating time, shifting attention and starting an activity can ask a great deal of someone. An external system can carry some of that work. Responsibility then concerns what the person can participate in changing, including asking for help and changing a demand that has become unreasonable.

Psychological treatment needs to enter the actual day. An OT can examine how an activity unfolds at home, at work or in study: its steps, surroundings, sensory demands, interruptions and personal meaning. We might practise starting it together and discover that the instructions are unclear, the materials are elsewhere, or the person becomes tense at the prospect of making an error. These observations help determine the next change. A strategy discussed comfortably in an appointment still needs a way to survive Tuesday afternoon.

Recent adult ADHD treatment research supports this practical emphasis. A programme combining organisation, activity initiation and mindfulness improved reported activation more than another established ADHD group treatment. Larger CBT studies also support work on planning, thoughts and daily functioning. I take this as a reason to make beginning and participation visible treatment goals. Someone should be able to identify what they are becoming able to do, as well as what they understand about themselves.

A useful system changes the work required at the difficult moment. A written first action can replace the demand to invent a plan while already overwhelmed. A calendar reviewed with another person can make tomorrow's commitments tangible. Materials left ready can remove a sequence of decisions. We also need to decide how the system is resumed after it is missed. A routine that only works during a perfect week is asking the person to live in circumstances they do not have.

Awareness of the inner monologue is particularly important during that return. We can notice the point at which an event becomes a verdict: I missed the walk, therefore I never follow through. A more accurate account might be that the workday ran late, the next step was unclear, and the person abandoned the whole evening after the first interruption. That account makes adjustment possible. Kindness toward oneself allows an honest examination to continue without turning the appointment, or the next attempt, into another punishment.

When a strategy works for a while and then stops, we need a review that the person can bear to stay involved in. What changed in the day? Was the step too large? Was there enough support? What happened in the inner monologue? If the lapse becomes further proof that “I am useless”, we have reinforced the very view that makes beginning harder.

A friend, OT or therapist can help keep the process open: try, observe, change the arrangement and return. Kindness gives the person room to keep taking responsibility. Sometimes this work also brings us to trauma, detachment or intense shame, which need recognition and appropriate care. The separate article on support, trauma and implementation explores that part of the picture.

Confidence develops through experiences that contradict an old expectation. The person starts a task with support, returns after being distracted, asks for a clearer instruction or finds a workable place for something they keep losing. We review how that happened so the success does not feel accidental. We also recognise capacities that were already present but difficult to use in the available setting. A positive outlook becomes more credible when the person can connect it to an experience, a resource or a change they helped make.

This work takes patience. Normalising an experience can reduce the isolation around it; practising a strategy helps make the next step possible; examining self-judgement helps the person remain involved when progress is uneven. Support from a therapist, an OT, trusted people or an understanding group can make those processes easier to sustain. We start where you are, with one difficulty described accurately and one change that can be attempted. That is how an understanding of ADHD begins to become a different way of living.

The evidence behind the article

Research notes and references

The stigma and diagnosis literature supplies first-person accounts and observational associations, including the new seven-person Irish study (reference 26); it does not estimate how commonly every adult has these experiences or establish a causal trauma pathway. The clinician's “undoing the work” formulation concerns re-examining internalised conclusions, with individual assessment of trauma where relevant. Reference 25 included 108 adults with predominantly inattentive ADHD and compared two active group treatments: activation improved more with CADDI, while procrastination and other between-group differences were nonsignificant. Pandemic exclusions, self-reports, limited power and no long-term assessment restrict interpretation. Existing adult CBT trials address broader treatment packages; OT trials and pilots separately concern occupational goals and systems. Suggested systems, restart arrangements and confidence-building examples are clinical applications. Diagnosis does not itself establish an individual's intelligence or remove the need to assess particular capacities.

References: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26.

Safren, S. A., et al. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA, 304, 875–880. doi 10.1001/jama.2010.1192.
Read source 1
Study notes
Adult randomised trial supports ADHD focused CBT for persistent symptoms alongside medication; not evidence for the feeling tone exercise itself.
Australasian ADHD Professionals Association. (2022). Australian evidence based clinical practice guideline for ADHD. Section 4.2.2 Cognitive behavioural interventions.
Read source 2
Study notes
Adult trials support structured cognitive and behavioural approaches. This evidence does not automatically establish the effectiveness of every coaching exercise.
Adamou, M., et al. (2021). Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network. BMC Psychiatry, 21, 72. doi 10.1186/s12888-021-03070-z.
Read source 3
Study notes
Expert consensus about OT assessment and intervention. A practice framework, not a trial showing that all proposed strategies improve ADHD symptoms.
Janssen, L., Kan, C. C., Carpentier, P. J., Sizoo, B., Hepark, S., Schellekens, M. P. J., Donders, A. R. T., Buitelaar, J. K., & Speckens, A. E. M. (2019). Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial. Psychological Medicine, 49(1), 55–65. doi:10.1017/S0033291718000429.
Read source 4
Study notes
Adult randomised trial supports structured mindfulness-based cognitive therapy alongside usual care. A multi-component programme does not establish the brief feeling-tone reflection as a treatment on its own.
Nordby, E. S., Guribye, F., Nordgreen, T., & Lundervold, A. J. (2023). Silver linings of ADHD: a thematic analysis of adults’ positive experiences with living with ADHD. BMJ Open, 13, e072052. doi 10.1136/bmjopen-2023-072052.
Read source 5
Study notes
Qualitative adult accounts support including strengths in discussion. Self reports do not establish that all adults with ADHD share a strength or that dopamine causes creativity.
Hansson Halleröd, S. L., Anckarsäter, H., Råstam, M., & Hansson Scherman, M. (2015). Experienced consequences of being diagnosed with ADHD as an adult – a qualitative study. BMC Psychiatry, 15, 31. doi:10.1186/s12888-015-0410-4.
Read source 6
Study notes
21 recently diagnosed Swedish clinic adults: 11 women and 10 men; mean age 32.2. Target age 20–35, with four participants aged 38–57. 20/21 described important positive consequences; 19/21 described increased self-understanding/value, and 12/21 regretted not being diagnosed earlier. Diagnosis helped some replace disparaging explanations of difficulties with greater self-acceptance. Negative identity consequences also occurred in the same people. Small selected sample excluded several major co-occurring conditions. One nonparticipant considered diagnosis extremely negative. These accounts do not establish universal relief, causal treatment benefit, or intelligence. Diagnosis can introduce stigma and identity uncertainty as well as validation.
Morgan, J. (2023, first published online 13 October). Exploring women’s experiences of diagnosis of ADHD in adulthood: a qualitative study. Advances in Mental Health. doi:10.1080/18387357.2023.2268756.
Read source 7
Study notes
52 women aged 19–56 in England, reporting psychiatrist-confirmed ADHD diagnosed in adulthood; primarily university students (35 students, eight graduates, seven other workers, two not working). Participants described empowerment alongside sadness about painful or traumatic earlier experiences, internalised ableism and perceived stigma. Many reported little psychological support after diagnosis. The accounts support discussing identity, emotional processing and support alongside practical ADHD management. Retrospective self-report in a female, largely university-connected sample; diagnosis was not independently verified. The study identifies unmet needs, not proven efficacy of a particular therapy. Traumatic experiences described here cannot establish PTSD or show that every disparaging label produces trauma.
Visser, M. J., Peters, R. M. H., & Luman, M. (2024, published online 1 October). Understanding ADHD-related stigma: A gender analysis of young adult and key stakeholder perspectives. Neurodiversity. doi:10.1177/27546330241274664.
Read source 8
Study notes
24 Dutch participants: 14 adults aged 18–30 with self-reported ADHD diagnoses (eight women, six men), three parents, four mental-health professionals and three primary-school teachers. Participants described denial of ADHD, moral blame, stereotyping and trivialisation. Misunderstanding and inadequate support were linked in their accounts to negative self-concept. Women described masking and disbelief; men described negative self-attributions, nondisclosure and difficulty seeking help. Small convenience sample including stakeholders without ADHD; retrospective accounts do not estimate population prevalence or establish causation. Reported gender patterns are contextual findings, not rules about all men, women or other genders.
Kreider, C. M., Medina, S., Judycki, S., Wu, C. Y., & Lan, M.-F. (2024). Stigma and Stigma Resilience: Role of the Undergraduate and the Campus Environment. OTJR: Occupation, Participation and Health, 44(3), 500–510. doi:10.1177/15394492241246233.
Read source 9
Study notes
52 US undergraduates aged 18–33: 18 ADHD only, 12 ADHD plus learning disability, 22 learning disability only. Participants were registered for disability accommodations and involved in a STEM support programme. Accounts connected stigma resilience with self-awareness, personally relevant understanding of strengths/difficulties and positive interactions with instructors or mentors. This supplies an occupational-therapy-relevant rationale for changing social conditions and support, alongside the person’s skills. Mixed learning-disability/ADHD sample: findings cannot all be attributed to ADHD. Selected college setting limits generalisation. This qualitative analysis does not prove that OT, mentoring or a particular system reduces stigma or symptoms.
Beaton, D. M., Sirois, F., & Milne, E. (2020). Self-compassion and Perceived Criticism in Adults with Attention Deficit Hyperactivity Disorder (ADHD). Mindfulness, 11, 2506–2518. doi:10.1007/s12671-020-01464-w.
Read source 10
Study notes
1,203 adults recruited through social media, forums and posters; approximately 46% reported an ADHD diagnosis. Also compared undiagnosed participants with high versus low ADHD traits. Diagnosed adults reported lower self-compassion and greater perceived criticism. Undiagnosed adults with high ADHD traits had similarly low self-compassion. Criticism statistically accounted for part of the diagnosis–self-compassion association even after adjustment for reported mood disorders. Self-reported diagnoses, convenience recruitment, single-item criticism measure and simultaneous measurements limit causal inference. This is not a compassion-treatment trial. Related Beaton 2022 papers draw on the broader same dataset; do not present them as independent replications.
Solanto MV, Marks DJ, Wasserstein J, Mitchell K, Abikoff H, Alvir JMJ, Kofman MD. Efficacy of Meta-Cognitive Therapy for Adult ADHD. American Journal of Psychiatry. 2010;167(8):958–968. doi:10.1176/appi.ajp.2009.09081123.
Read source 11
Study notes
88 clinically referred adults with diagnosed ADHD, stratified by medication use. Skills-focused therapy improved inattention more than supportive psychotherapy. Sessions practised task breakdown and planning, then reviewed practical and emotional obstacles to implementation. Self-esteem, depression and anxiety did not improve more than in the comparison group. Some organisation measures showed only trends. This tested a treatment package, not individual strategies.
Emilsson B, Gudjonsson G, Sigurdsson JF, Baldursson G, Einarsson E, Olafsdottir H, Young S. Cognitive behaviour therapy in medication-treated adults with ADHD and persistent Symptoms: A randomized controlled trial. BMC Psychiatry. 2011;11:116. doi:10.1186/1471-244X-11-116.
Read source 12
Study notes
54 medicated adults with diagnosed ADHD, 27 per group; three-month follow-up. The CBT group improved more in ADHD symptoms. Coaches helped participants apply skills between sessions: the programme explicitly connected learning with daily implementation. Small sample and missing follow-up data; more contact in the intervention group; medication and other treatments were not fully controlled. Coaching was not tested separately.
Kastner L, Velder-Shukrun Y, Bonne O, Traub Bar-Ilan R, Maeir A. Pilot Study of the Cognitive–Functional Intervention for Adults (Cog-Fun A): A Metacognitive–Functional Tool for Adults With Attention Deficit Hyperactivity Disorder. American Journal of Occupational Therapy. 2022;76(2):7602205070. doi:10.5014/ajot.2022.046417.
Read source 13
Study notes
14 adults aged 18–60 with ADHD and executive-function impairment; 12 completed. The programme linked guided discovery and strategy use to personally meaningful activity goals. Participants reported improved daily performance and quality of life after treatment. No control group and very small sample; some quality-of-life gains declined at follow-up. Promising direct adult OT evidence, not an established estimate of efficacy.
Beaton DM, Sirois F, Milne E. The role of self-compassion in the mental health of adults with ADHD. Journal of Clinical Psychology. 2022;78(12):2497–2512. doi:10.1002/jclp.23354.
Read source 14
Study notes
543 adults with self-reported ADHD plus positive screening, and 313 comparison adults. Lower self-compassion was associated with poorer wellbeing and greater depression, anxiety and stress. This identifies a relevant psychological target rather than proving treatment effectiveness. Self-report and cross-sectional mediation cannot establish cause or direction. Data overlap the Beaton 2020 criticism paper, so these are not independent replication studies.
Gutman SA, Balasubramanian S, Herzog M, Kim E, Swirnow H, Retig Y, Wolff S. Effectiveness of a Tailored Intervention for Women With Attention Deficit Hyperactivity Disorder (ADHD) and ADHD Symptoms: A Randomized Controlled Study. American Journal of Occupational Therapy. 2020;74(1):7401205010p1–7401205010p11. doi:10.5014/ajot.2020.033316.
Read source 15
Study notes
23 women analysed; 19 formally diagnosed, four with inconclusive screening. Most used medication. Tailored routines, organisation and time-management work improved self-rated daily performance, satisfaction, stress and ADHD symptoms compared with controls one week after treatment. Small educated female sample, incomplete diagnostic confirmation, self-report and unblinded therapists. No sustained follow-up or active attention comparator; unusually large effects need replication.
Zhang LQ, Pan MR, Dong M, Kong X, Yu ZY, Zhang SY, Li HM, Liu L, Wang YF, Qian QJ. Group dialectical behavior therapy skills training versus group cognitive behavioral therapy for adults with ADHD: a randomized controlled trial. BMC Psychiatry. 2026;26:512. doi:10.1186/s12888-026-08130-w.
Read source 16
Study notes
98 adults with diagnosed ADHD in China, 49 per group. Both groups' self-efficacy improved over time; neither treatment showed a stable advantage on that outcome. Sessions reviewed practice difficulties and adapted support. No untreated comparator, so within-group confidence changes cannot be attributed solely to therapy. Therapist pairs differed by treatment; selected sample and follow-up medication changes limit interpretation.
Bodalski, E. A., Abu-Ramadan, T. M., Hough, C. E., Lefler, E. K., Meinzer, M. C., & Antshel, K. M. (2023). Low standards yet disappointed: ADHD symptoms and experiential avoidance in college students. Journal of Contextual Behavioral Science, 28, 180–184. https://doi.org/10.1016/j.jcbs.2023.04.002
Read source 17
Study notes
3,720 undergraduates; ADHD symptoms and experiential avoidance measured by questionnaires. Not a clinically diagnosed adult ADHD case-control sample; age range not verified in accessible abstract. ADHD symptoms were associated with experiential avoidance. Perfectionism dimensions partly accounted for that relationship: greater perceived discrepancy between expectations and achievement, alongside lower standards and order. Provides a direct research route into avoidance and harsh self-judgement. Cross-sectional self-report cannot establish causal mediation. This was not an acceptance-treatment trial and does not establish that feeling-tone practice reduces avoidance, or that avoidance is solely a dopamine phenomenon.
Netzer Turgeman, R., & Pollak, Y. (2023). Using the temporal motivation theory to explain the relation between ADHD and procrastination. Australian Psychologist, 58(6), 448–456. https://doi.org/10.1080/00050067.2023.2218540
Read source 18
Study notes
202 adults; symptom questionnaire sample, not a confirmed ADHD patient cohort. More ADHD symptoms correlated with more procrastination, task aversiveness and impulsiveness, and less confidence in successful completion. Statistical indirect effects implicated lower success expectancy and greater impulsiveness. Task aversiveness correlated with symptoms but did not emerge as the explanatory mediator reported in the abstract. Cross-sectional mediation is not causal evidence. Supports asking how a task feels and whether success seems possible, not reducing all procrastination to unpleasantness.
Farmer, G. M., Bayliss, D. M., Finlay-Jones, A. L., & Ohan, J. L. (2026). Self-Compassion in University Students With ADHD: A Qualitative Exploration. Emerging Adulthood, 14(2), 344–356. doi:10.1177/21676968261417727. Published online 16 January 2026.
Read source 19
Study notes
Primary qualitative study: 14 Australian university students aged 18–25 with institution-registered clinical ADHD diagnoses; interviews took place November 2021. Themes included persistent inadequacy, pressure to try harder, difficulty practising self-compassion, and understanding/acceptance. Participants described criticism and character-based explanations of difficulties. Particularly relevant to the author's clinical account. A selected university sample and retrospective accounts do not estimate prevalence or establish treatment efficacy. Full methods and findings read.
Pan, M.-R., Dong, M., Zhang, S.-Y., Liu, L., Li, H.-M., Wang, Y.-F., & Qian, Q.-J. (2024). One-year follow-up of the effectiveness and mediators of cognitive behavioural therapy among adults with attention-deficit/hyperactivity disorder: secondary outcomes of a randomised controlled trial. BMC Psychiatry, 24, 207. doi:10.1186/s12888-024-05673-8.
Read source 20
Study notes
Secondary one-year follow-up of 98 adults aged 18–45, on stable medication with residual symptoms, randomised to group CBT plus medication or medication alone; 87 supplied follow-up data. CBT joined organisation, planning, distractibility, cognitions and procrastination. It improved ADHD symptoms, depressive symptoms and psychological quality of life relative to comparison; between-group cognitive measures showed trends rather than significant superiority. Mediation suggests related pathways without definitively establishing mechanism. Full methods, results and limitations read.
Baig, S. K., & Kahya, H. H. (2025). ‘I felt like a broken person’: the experiences of women navigating a late ADHD diagnosis in the UK. Advances in Mental Health. doi:10.1080/18387357.2025.2524513. Published online 29 June 2025.
Read source 21
Study notes
Primary qualitative study: eight UK women aged 28–53 interviewed about adult diagnosis; reflexive thematic analysis. Accounts described early distress and low self-esteem, being misunderstood or dismissed, self-advocacy, reinterpretation of personal history, identity and stigma after diagnosis. Supports attention to psychological history and adjustment. Small female sample cannot establish a universal sequence or causal treatment outcome. Abstract and university publication metadata read; full article not used for additional claims.
D’Amelio, R., Betz, L. T., Jow, S. M., Retz, W., Philipsen, A., Klein, J. P., Fassbinder, E., Jacob, G. A., & Retz-Junginger, P. (2026). Effectiveness of attexis, a digital intervention based on cognitive behavioral therapy for adults with ADHD: a randomized controlled trial. Psychological Medicine, 56, e54. doi:10.1017/S0033291726103390.
Read source 22
Study notes
Pragmatic RCT: 337 adults aged 18–65 with clinician-confirmed ADHD, self-guided CBT/mindfulness programme plus usual care versus usual care. ADHD symptom effect at three months d=0.85; functional impairment, depression, self-esteem and quality of life also improved, with effects sustained at six months. All outcomes self-reported and participants unblinded; comparator lacked matched attention. Developer funded study and employed two authors. Supports structured psychosocial content, without demonstrating that every adult requires therapist support. Full primary methods, outcomes and limitations read.
Cooper, K., Thomas, K., Burnley, A., & Smith, L. G. E. (2026). Understanding ADHD identity and preferred terminology for adults with ADHD in the UK: associations with medication use, well-being and mental health. British Journal of Psychiatry. doi:10.1192/bjp.2026.10652. Published online 4 May 2026.
Read source 23
Study notes
Cross-sectional primary survey of 319 UK adults with ADHD aged 18–73. Overall ADHD identification was not significantly associated with self-esteem, anxiety or depression. Satisfaction with that identity had an indirect association with better mental health via self-esteem and wellbeing. Most preferred person-first terminology. Useful context for treating diagnostic identity and acceptance individually, rather than assuming a stronger identity label always improves wellbeing. Preregistered statistical models do not establish causality. Primary indexed abstract read; publisher full text unavailable.
Hargitai, L. D., Laan, E. L. M., Schippers, L. M., Livingston, L. A., Fairchild, G., Shah, P., & Hoogman, M. (2025). The role of psychological strengths in positive life outcomes in adults with ADHD. Psychological Medicine, 55, e278. https://doi.org/10.1017/S0033291725101232
Read source 24
Study notes
Matched cross-sectional online study: 200 UK adults reporting a formal ADHD diagnosis and meeting symptom-screen criteria, versus 200 controls. ADHD participants endorsed ten strengths more strongly, including creativity, hyperfocus, humour, spontaneity and broad interests. Groups had similar strengths knowledge and use. Greater knowledge of personal strengths was associated with better wellbeing, quality of life and fewer mental-health symptoms in both groups. Self-reported strengths and correlational outcomes; not objective proof of superior creativity or a strengths-treatment trial.
Strålin, E. E., Thorell, L. B., Lundgren, T., Bölte, S., & Bohman, B. (2025). Cognitive behavioral therapy for ADHD predominantly inattentive presentation: randomized controlled trial of two psychological treatments. Frontiers in Psychiatry, 16, 1564506. https://doi.org/10.3389/fpsyt.2025.1564506
Read source 25
Study notes
108 adults with predominantly inattentive ADHD in six clinics; CADDI versus an active ADHD CBT/DBT protocol. Organisation, activation and mindfulness were combined with follow-up support. Self-reported activation improved more with CADDI (d=0.49), but procrastination and other between-group outcomes were nonsignificant. Pandemic exclusions after randomisation, limited power and no longer follow-up matter. Primary methods, treatment components, results and limitations checked.
Smith, S., & McVeigh, J. (2025). Perceptions of stigma and social inclusion amongst a sample of university students with ADHD in Ireland. Disabilities, 5(1), 24. https://doi.org/10.3390/disabilities5010024
Read source 26
Study notes
Nine interviews with seven university adults aged 21–31 who reported a professional ADHD diagnosis. Accounts described internalising dismissive judgements, shame, withdrawal, belonging among understanding peers and institutional barriers. Convenience/snowball sampling, unassessed comorbidity and a small university-only sample limit transfer. No prevalence or treatment effect is established. Primary publisher methods, findings and limitations read through indexed full text.

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