Adult ADHD · 6:17
Knowing what helps, and being able to do it
Why implementing advice can encounter shame, trauma or dissociation, and how practical help and psychological care belong together.
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0:00Knowing and doing
In therapy, I often find that people already know a great deal about what would help. They know they need sleep, that the phone is taking over, or that a walk and an earlier beginning would make a difference. Doing it is a different ball game. We meet remembering, organising, beginning, tolerating discomfort and returning after interruption. We also meet the person's history. For some people, a small difficulty carries years of being called lazy, dumb or stupid. The task becomes pressurised because it seems to ask a much larger question: am I capable of anything?
0:40Work on the view and the system
A strategy may work for a while and then stop. If you already believe something is fundamentally wrong with you, that interruption becomes more evidence against yourself. The monologue grows derogatory and the next attempt becomes harder. I sometimes describe this clinically as internalised aggression: frustration and judgement turned against yourself. Studies of criticism, stigma and self-compassion help us understand the psychological burden, although associations do not prove that kindness alone treats ADHD. A diagnosis can offer a different explanation. It takes time to settle, and we need to work on that view while we work on the practical system.
1:26Support that helps you keep trying
Patience and kindness belong in implementation. Find where the arrangement breaks down, change it and try again. Was the next step clear? Was the task too large? Did you have enough time and energy? What did you say to yourself when it slipped? Sometimes a friend can help you begin and remember that an interruption is recoverable. Sometimes you need an OT, therapist or coach who stays involved long enough to see the pattern recur. This is easy on paper. In practice, it takes repeated contact with the same difficulty. Taking ownership means returning to the conditions we can change, with enough kindness to keep returning.
2:11When history matters to the task
We also need to acknowledge trauma. Some adults with ADHD have traumatic experiences, anxiety, dissociation and other mental health difficulties that affect functioning. Research in diagnosed adult groups links childhood trauma with greater anxiety and functional difficulty. Dissociation needs careful understanding. Someone may feel detached from their body or emotions, find the world unreal, become numb, or experience gaps in continuity of memory. Distraction and daydreaming can overlap with questionnaire descriptions. We need to understand what happens for this person, when it began and what brings it on. A label alone does not explain the state.
2:58A developmental question
Gabor Maté proposes that tuning out can begin as a way of coping with overwhelming childhood conditions. I find the question clinically important: what might this pattern have helped the person survive? This is a developmental theory, giving us a question to investigate. A recent study of students and diagnosed adults found statistical links involving childhood trauma, dissociation and continuing ADHD symptoms. It used cross-sectional data and retrospective childhood reports. Longitudinal findings show a more complicated relationship, including a study where childhood maltreatment did not predict later ADHD after accounting for childhood ADHD. We can take the connection seriously while investigating the person's actual history.
3:48Awareness with manageable demand
In clinical experience, becoming more present can sometimes make painful emotions or memories more apparent. For someone who has spent a long time numbing or distancing themselves, ordinary demands may feel unexpectedly difficult as that distance changes. The practice discussed here is chosen contact with a manageable neutral or unpleasant task: notice its feeling tone, relax where possible, stay curious and take a small step. Mild boredom during a few minutes of paperwork differs from feeling unreal, losing continuity or being overwhelmed by a trauma reminder. That distinction changes how we work. The person needs steadiness and support around the experience.
4:33Respond to what the person brings
If a task brings that larger response, reduce the immediate demand, help the person orient to the present and involve an appropriately trained therapist. Work with the memories and symptoms the person actually brings. A difficult response does not tell us the content of an unremembered event. Professional trauma therapies can improve PTSD and dissociative symptoms. How much dissociation someone experiences before treatment, and how it changes early in therapy, may matter for progress. The pace and preparation follow an individual assessment. A trial comparing preparation followed by EMDR with immediate EMDR did not find an advantage for obligatory preparation. Support should help someone engage, without becoming another test before treatment.
5:23Support around everyday life
An OT can work with routines, demands, environments and the practical sequence. A psychological therapist can work with distress, entrenched self-beliefs and trauma within their training. A GP and psychiatrist can assess the wider mental health picture and discuss treatment, including medication where appropriate. Someone may need help for anxiety, depression, sleep or PTSD alongside ADHD. The SEEDS view includes the person, body, history, relationships and environment. Support may be a friend for the first ten minutes, therapy, a quieter place or a smaller task with a clear ending. Start where you are and review without another attack on yourself. You are building a life in which your abilities can become more available.