Adult ADHD Diagnosis

Seeking Information or Guidance on Coping and Support

It can be challenging to live with ADHD, as our society often has expectations that may be difficult for ADHD brains to meet. ADHD medication can be helpful, however it is not a magic fix and there are many other things that can and should be done to support a person who has ADHD alongside medication use.

1️⃣ I would like to know more about what ADHD is and how it affects people.

2️⃣ I have been diagnosed with ADHD and I am seeking advice on:

  • Emotional dysregulation and anger issues
  • Help with coping with the symptoms or consequences of ADHD
  • Workplace issues
  • Different medication available, how medication can affect us, titration and so on
  • How ADHD is affecting my relationships
  • How ADHD is affecting my parenting

3️⃣ I am the relative or partner of an ADHD adult, and I am seeking advice on how to:

  • Understand, encourage and support them

I want to know more about ADHD and how it affects people

ADHD is a condition that affects the brain and system that controls and supports it, and this in turn affects behaviour.

ADHD is largely genetic, which means that if a child has ADHD, then probably (but not always) one or both parents also have ADHD or another neurodevelopmental disorder such as dyslexia or autism.

One of the ways that ADHD affects a person is that their “executive functions” develop slower than other children, and even as an adult, that person probably has weaker executive functions than other people. This means that people with ADHD usually have to try harder and spend more energy to do things that need executive function, for example:

  • Control of attention: ADHD brains are attracted to anything new, interesting, or exciting, making it very difficult to pay attention to anything that is boring to them. They are easily distracted by what they can hear or see, and can even be distracted by their own thoughts!
  • Motivation: ADHD brains do not feel the same motivation that most other people do – important tasks just don’t feel important and some may leave things pending till right before deadlines, until the last minute panic and urgency can finally help motivate the brain to feel motivated and productive. This means that ADHDers often procrastinate.  Things like paperwork, admin tasks, housework, school homework, assignments or studying, paying bills, filing taxes often get left behind and pile up
  • Working memory: the ability to remember what you were doing, what you just did, or what you are supposed to be doing right now. ADHD brains often forget important tasks, dates or information – not because they don’t care, not because they are irresponsible, but because they may struggle to remember current information. They may still remember highly-emotional conversations from years ago though – that’s a different kind of memory!
  • Emotional regulation: this is an important skill, the ability to calm yourself when you are angry, for example. ADHD brains often struggle with this, so people can seem to be “hot-tempered” or “easily upset” or a “crybaby” – this is not because they are immature, but because their ability to self-regulate is impaired.
    • RSD or “Rejection Sensitive Dysphoria” is a fairly newly-recognised condition that many ADHD people also have – it causes people to react very strongly to negative criticism, and to worry a lot about how other people view them. Someone with RSD might get very upset if they think that someone is judging them, and might react by getting very sad or even very angry.
  • Planning: ADHD brains tend to live in the present moment, and many are not really able to look ahead to the future. This makes it difficult to find enough motivation to spend time on planning in advance. Unfortunately, the lack of planning can often cause further complex problems later on.
    • Difficulty planning also makes it difficult to prioritise – ADHD brains tend to focus on the immediate problems, possibly ignoring long-term goals. Projects or tasks with deadlines tend to be worked on in a hurry right before the deadline, when they become urgent enough to trigger action.
  • Task Initiation: The hardest part of a task is often the “getting started”! ADHD brains can feel overwhelmed when a task or project is big and vaguely defined, and there is no clear starting point or process. On the other hand, if there is clarity but also a long to-do list, that can also trigger overwhelm, especially if the to-do list is full of tasks that don’t excite or inspire the ADHD brain. This means that tasks or projects are often procrastinated, leading to problems such as running out of petrol, missing deadlines (even for nice things like buying performance tickets), and getting fined for filing taxes too late.
  • Time Awareness: ADHD brains often are not aware of time passing, and an hour can feel like a few minutes. This is one of the reasons why ADHD people are often late – it’s because they underestimate how long it will actually take them to get ready, leave the house, and arrive at their destination. Or else they just… lose track of time!
  • Impulse Control 
  • Ineffective Delegation: Reluctance to delegate due to perfectionism or an inability to organize the steps necessary for others to take over, which increases the executive’s own administrative burden.
  • Impulsive Decision-Making: Moving quickly on new ideas without fully considering long-term consequences, or interrupting colleagues during high-stakes meetings.
  • Disorganized Workspaces: Maintaining a chaotic physical or digital environment—such as a cluttered office or a buried inbox—making it difficult to locate essential documents or track follow-ups.
  • Difficulty with Task Switching: Struggling to transition from “big-picture” strategic thinking to granular operational details, or vice versa, causing significant mental fatigue.

Unfortunately, many people think that these behaviours are choices, and they blame ADHDers for “choosing” to behave like this – but that is not what is actually happening.

Therapy and training to improve these issues may not work well if it only focuses on trying to change the behaviour. It is always important to understand what is causing the difficulties and then try to support that underlying need.

I have been diagnosed with ADHD. I am seeking advice on:

 1. Issues with my behaviour / emotional regulation

Being diagnosed with ADHD often brings greater understanding, particularly around behaviour and emotional regulation. ADHD is not only associated with attention difficulties but also with challenges in impulse control, emotional regulation, and self-monitoring (Barkley, 2015; Shaw et al., 2014).

An ADHD brain may react quickly before thinking, experience emotions more intensely and struggle to pause or shift responses – these experiences are due to differences in self-regulation processes (Barkley, 2015).

You may notice that you react quickly, interrupting, or saying things you later regret. Your emotions may rapidly shift from calm to overwhelmed and you may experience very strong emotions (e.g. frustration, anger, hurt).  You may ruminate – finding it difficult to let go of thoughts or act without thinking (Shaw et al., 2014).

2. Strategies

An important strategy in managing ADHD-related emotions is developing the ability to pause before reacting. ADHD involves difficulty with inhibitory control, which affects the ability to delay responses (Barkley, 2015). Medication may also help with this.

The goal is not to eliminate emotions, but to create a gap between feeling and reacting.

  1. Simple techniques such as counting down from ten, breathing, or moving away from the situation can help interrupt automatic reactions. Even brief delays can support improved self-regulation (Barkley, 2015).
  2. Becoming aware of and labelling emotions (e.g., “I feel frustrated”) can help with becoming less reactive and more reflective. This supports emotional regulation (Shaw et al., 2014).
  3. Becoming aware of physical and emotional cues (e.g., tension, irritability, urgency to respond) can help identify escalation early and prevent impulsive reactions (Barkley, 2015).
  4. Communicating the need to step away (e.g. saying “I need a moment”) allows time for emotional regulation and reduces the likelihood of escalation (Ramsay, 2010).
  5. Being aware of what triggers emotional dysregulation can help you be less reactive and help you improve coping strategies. (Emotional triggers may include perceived criticism, overwhelm, and time pressure) (Shaw et al., 2014; Ramsay, 2010).
  6. Learning to repair after impulsive reactions is an important part of maintaining relationships and reflects improved self-awareness. Though impulsivity can lead to shame, acknowledging and apologising, as well as having understanding people around you is important. (Ramsay, 2010)
  7. External supports such as ADHD-aware therapy, coaching, reminders, and medication can support emotional regulation by reducing cognitive load and improving executive functioning (Ramsay, 2010; Barkley, 2015).

ADHD emotions are not all negative! These same emotions are associated with passion, engagement, and emotional intensity. We need to learn to manage our emotions more effectively. (Barkley, 2015).

3. Workplace-related issues

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that persists into adulthood for many individuals and can significantly impact occupational functioning. While many individuals with ADHD bring strengths such as creativity and problem-solving, they frequently encounter barriers in structured work environments.

  1. Differences in executive functions may lead to workplace difficulties with planning, organizing, prioritizing, and time management. Adults with ADHD may struggle to meet deadlines, manage multiple tasks, and maintain consistent productivity (Barkley, 2015). 

What can be done:

Use of digital planners, task management apps, and checklists can compensate for deficits in executive functioning (Barkley, 2015). Breaking tasks into smaller, manageable steps and setting clear priorities can also improve productivity (having a colleague to help breaking tasks down may help greatly)

Workplace accommodations may include:

  • Written instructions instead of verbal-only directions
  • Regular check-ins with supervisors
  • Project management tools (e.g., task boards)

These supports reduce cognitive load and help individuals maintain task direction (Kooij et al., 2010).

  1. Attention challenges – adults with ADHD often experience distractibility, especially in environments with high levels of stimulation such as open-plan offices. This can lead to incomplete tasks, errors, and difficulty following instructions (American Psychiatric Association, 2022). Alternatively experiencing “hyperfocus,” which can be positive when the focus is getting one task done, may lead to some tasks being done whilst others are not (Hupfeld et al., 2019).

What can be done:

Minimizing distractions as much as possible helps with improving focus. Quiet workspaces, noise-cancelling headphones, or remote work options can significantly enhance concentration (American Psychiatric Association, 2022). Using strategies like the Pomodoro method, scheduling breaks to limit or prevent cognitive fatigue and limiting multitasking could help.

Workplace accommodations may include:

  • Flexible seating or workspace arrangements to support attention regulation.
  • Time management and procrastination – Time blindness is a common issue in ADHD. This can affect the ability to perceive and manage time effectively. Adults may underestimate how long tasks will take or delay starting tasks until deadlines are imminent (Barkley, 2015). Chronic procrastination on the other hand can result in missed deadlines and increased workplace anxiety, negatively impacting both performance and professional relationships (Sirois & Pychyl, 2013).

What may help:

Tools such as alarms, timers, and calendar reminders help individuals track time and meet deadlines (Barkley, 2015). Strategies such as setting immediate, short-term goals, can also help reduce procrastination (Sirois & Pychyl, 2013).

Effective accommodations include:

  • Flexible deadlines where possible
  • Interim deadlines for long-term projects
  • Visual timelines or progress trackers
  1. Emotional regulation difficulties, a core feature of ADHD may lead to experiences of frustration, irritability, or heightened sensitivity to criticism in the workplace (Shaw et al., 2014) which can affect teamwork, communication with supervisors, and conflict resolution, sometimes leading to misunderstandings or strained professional relationships.

What may help:

Techniques such as mindfulness, stress management training, and cognitive-behavioral therapy (CBT) have been shown to improve emotional control (Shaw et al., 2014).

Workplace accommodations may include:

  • Flexible breaks during periods of stress
  • Supportive and constructive feedback styles

A psychologically safe work environment can reduce emotional reactivity and improve overall functioning.

  1. Interpersonal / communication difficulties – Adults with ADHD may interrupt conversations, miss social cues, or struggle with active listening. These challenges can affect collaboration and team dynamics (Kooij et al., 2010). Misinterpretations by colleagues may lead to perceptions of carelessness or lack of professionalism, even when the individual is highly capable.

What may help:

Adults with ADHD may benefit from having written follow-ups given after meetings, clear  expectations and role definitions are important, and communication training or coaching may help the individual improve further.  Mentorship or peer support systems can also enhance social integration in the workplace.

  1. Disorganization is another common issue. Adults with ADHD may have cluttered workspaces, lose important documents, or forget key tasks (Barkley, 2015).  These difficulties can contribute to inefficiency and may require additional supervision or support in structured environments.

What can be done:

Structured systems and routines are a great help, as well as using labeled storage systems can reduce disorganization (Barkley, 2015).

Helpful accommodations include:

  • Decluttering support or organizational tools
  • Digital document management systems
  • Daily or weekly planning sessions

4. Asking for accommodations – Should I divulge my diagnosis?

Many adults with ADHD face stigma in the workplace and may hesitate to disclose their diagnosis due to fear of discrimination. Lack of understanding from employers and colleagues can exacerbate challenges and limit access to accommodations (Mueller et al., 2012).  However disclosing also leads to understanding, and accommodations which could lead the individuals to receiving reasonable adjustments that could significantly improve their performance.  Encouraging open dialogue can help reduce stigma and increase access to support.

Individuals with ADHD often possess valuable strengths, including creativity, adaptability, high energy, and innovative thinking and when they find themselves in a non-judgemental, supportive environment, these strengths can be used to enhance workplace performance (Sedgwick et al., 2019).

I am the relative or partner of an ADHD adult, and I am seeking:

1. To encourage them to get a diagnosis and where to go

“Diagnosis is not a label, it is the key to the door of understanding”, Dr. Edward Hallowell

If you suspect your partner has ADHD, and would like to encourage them to seek an assessment, keep in mind that the goal is understanding and support, and not a reason to change them. 

Getting an ADHD diagnosis can be a turning point for the relationship (as well as for the person).  Being diagnosed with ADHD is not a magic wand that fixes everything, but it can bring clarity, increase understanding of each other as a couple and help put strategies in place.  

It is important to learn about ADHD as much as possible, reach out to adults in the ADHD community and understand the process of getting a diagnosis in Malta. 

2. To understand how ADHD affects our relationship

Being in a relationship with someone who has ADHD can feel intense. ADHD and inconsistency often go hand in hand, as difficulties with attention regulation and executive functioning can affect consistency in behavior and engagement (Barkley, 2015; CHADD, 2023). At times, they may be highly attentive, engaged, and full of energy, passion, and excitement, while on other days they may seem distracted, disconnected, or unavailable. This can feel confusing or even upsetting and may be interpreted as a lack of care; however, individuals with ADHD may simply be experiencing cognitive overload, leading to increased distractibility and forgetfulness (American Psychiatric Association, 2013).

Individuals with ADHD are often strong out-of-the-box thinkers, bringing creativity, spontaneity, and novel ideas into the relationship (Sedgwick et al., 2019). However, impulsivity and inattention can create communication challenges, such as interrupting, missing details, or appearing not to listen, which may impact how heard a partner feels (CDC, 2023; Barkley, 2015).

Executive function difficulties can make planning, organizing, and time management more challenging, meaning that starting tasks may feel easier than completing them (Barkley, 2012). As a result, partners may find themselves taking on more responsibility for reminders, logistics, or routines, which can lead to frustration if not addressed collaboratively (Orlov, 2010). Developing shared strategies is therefore important for managing these challenges as a couple.

Many individuals with ADHD are experienced as genuine and authentic, which can foster a strong sense of openness in the relationship (Hallowell & Ratey, 1994; Sedgwick et al., 2019). However, forgetfulness and inattention may make it difficult for them to maintain consistency, sometimes requiring additional accountability within the relationship.

Emotional experiences are often more intense in ADHD, with quicker and stronger reactions due to difficulties with emotional regulation (Shaw et al., 2014; Barkley, 2015). This can result in conflicts escalating more rapidly and feeling harder to resolve. For some individuals, this may be further influenced by rejection sensitive dysphoria (RSD), which involves intense emotional responses to perceived criticism or rejection (Cleveland Clinic, 2022). At the same time, many individuals with ADHD develop resilience and can be resourceful and persistent in repairing relationships after conflict (Sedgwick et al., 2019). Their emotional intensity can also contribute to being engaging, fun, and joyful partners.

Being in a relationship with someone with ADHD often involves higher highs as well as lower lows. Psychoeducation about ADHD is essential, as it helps both partners develop understanding, reduce judgment, and work collaboratively to create strategies that support the relationship (CHADD, 2023).

3. Ways to communicate better 

Effective communication is communicating in a way that is respectful of both people. ADHD can affect attention, emotional regulation, memory, and processing speed, all of which influence how individuals communicate, so understanding how ADHD affects communication is imperative (Barkley, 2015; CHADD, 2023). ADHD may lead individuals to unintentionally miss parts of conversations, interrupt or jump between topics quickly, forget agreements or details, and react emotionally faster or more intensely (American Psychiatric Association, 2013; CDC, 2023).

In all relationships, learning about each other’s communication patterns is crucial. However, there are some specific approaches that may help when a partner has ADHD, while also recognising that experiences can vary between individuals.

  1. It is important to be clear about what you want to say—focusing on expressing needs rather than only pointing out what is wrong—and to avoid vague language. Keeping sentences shorter and focusing on one topic at a time can help reduce misunderstandings (Barkley, 2015).
  2. Choosing the right moment for important conversations can also make a significant difference. Starting conversations when a partner is in the middle of a task, distracted, or overwhelmed may reduce their ability to engage effectively due to attentional limitations associated with ADHD (CHADD, 2023).
  3. Using gentle reminders that convey teamwork and care, rather than criticism, is important. Shared tools such as calendars, to-do lists, and reminders can support memory and organisation, reducing potential conflict (Barkley, 2012; Orlov, 2010).
  4. Emotions in ADHD can escalate more quickly due to difficulties with emotional regulation (Shaw et al., 2014; Barkley, 2015). It is therefore important to have discussions when both partners are calm. Couples can benefit from agreeing on strategies for raising concerns, recognising signs of overwhelm, and using agreed phrases such as “let’s take 10 minutes” to de-escalate. Equally important is having a plan for repairing the relationship after disagreements. While this will not prevent arguments, it supports respect, teamwork, and relationship maintenance (Ramsay, 2010).
  5. Perceived criticism can be particularly challenging for individuals with ADHD and may lead to rapid escalation during conflict, especially in the presence of rejection sensitive dysphoria (RSD), which involves intense emotional responses to perceived rejection (Cleveland Clinic, 2022; Dodson, 2019). Acknowledging effort before expressing needs can help reduce the likelihood of communication being experienced as critical.
  6. If communication difficulties persist, seeking support may be beneficial. Couples therapy, particularly with a clinician who understands ADHD, can significantly improve communication and relationship functioning (Ramsay, 2010; CHADD, 2023).

4. To understand Rejection Sensitive Dysphoria (RSD) and emotional regulation

Rejection Sensitive Dysphoria (RSD), a term coined by Dr. William Dodson, refers to extreme emotional sensitivity and pain triggered by perceived rejection or criticism (Dodson, 2019; Cleveland Clinic, 2022).

For someone with ADHD, emotional changes associated with RSD can feel sudden, like a switch flipping. Emotions may become rapidly overwhelming, making it very difficult to regulate or think through the situation in the moment (Shaw et al., 2014; Barkley, 2015). To an outside observer, this may appear as overreacting; however, it reflects differences in how the ADHD brain processes emotional signals (Barkley, 2015).

What to look out for:

Your partner might take small comments very personally feeling they did something wrong, react strongly to tone, facial expressions, or silence and feel deeply hurt even when you didn’t intend criticism. They may suddenly become defensive, shut down, or appear overwhelmed. These reactions are consistent with emotional dysregulation commonly associated with ADHD (American Psychiatric Association, 2013; CHADD, 2023).

Why it happens:

Although RSD is widely used to describe this experience, it is not a formal diagnostic term (Dodson, 2019). However, emotional dysregulation is recognised as a common and often overlooked feature of ADHD (CHADD, 2023; Shaw et al., 2014).

ADHDers, due to executive functioning differences may struggle more with emotional regulation and may be more sensitive to social feedback. The brain may register potential rejection more quickly and struggle to regulate the emotional response. (Barkley, 2012; Barkley, 2015)

In fact RSD is a real, very intense emotional experience, however it is not always an accurate reflection of what actually happened, which means that your partner may genuinely feel rejected even if you did not reject them, however their experience is real (Cleveland Clinic, 2022).

What happens and the aftermath:

The strong emotional response is not usually a conscious choice—it happens before logic kicks in. After the reaction, your partner may feel embarrassed, guilty for the way they reacted and “too sensitive” which can make them spiral further. (Barkley, 2015; Dodson, 2019).

What may help:

The experience of RSD often may not appear logical, however it is a very real experience.  Gently reassuring your partner that you care about them and are not upset with them may help. Communicating as clearly as possible may reduce (though not eliminate) misinterpretation, however once RSD hits it helps to give emotions time to settle before trying to resolve the issue. 

As a partner being aware of RSD means you need to be kind, however it does not mean you need to ‘walk on eggshells’ around your partner to not trigger RSD. You can show you are aware, however your partner is ultimately responsible for learning to and taking responsibility to manage their reactions over time. (Barkley, 2015; Ramsay, 2010; CHADD, 2023)

5. To understand the role of ADHD medications and how they work

ADHD is a neurodevelopmental condition. (American Psychiatric Association, 2013; National Institute of Mental Health [NIMH], 2023) There are a number of differences in brain chemicals, especially in Dopamine which affects motivation, reward, and focus, and Norepinephrine which affects attention, and alertness. (Arnsten, 2009; NIMH, 2023)

ADHD medication helps by increasing the availability of these chemicals and improving communication between different brain regions, thus supporting executive functions (such as planning, and regulation).  In this way medication may help tasks, conversations, and emotions become easier to manage. (Arnsten, 2009; Stahl, 2013; Barkley, 2015)

Medication may help improve focus, reduce impulsivity, help regulate emotions and make it easier for a person with ADHD to follow through on tasks. However, ADHD medication is not a magic wand that ‘fixes everything’ – it is a window of opportunity to help the person understand himself better and put coping strategies in place. Even with medication, being mindful of communication still matters! (Barkley, 2015; Cortese et al., 2018; Ramsay, 2010)

 ADHD medication also should NOT change your partner’s personality (if it does they may need to speak to their psychiatrist as the dose may be too high or the medication may be the wrong type for them). (Stahl, 2013; NIMH, 2023).

As a partner it is important to notice small improvements, be curious and avoid judgement and be patient whilst your partner finds the right dose of medication. (NICE, 2018; Cortese et al., 2018).

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