Psychological assessment and treatment for ADHD

ADHD is a neurodevelopmental condition that can affect attention, impulse control, organisation and, in some cases, activity level. It does not appear in the same way in every person or at every stage of life.

Common signs can include difficulty sustaining attention, forgetfulness, disorganisation, impulsivity, a sense of mental dispersion, difficulty finishing tasks or managing priorities. In children and adolescents, restlessness, difficulties following routines or repeated conflicts around studying and rules may also appear. In adults, it is often experienced more as overload, procrastination, disorder or a constant feeling of needing extra effort.

In general terms, three clinical presentations of ADHD are usually described: predominantly inattentive presentation, predominantly hyperactive-impulsive presentation and combined presentation, where features of both profiles appear.

Even so, in consultation the important thing is not only fitting the person into a category, but understanding how the difficulty appears in everyday life. Two people with the same diagnosis may have very different difficulties and need different forms of support.

There is no single way a person with ADHD behaves. Some people show more distraction, forgetfulness, disorganisation or difficulty following long tasks. Others show more impulsivity, restlessness, impatience or difficulty stopping quick responses.

Difficulties with planning, maintaining routines, regulating frustration or sustaining effort in less stimulating tasks are also common. In adults, there may not be obvious external hyperactivity, but there may be an internal sense of overwhelm, mental acceleration or constant difficulty organising priorities.

For many years, the expression ADD was used to refer to profiles where attention difficulties predominated without obvious hyperactivity. Today, in current clinical practice, ADHD is used and different presentations are distinguished, one of them being predominantly inattentive.

So when someone says “ADD”, they are usually referring to an ADHD profile where distraction, forgetfulness and disorganisation are more prominent than visible hyperactivity.

ADHD is not usually defined in clinical language as a “mental disability” in itself. It is a neurodevelopmental condition that can create important difficulties in certain areas of functioning, but its impact varies greatly from one person to another.

Some people experience mild interference, while others need more support because of the impact on study, work, emotional regulation or family life. The important thing is not to reduce the person to a label and to assess individually what difficulties actually exist and what support may help.

Yes. Many people with ADHD can lead a full, satisfying and functional life. However, this does not mean that the difficulty cannot generate effort, distress or specific problems when what is happening is not properly understood.

When the person receives a good assessment, understands their functioning better and learns tools adapted to their case, their ability to organise themselves, take care of themselves, relate to others and sustain responsibilities can improve significantly.

When significant ADHD is not addressed, difficulties such as disorganisation, impulsivity, low performance, procrastination, family conflict, frustration or damaged self-esteem may continue or increase. In some cases, the problem affects not only performance, but also emotional wellbeing and the way the person sees themselves.

Not addressing it does not automatically mean that everything will get worse, but it may mean that the person continues functioning with much more effort than necessary and accumulating experiences of misunderstanding or failure.

In some cases, yes. Some people with ADHD improve significantly with assessment, psychoeducation, psychological treatment, family support, changes in habits and organisation strategies. In other cases, medication may form part of the approach and should be considered with the appropriate medical professional.

The decision should not be based on simplistic messages for or against medication, but on an individual assessment of the impact, needs and clinical situation of each person.