How does ADHD shape a young person’s sense of self?

Over the years, I have had the opportunity to work with children and young people who live with Attention Deficit Hyperactivity Disorder (ADHD). Each person brings a different story, yet one thread that often runs through these conversations is how misunderstood ADHD can feel. 

When ADHD Is misunderstood

ADHD is often spoken about in terms of difficulties: trouble focusing, impulsivity, or restlessness. While these challenges are very real, they can be only part of the picture. This might mean being constantly told to “try harder” when they are already exerting huge amounts of effort to concentrate. It can be the exhaustion of masking, attempting to appear calm or organised while inside feeling scattered and overwhelmed. This can often carry the weight of years of self-doubt and frustration, particularly if their diagnosis came later in life. I often notice how much of a struggle it is with the hidden burden of how these difficulties have been received by others. They can become internal voices that can be heard after the original words were spoken, shaping how we sees ourselves. Children can also absorb the feelings of the adults around them, for example frustration may be taken in as a belief that ‘I am bad’ or ‘I am too much.’ 

How internalised voices emerge in therapy

In the therapy room, I often hear these voices emerge. A child or young person may dismiss their own difficulties, saying, “it’s just me being useless again,” or apologise for losing track of their thoughts in session. These are perhaps not just casual remarks as they may be revealing the way early criticism has become lodged inside, replaying automatically and harshly. Part of the therapeutic work is to notice these voices together, to understand that they are not the whole truth but an internalised presence of how others once responded. The space psychotherapy provides is a chance to untangle those beliefs and to help children begin to see their authentic self.

ADHD, relationships and the fear of being ‘too much’

Living with ADHD can also shape the way young people experience their relationships with peers. I have often heard a fear of being “too much” alongside a worry about somehow being “not enough”. There can be a great deal of effort involved in trying to manage how they are seen, particularly when they have learned that their natural ways of responding can be met with irritation or misunderstanding. A young person may become highly controlled, holding back their energy or carefully monitoring what they say, while underneath there remains a fear that allowing more of themselves to show will become overwhelming for other people. I find myself wondering what happens to a developing sense of self when so much attention has to be given to whether that self will be accepted.

Finding acceptance in the therapeutic relationship

These expectations can find their way into the therapy relationship, which can take time before there is enough trust for these expectations to become something we can think about together. When they do, the relationship can become a place where the young person begins to experience themselves differently. They can bring the parts of themselves that have felt difficult or unacceptable and discover that they can be understood without needing to hide them. I think this matters because the qualities that create difficulty in one environment can be experienced very differently in another. Therapy cannot remove the difficulties associated with ADHD, but it can offer a relationship in which a young person does not have to reduce themselves to those difficulties. Over time, this can create more room for a fuller sense of who they are, including the parts they may have learned to keep out of sight.