ADULT ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that typically appears in early childhood and often persists into adulthood. It affects the brain's executive functions, which are essential for managing and organising tasks. Think of these functions as the brain's CEO.

ADHD challenges include issues with self-control, focus, distractibility, memory, hyperactivity, impulsivity, emotional sensitivity, poor time management, and distorted time perception. It often coexists with learning disabilities, dyspraxia, and autism, leading to problems like depression, anxiety, low self-esteem, poor academic and work performance, relationship issues, financial struggles, substance abuse, disordered eating, and legal troubles. Adults with ADHD are also at higher risk for accidents, premature death, and unintended parenthood.

In adults, hyperactivity may manifest as internal restlessness and difficulty relaxing. Coping strategies like schedules and alarms can help, but diagnosis and treatment are crucial for managing symptoms effectively. ADHD is genetic, and some adults only discover their condition after their child is diagnosed.

The Adult ADHD Self-Report Scale (ASRSv1.1) is a free tool for screening ADHD symptoms in adults. It can be completed here.

The medical community now recognises that ADHD often continues into adulthood, but resources for adult assessment are limited, often necessitating private evaluation. Despite these challenges, seeking professional evaluation and treatment is important for adults who suspect they have ADHD.

In New Zealand, ADHD diagnoses must be carried out by a psychiatrist or a clinical psychologist. Only psychiatrists can prescribe stimulant medication for adults, using special authority codes. In Canterbury, a psychological assessment can be used to obtain medication through the public health system via a referral from a GP. Stimulant medications are the most effective treatment for most people with ADHD, followed by behavioural therapies.

ADHD is a serious and often lifelong condition that can significantly impact individuals and their loved ones. Effective treatments are available, but the first step is obtaining an assessment and accurate diagnosis. For more information about pursuing an evaluation, please visit the Adult ADHD Assessment page.

Have a look at this video from the excellent YouTube channel, How to ADHD, about what it's like to be diagnosed with ADHD as an adult. And have a look at this video for a great explanation of what ADHD is and how it works by ADHD expert clinician and researcher Dr Russell Barkley.

Both psychologists and psychiatrists can diagnose adult ADHD, and from February 2026, GPs and nurse practitioners can too. Only psychiatrists, GPs, and NPs can prescribe ADHD medication, but a psychologist assessment may be accepted to access medication (ask your GP, NP, or psychiatrist first!)

So how might an assessment differ between professions?

A psychiatrist will likely conduct a briefer assessment than a psychologist, resulting in a shorter report. They may feel comfortable prescribing medication at the end of the assessment appointment and can either manage the prescribing process themselves or refer this responsibility to the patient's GP, acting in a consultant role. Psychiatrists are unlikely to offer therapy for ADHD, and their assessment fees will likely be lower than those of psychologists.

A psychologist is likely to perform a more detailed assessment and provide a comprehensive report. This report will need to be reviewed and approved by a psychiatrist to prescribe stimulant medication, with medication management then handled by either a psychiatrist or GP. Psychologists may offer therapy for ADHD management, but their assessment fees are typically higher than those of psychiatrists.

I wrote a blog post on some reasons why ADHD assessments can be hard to find in New Zealand, and another on what my ADHD assessment comprises.

I offer assessment for adult ADHD (age 18+) and psychotherapy and behaviour strategies for the management of ADHD in adults. I do not prescribe or provide special authority numbers for ADHD medication. This has to be done by a psychiatrist.

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A standard assessment includes:

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1. A ~50-minute screening interview to screen for ADHD symptoms and other relevant mental health and lifestyle factors before booking confirmation.

2. Completing a self-report questionnaire about current ADHD symptoms and completing an observer report form by someone who knows the person well. Screening tests for mental health issues are also performed depending on the issues present (e.g. depression, anxiety, eating issues). These are all completed online.

3. A two-hour-and-a-half-hour assessment that includes a semi-structured clinical interview for ADHD, discussing other significant life history events and current symptoms of other mental health problems.

4. A review of symptoms present before age 12 by interviewing someone who knew the person as a child (such as a parent, caregiver, or sibling) and any available documentation such as school or other assessment reports.

5. A 50-minute feedback session regarding the assessment, recommendations, and the next steps (medication, therapy etc.)

Please note that there has to be evidence that the person had "several" symptoms of ADHD in childhood and early adolescence for diagnosis. This has to be evident in school reports and/or the report of someone who knew the person as a child. If neither of these exist (including if the observer does not report symptoms of ADHD when questioned), then coming to see me isn't the right assessment option. You will likely need to find a psychiatrist who places less emphasis on collecting childhood evidence from third parties.

If there is evidence that ADHD is present, a report will be provided to the person's GP, who may then decide whether to prescribe medication for ADHD. I recommend checking with your GP first as to whether they will prescribe based on a psychologist assessment report.

The fee for this service is $1800 with $210 paid at the end of the screening interview. In assessments where additional work is required, a further hourly fee may be added. This is no charge for the telephone screening interview. The total fee is payable two weeks before the first assessment appointment. Payment is accepted by bank transfer.

Stimulant medication

Stimulant medications such as methylphenidate and amphetamine preparations are the most effective and extensively researched treatment option for ADHD in children, adolescents, and adults. They have a short half-life with the therapeutic effects wearing off ranging from hours to a day depending on the specific preparation. When used as prescribed, these medications are safe and effective. They are considered the first line of treatment for ADHD due to their proven effectiveness

Determining the appropriate formulation and dose of stimulant medication may require some trial and error, but the results can be transformative for some individuals. In New Zealand, these medications are controlled substances that require a special authority number from a pediatrician or psychiatrist that must be renewed every two years. It is important to work closely with a prescriber to determine the most appropriate formulation and dosage for an individual's needs.

See this video and this video from the excellent YouTube channel How to ADHD about the usefulness of stimulant medications, and also about the stigma and misinformation that exists about them.

See here for a good summary of stimulant medications and related issues. Note that in America there are many more formulations available than in New Zealand. See this video for a detailed explanation of how both methylphenidate and dexamphetamine work in the brain.

Non-stimulant medication

For the small group of people who are unable to tolerate or do not respond to stimulant medications, there are non-stimulant options available. While generally not as effective as stimulant medications, they can be a good option for some people. More information about nonstimulant medications can be found here.

For an excellent podcast on the importance of getting medication right, please click here to hear from a psychiatrist who is an expert in ADHD and medication.

Psychotherapy

Even with the use of optimised stimulant medications, some symptoms of ADHD will persist. These medications can help to improve skills and abilities, but they are not a panacea for all aspects of the disorder. Consulting with a psychologist to identify remaining challenges and determine strategies for addressing them can be beneficial in managing the long-term effects of ADHD.

However, treatment for ADHD often goes beyond just managing ADHD symptoms. Having ADHD, especially if it is diagnosed in adulthood, can lead to a range of mental health and self-esteem issues, as well as feelings of embarrassment, guilt, and shame. These problems are not necessarily resolved with stimulant medication and may benefit from education about ADHD and psychotherapy that focuses on acceptance and understanding of neurodiversity in order to live a fulfilling life despite the challenges of ADHD. Co-existing mental health issues may require their own medication or therapy treatment.

As a therapist, I specialise in treating adults with ADHD. I offer in-person therapy in Christchurch and online therapy via Zoom for clients nationwide.

Have a look at this video from the excellent YouTube channel How to ADHD about the process of acceptance and changing expectations following an ADHD diagnosis.

I have a blog post about evidence-based talk therapies for ADHD.

I'm often full for therapy clients. Check the home page where availability is clearly advertised.

Women with ADHD often have a different experience from men with ADHD in various aspects of life. There is a lack of research on this topic, but there is growing evidence suggesting that women with ADHD may face unique challenges, such as the relationship between estrogen and dopamine levels and the impact on the menstrual cycle and menopause. This may also affect the effectiveness of stimulant medications.

Here are my blog posts on related issues:

Women and ADHD: Hormones

Understanding ADHD in Women: Pregnancy, Medication, and Postnatal Considerations

Below are some resource recommendations:

Brief articles:

1. ADHD in women

2. Menstrual Cycle Phases and ADHD: Why Cycle Syncing Is Essential

3. Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately

4. ADHD Looks Different in Women. Here’s How — and Why

5. Menopause, Hormones & ADHD: What We Know, What Research is Needed

6. Q&A: Is It Worth Seeking an ADHD Diagnosis After 50?

7. The Transformative Power of an ADHD Diagnosis for Older Women

Books:

1. A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers – Sari Solden & Michelle Frank (a clinical psychologist and a therapist with ADHD).

Podcasts/webinars (all the below can be streamed directly from the ADHD Experts website and can also be found on streaming services such as Spotify:

1. ADHD Experts Podcast episode no 337, entitled "Why ADHD is Different for Women: Gender-Specific Symptoms and Treatments", presented by clinical psychologist Dr Ellen Littman discusses recent research into the differences in female presentations of ADHD, including the crucial role of sex hormones (specifically estrogen) in the exacerbation of symptoms at puberty, menopause, and as part of the menstrual cycle.
   

2. ADHD Experts Podcast episode no 392, entitled "Regret and Resolve: How Women with ADHD Can Transform the Challenges of a Late Diagnosis" presented by Dr Kathleen Nadeau, who is an older woman with a lifetime of professional (and personal) involvement with people with ADHD, and who specialises in diagnosing girls and women with ADHD. She also has ADHD herself.
   

3. ADHD Experts Podcast episode no 380, entitled "Menopause and ADHD: How Estrogen Changes Impact Dopamine, Cognition, and Women’s Health" presented by Dr Jeanette Wasserstein, who is a clinical neuropsychologist who specialises in the diagnosis, research, and treatment of adults with ADHD.
   

There are a number more women-specific podcasts on the ADHD Experts webpage. Word search “women” on the page to find them.

Some individuals with ADHD also have autism, with research indicating that a high percentage (50% or more) of individuals with autism also have ADHD. If autism is suspected or being assessed and there are signs of ADHD, it is important to assess for ADHD as it is as there are effective treatment options. While I do not provide diagnostic assessments for ASD, I can perform screening tests and gather information about symptoms through questioning and speaking with a childhood informant to determine whether autism may be present. If a more comprehensive autism assessment leading to diagnosis is desired, I can recommend other clinicians who offer this service.

Please note that I do not assess or screen for autism on its own, only in the context of an ADHD assessment or if it arises during therapy sessions. There are publicly available screening measures for autism. For adults, I recommend the Autism Spectrum Quotient and the Ritvo Autism and Asperger Diagnostic Scale, both of which are available online.

While not an official diagnostic criterion, many individuals with ADHD struggle with impulsive negative emotions such as anger, rage, shame, and a sense of rejection. ADHD can affect all forms of self-control, including playing a role in regulating emotional experience, expression, and social behavior. As a result, people with ADHD may have difficulty with social relationships due to impulsive verbal behavior, offending others, feeling criticized or rejected, and rejecting others. Anxiety related to social situations is also common among individuals with ADHD.

In recent years, the concept of rejection sensitivity dysphoria (RSD) has been proposed to explain the intense feelings of rejection and distress that people with ADHD may experience in response to perceived or actual rejection by others. For more information about RSD, I recommend the following resources:

How ADHD Ignites Rejection Sensitive Dysphoria

New Insights Into Rejection Sensitive Dysphoria

How Does RSD Really, Actually Feel?

This video from the excellent YouTube channel How to ADHD

I have a blog post about emotional dysregulation in ADHD.

When adults seek an ADHD assessment, they often have a history of feeling different and not understanding why. They may have experienced multiple instances of failure in various areas of their lives, such as primary and high school, higher education, social relationships, work, and intimate relationships. These experiences can lead to low self-confidence, self-efficacy, and self-esteem, as well as increased difficulties with anxiety, depression, and addiction.

In my practice, I view education as an important first step in helping individuals with ADHD understand and accept their condition. Learning about how ADHD symptoms can affect different areas of life can be a relief and help individuals recognise that their struggles are not their fault. It is unfortunate that the condition was not identified earlier, but it has been now, and effective treatment is available to help individuals move forward.

Some related blog posts are:

Unmasking Stigma and Shame: A Candid Look at ADHD

Imposter Syndrome and ADHD: Navigating the Silent Struggle

Grieving May Be An Important Process in Coming to Terms With an ADHD Diagnosis

Books

Below are some excellent books for education for the person with ADHD and essential people in their lives.

1. Taking Charge of Adult ADHD by Dr Russell Barkley (an ADHD researcher, expert, and family member of people with ADHD)

2. When an Adult You Love Has ADHD: Professional Advice for Parents, Partners, and Siblings by Dr Russell Barkley

3. ADHD 2. 0: New Science and Essential Strategies for Thriving with Distraction - From Childhood Through Adulthood by Dr Ned Hallowell and Dr John Ratey (both psychiatrists with ADHD)

4. The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps by Melissa Orlov

Online resources

I recommend the website ADDitude, a long-standing US ADHD support and information page. There are many articles about ADHD as well as books and other resource recommendations. I strongly recommend their podcast/webinar series called ADHD Experts Podcast, which has been running for many years now with over 450 episodes. The webinars invite experts in the field to discuss a range of ADHD-related material for people in all age ranges. Episodes can be streamed directly off the link above or in podcast form services including Spotify.

The YouTube channel How to ADHD is run by Jessica, a woman who was diagnosed with ADHD at age 12. She has produced dozens of educational videos over several years and I highly recommend them.

ADHD expert psychologist and researcher Russell Barkley (now retired) maintains a YouTube archive of his presentations on a range of ADHD-related issues, and presents a weekly video round-up of newly published research on ADHD. He is an engaging and authoritative speaker, who doesn't shy away from challenging non-evidence-based opinions about ADHD.

For recommendations for women with ADHD see the separate FAQ category

ADHD is a chronic condition that often persists into adulthood. Research suggests that a high percentage (70% or more) of adolescents with ADHD will continue to have ADHD as adults, and even those who may no longer meet all of the diagnostic criteria may still experience significant and impairing symptoms. This can create challenges throughout an individual's life, and loved ones may need to provide additional support to help a teenager or adult with ADHD manage their responsibilities and daily tasks. It is important for individuals with ADHD and their family members to be aware of the ongoing challenges and to seek appropriate treatment and support to manage the condition.

I thoroughly recommend the following book:

• When an Adult You Love Has ADHD: Professional Advice for Parents, Partners, and Siblings by Dr Russell Barkley

Russell Barkley is a leading expert on ADHD who has personal experience with the condition through close family members with ADHD. This book draws on his education, personal experience, and work with clients affected by ADHD to provide a comprehensive understanding of the challenges and differences that may arise when a loved one has ADHD, as well as practical strategies for supporting and understanding that person. If you would like additional support and education on how to effectively help a family member with ADHD, you can email me to schedule a therapy session.

Here in Canterbury, there isn't a pathway for a psychologist assessment to lead to the management of stimulant medication in the public health system for under-18s. As with adults, stimulant medication is the most effective treatment for ADHD, and while medication was often very stigmatised in decades past, it appears to be more accepted now. Here is a fantastic one hour podcast about these medications, presented by a developmental pediatrician of 30 years. To get a diagnosis that allows your child/adolescent to trial stimulant medication, you will either need to be referred to the child and family mental health service or the pediatrics service, or find a private child psychiatrist or pediatrician to diagnose. Talk to your child's GP about a referral to the public health service. The wait time is likely to be many months, depending on the severity of the symptoms. Sometimes a school can assist with a referral, such as if an educational psychologist through the Ministry of Education has become involved.

If you can afford it, I recommend going to a private pediatrician or child and adolescent psychiatrist. I have one recommendation:

1. Pediatrician Garth Smith in Nelson specialises in both ADHD and autism. While the first appointment needs to be done face-to-face, follow-up can be done via telehealth. You can book directly on his website, but appointments are posted sporadically, often three months in advance, so keep checking.