ADHD Therapies

ADHD Therapists Share Their Toughest Cases

Practitioners reveal their neurodivergent clients’ biggest obstacles — and offer their advice. Do try this at home!

By Carole Fleck Updated on May 7, 2025
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Adults with ADHD bring deeply personal and unique struggles to their therapists. And, in many cases, personal growth and development hinges on better management of the condition.

ADDitude magazine asked practitioners who specialize in ADHD about their clients’ toughest problems, and the strategies that move them in the right direction. Here is what they said.

Identify the Benefits

Ari Tuckman, Psy.D.

As Russell Barkley, Ph.D., has famously said, ADHD is not about knowing but about doing. This is especially true with co-occurring conditions that make it even harder to get going. I have engaged in some great conversations in session about what to do and how to do it, but then faced disappointing weeks when clients struggled to follow through – again.

It’s easy with ADHD to feel like too much of life is about avoiding negatives, so I make a point of talking about the positives that clients will gain from doing what we discuss. For example, walking into a work meeting feeling confident rather than hoping to be ignored. Or getting into bed earlier tonight so you’ll be more effective tomorrow and then have time after work to meet up with friends.

We all benefit from working toward something that is important and meaningful. Anxiety and depression can steal this sense of purpose, so you need to figure out what that is for you. This will become your source of real, lasting motivation.

Value Persistence Over Perfection

Sharon Saline, Psy.D.

I really enjoy the outside-the-box thinking that people bring to our sessions – their humor, their intelligence, their candor about their strengths and limitations, and their sensitivity. In my office, laughter is often mixed with personal insights, curiosity, and tears.

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The main challenges I see in my work with clients with ADHD: consistently inconsistent motivation, a hallmark of ADHD, mixed with perfectionism and helplessness. All of my clients sincerely want to change but wrestle with how. They are willing to try a new technique or take a risk, but they struggle with persistence, unrealistic standards, and self-esteem. They become discouraged and give up.

When this occurs, we begin by exploring the obstacles they face, patterns that might be recurring, and any past successes that could be applied to this situation. We work together to adjust their expectations about “success,” look for something to re-engage them, and then pivot to trying again with new tweaks and a different perspective. This process helps them regroup, aim for steadiness instead of perfectionism, and feel empowered.

Determine the Conditions at Play

Roberto Olivardia, Ph.D.

ADHD rarely travels alone. Yet many patients are unaware of the hand that ADHD plays in the etiology, presentation, and/or course of their other conditions – which may be unidentified or misdiagnosed. This is particularly true of ADHD in adults, since many symptoms mimic and overlap with traits of other disorders.

Patients are perceived as complicated when previous treatment methods seem ineffective. However, a primary reason for this is the clinical underappreciation of ADHD. Even when ADHD has been diagnosed, many patients are told that ADHD treatment is secondary to treatment of “more serious” problems. Meanwhile, untreated ADHD often undermines the treatment of other conditions. Patients feel unfixable.

[Read More from Dr. Olivardia]

My role is to empathically work with a patient to place all the pieces of the diagnostic puzzle on the table. You have to inquire about each of the problems to capture the story of the symptoms. For example, not sleeping for three consecutive days could be a symptom of a manic episode, a cocaine-fueled bender, a depressive episode, or because you were writing your senior honors thesis (and I have experience in this) after your ADHD had you put it off until 72 hours before the deadline.

As clinicians, we always have to ask, “What diagnosis is driving the bus?” – especially when multiple diagnoses are present. Only then can we properly put the puzzle pieces together and deliver to our patients the heartfelt message that they are not broken but simply needed more time and examination for the proper treatment to be effective.

Put On Your Own Oxygen Mask First

Dawn K. Brown, M.D.

Women of color with ADHD carry an immense load. They balance careers, family life, and societal expectations while managing ADHD, not to mention other conditions like anxiety or hormonal imbalances. I always tell my patients that taking care of themselves is not optional. In a world that often expects them to be last, they must intentionally choose to put themselves first. Without that, everything else falls apart.

I begin by helping them create a personal roadmap for managing life with ADHD. For instance, I had a patient who was a single mother with a demanding career. She felt overwhelmed, always chasing her to-do list but never catching up. We started by breaking down her day, prioritizing tasks, and integrating time for self-care. I introduced her to time-blocking: setting specific times for work, family, and herself. She also used organization apps, like Todoist, to break down tasks into smaller, manageable steps. Over time, she learned to delegate more responsibilities at home and let go of the pressure to do everything perfectly.

We also focused on setting boundaries. For many women of color, there’s pressure to be everything to everyone. I encourage my patients to set limits and say “no” without guilt. This might mean communicating with family about their need for quiet time or asking for help at work to lighten the load.

Unite and Conquer

Paul Mitrani, M.D., Ph.D.

My adult clients report frequent problems in relationships, especially when they have ADHD and their partner does not understand the difficulties it brings, like forgetting to do things or neglecting to share responsibilities. When must-dos fall by the wayside, that’s when trouble begins. It’s important for individuals and their partners to think about how to delegate – this is my strength, this is yours, and this is how we’ll partner up. I also work to educate the partner that this is a medical condition and not just the other person forgetting or not seeming to be as interested in things.

How to Set Emotional Boundaries: Next Steps

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