Psychotherapeutic counsellor Bev Woolmer helps us to understand that ADHD doesn’t just happen in a vacuum. An ADHDer’s comorbid conditions can impact and/or mask symptoms of the condition.

(5 minute read)

Awareness, information and debate about ADHD have increased significantly. ADHD has become part of our social discourse and the increase of people seeking diagnosis and support is rising. It is likely that within our circles we know people with ADHD or we may be neurodiverse ourselves.

Data from the NHS Business Services Authority show that in 2022–2023, more adults were prescribed medication for ADHD than children – a rise of 32% in adult prescriptions (NHSBSA, 2023). In March 2024, the National Institute for Health and Care Excellence (NICE) estimated that 3 to 4% (roughly 1.9 million adults) and 708,000 children in the UK have a diagnosis of ADHD.

Statistics aren’t, generally speaking, my thing, but what resonates here for me, and something that is maybe less discussed, is ADHD and comorbidity (AADD UK; Plos One; The Understood Team). Comorbidity means the tendency for one condition to co-exist with another. What I recognise both personally and professionally is how anxiety and depression are often diagnosed, and what can often be missed are conditions within the umbrella of neurodiversity.

Recognising in later life that my brain is neuro-spicy, that there is a reason why numbers, “clumsiness”, not knowing my left or right, being a “daydreamer” (a firm favourite in school reports) all started to fall into place. I began to piece together the things that had challenged me and began to see all this was unique.

It is no surprise this is also a large feature within my work as a counsellor with clients. The privilege in holding space for others, where the mask they’ve worn can be explored with compassion and curiosity. A supportive ally on the journey of self-discovery, the reflecting back, seeing the signs and missed opportunities, often a grieving process, recognising the loss and the re-building.

This piecing together often brings into view co-morbidity and how the presence of these can affect ADHD symptoms as well as mask ADHD.

How anxiety and depression mask ADHD

Anxiety: this can impact the ability to concentrate, the racing of thoughts, constant worry and fear. It can exist as a generalised anxiety disorder and be experienced in relation to health or social anxiety. Perfectionism, and comparing oneself to others who seem to function and manage, are often internalised. About 50% of adults with ADHD will also have an anxiety disorder.

Depression: adults with ADHD are three times more likely to experience depression; they are more likely to be significantly affected by their symptoms than those with either disorder alone. Low mood and low self-esteem can impact self-image and can result in a sense of failure in not meeting expectations or goals. This can impact both personal and professional relationships, struggles with communication, reading body language and “fitting in”.

 

How specific learning differences mask ADHD

Specific learning differences are neurological conditions that can impact how a person learns. These are not related to intelligence, and those with one or more of these conditions are more likely to have ADHD or ASD than people who do not have a specific learning difference.

Dysgraphia: this can cause challenges with written expression, handwriting, spelling, grammar and putting thoughts onto paper as well as fine motor skills – for example, holding a pen.

Dyspraxia: challenges with movement and co-ordination, including poor hand-to-eye co-ordination, manual dexterity and poor balance. It can also affect language, perception and organising thoughts.

Dyscalculia: affects the ability to acquire arithmetic skills – for example, in performing mathematical calculations, understanding place value, reading timetables, telling and tracking of time, and challenges with distinguishing left and right.

Dyslexia: causes difficulties with reading, writing and spelling. It can cause confusion over the order of letters, which may be written the wrong way round. It can also cause challenges with following directions, perception, planning and organisation.

Empowering ourselves

Being able to understand ourselves, to name what challenges us, can enable and empower us. It can provide an opportunity to learn strategies, to reframe our story and to find a sense of self of who we are. As poet Maya Angelou says: “If you’re always trying to be normal, you will never know how amazing you can be.”

 

References

AADD UK. No date. Accessed 3 December 2024: https://aadduk.org/symptoms-diagnosis-treatment/comorbidities/

National Institute for Health and Care Excellence. 2024. Accessed 3 December 2024: https://cks.nice.org.uk/topics/attention-deficit-hyperactivity-disorder/background-information/prevalence/

NHS Business Services Authority. 2023. Accessed 3 December 2024: https://media.nhsbsa.nhs.uk/news/nhs-releases-mental-health-medicines-statistics-for-20222023-in-england

Plos One. No date. Accessed 3 December 2024. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277175

The Understood Team. No date. Accessed 3 December 2024:https://www.understood.org/en/articles/adhd-comorbidity