13 lessons from an ADHD Therapist

This article is in bullet points because, if you, like me, have ADHD, you’re probably not going to bother reading a giant wall of text. So, here are a few succinct(ish) thoughts:

Who am I?

• My name is Zameer Esmail. I am a provisional psychologist who works with ADHD. I also have ADHD. But that is not all I am. I have lived in 6 countries, I speak a bunch of languages, and haven’t been able to stop (read: escape from) studying my whole life. I have worked in clinics and outreach programs in several different countries, and have an eclectic background that involves a degree in biochemistry, to DJ’ing and hosting radioshows, to growing up on construction sites, and fighting Muay Thai.

1. It’s genetic.

• Some years ago, I somehow found myself in rural Australia working with children with ADHD. Eventually, I broadened to adults with ADHD, because very often a child with ADHD means one or both parents also have symptoms of, or full blown, ADHD.

• The general consensus is that ADHD is about 80% heritable. This is higher than most other psychiatric disorders.

2. It is not just a lack of attention!

• ADHD-attention deficit/hyperactivity disorder. The name is bit of a misnomer. It is not so much a lack of attention, but a problem with regulating attention. Fixating on something (e.g., hyperfocus) can be just as much of a feature of ADHD as not being able to stay fixated on something.

• ADHD is complex. It goes deep. It's a developmental issue. It impacts the development of your brain. This in turn impacts how you interact with almost everything in your life. And often how others interact with you.

3. You are not your ADHD.

• Okay so you might have ADHD. Have you joined that community online? Have you read this book? Did you see that Ted Talk? Have you heard of this medication? Did you know that if you do this one random thing, it means it’s an ADHD thing? It can feel like every part of your life has something to do with ADHD, and if you don’t focus on it, you will fail at life (or something dramatic to that effect…).

• Try not to make ADHD your entire identity. It is a slippery pathway that can lead to complacency. It is not you; it is one thing that is affecting you! You are far too complex, beautiful, and experienced to chalk the bulk of your identity down to 4 letters (or 4 words… don’t be pedantic, I know you thought it. Focus!).

• Remember, you have a duty to yourself, to me, and to everyone else struggling with ADHD, to not let it own you. You may not realise it, but the way you live your life makes you a beacon of light and an inspiration for others who not only have ADHD, but any kind of issue or hardship (which is basically everyone).

• You can do something about it.

4. Something something Michael Phelps… Yes, he has ADHD too!

• While not letting it own you, acknowledge that there is a struggle. Yes, there are people out there who may have it worse, like in warzones or late-night kebab vendors, or people that wear jean shorts (just…why?).

• But if I have learned anything, it is this: Some people have enough problems to fill up a swimming pool, and some only enough to fill up a bathtub.

• There is still enough water to drown in a bathtub.

• Either way, woe is not you. Learn to swim. If Dory can do it, so can you! Your younger self is watching, and your future self depends on it.

5. It’s not the usual therapy.

• It has been tricky working with ADHD in the sense that I have had to challenge my perception of traditional therapy. Sessions can have a haphazard theme to them. Additionally, clients can have anxiety and depression and trauma all at once. Learning how to deal with it all has allowed me to learn things about myself, and about ADHD in others.

• Therapy sessions generally should have a direction/focus or they might get derailed or not really have a rail at all…and be like a train on the ground. Without a rail. Wait, can trains move on the ground without rails? Will the wheels damage the ground? Will they lose direction…Like this post?

• ANYWAYS!

6. Can E.T. actually ride a bike?

• If your bicycle is broken. Before you try to fix it, you should probably try to understand how the parts work together.

• A big part of my approach is to first help with psychoeducation of ADHD. It’s imperative to understand how and why it is affecting you. You walk out of your house and go back in again because you forgot something. That happens so often. Yes, it’s a quirky ADHD thing, and you laugh about it, but why is it happening? What is the mental process there?

• Once you understand the workings of it, doing something about it becomes the next logical step. You will understand why the techniques that are suggested, are suggested! Most of them are not revolutionary or genius lightbulb approaches, they’re just the common-sense next step things to implement when you figure out how and why you are being affected.

• Think of riding a bike. Why oil the chain? If you don’t know how a chain works, putting oil on it is not really intuitive, and you wouldn’t do it unless you were told to. However, oiling a bike chain logically makes sense once you take time to figure out that there are metal pieces that need to move against eachother with minimal friction, right? It works the same with ADHD.

7. There is no one technique that will fix everything.

• Stop believing all the Tik Tok or Instagram videos that have an ADHD hack. ADHD goes deep, and not everyone struggles in the same way. Every technique will, at some point fail. Probably today… or tomorrow… or yesterday.

• You usually have three options: Drop it, keep pushing through, or tweak it. Understanding what is going on below the surface will allow you to:
• (i) Be compassionate, not complacent, whether or not you drop it or push though, or
• (ii) Tweak the technique to work for you.

8. To understand ADHD, you have to understand dopamine theory.

• What’s dopamine? That reward thing right? No. Well…kind of. In a nutshell, dopamine is one of the main things that drives us to do things. It’s involved in things such as motivation, learning, behaviour, and emotions. In day-to-day life it means if you do some thing or get an idea to do something, you get dopamine!

• Our brain is basically made up of a huge number of neurons (think: nerves) that are connected in a network. All of them work by firing and communicating with each other. They communicate with each other by sending out signals called neurotransmitters. Dopamine is one of these neurotransmitters. So, a neuron secretes dopamine, the next one receives it, and little transporters mop up whatever is left.

• In ADHD, there is research that suggests we have transporter issues. These transporters suck up the dopamine, so that there isn’t just a bunch of random dopamine hanging about between the neurons. In ADHD, there can be too many transporters, which means we don’t have enough dopamine laying around doing what it’s supposed to be doing!

• This means even if we know something is important, there are dopamine supply chain issues, so we sit there unable to do the thing. If it’s a hard task, it needs more dopamine, but if it’s easy, it needs less dopamine. That means the pathways that need less dopamine are more likely to be active… so we pick the easier tasks, like scrolling on social media or cleaning the windowsill instead of doing the report that is due!

9. How many steps to make a coffee?

• Think of your mornings. Making coffee or brushing your teeth might be one of the first things you do. On some days the steps to making the coffee are simple: Wake up. Make coffee. Drink Coffee.

• One other days, however, it is harder. The steps can be: Wake up. Get up. Find the floor. Find the kitchen. Identify coffee machine. Where do I keep the cups? Do I take sugar? Etc, etc. On a hard day three simple steps become 17 steps.

• The harder days are low-capacity days. Low dopamine levels, bad sleep, stress, burnout, diet, nightmares about wearing jean shorts... all these things can contribute to these days.

• Be compassionate towards yourself. It is okay to struggle! You have ADHD.

• A good day is A GOOD DAY! By definition, that means it is an above average day. Manage your expectations, a good day everyday would not make them good days, they would then just be classified as average days. Are you expecting (and subsequently disappointing) yourself to have a good day everyday?

• Manage your day based on your capacity. Don’t expect yourself to perform as well as on a good day everyday, and also, don’t let your entire day go just because you have reduced capacity. You can still do more than you realise! Don’t be a victim.

10. Therapy is as important as medication.

• Medication, on arverage, contributes to about a 30% reduction in ADHD symptoms. And it wears off in 6 or 12 hours depending on what you take. It helps, immensely! But it is not the be-all and end-all of managing ADHD.

• Having a therapist will allow you to have a consistent benchmark by which to measure your journey through life. All your friends will be excited and/or bored at the crazy new idea or adventure you tell them about. It sounds nice but more often than not, consistency is what makes or breaks success.

• Realistically, if you are not Michael Phelps, who is holding you accountable? Not your friends, they have their own struggles (they might be contemplating wearing jean shorts and long socks… you should probably give them your therapist’s number). And most people are too afraid conflict to dissuade you. What about you? Will you keep yourself accountable? Can you remember what you ate for lunch 3 days ago? Can you remember the goal you set at midnight 37 days ago? Probably not. Go see your therapist.

11. Just ten minutes more! Please?

• Speaking of dopamine regulation issues, addiction comes easy. So does rabbit hole-ing (holing?, holeing, whatever, the act of falling down rabbit holes). Anything that allows for a surge of dopamine or good feelings, the ADHD brain will crave. Be it cocaine or candy crush. The ADHD deprived brain will be drawn to activities that supply dopamine without much effort.

• You have to be honest with yourself about whether or not you need something, and more importantly, what impact it will have on you if that thing were to no longer be there in your life.

12. Distraction and memory issues are rampant!

• Look over there! Up in the sky! It’s a bird! No,it’s a plane! No wait it’s superman! With underwear on the outside… Odd… Does he still wear underwear under his pants too? But like… that must be so much laundry? Wait… What were we talking about?

• Think about sometimes sitting down to do work on the computer, and somehow you find yourself cleaning the lamp shade in the garage five minutes later. How did you end up there? It’s not one thing, it’s a combination of things.

• Distraction happens, in part, because we fail to process and prioritise all the information we take in from our surroundings. Processing information is challenging, and storing it in our memory is challenging too. Inhibiting impulses is another issue. Problems with shifting attention to something we have not anticipated is also an issue. All these things are called executive functioning issues, or executive dysfunction.

• These issues must be SUPPORTED. Kids are reprimanded for not staying on task. Adults chastise themselves and force themselves to work. While there is some merit in instilling work ethic and making kids aware of real world or imposed consequences, and pushing yourself to do a task, the reality is the long-term consequences, and exhaustion/dopamine depletion that happens here are just not worth it. Why are you forcing yourself to do the task, or expecting yourself to remember that one thing? If you could to that, you wouldn’t have ADHD.

• Supports are some of the things we learn in therapy. The therapeutic techniques show specific ways to do things like to-do lists, calendars, alarms, decision making, and emotion regulation techniques, to name a few.

13. Neurodiversity attracts.

• What I have found is that if you have a neurodevelopmental issue like ADHD, autism, or a learning disorder of some kind, chances are, a large part of your social/family environment will have symptoms of some of these conditions too.

• So many of my clients have found out pretty late in the day that they have partners who are not entirely neurotypical, and it’s awesome and amusing to see how they make their lives work.

• Some people accept these issues, some are in denial it exists, and some self-victimise. Either way, talking to people about how they handle their issues might open up doors for support and success you did know were there.

These are a few lessons that I have found myself coming back to time and again. I hope they can help you too!

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