We all want to provide the best possible support for our neurodivergent clients. Yet, systemic biases and outdated stereotypes still quietly influence how we recognise, diagnose, and treat ADHD. As therapists and clinicians, we have a duty to challenge these assumptions and meet each person exactly where they are.
Here is how we might be able to actively dismantle bias in our practice and provide truly individualised care.
Acknowledge the Historical Baseline
Historically, the medical model built its understanding of ADHD around a very specific baseline: hyperactive young boys. Because of this narrow lens, generations of women, girls, and non-binary individuals were left in the dark. Their internalised traits were frequently dismissed, often mislabelled as anxiety, depression, or emotional dysregulation.
We are finally having vital conversations about these systemic blind spots. Correcting this long-standing imbalance is essential. We must validate the experiences of those who have spent their entire lives feeling misunderstood by the very systems meant to help them.
Embrace the Both/And Approach
Correcting a historical bias does not mean we should introduce a new one. We must hold two truths at once. Yes, we need a clear-eyed recognition of how women and girls have been missed. However, we also need to remember that ADHD does not fit neatly into binary boxes.
If we assume all women internalise their traits and all men externalise theirs, we will simply create new blind spots. We risk missing the boy who heavily masks his struggles just as much as the girl who presents with highly externalised behaviours. ADHD is shaped by our environments, our contexts, and our unique neurology. We must look beyond gendered expectations.
Actionable Steps for Your Practice
To stop bias from creeping into your work, you can implement a few practical shifts in how you approach assessments and support:
- Focus on the individual ecosystem. ADHD is deeply personal. It interacts with a person’s environment, their upbringing, and other co-occurring conditions like autism. When a client seeks help, start with their unique story rather than a rigid checklist of expected behaviours.
- Ask open-ended questions. Frame your assessments around their daily experiences. Ask, “What challenges do you notice when you try to rest?” or “How does your energy shift throughout the week?” This allows their actual lived experience to guide the session, rather than leading them toward a specific presentation.
- Actively challenge your assumptions. We all have unconscious biases. Take time to reflect on your practice. Notice if you unconsciously expect a certain presentation based on a client’s gender, age, or background. Check if you are quicker to label a woman’s struggles as anxiety before exploring neurodivergence.
- Use research as a compass, not a map. Keep up with the latest studies on how ADHD presents across different demographics. Use this knowledge to broaden your understanding, but never use it to box someone in.
The Path Forward
True support means taking the time to understand how ADHD shapes a person’s unique world. By checking our biases and committing to highly individualised care, we build a safer, more inclusive environment for every ADHDer who walks through our doors.
Let us keep learning, reflecting, and advocating for a standard of care where no one is left behind. Take some time this week to review your assessment materials and reflect on your recent client interactions. The more we learn, the better we can support the beautiful diversity of the neurodivergent community.
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