Attention-deficit/hyperactivity disorder, predominantly inattentive (adult)
Late-diagnosed ADHD after child's diagnosis; presents with executive overwhelm, shame, and burnout.
Presenting concern
ASRS positive. Pursued evaluation after her son was diagnosed and she recognized herself. Chronic late-everything, working memory issues impacting career, intense shame from years of being told she was 'lazy' or 'not living up to potential.' Currently in burnout from over-compensating.
History
No prior psychiatric diagnosis. Likely missed due to gender and inattentive presentation. Coping via overwork and high effort, sustained until recent burnout. Started stimulant medication 2 months ago with good response.
- Active burnout
- Internalized 'lazy/incompetent' narrative
- Comorbid sub-threshold depression and anxiety
- Marital strain around household labor distribution
- Bright, creative
- Medication-responsive
- Insight is rapidly developing
- Supportive partner once educated
Conceptualization across modalities
Executive function deficits create real performance gaps; compensation strategies have been overdeveloped and unsustainable. Maladaptive cognitions ('I should be able to do this like everyone else') drive overwork and shame. Behavioral skills (externalize, automate, scaffold) close gaps without requiring willpower.
- Externalize working memory (lists, calendars, timers)
- Body-double and accountability strategies
- Task initiation skills (5-minute rule, implementation intentions)
- Restructure 'lazy' narrative
Years of internalized failure narrative create fusion with self-as-broken story. Values clarification surfaces what she actually wants, separate from neurotypical performance standards.
- Defusion from 'I'm broken' thoughts
- Values work — what does success look like for her, not for them
- Self-compassion practices
- Committed action sized to her actual capacity
Treatment plan
Recover (1–4)
Stop the burnout — reduce load, sleep, get supports in place.
Scaffold (5–12)
Build externalized executive function systems.
Reframe (13–18)
Address shame, recalibrate standards, partner education.
Maintain
Quarterly check-ins, system tune-ups.
Burnout resolved by month 3. Major shift in identity narrative by month 6 — describes herself as 'differently wired' rather than 'broken.'