When ADHD occurs alongside mental health problems
Giving young people space to talk and access to support can keep high achievers from slipping through the net
This article is the fourth in a series on youth mental health co-written by youth development researcher Kathryn Bates and young people with experience of mental health conditions. The messages and formats of each article were led by the youth co-writers, and draw on both lived experiences and evidence from research.
Alma* was a high achiever at school. She kept her head down, didn’t disrupt her classes, and performed well on exams. The adults around her were unaware that she was struggling with depression and that she would subsequently be diagnosed with attention-deficit/hyperactivity disorder (ADHD). ADHD is characterised by symptoms of inattention, impulsivity and/or hyperactivity, which must persist for over 6 months for an individual to receive a diagnosis. ADHD rarely occurs on its own and almost half of those with ADHD are also diagnosed with mental health problems.
Around 5% of children globally are diagnosed with ADHD, but there are many more who have not yet been diagnosed or are waiting for an assessment. In the UK, children can wait up to 5 years for an ADHD assessment. With the peak age of onset at about 10 years for ADHD, we can’t afford to allow children who need support to go unnoticed.
ADHD does not look the same for all children and teenagers. Kathryn asked Alma, now 22 years old, about her experience and what she needed to feel supported.
“Almost half of those with ADHD are also diagnosed with mental health problems.”
Kathryn: How was school for you?
Alma: I had to put in the work to succeed. It didn’t come naturally. I worked outside of school hours to get ahead and practise more. I struggled to focus in noisy environments, as I needed silence, so I really had to pay attention at school. While I may not have realised it at the time, I was working hard to make sure my grades would get me to the next stage in my journey to study my dream subject at university. I did whatever it took to ensure my grades were high. My school only looked at academic performance to determine whether there was anything worrying happening at home, or if a student had any special educational needs or disabilities, so I went unnoticed.
In year 6, when I was about 10 years old, I got my mum to come in and support me in asking my teacher for permission to attend the additional classes offered to students out of school hours to help them with English and maths, and we got a curt ‘no’ because my grades were okay. This was upsetting, as I was simply asking for extra help. I was struggling to learn and work in the classroom environment and had similar difficulties to some of the students who qualified for extra help. I put a lot of pressure on myself. I then had to struggle my way through secondary school.
Kathryn: How did you find studying for exams?
Alma: Exam season was more stressful than the rest of the year. I had to find a way to revise and answer exam questions. On reflection, I think I was showing symptoms of ADHD, but no one picked up on them. I needed extra support – I was doing too much on my own. ADHD can look different in females compared to males. We don’t tend to be hyperactive, and we are usually more inattentive, which is something I battled every time I tried to revise.
My home environment made it harder: I lived in a one-bedroom flat, sharing a room with all my siblings. It was overcrowded and I didn’t have a desk to work at. As soon as I woke up, I was reminded that I needed to work hard to give myself a better quality of life.
Kathryn: When were you diagnosed with ADHD? How was that process?
Alma: At the age of 21. The process was hard. I took myself to the GP. I was going to university and the only way I could get the help I needed was to get a diagnosis. If it turned out I didn’t have ADHD, I was okay with that.
The process takes longer if you’re over 18. I was assessed by my GP, who had to send the assessments externally, and that took two years. The waiting lists, the admin, and poor communication throughout meant that it dragged on. But eventually receiving a diagnosis made me feel better, because I now knew why I was doing certain things, and it gave me access to additional help.
Kathryn: What is your experience of depression?
Alma: I didn’t have a formal diagnosis of either ADHD or depression when I was at school. I felt hopeless at times. I would look at the quality of life of people around me, or those who lived in the same area, and how they faced a daily struggle to live with the knock-on effects of financial strains. I picked up on this from a very early age. It was depressing to see. When I felt like my grades would slip, I went into a state of panic and felt depressed and unworthy – I needed academic validation.
Kathryn: Did your parents and teachers do anything that helped?
Alma: My mum did what she could. She provided me with learning materials, such as revision guides, books, and texts, if I needed them. She also put me into tuition for my core subjects to ensure I got additional, personalised help. This really boosted my grades throughout secondary school.
I wish teachers had asked more often how things were at home. There were stressful events at home, arguments, overcrowded rooms, and no desks to study at. Sometimes when asked, I would lie and say ‘I’m fine’ as I didn’t want school to know about my home situation – it was embarrassing. I wish teachers had prodded beyond one question.
My advice to anyone feeling like this is to reach out to someone you can trust at school. Try to talk to others who have similar experiences, as this could help you feel validated and even inspired.
Recommendations from the community and the research on how to support young people
It is difficult to know what a young person is going through, either within themselves or at home. Alma’s experience shows that even those who appear to be succeeding might be struggling. Adults need to check in regularly and give young people the space to talk about what they are struggling with, and explore different types of support. We offer the following recommendations.
“Even those who appear to be succeeding might be struggling.”
ADHD can involve a complex array of strengths and difficulties: Not all young people with ADHD will experience the same symptoms. As Alma points out, because she was not disruptive in class (an indicator of hyperactivity or impulsivity), her issues largely went unnoticed. Less well-known symptoms of ADHD include feeling overly sensitive, struggling to remember important appointments, and having difficulty maintaining relationships. Some describe ADHD as their superpower: Often, individuals with ADHD can hyperfocus, can be highly creative, and can be good at problem-solving. To help young people thrive at school, it is important to understand their strengths as well as their difficulties.
Joining a community can be validating: Feeling different and misunderstood can make young people with ADHD feel isolated. There are organisations led by people with ADHD that offer support and help to build networks within the community; these organisations often welcome people with ADHD and those wanting to support loved ones. For example, ADHD Babes is a community organisation for Black women and non-binary people with ADHD, ADHD UK has a list of support groups on its website, and MindMate, run by the NHS, has a webpage with online groups and communities for neurodivergent young people.
Resources to learn more about ADHD and mental health
- YoungMinds has evidence-based guides on low mood/depression and on ADHD and mental health.
- ADDitude magazine (produced by people with ADHD) published an article on women’s lived experiences of ADHD.
- Edmund Sonuga-Barke, professor of developmental psychology with lived experience of learning difficulties, has co-written an article on the potential benefits and risks of ADHD in the digital world with Katarzyna Kostyrka-Allchorne.
Footnotes
*Alma is a pseudonym, as the interviewee prefers to remain anonymous.
This interview has been edited for clarity.
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