Clinical Psychologist, Sarah Hindle, works in private practice in Leichhardt, Sydney, and has a special interest in adult ADHD, focusing on therapeutic support of adults with a late diagnosis. Sarah presented at the first Spotlight Session for the Mental Health and Pastoral Care Institute, informed by research, experience as a clinician, and her experiences living alongside family-members with ADHD.
Written by Kate Morris, ADM Fellow 2024. Kate Morris is currently working to produce useful, bite-sized materials for Christian families with neurodivergent members (ADHD, autism, etc) and their supporters. If you are interested in these resources, subscribe for free to her posts here: anextraordinarynormal.substack.com
Read Living with Adult ADHD – part 2, in which Kate summarises our interview with Rev. Simon Carter, giving an insight into his lived experience of Attention Deficit and Hyperactivity Disorder, or ADHD.
With more than a million people in Australia diagnosed with ADHD,[1] it’s no surprise that this is a topic of current interest. And with more than 300 people accessing this Spotlight Session event physically and online, it is clear that many in our churches share this interest. Not all information about ADHD available through various media outlets is helpful, accurate or neuro-affirming. Sarah helps clear the fog.
What is ADHD?
Inaccurate information about ADHD can cause harm. The facts are important. ADHD is not a recently recognised condition – it was first documented in 1798.[2] ADHD is not simply a description of children who can’t sit still – it’s a lifelong condition and impacts many areas of life and functioning. Although ADHD affects behaviour – at its core, it is neurobiological. These distinctions are fundamental to understanding ADHD, particularly in adults.
Sarah explained some of the neurobiological features of ADHD, particularly in relation to the connections and functioning of the brain. In ADHD, differences are apparent in the control centre of the brain, the prefrontal cortex, which impact emotion regulation and attention regulation. Also, lower levels of dopamine in the brain can spur a person to seek various forms of stimulating activity that can quickly and effectively increase dopamine.
These differences are not derived from environmental influences, and they don’t stop after childhood; they are part of how the brain is wired.
How ADHD presents in adults[3]
An ADHD presentation in children often involves easily observable behaviours, but it can be harder to recognise in adults. It may present as:
- No time to stop: Hyperactivity internalises to become a “buzz”, an internal restlessness.
- Difficulty relaxing: A busy mind following a steady stream of unrelated thoughts.
- Procrastination: In ADHD, this functions to generate motivation, using the rising stress to launch into the task
- Organisation then over-whelm: Periods of intense compensation for ADHD, then periods of exhaustion. This can contribute to burnout.
- Time-agnosia: Underestimating how long a task will take to complete.
In her practice, Sarah has noticed that a late diagnosis can initially bring a strong grief reaction. The person wonders what life might have been like if they had received assistance years or even decades earlier. Moving forward requires them to rework their understanding of their brain and develop effective strategies and skills. Whether we are in that situation or supporting someone who is, it’s important to remember that this process will take time.
And it’s often complicated, because ADHD co-occurs with other neurodevelopmental and mental health conditions. Those diagnosed as adults may have spent all their lives managing or masking the various features of their ADHD. This compensatory behaviour has a particular link to secondary mental-health difficulties, especially when it has gone undetected until adulthood. The importance of diagnosis and support is apparent.
Medical and non-medical interventions
But what support can be offered? Sarah has observed that correct medication taken under supervision can be life-changing. This is best coupled with therapeutic (non-pharmacological) interventions including psychoeducation,[4] ADHD Coaching, Cognitive Behaviour Therapy (CBT) for ADHD, and Schema Therapy.[5] As important as these medical and therapeutic interventions are, Sarah believes more is required. She would love to see the community grow in understanding of ADHD which will facilitate the ability to provide effective care and support.
Neurodiverse-affirming language and practice
We are all aware of the shift in society away from the past negative treatment of people with differences. We can (and should) be part of this change! Christian believers have God-given reason to be neurodiversity-affirming: what God has created is richly diverse, and every person, irrespective of capacity, ability, or anything else, is equally precious as those made in his image. Sarah encourages us to give expression to these truths by using neurodiversity-affirming language and principles, as expressed in the tables below.
Neurodiversity-affirming language
| Neurodivergent | A person whose mental or neurological function differs from what is considered typical. E.g, a person with ADHD is neurodivergent (we do not say an individual is neurodiverse) |
| Neurodiversity | The range of differences in individual brain function and behavioural traits, regarded as part of the normal variation in the human population. Any group of people is neurodiverse – there is a range |
| Neurotype | A type of brain, in terms of how a person interprets and responds to the world. E.g. autism is one neurotype, while ADHD is another. |
| Neurotypical | Not displaying or characterised by neurologically atypical patterns of thought or behaviour |
Neurodiversity-affirming principles
| Avoid ableism | Ableism is social prejudice against people with disabilities based on the belief that typical abilities are normal or superior. It leads to “othering” or attempting to “fix” others. |
| Hear neurodivergent voices | Ensure neurodivergent individuals are involved as co-creators of their support; ask “what do you need?” |
| Use affirming language | This is where our respect is communicated. |
| Promote awareness of our own biases | We all have biases. They can be deeply harmful if not addressed. |
ADHD, faith, and the church[6]
Thankfully, awareness and advocacy around ADHD matters are increasing in the community and the church. More information is available than ever before, and, importantly, within the church there is less suspicion of psychological information and intervention.
And yet, Sarah believes that sometimes there are attitudes and assumptions in church life that can be harmful. In particular, she noted the culture in many churches of striving to be better, to do more, to try harder. The motive here can be admirable: we want to do well because we value what we’re doing in church and want to be faithful in serving God. However, when church culture overemphasises belonging based on consistency, timeliness, concentration, memorisation, and extensive engagement in rosters and activities, neurotypical individuals will immediately move to the cultural heart of church, while neurodivergent individuals will struggle. And in relation to those with ADHD, what if the wiring of a person’s brain makes it impossible for them to conform to these expected norms? Or the consequence of seeking to do so results in mental health repercussions?
Sarah encourages us all to be advocates for ourselves and those who are neurodivergent. We can all play a part: “Do I need to ask for, or be involved in a change?”; “How can I make sure my spiritual needs are met even if church is not an ideal environment for me?”; “What do we need to do to ensure that our church is welcoming and supportive across the full range of neurodiversity?”
Sarah also encouraged church leaders to speak of ADHD and other forms of neurodivergence at church. Naming an experience helps to normalise an experience and can contribute to a sense of belonging. And that is a wonderful thing, for all God’s children with all their differences are part of his family. We all belong.
Read Living with Adult ADHD – part 2, in which Kate summarises our interview with Rev. Simon Carter, giving an insight into his lived experience of Attention Deficit and Hyperactivity Disorder, or ADHD.
[1] https://www.smh.com.au/national/why-has-everyone-suddenly-got-adhd-20240214-p5f4rr.html
[2] Still, Sir G. F., The History of ADHD Part 1, The Lancet, written 1798, published 1902
[3] The DSM-5, 2022 identifies three possible presentations of ADHD: predominately hyperactive/impulsive type, predominantly inattentive type, or combined type.
[4] A useful tool is the Australian Evidence-Based Clinical Practice Guidelines for ADHD, 2022. https://adhdguideline.aadpa.com.au
[5] Ruth Holt has designed Schema Therapy resources for Christians. Holt, R., Schema Therapy for Christians, http://www.schematherapyforchristians.com/client-resources.html
[6] For a fuller consideration, see Brooke Hazelgrove, “How a late ADHD diagnosis is growing my understanding of God, faith and self” CCL, 21/02/24 https://ccl.moore.edu.au/resources/late-adhd-diagnosis-brooke-hazelgrove/
