Longitudinal clinical relationships offer significant advantages in diagnosing ADHD, allowing therapists to develop a nuanced understanding of their clients' struggles over time. Research by Drechsler et al. (2020) confirms that this approach yields more accurate diagnostic insights compared to brief assessment sessions1. By getting to know clients closely, therapists can carefully discern whether ADHD symptoms are present and how they impact the individual's life, leading to more informed and personalized treatment plans.

Unrecognized ADHD can significantly impede therapeutic progress, leading to treatment resistance in therapy for depression and anxiety, as demonstrated by Leahy and Holland (2020)1. Emotional dysregulation, a core feature of ADHD identified by Shaw et al. (2014), often manifests as heightened reactivity, sensitivity, and misinterpretation of information, creating challenges in therapeutic settings1. Addressing these underlying neurodiversity issues is crucial for breaking out of "therapeutic loops" and enabling clients to make meaningful progress in their mental health journey.

Pharmacological interventions can create a "therapeutic window" where psychological treatments become more effective for individuals with ADHD, as confirmed by recent research from Stern et al. (2022)1. This medication-induced state often brings less overwhelm, allowing clients to engage more fully in therapy by accessing calmness, clarity, perspective, and courage. Meta-analyses by Cortese et al. (2018) have demonstrated that pharmacological treatment significantly improves therapeutic engagement and outcomes, enabling clients to more readily access their internal resources during therapy sessions1.

Discerning ADHD symptoms from trauma responses presents a significant challenge for therapists due to symptom overlap. Recent work by Stein et al. (2023) provides clinical guidelines for differentiating between these conditions, emphasizing the importance of careful assessment1. Therapists must consider whether struggles stem from traumatic environments or ADHD combined with environmental factors. This distinction is crucial for tailoring effective treatment approaches and avoiding misdiagnosis.

Key considerations include:

• Distinguishing procrastination from dissociative checking out

• Differentiating anxious guarding and heightened nervous system in trauma from the state of urgency and impatience associated with ADHD

• Recognizing that both conditions can coexist, requiring a nuanced understanding of their interplay