Recognizing and Supporting ADHD as a Neurotype in Gender-Affirming Therapy

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Introduction: Rethinking ADHD as a Neurotype

ADHD is often misunderstood, especially when viewed through the traditional lens of disorder and pathology. As a Registered Psychotherapist and Board Certified Art Therapist with a diagnosis of non-hyperactive adult ADHD, I have experienced firsthand the unique challenges and strengths that come with this neurotype. Working with clients who share this wiring has deepened my understanding of how ADHD shapes our lives in ways that are far more complex than traditional diagnoses often capture.

Rather than viewing ADHD as a disorder in need of fixing, I see it as a distinct neurotype—one that is driven by interest, passion, novelty, urgency, and challenge. For those of us who thrive on these factors, the traditional reward-based and priority-driven frameworks of neurotypical brains don’t quite fit. We often find ourselves engaged when we’re fully immersed in something exciting, but we can struggle when the task at hand lacks these motivating elements. This perspective shift, recognizing ADHD as an interest-based brain wiring, opens the door to embracing our neurodivergence rather than pathologizing it.

This reframing is especially critical for trans*, nonbinary, and gender-expansive individuals, who often face additional barriers in accessing the support they need. These barriers aren’t just due to a lack of understanding about ADHD; societal biases and systemic inequalities in mental health care compound them. When we consider how gender socialization influences the recognition of ADHD, it becomes clear that many individuals, particularly those who are assigned female at birth (AFAB), may go undiagnosed for much of their lives due to masking and societal expectations.

In my practice, I frequently see the power of reframing ADHD for clients. Recognizing that their brain wiring is different, not deficient, can be a game-changer. For trans*, nonbinary, and gender-expansive clients, the journey of embracing their neurodivergence is often interwoven with their experiences of gender identity. Both journeys are about self-recognition, acceptance, and empowerment in the face of a world that may not fully understand or affirm their experiences.

This blog post will explore ADHD as a neurotype from an anti-oppressive lens, focusing on how gender socialization impacts recognition and support. We’ll dive into the importance of trans-inclusive approaches to ADHD neurotype recognition, practical applications for therapy, and ways to help clients feel empowered in embracing their neurodivergence.

Socialization and Gender Norms: How They Shape ADHD

For therapists working with gender-diverse clients, understanding how socialization affects the recognition of ADHD is crucial. AFAB (assigned female at birth) individuals, including cisgender women, nonbinary individuals, and trans masculine people, are often socialized to embody traits such as compliance, emotional regulation, and organization. These societal expectations can push AFAB individuals to mask their ADHD traits—traits like inattentiveness, impulsivity, or hyperactivity—in order to align with perceived “feminine” behavior norms. As a result, ADHD in AFAB individuals frequently goes unrecognized until later in life, as their neurodivergence is often overshadowed by the pressures to fit into societal molds (Steer & Berry, 2024; Maschke, 2024).

The masking of ADHD traits is particularly harmful because it reinforces feelings of inadequacy and self-doubt, as individuals are constantly managing the tension between their internal experiences and external expectations. Many clients I’ve worked with describe years of feeling “off” or misunderstood, not realizing that ADHD was the underlying cause. For therapists, recognizing this masking is key to providing the compassionate and personalized support that AFAB individuals need to feel seen and validated.

On the other hand, AMAB (assigned male at birth) individuals—cisgender men, nonbinary people, and trans feminine individuals—are often given more social leniency when displaying behaviors typically associated with ADHD, such as impulsivity or hyperactivity. From a young age, boys are often allowed to express more overt restlessness, and this can lead to earlier recognition of ADHD traits. However, this also reinforces rigid gender norms that frame impulsive behaviors as “normal” for boys while failing to account for the complexities of neurodivergence (Otsuka, 2023).

For AMAB individuals who later transition, these early socialization patterns can create additional layers of internal conflict. They may find themselves grappling with societal expectations tied to their assigned gender while also navigating their neurodivergence. Understanding how gender norms influence the way ADHD is recognized and experienced helps therapists take a nuanced approach, fostering deeper empathy and a more individualized path toward support.

By paying attention to these patterns of socialization, therapists can offer a more inclusive and anti-oppressive approach to working with clients across the gender spectrum. Each person’s experience with ADHD is shaped not only by their neurotype but also by the societal lens through which they were socialized. Recognizing these dynamics allows for a therapeutic approach that meets clients where they are, honoring both their gender identity and neurodivergence (Steer & Berry, 2024; Maschke, 2024).

The Importance of Trans-Inclusive ADHD Neurotype Recognition

Traditional diagnostic tools for ADHD often fail to account for the experiences of gender-diverse individuals. Many clinical settings still operate under binary assumptions, reinforcing the outdated notion that ADHD presents the same way in men and women. This binary thinking often leaves trans*, nonbinary, and gender-expansive individuals either overlooked or misdiagnosed. For instance, a trans woman may have been socialized as male, which influences both the expression of her ADHD and how she has learned to manage it over time. This dynamic requires a thoughtful and inclusive approach from therapists that goes beyond binary frameworks (Maschke, 2024; Otsuka, 2023).

An intersectional lens is crucial when recognizing ADHD in gender-diverse clients. Therapists must consider not only gender, but also how factors such as race, class, and access to healthcare intersect with neurodivergence. Many marginalized individuals face additional barriers to recognition and support due to systemic biases in healthcare. By using trauma-informed and anti-oppressive practices, therapists can avoid reinforcing these biases, which disproportionately harm already marginalized communities. This inclusive approach allows us to better recognize ADHD traits and provide more effective support, empowering clients to embrace their neurodivergence (Steer & Berry, 2024).

ADHD as a Neurotype: Moving Beyond the Pathology

ADHD is not a disorder that needs to be “fixed.” Instead, it is a neurotype—a natural variation in brain wiring that shapes how individuals engage with the world. As someone diagnosed with non-hyperactive adult ADHD, I see ADHD as an interest-driven neurotype, where motivation is sparked by factors like Interest, Novelty, Challenge, Urgency, or Passion (INCUP). This brain wiring contrasts with the priority-based, reward-driven motivation often seen in neurotypical individuals (Maschke, 2024).

For those of us with ADHD, the traditional frameworks of diagnosis and treatment often feel incomplete. They reduce our experiences to a set of symptoms—such as inattention or impulsivity—that are viewed through a deficit-based lens. This pathologizing language suggests that something is inherently wrong with our way of being. However, understanding ADHD as a neurotype shifts the focus from dysfunction to difference. This perspective allows us to embrace our brains for how they naturally function, rather than trying to force ourselves into neurotypical molds (Otsuka, 2023).

When we move beyond the pathology paradigm, we begin to celebrate the unique traits that often accompany the ADHD neurotype. Creativity, hyperfocus, adaptability, and a strong capacity for problem-solving are just a few of the strengths that ADHDers bring to the table. These traits are often overlooked in a clinical setting because the focus is typically on managing “symptoms” rather than nurturing strengths. By reframing ADHD as a different but equally valuable way of processing the world, we empower clients to develop self-compassion and take pride in their unique strengths (Steer & Berry, 2024).

This neurotype perspective can be particularly empowering for trans*, nonbinary, and gender-expansive clients, who may already face societal pressures to conform. Recognizing that their brain wiring is different—but not deficient—allows clients to challenge internalized stigma and embrace both their neurodivergence and their gender identity. In therapy, this shift can create space for clients to explore their full selves, fostering a sense of self-acceptance and resilience (Otsuka, 2023).

Working with clients who have ADHD requires us, as therapists, to hold space for their experiences in a way that acknowledges both the challenges and the gifts of this neurotype. It’s about moving away from deficit models and toward a strengths-based approach that aligns with the neurodiversity paradigm. When we do this, we not only support clients in managing their daily lives but also in thriving by embracing who they are at their core.

The Intersection of ADHD and Gender Incongruence

For many trans* and nonbinary individuals, the coexistence of ADHD and gender dysphoria can present complex and layered challenges. ADHD already makes navigating everyday life more difficult due to difficulties with focus, emotional regulation, and self-esteem. When compounded by the mental and emotional strain of gender dysphoria—especially in hostile or non-affirming environments—the challenges can feel overwhelming. Gender dysphoria, which involves a deep discomfort with one’s assigned gender at birth, adds another layer of stress to an ADHD brain that thrives on novelty, interest, and passion. This compounding stress often exacerbates ADHD traits, leading to heightened difficulties in concentration, mood regulation, and self-confidence (Maschke, 2024).

Living in a society that frequently invalidates or stigmatizes gender-diverse identities can create chronic stress for trans* and nonbinary clients. This lack of affirmation can lead to what some clients describe as a cycle of burnout, where the constant pressure to mask both their neurodivergence and their gender identity drains them of emotional and mental resources. This makes it harder to access the energy needed for task initiation, focus, or even engaging in self-care. The result is often a sense of deep frustration, isolation, and internalized shame—not only about their ADHD but also about their gender identity (Otsuka, 2023).

Therapists have a crucial role to play in breaking this cycle by validating both the ADHD neurotype and the client’s gender identity. Providing a space where clients feel fully seen and supported—where they don’t have to mask either their neurodivergence or their gender—is vital. Gender-affirming care combined with neurodivergent-affirming approaches can help clients feel a sense of acceptance for who they are, reducing the internalized stigma that many gender-diverse clients carry. This dual approach not only allows for deeper healing but also gives clients the tools they need to navigate a world that is often not built with their needs in mind (Steer & Berry, 2024).

By affirming both the client’s neurotype and gender identity, therapists can empower clients to live authentically without feeling they must choose between addressing their ADHD or their gender dysphoria. Instead, both can be embraced as integral parts of who they are, leading to greater self-compassion and resilience in the face of societal pressures.

Social and Environmental Factors: Beyond Biology

ADHD is not simply a matter of brain chemistry; it’s profoundly shaped by the environments we live in and the societal systems we navigate. Cultural expectations, socioeconomic status, and access to gender-affirming healthcare all influence how ADHD is recognized and supported in individuals. For many clients, especially those who are trans*, nonbinary, or gender-expansive, these environmental factors can complicate their experience of ADHD. The trauma of discrimination, marginalization, and living in a world that invalidates their gender identity often compounds the challenges of ADHD, making it more difficult to manage symptoms like inattention, emotional dysregulation, and impulsivity (Maschke, 2024).

Trauma-informed care is essential for understanding how these external factors contribute to distress. Many clients with ADHD have experienced ongoing trauma—not only from their neurodivergence but also from navigating a society that stigmatizes their gender identity. This intersection of trauma and ADHD requires a careful, thoughtful approach to therapy. Recognizing how past and present traumas shape ADHD traits enables therapists to provide more holistic care that goes beyond symptom management. Instead, it focuses on healing the root causes of distress while affirming both the client’s neurodivergence and gender identity (Steer & Berry, 2024).

Societal pressures to conform to binary gender norms also play a significant role in exacerbating the challenges faced by individuals with ADHD. For many gender-diverse clients, the expectations placed on them to “fit in” with traditional gender roles can create additional layers of stress and shame. These pressures often lead to masking—both of neurodivergent traits and gender identity—which can take a toll on mental health and overall well-being. As therapists, it’s our responsibility to create a safe and inclusive environment where clients feel empowered to explore both their gender identity and their neurodivergence without judgment (Otsuka, 2023).

By providing a space where clients can bring their full selves into the therapeutic relationship, we help dismantle the societal norms that marginalize them. In doing so, we enable clients to access the support they need to navigate both ADHD and the broader social challenges they face. This approach is not just about recognizing ADHD as a neurotype—it’s about recognizing the whole person and their lived experience, which is deeply shaped by social, cultural, and environmental factors.

Inclusive ADHD Support Approaches in Gender-Affirming Therapy

Creating an inclusive therapeutic space is essential for supporting clients with ADHD, particularly those who are trans*, nonbinary, or gender-expansive. Inclusive care goes beyond merely recognizing a client’s neurodivergence—it means actively affirming both their ADHD neurotype and their gender identity. This dual affirmation allows clients to feel fully seen and supported, creating a foundation for deeper therapeutic work. For therapists, this begins with using gender-affirming language and providing a safe, judgment-free space where clients can explore the intersections of their ADHD and gender without fear of invalidation (Otsuka, 2023).

Individualized treatment plans are crucial because ADHD manifests differently in every person. Gender-diverse clients may face unique challenges that require tailored approaches. Some clients might find it helpful to engage in body-centered therapies, such as somatic therapy or Sensorimotor Psychotherapy, which allow them to reconnect with their bodies and explore how their ADHD neurotype influences their felt sense of identity. These approaches can be particularly empowering for clients who have spent years masking their traits, helping them build a more authentic relationship with both their neurodivergence and gender identity (Maschke, 2024).

Other clients may find validation and healing in community-building or creative outlets. For some, connecting with ADHD or queer-affirming support groups provides a sense of belonging that can counter the isolation they may have felt in other areas of their life. Creativity is also a powerful tool for many neurodivergent individuals, allowing them to channel their energy and focus into projects that ignite their passion and imagination. Whether it’s through art, writing, or other forms of expression, creative outlets can serve as a space for clients to explore their identity, process their emotions, and celebrate their unique strengths (Steer & Berry, 2024).

Ultimately, the goal of gender-affirming therapy for clients with ADHD is to co-create a therapeutic approach that feels supportive, flexible, and attuned to the client’s individual needs. This includes recognizing the multifaceted ways ADHD and gender identity intersect, and offering tools and strategies that honor both. By affirming neurodivergence and gender, therapists can help clients navigate the complexities of their lived experiences while fostering a deeper sense of self-acceptance and empowerment (Otsuka, 2023).

Helping Clients Feel Recognized and Connected to Their ADHD Neurotype

One of the most empowering things we can do as therapists is to help clients feel deeply recognized and connected to their ADHD neurotype. The first step in this process is to shift the narrative from one of fixing or “managing” ADHD to embracing it as a core part of who they are. ADHD is not a flaw, nor is it something to be “cured.” Instead, it’s a neurotype that offers unique strengths and perspectives. By encouraging clients to reflect on their abilities—whether it’s their creativity, problem-solving skills, or resilience in the face of societal challenges—we can help them see the inherent value in their neurodivergence (Maschke, 2024).

For many clients, particularly those who are also navigating complex gender identities, this reframing can be transformative. Often, gender-diverse clients come to therapy with layers of internalized stigma, both from the ways society views ADHD and the ways it perceives gender nonconformity. As therapists, we can provide a space where clients feel fully seen for all aspects of their identity. By validating both their neurotype and their gender, we give clients permission to embrace their full, authentic selves, fostering a greater sense of self-acceptance and confidence (Otsuka, 2023).

Building a sense of community is also a powerful tool in helping clients feel connected to their ADHD neurotype. Many ADHDers find solace in connecting with others who share similar experiences. Peer support groups, whether ADHD-specific or for gender-diverse individuals, can provide a vital space for clients to feel validated in both their neurodivergence and their gender identity. These communities offer an opportunity for clients to share their experiences, strategies, and insights in a non-judgmental environment, where they can draw strength from knowing they are not alone in their journey (Steer & Berry, 2024).

In therapy, encouraging clients to seek out or participate in these types of support networks can be a key part of their healing process. It reinforces the idea that their ADHD is not a burden but a source of connection and strength—one that can be celebrated alongside their gender identity. By helping clients build these connections, we foster resilience, empowerment, and a sense of belonging that is crucial to their mental health and overall well-being (Otsuka, 2023).

Conclusion: Embracing Neurodivergence and Gender Diversity in ADHD

ADHD is a neurotype, not a disorder. For therapists working with trans*, nonbinary, and queer clients, it’s essential to recognize and honor the interplay between neurodivergence and gender identity. By adopting an anti-oppressive and gender-affirming framework, we create a space where clients can embrace their ADHD neurotype, not as something to be managed or corrected, but as an integral part of who they are. This approach fosters empowerment by affirming both their unique ways of thinking and their authentic selves.

When we help clients see their ADHD as a source of strength—whether it’s through creativity, problem-solving, or resilience—we’re not just supporting their mental health. We are fostering a deep sense of self-acceptance that helps them navigate the world with confidence. In embracing both their neurodivergence and gender identity, our clients can experience the liberation of being seen, heard, and valued in all aspects of who they are.

Continue the Convo

If the ideas in this blog resonate with you, I warmly invite you to connect with me. Whether you’re a therapist seeking to enhance your understanding of gender-affirming therapy, or someone navigating the complexities of ADHD and gender identity and looking for support, I’m here to help. You may book individual therapy sessions or peer consultations online. Be sure to bookmark this blog for future insights, reflections, and updates.

References

Maschke, J. (2024). A Feminist’s Guide to ADHD. Watkins Media Limited.

Kelley, A. (2024). Powered by ADHD. Penguin Random House LLC.

Steer, J. & Berry, C. (2024). Understanding ADHD in Girls. Achieving for Children Publications.

Otsuka, T. (2023). ADHD for Smart Ass Women. Headline Publishing Group.

Disclaimer: This blog offers general educational information and does not constitute professional advice or establish a therapist-client relationship. Please consult a healthcare provider for personalized guidance. Any decisions based on the content are the reader’s responsibility, and Clayre Sessoms Psychotherapy assumes no liability. All case studies are hypothetical with fictional names and do not reflect actual people. We prioritize your privacy and the confidentiality of all of our clients. We are committed to maintaining a safe, supportive space for 2SLGBTQIA+ community care.

Clayre Sessoms is a trans, queer, and neurodivergent Registered Psychotherapist (RP), Certified Sensorimotor Psychotherapist, and Board Certified Art Therapist (ATR-BC), offering online therapy for trans*, nonbinary, queer, and 2SLGBTQIA+ allied adults and teens across Canada. With a deep commitment to trauma-attuned gender-affirming care, Clayre integrates talk therapy, experiential collaboration, and creative expression to support clients to grow, heal, or navigate change. When not working with clients or supervising newly-licensed therapists, Clayre finds solace in nature, where she recharges her creativity and compassion.

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