How does ADHD affect people?

ADHD is a condition which affects your neural wiring, affecting your ability to maintain focus and / or how impulsive you are. However, this condition presents uniquely in each individual. There is no cookie-cutter mold that tells you exactly how someone with ADHD will look.

For years, the stereotypical face of ADHD has been of rowdy boys who can’t sit still and disrupt the classroom environment.

“ADHD isn’t always loud. The hyperactive ADHDer under 12 years old is often easily identified, but the little girl daydreaming is missed,” says naturopathic doctor, Monica Xu.

The majority of studies on ADHD have been on this demographic - but with rising rates of diagnosis among young women, and people who don’t fit the typical depiction of ADHD - it’s clear the picture is much more broad. It includes the woman struggling to keep up with her endless to-do list, the man with endless alarms to try and remember his appointments, overworking to make up for distraction during the work day, the girl labelled by her teachers as a daydreamer.

“Someone with the inattentive type of ADHD might be quiet, and therefore easily missed. ADHD in women is underdiagnosed,” Monica adds.

As Dr Stephen Shore says, “If you’ve met one person with autism, you’ve met one person with autism.” The same principle applies to people with ADHD. The challenges of neurodiverse people are varied. You can imagine these challenges as coloured balls of varying sizes and colours in a bucket. Different colours represent different challenges – like social skills, ability to focus, impulsivity or sensory sensitivity.

This principle is called ‘Wrong Coloured Balls’ and was created by Do-IT, a company providing tools for screening neurodiversity.

Some people may only have one purple ball; others may have nine, and more balls indicate a more severe challenge. More balls also equal a more visible challenge.

Some people face difficulty getting diagnosed because they don’t have enough visible balls to meet the criteria, which may be a result of masking ADHD. This results in a system and society that fails people who have multiple needs when those needs don’t meet a specific threshold of visibility. These people are often left treading water, without diagnosis, support or understanding.

What are the types of ADHD?

There are three different types of ADHD: inattentive, hyperactive-impulsive, and combined – those who exhibit symptoms of both the inattentive and hyperactive subtypes.

Oxford CBT cites that women and girls are more likely to have ‘quiet ADHD’ – the inattentive subtype.

People with the inattentive form may seem calm on the outside, but their inner world is whirling with overwhelm. They’re more likely to be diagnosed later and have mental health conditions like anxiety or depression.

Research into ADHD has historically been weighted towards boys, and boys are twice as likely to be diagnosed – 10% of boys are diagnosed with ADHD, compared to 5% of girls. Women and girls are often underdiagnosed, diagnosed later, or misdiagnosed with anxiety or mood disorders like bipolar.

What are the symptoms of inattentive ADHD?

DSM-5 recognised challenges of the inattentive subtype of ADHD include
-          being easily distracted.
-          frequently overlooking details.
-          often not seeming to be listening, even when there is no clear distraction.
-          struggling to complete tasks.
-          struggling to break down or organise tasks.
-          often avoiding tasks that require sustained or complex mental effort.
-          often losing things.
-          often forgetting to do daily tasks – like keeping appointments or doing chores.

What are the symptoms of hyperactive ADHD?

DSM-5 traits of hyperactive- impulsive ADHD are
-          fidgeting.
-          don't stay seated when they are expected to – like in a meeting, or at school.
-          running around when they’re supposed to stay still – as you get older, this might be a trait you learn to mask, and manifest itself as feeling restless.
-          often loud when speaking.
-          struggles to stop or rest – as though they are spurred on by a motor.
-          talking a lot.
-          interrupting.
-          struggling to wait their turn.
-          interfering with what others are doing – taking control of games, or what someone else is doing.

Children with the combined subtype of ADHD must demonstrate 6 symptoms in each category. Adults must demonstrate 5 symptoms in each category and symptoms must also have been present before the age of 12.

People with hyperactive-impulsive subtype are more likely to be boys or men, and diagnosed in early childhood. They’re more likely to exhibit defiance towards authority figures like parents or teachers – sometimes known as ODD (oppositional defiant disorder). Some may have conduct disorder, which is characterised by rule-breaking behaviours which disregard others’ boundaries.

There are shared traits between the three different sub-types. People with any kind of ADHD often have difficulties with sleep, sensory processing, self-esteem, executive function (ability to plan, focus and multitask) and memory.

People with ADHD are more likely to experience mental health conditions. Rejection sensitivity (intense emotional pain when you think you’ve been rejected) is common among people who have ADHD.

ADHD traits or challenges may not always be visible – not just because there are less balls in their bucket, but because the individual is very good at making their balls seem invisible. This phenomenon is called masking -  when you hide ADHD or neurodivergent traits.

It may be unconscious or conscious, and is more common in women and girls than in boys and men, because of the societal pressures women and girls are subject to.

Can you have ADHD and autism at the same time?

Studies show that 21% of kids with ADHD meet the criteria for autism. These two conditions present internal conflict for those who have both diagnoses - also known as AuDHD.

It was only in 2013 that it was officially recognised that ADHD and autism could co-occur. Before this, the DSM-5, the manual which dictates the criteria for diagnosis, did not allow an ADHD diagnosis if someone was already diagnosed with autism.

Research shows that the symptoms of AuDHD are likely to be more severe than someone who has a single diagnosis.

“Autistic traits, like a desire for routine or rule following might come into conflict with ADHD qualities that seek spontaneity or lean into rule-breaking. The brain fights against itself in AuDHD as different needs collide,” says naturopathic doctor Benita Perch.

AuDHD individuals might experience heightened levels of traits which ADHD and autism share, like hyperfocus, social difficulties, sensory problems, rejection sensitivity, sleeping problems and emotional dysregulation. They may also struggle to identify internal states like tiredness or hunger.

People with AuDHD may struggle to understand the interplay of ADHD and autistic symptoms within themselves.

What affects executive function in ADHD?

On an individual level, your executive function may oscillate dramatically. Physical factors like sleep, gut health, toxin levels, and in women - hormonal changes can all influence ADHD.

25-50% of people with ADHD have sleeping problems – whether that’s trouble drifting off, staying asleep, or getting enough quality REM time. It could also look like having diagnosed sleep conditions. Studies show that sleeping problems in individuals with ADHD affect their memory and ability to concentrate during the day. Even neurotypical adults are more likely to report ADHD-like symptoms if they’re not getting enough sleep.

Recent research has shown that the balance of good and bad bacteria in your gut (also known as your gut microbiome) plays a role in ADHD symptoms. Your gut and brain work on a bidirectional axis, and both affect one another. Excessive levels of bad bacteria in the gut (also known as dysbiosis) are known to cause brain fog, mood problems and memory problems – all problems which tend to affect those with ADHD.

“Disruptions to your microbiome lead to neuroinflammation, which affects hyperactivity and your ability to concentrate,” says Dr Benita.

“This is why food choices really matter for people with ADHD. If you’re eating a lot of sugar or white carbs like bread or pasta, you’re feeding your microbiome with the things that will lead to imbalance and more intense symptoms. Eating foods you’re intolerant to can also contribute to neuroinflammation. On the flip side, if you increase your intake of fish free from heavy metals, and foods rich in polyphenols - like fresh fruits and vegetables, you can support your gut microbiome balance,” Benita adds.

Hormonal fluctuations throughout your menstrual cycle are also a key player in ADHD symptoms. Oestrogen can increase dopamine and serotonin – the two neurotransmitters that are imbalanced in ADHD. Lower oestrogen levels in women, which occur after ovulation, after birth or at menopause can cause an increase in ADHD symptoms. Hormonal imbalances outside of these natural shifts might be indicated by irregular periods, weight changes or skin problems.

After genetics, exposure to environmental toxins (particularly lead) and air pollution have been shown to be a major factor in the development of ADHD. There hasn’t been enough research into the short term effects of high toxic load on ADHD in adulthood, but studies on children have shown an increase in ADHD symptoms when consuming more additives in foods.

“Toxins like mould, pm 2.5 (air pollution) and heavy metals contribute to neuroinflammation, which leads to brain fog and difficulty concentrating. We can test you for these toxins to confirm whether or not your body is under stress due to toxic load,” says Benita.

And for those with AuDHD, these physical factors affect autism as well as ADHD.

Diagnosis & testing physical factors that contribute to ADHD

Our clinical psychologists, psychotherapists and counsellors can support you as you integrate your understanding of how your neurodiversity intersects with your identity.

Maybe you’ve been feeling like your struggles are invisible. Maybe you work so hard at masking your ADHD that you’re burnt out. Perhaps you’re navigating the difficulties of raising a neurodivergent child. Our talk therapists provide a protected space for you to explore your feelings, understand yourself better and foster greater self-compassion.

If there’s been a shift in your ADHD symptoms, our naturopaths can help identify health issues which may be contributing. They complete a thorough assessment of your symptoms, and use industry-leading tests to confirm which physical factors are at play.

References
G Ayano, The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses, 2023
N Nussbaum, ADHD and female specific concerns: a review of the literature and clinical implications, 2012
Do-IT, ‘Coloured Balls in a Bucket’ – The Inspiration Behind our New Logo, 2021
Neurodivergent insights, The ADHD Subtypes
Oxford CBT, ADHD Masking, 2025
Very well mind, What does ADHD masking look like? 2024
Ellen Littman, Women with ADHD: No more suffering in silence, 2025
J Hollingdale, Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analytical review, 2019
Autistica, ADHD and autism
D Wajszilber et al, Sleep disorders in patients with ADHD: impact and management challenges, 2018.
A Shamshad et al, Association between ambient air pollution and attention-deficit/hyperactivity disorder (ADHD) in children: a systematic review and meta-analysis, 2024.
A Checa-Ros et al, Current evidence on the role of the gut microbiome in ADHD pathophysiology and therapeutic interventions, 2021.