Stefanie Hagger

Introduction

ADHD is often described as a neurodevelopmental condition marked by inattention, hyperactivity, and impulsivity. As a clinical registered counsellor, I’ve worked with many individuals, young people, parents, and adults who carry this diagnosis. Over time, I have come to see that the textbook version of ADHD doesn’t always match what people actually live through.

My role is not to diagnose, but to listen and support. And in doing so, I’ve started to ask a deeper question: is ADHD always a disorder, or could it also reflect a different way of thinking that doesn’t quite fit within traditional systems?

An estimated 814,000 or more Australians live with ADHD, including more than 280,000 children and around half a million adults, according to a 2019 report by Deloitte. Diagnoses are more common in children (around 4.1 per cent for those aged 0–14), and slightly lower in adults (around 3.0 per cent), and males are more frequently diagnosed than females. These numbers give us a sense of scale, but they don’t capture the lived experience, the day-to-day challenges and strengths that often go unseen.

This piece is a reflection from practice. I explore how ADHD may sometimes function as both a disorder and a difference and why viewing it through only one lens might be limiting. I’ll also touch on ethical concerns, including how cultural background, parental experience, and clinical assessment can shape what gets noticed and what doesn’t.

Seeing Two Sides: Disorder and Difference

ADHD is generally understood as a disorder. The DSM-5 describes it in terms of ongoing patterns that interfere with functioning (American Psychiatric Association, 2013). In many cases, this is accurate, especially when symptoms impact learning, relationships, or emotional well-being. But sometimes what we call ADHD looks more like a different cognitive style, not a dysfunction.

I have met clients who are intensely creative, energetic, and quick to problem-solve. They don’t struggle because they are incapable; they struggle because the systems around them reward a narrow kind of focus and behaviour. In the right environment, they often thrive.

I sometimes use a GPS metaphor in sessions. Most people follow the fastest route. But when a road is blocked, some panic. Others calmly re-enter the address and find a different way. That ability to re-route, that mental flexibility, is something I see often in clients with ADHD. It’s not about being lost – it’s about having a different internal compass.

For many, a diagnosis brings relief and clarity. But it can also carry stigma or reduce identity to a checklist of deficits. By exploring both the challenges and the strengths, we can tailor support in a way that respects each person’s unique way of thinking.

Context Is Everything: The Limits of Diagnosis

ADHD doesn’t show up in isolation: a child who fidgets in a strict classroom might thrive in a hands-on learning space; a teen who forgets assignments may excel when given autonomy. Factors like family stress, trauma history, school environment, and culture all play a part in how ADHD presents.

Current assessments often focus on what’s not working, such as inattention, impulsivity, and disorganisation. But they rarely ask about adaptability, creativity, emotional insight, or environmental fit. That limited scope risks missing key parts of the picture.

Instead of asking only what’s wrong, we should also ask what’s working. Where does the person succeed? What kinds of tasks light them up? And are their difficulties rooted in neurobiology or in a mismatch between them and their setting?

In Practice: Looking Beyond Symptoms

One of my clients is a 16-year-old girl with an ADHD diagnosis. She does well in school, has friends, plays sport, and is deeply creative. She also struggles with body image and is anxious about reducing her stimulant medication because of how it affects her appetite.

In many ways, she reflects typical adolescent development. But she also faces real challenges tied to both her diagnosis and her stage of life. It’s a reminder that ADHD traits don’t exist in a vacuum: they are shaped by culture, gender, family dynamics, and personal history.

Medication can help with focus, but it can also affect mood, appetite, and identity. In this case, care needs to be holistic supporting mental health, physical health, and self-image, not just attention span.

Strengths-based framing is also essential. Focusing only on what’s hard can feed shame. Helping clients recognise their talents and reframe their experiences often builds confidence and motivation.

Ethical Reflections in Assessment

Labels carry weight. Diagnosing ADHD can open doors to support, but it can also narrow how someone sees themselves. It’s important to ask: are we responding to genuine impairment, or simply to a different way of functioning that doesn’t align with certain systems?

Assessment tools like the WFIRS-S or Conners 4 are useful, but not always clear to families. They are often completed via email, with little guidance. In sessions, I’ve supported teens through these forms, not to influence outcomes, but to make sure they understand the questions. Parents have told me this process gives them peace of mind.

In the education system, teachers might see only one side of a student, and school reports can miss strengths in art, sport, or other domains. When results are conflicting, families may feel guilt or confusion. Some parents also recognise their own traits in their child, which can bring up unresolved feelings.

Language, culture, and literacy also affect assessment. Many tools assume fluency in English and familiarity with psychological concepts. For families from diverse backgrounds, or for young people with low literacy, this creates barriers. Wherever possible, assessments should be supported in-session to ensure clarity and fairness.

Ethical care is about more than accuracy, it’s about respect, empathy, and cultural awareness.

Looking Ahead

There’s still so much we don’t fully understand about ADHD and the many ways it shows up in people’s lives. It doesn’t exist in a vacuum; it’s shaped by the worlds people live in their gender, culture, family, trauma history, and learning environments. These layers all influence how traits are expressed and how they’re understood by others.

We also need to broaden how we think about ADHD. Too often, the focus stays on impairment, what’s not working, rather than on adaptation or strength. Many people find creative ways to manage their attention, energy, and focus, often developing skills that go unnoticed because they fall outside what’s considered “typical”. Medication can be an important part of care, but it can also affect self-image, especially for young women navigating complex changes in identity and body.

As counsellors, we stand at the crossroads between research and lived experience. Listening deeply to our clients and reflecting on what we notice in practice helps us see beyond diagnostic labels. These moments, when someone’s story challenges what the textbooks say, are often where the most meaningful insights appear.

Research is starting to echo what many clinicians and clients have observed for years. For instance, a recent study by Tapia et al. (2024) found significant disparities in ADHD diagnoses across gender and racial groups, suggesting that environment and identity can shape not only how ADHD is experienced but also whether it’s recognised at all. Studies like this remind us that ADHD isn’t one thing; it’s lived and expressed differently depending on context.

There’s still much to learn. By asking not just what’s wrong but also what’s working, we can help build a more complete understanding; one that honours both the challenges and the strengths. In doing so, we move closer to care that is curious, compassionate, and grounded in the realities of people’s lives.

Conclusion

ADHD can be a disorder. It can also be a difference. It depends on how it shows up, where, and for whom.

As counsellors, our work is to notice patterns, but also people. To move beyond a checklist and listen for the story beneath. A diagnosis has value, but only when paired with curiosity, context, and care. When we look at strengths as well as struggles, when we respect cultural and emotional complexity, and when we question rigid models, we offer something far more meaningful than labels: we offer understanding.

These reflections continue to shape my practice, how I listen, how I support, and how I hold space for the many ways ADHD can be lived.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders, 5(5). https://doi.org/10.1176/appi.books.9780890425596

Deloitte Access Economics (2019). The social and economic costs of ADHD in
Australia. https://aadpa.com.au/wp-content/uploads/2019/07/Economic-Cost-of-ADHD-To-Australia.pdf

Tapia, J. D., Sparber, A., Lopez, O., et al. (2024). Racial and gender disparities in community mental health centre diagnoses of adolescent ADHD and comorbidities: A mixed methods investigation. Journal of Child and Family Studies, 33(10), 3472–3485. https://doi.org/10.1007/s10826-024-02857-4

Author Biography

Stefanie Hagger is the founder and a clinically registered counsellor at Stress Therapy Australia, working with teens, adults, and families across the lifespan. Her practice is grounded in contextual, strengths-based care that honours identity, lived experience, and individual differences. While not limited to neurodivergent clients, Stefanie supports those navigating ADHD and related challenges with ethical, inclusive care. She holds clinical registration with both ACA and PACFA and is currently exploring doctoral research in neurodiversity and clinical ethics.