Rethinking Attention in Adult ADHD: Not Just a Deficit

What is it about?

This paper explores a question many clinicians encounter but may find difficult to think about in psychological or therapeutic terms: what does attention mean in adult ADHD? While ADHD is often understood in neurobiological or cognitive terms, some attentional difficulties seen in psychotherapy appear closely linked to emotional and relational experience. In particular, attention may break down at moments of emotional closeness, interpersonal expectation or demand, or when a person feels themselves to be the focus of another’s attention. Drawing on a composite clinical vignette (a fictionalised account based on recurring patterns across multiple patients), I suggest that in some adults diagnosed with ADHD, inattention can function as a way of regulating overwhelming emotional or relational experience, rather than reflecting a fixed difficulty in attention or executive functioning. These patterns are often described in psychoanalysis as “schizoid” ways of coping, not as a distinct clinical category, but as an underlying psychological organisation in which withdrawal helps manage a tension between a wish for connection and a fear of being emotionally overwhelmed or intruded upon. The paper integrates ideas from object relations theory, particularly the work of Wilfred Bion, with contemporary observations about the pressures on attention in digital life. It does not propose abandoning neurodevelopmental models of ADHD, but offers a complementary lens through which some attentional difficulties may reflect problems in sustaining emotional meaning, within core psychological processes sometimes described in psychoanalysis as “symbolization”. This perspective may also help clarify presentations often described as involving both autism and ADHD (“AuDHD”), where the relationship between these features remains debated, and where attentional patterns, withdrawal, and overstimulation may carry different psychological meanings. The paper’s aim is to offer clinicians a way of thinking about adult ADHD that includes, but is not limited to, neurocognitive explanations, and to support analytic and psychotherapeutic work with patients whose attention may fluctuate under relational pressures and interpersonal demands.

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Photo by Yang Deng on Unsplash

Photo by Yang Deng on Unsplash

Why is it important?

Adult ADHD is increasingly encountered across psychotherapy, psychiatry, and everyday clinical practice, yet it is often understood primarily in neurodevelopmental or biomedical terms. This can leave clinicians with limited ways of thinking about the emotional and relational dimensions of attention, particularly when presentations do not fully fit standard models. This paper offers a complementary perspective, suggesting that in some cases attentional difficulties may reflect how the mind manages relational pressure, emotional intensity, and the demands of being in contact with others. By bringing psychoanalytic ideas into dialogue with contemporary understandings of ADHD, it aims to expand how clinicians recognise and work with these patterns in practice. In a cultural context where diagnoses such as ADHD and autism are becoming increasingly common, and where their overlap is widely debated, this perspective may help clarify differences in meaning and experience that are not always captured by diagnostic frameworks alone. More broadly, the paper contributes to ongoing efforts to build dialogue between psychological, psychoanalytic, and neurodevelopmental approaches, offering a way of thinking that does not require choosing between them.

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