Working with young adults who are navigating ADHD is rarely straightforward. They’re often dealing with more than just distractibility or missed deadlines. There’s anxiety, identity shifts, life transitions, and sometimes a long history of feeling misunderstood. This isn’t about checking boxes on a symptom list, it’s about understanding how their brain, their environment, and their story all interact. Today, we’re going to unpack that. 

Published On: 10/27/2025

Duration:  16 minutes, 14 seconds

Transcript:

GENEVA VALESKA: Before we dive in today, I just want to say working with young adults who are navigating ADHD is rarely straightforward. They're often dealing with more than just distractibility or missed deadlines. There is anxiety, identity shifts, life transitions, and sometimes a long history of feeling misunderstood. This is not about checking boxes on a symptom list. It's about understanding how their brain, their environment, and their story all interact. Today, we are going to unpack that.  

JOSH FEDER: I am Dr. Josh Feder, editor-in-chief of The Carlat Child Psychiatry Report and co-author of The Child Medication Fact Book for Psychiatric Practice, Second Edition (2023), as well as Prescribing Psychotropics.

GENEVA VALESKA: And I am Geneva Valeska, a graduate with a degree in neuroscience and cognitive science, and a podcast coordinator here at The Carlat Report. As I mentioned at the start of today’s episode, we are focusing on ADHD in young adults, not just the diagnosis itself, but how it shows up in real life, college, work, relationships, and how we can support that transition into adult routines.

JOSH FEDER: Let's start with the question we get all the time: Do I have ADHD, or am I just overwhelmed?  

GENEVA VALESKA: It's a good one. Clinicians may want to start by asking, What's behind the inattention? Are they sleeping? Are they anxious? Are they recovering from something like grief, a breakup, or burnout?

JOSH FEDER: Great points, Geneva. Never assume that inattention means ADHD. Instead, ask about patterns when it started, whether it showed up in childhood, and how it affects their day-to-day life. You might bring in neuropsych testing if things are unclear, but even without it, clinical interviewing gives us a lot, and remember, these are clinical diagnoses. Testing helps, but it doesn't make the diagnosis. 

GENEVA VALESKA: And try to keep trauma and depression on your radar. We've seen young adults who could not concentrate at all, and it turns out they were dealing with untreated PTSD or just constant stress. ADHD gets a lot of attention, but it is rarely the whole story,  

JOSH FEDER: Right. Focus on what their attention looks like across settings, across school, work, relationships, and also on how these people manage time, how they organize or have trouble organizing, and how they deal with responsibilities that don't come with deadlines. In my general clinical practice, I see so many people with ADHD, and it is often mixed with all kinds of other things going on. So depressed and ADHD, autistic with ADHD, anxiety disorders with ADHD, it is pretty darn pervasive, and we need to tease out these different parts of it and really get that individual story about what life is like, trying to see the world through the person's eyes, hearing their story of their life. 

GENEVA VALESKA: So, once we figure out ADHD is part of the picture, what happens next for you? 

JOSH FEDER: I work with a young adult to put together a plan that pulls in more than just medications. Ask what kind of support helps them follow through, maybe a coach, a tutor. Sometimes, a structured therapy like cognitive behavioral therapy or executive function work is very helpful.  

GENEVA VALESKA: It may be helpful to talk to clients about structure, not in a rigid way, but as scaffolding. Like, what's in place to help you stay on track when motivation drops? That could be reminders, alarms, shared calendars, or even roommates who nudge them.  

JOSH FEDER: And then check for other layers if they're also anxious or depressed, that's going to affect how ADHD shows up. Adjust the treatment, depending on what else is going on. Sometimes antidepressants help, sometimes therapy creates more impact than medication can do. I've seen this often, right? So you see somebody that come in, they can't focus, and then you determine actually it's the depression or the anxiety, and when you treat that, it gets better. But lots of times there's still ADHD. I'm thinking about somebody right now who I've been treating for depression for a while, and they're not keeping up with their work. But we're taking another look at ADHD, I'm actually asking for some additional testing, right? Hopefully, it'll help me tease out what's going on and whether it makes sense, for instance, to do a stimulant trial with that person. The other thing that we're all always looking for are learning differences, because those make you inattentive and can make you anxious or depressed or whatever as well; it can really be discouraging.  

GENEVA VALESKA: Let's talk executive function, that's where the breakdown often happens. Not attention, but planning, prioritizing, and self-monitoring.  

JOSH FEDER: And we see it most clearly when someone moves from high school into college or work, that external structure just drops away, no one's checking if you went to class or if you studied for the exam that's six weeks away.  

GENEVA VALESKA: And for the folks who don't go to college, it's still the same issue. At work, they are expected to manage their own tasks, show up on time, and not miss steps, but no one is giving them a behavior plan or a parent check-in. 

JOSH FEDER: So you may want to talk about ways to rebuild that scaffolding, whether it's an accountability buddy, a therapist, a coach, or even just better sleep and routines. A lot of this isn't about willpower; it's about having systems that match how the brain works. So a great example is when in college, you can sometimes use the student disability services as a place to check in, maybe once a week, and track how your progress is going with projects, with other classwork. The other thing that can be really helpful is meeting with friends to study on a regular basis. So if you have a study group, you're more likely to work together, to get work done, to bounce ideas off each other, as long as you don't get distracted doing other things together, but so often being part of a social group that's bent on studying makes a very positive difference.  

GENEVA VALESKA: Something providers might want to consider is talking with families about how to support without micromanaging. There's this urge to control everything when a young adult is struggling.  

JOSH FEDER: On the other end, some families pull back too fast. I usually recommend something in the middle. Enough involvement to offer support, but not so much that the young person doesn't get into practice being independent.  

GENEVA VALESKA: Some families do Sunday night check-ins, just 15 minutes to look at the week ahead, see what's working, and adjust as needed. It's simple, but it opens the door for more communication and less tension.  

JOSH FEDER: And if there's conflict, clinicians may want to think about modeling those conversations in session. Teens and parents both benefit from practicing flexibility, compromise, and just owning when things don't go well. I mean, the thing is that there's so much that people think about when it comes to becoming an adult and having ADHD or ADHD symptoms, right? People worry that you're not going to get into the college you want, you're not going to make it as an independent person, you won't remember to take your medicine, maybe change your sheets, or do the laundry, all those kinds of things. There's a lot riding on it, and people are often very nervous. So that overwhelm itself can get in the way of just getting into a rhythm that works for people, and the natural separation-individuation stage of life makes it so that a lot of teens and young adults don't really want their parents looking over their shoulder, they feel it's micromanaging, even if it's not that much, you have to wait about a decade before that goes away. So it's as John Meeks called it, a fragile alliance both between us as providers with teens and young adults, but also with parents and for parents supporting them so that they can hold steady when their teen or young adult is giving them a hard time, but they still need to check in with their kid and see how things are going, is really a big service to those families. 

GENEVA VALESKA: Let's shift to how different this generation is. Gen Z is growing up with constant access to the internet, social media, and a world that's unpredictable.  

JOSH FEDER: Yeah, and they're pretty much open to talking about mental health, which is helpful, but they're also carrying more collective stress. Things like climate change, social justice issues, violence; it weighs on them. 

GENEVA VALESKA: So, when we assess ADHD in this group, we can't ignore the context. A young adult might be distracted in class but also dealing with anxiety, activism, or just feeling overwhelmed by everything that they're seeing online.  

JOSH FEDER: Ask about all of it. Social media use, sleep relationships, and whether they feel like they can focus when the world feels so chaotic, sometimes that leads to a discussion about ADHD, other times it points to something totally different. There are so many people who are distracted by world events and climate change, or just whatever disaster is happening this week, whether it's a manmade issue or a natural disaster, and really, your ability to talk with people about those things in a calm and competent way can go a long way. So, for instance, when we have kids who are worried about school shootings, well, you know, when you see something, you do need to say something, but the truth is that most people at most schools, most of the time, are perfectly safe. Now, you don't say to the person, Don't feel bad, you're safe. You know, that's not really going to work, but what you can do is you can listen to their fears and their concerns, and you can reflect that, luckily, these things are pretty rare events, and schools have pretty good communication systems in place to try to avoid those kinds of problems. Similarly, with climate change, you can talk about their concerns about that, but also things they might do to get involved in the effort to reduce the impact of climate change.  

GENEVA VALESKA: We're talking a lot about young adults. Some of this starts way earlier. 

JOSH FEDER: And when it does, early support really helps. But even when someone shows up at 22 saying, I've always felt this way, we can still work with that; it's not too late to learn new strategies or adjust the environment. 

GENEVA VALESKA: Whether it's a new diagnosis or something that's been overlooked for years. The approach stays similar. Understand the full picture, support the person, and build out what helps them function.

JOSH FEDER: And we always keep room for adaptation. What works in college might not work in a job, what helps at 20 might look different at 25; that's the process that's continually adjusting. I see this all the time, especially that transition from college to work life, and I have to say the people who seem to do the best in my experience through my career are people who are actually working during high school or maybe even before they kind of get the sense of. What it is you're supposed to be doing as an adult, and so, it's so much easier, but many people have never held a job until they leave college, and then they're pretty anxious about what they're going to do and what it's like. And being at college, we talked about how there are fewer structures. Being at work, there are also fewer structures, but there are also clearer expectations that you might not even understand or know about. So, talking with people so that they understand that part of their job is asking questions, so that they know what they're supposed to be doing, is kind of like skill number one when you're entering the working world.  

GENEVA VALESKA: If you're working with young adults or you are one, the main thing is to remember that ADHD doesn't exist in a vacuum. It interacts with everything else: your schedule, your stress, your identity, your history.  

JOSH FEDER: And that's why we take a full-spectrum approach, not just symptoms, but daily life. We're looking at how to build support that's practical and sustainable. The Stanford Neurodiversity Project, which is run by Dr. Lawrence Fung, is brilliant. A lot of people think about ADHD as another flavor of neurodiversity. Neurodiversity is a concept, Dr. Fung says, that regards individuals with differences in brain function and behavioral traits as just part of normal variation in the human population. And these conditions include autism, ADHD, specific learning disorders, and many, many others. Some of what we think about with ADHD includes strengths, which often include rapid decision making, high energy, great focus on interesting tasks, creativity, resilience, multitasking, big picture thinking, and staying cool in a crisis. But the challenges, as we know, include impulsivity, hyperactivity, difficulty focusing on tasks that aren't interesting, and distractibility. The neurodiversity movement has been around for a while, and we are thinking more about principles for neurodiversity affirming language. So respecting identity, where different individuals and communities kind of have different preferences, right? Avoiding deficit framing. So, framing neurodivergence as a difference, a strengths-based approach. So, emphasizing abilities, talents, and perspectives while recognizing support needs. This is all from the Stanford Project. Context matters; a trait can be a challenge in one setting and a strength in another, and empower self-advocacy, promoting agency and voice, rather than paternalism. So, there are some examples of neurodiversity affirming and non-affirming language. For instance, a deficit-based non-affirmative language would be like, suffers from ADHD versus has ADHD or disorder as an identity versus a neurodivergent identity or neurologic difference, or a normal person versus a neurotypical person, or talking about deficits and skills versus just a different style, special needs versus support needs, things like that. The ideal definition of neurodiversity informed healthcare, so far, from the Stanford Neurodiversity Project is neurodiversity informed healthcare, understands that people think, speak, and learn in different ways, rather than treating these differences as deficits, it focuses on real-life tools and supports that help each person to do their best, real-life experiences valued alongside clinical experiences, embracing the strengths and challenges of neurodivergent conditions, systems that are adapted to reduce barriers designed for neurotypicals, partnering with medicine, not excluding ourselves from it, environments that are flexible and responsive to individual needs, comprehensive health focus, physical and mental, for better quality of life, and trust and respect at the heart of every decision. 

GENEVA VALESKA: You can read more about this topic in our July/August/September 2025 newsletter in an interview that inspired today's podcast, with Dr. Gene Beresin. We will link it in the show notes, and if you found this episode valuable, which we hope you did, please share it with others who need to hear this message.  

JOSH FEDER: Everything from Carlat Publishing is independently researched and produced. There's no funding from the pharmaceutical industry.  

GENEVA VALESKA: The newsletters and books we produce depend entirely on reader support. There are no ads, and our authors don't receive industry funding. That helps us to bring you unbiased information that you can trust.  

JOSH FEDER: Thanks to everyone for tuning into this episode. Again, like Geneva said, if you found this discussion helpful, subscribe to more episodes on mental health and psychiatric care, and tell your friends. Until next time, remember when you look for good things, more good will happen. Thanks!

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