A Critical Accommodation for ADHD Clinicians

The sun had just fallen below the horizon, and the neighborhood had gone quiet in that particular way it does when everything is blanketed in snow. It was December, and I was sitting at my dining room table, close enough to the living room to hear my kids laughing. In front of me sat a stack of legal pads, a month’s worth of handwritten session notes, and a laptop with my EHR open and waiting. The cursor wasn’t moving. Neither was I.

The pages were covered in chicken scratch, desperate attempts to scaffold what I could remember—the important moments, the clinical observations, the things that mattered. The work was all there, somewhere in those pages. I just couldn’t get to it.

I felt a pressure in my chest, ready to burst forth like a runner on the starting line. My mind was a maelstrom, holding thoughts with nowhere to land.

Being in a session, as opposed to in my living room with my notes, is something different entirely. A session feels like a dance, a constant push and pull of energy. The client brings the first wave. You receive it, read it, then send something back. Then you do it again. And again.

For a brain wired like mine, a therapy session is actually an ideal condition. The constant movement, the emotional intensity, the simultaneous tracking of what’s said and unsaid, reading the body, holding the clinical framework, and managing your own internal response, all at once.

The ADHD brain isn’t attention-deficient as much as it’s stimulation-driven. It locks onto novelty, emotional intensity, and human complexity. A therapy session provides all of that simultaneously. Many clinicians with ADHD will tell you they feel most present, most alive, and most like themselves in the therapy room. The chaos of it keeps us sharp.

Then the client walks out.

And the stimulation that was holding everything together has left with them. A brain that was just operating at full capacity is suddenly asked to do the thing it’s worst at: complete a low-stimulation, self-directed task, like completing progress notes, with no immediate reward. This is the dopamine cliff, and while standing at the edge of it, something as simple as deciding whether to go to the bathroom, get a snack, or open a chart can feel genuinely overwhelming.

What’s left in these moments is a choice that doesn’t feel like one. You can sit with the depletion and let your mind go numb while you scroll through your phone, or you can push through and try to do the thing your brain is least equipped to do right now. Either way, you pay for it. Either way, it costs something. And you do this multiple times a day.

Consider what a typical day actually looks like in your practice. You arrive at your office (or home office) minutes before your first client. You close one door and open another, and you’re expected to be present, regulated, and clinically sharp.

Between sessions, you might have five or 10 minutes. That’s enough time to use the bathroom, drink some water, and glance at your notes for the next client. It’s not enough time to decompress, transition, or let your nervous system find its footing again. Lunch might be an hour, but let’s face it, many of us don’t take that hour for ourselves, because time is money and the pressure to fill your schedule is its own particular weight.

The intention at lunch is always the same: catch up on the morning notes. But instead, you eat and scroll. After all, your brain has been screaming for rest, and there are at least a hundred videos of puppies on Instagram that need your immediate attention. You tell yourself you’ll make time for notes later.

The afternoon looks the same: two, three, sometimes four sessions. By the time the last client logs off or walks out the door, you’re depleted beyond recognition. You go home. You want to see your family. You try your best to ignore the low hum of resentment that “something” is still hanging over you, unresolved and waiting. Why didn’t I just do the damn notes? Ugh.

But that’s a problem for another day. Because right now, your brain is done.

As clinicians, we’ll fight for our clients without hesitation. We’ll research every accommodation, advocate for every support, and chase down every tool that will help them function at their best. We do this because we believe they deserve to operate at full capacity. We do this because we understand that the right support doesn’t diminish someone—it frees them.

And then we go home, sit alone at the kitchen table, and drown in a pile of notes that’s eating us alive.

The Accommodation Double Standard

Somewhere along the way—in graduate school, in supervision, in the culture of the profession itself—many of us absorbed the belief that asking for help means admitting failure, that needing help is a blight on our competence, rather than a reasonable response to an unreasonable set of demands.

For those of us diagnosed with ADHD later in life, that belief runs even deeper. We spent years, sometimes decades, developing workarounds we called personality traits, compensating in ways we called resilience, and pushing through in ways we called dedication. We never learned the language of accommodation, because it was never offered.

It’s interesting that nobody questions accommodations for therapists who struggle in other ways. People wouldn’t think twice about a therapist needing a standing desk, a screen reader, or a noise-canceling headset because the workspace is too loud. These things don’t generate ethical debates. Nobody pulls these clinicians aside to ask whether they’re really committed to their clients.

But with ADHD, when the only struggle that shows is the output—the late note, the incomplete chart, the documentation that doesn’t reflect the quality of the session that preceded it—the field fills in the gap with judgment of character. “Why is this so hard for you?” people ask. “You just need to get organized.”

Until recently, I smiled when I heard comments like these. I’ve always been good at smiling and blending in. But underneath the smile, something older was happening—a memory. I’m eight years old, and my teacher has just overturned my desk in front of the class. I’m picking my belongings off the floor, holding back the knot in my throat and feeling the stares of my classmates. I’m learning, in the way children learn things that stay with you forever, that my particular mind is a problem to be managed.

I don’t use the word trauma lightly. But I know what it means when your body arrives somewhere before your mind does. When a colleague says something offhand about your perceived inability to get the things done, the smile comes first. The internal withering comes after, when you’re stuck with the internal thoughts of Am I good enough? That thought alone tends to make many with ADHD feel overwhelmed and stuck, which only compounds the cycle. Your brain tells you you’re a failure, and your actions stay the course.

What comments like these from fellow therapists completely disregard is the incredible effort therapists with ADHD are exerting to simply hold their lives together—the morning spent ingesting enough caffeine to make sure you’re “with it” and attentive, remembering to take your meds (if you’re on them), and pumping yourself up with copious positive affirmation. You’re literally telling yourself every day, before the work, that you can do the work, rather than just knowing you can. It’s exhausting to start every day feeling mentally drained instead of feeling excited about the work ahead. To construct and reconstruct a mental scaffolding just to stay present and functional.

For some of us, staying present feels like trying to focus on a photograph that keeps going blurry. You pull it into focus, it drifts, and you pull it back, again and again. For others, it’s different: a physical restlessness beneath a calm exterior, the leg that won’t stop bouncing, the racing thoughts running ahead of the conversation, or the energy that has nowhere to go in a room requiring stillness. And underneath it all runs a quiet, cruel loop: Why can’t I just do this? Why is this so hard? None of it gets acknowledged. It simply disappears in the assumption that everyone’s baseline is the same.

It isn’t.

When Something Finally Works

The irony is that the same colleagues who’d never question a client’s right to accommodations have questioned mine. Because mine involves AI—specifically, an AI documentation assistant. AI isn’t magic. It doesn’t do the clinical thinking. What it does is remove the translation tax for someone with ADHD, the exhausting work of reconstructing in writing what my brain did deftly in the consulting room. When a fellow clinician questions my ethics for using it, it takes me right back to the classroom floor.

When I first tried an AI documentation assistant, I almost didn’t follow through. The weight of the ethical debate, the voices of my colleagues, the years of internalizing that needing help meant something was wrong with me, all of it sat between me and the thing that might actually help. It felt forbidden before it felt useful. I approached it the way you approach something you aren’t sure you deserve.

What I found was this: the output in front of me reflected, maybe for the first time, the actual quality of what had happened in the room—the dance, the push and pull, the clinical observations I’d made in real time but could never quite reconstruct afterward. It was all there.

My first feeling wasn’t pride. It was relief. The knot released. Something I’d been holding for a very long time loosened just slightly. My brain, it turned out, had been beautiful and capable all along. I could be a great clinician even if I wasn’t great at the administrative duties. Those were never the same thing. It just took me longer than it should have to believe it.

Now, on most evenings after my last session, I close the chart and I’m done. The notes are written. The day is actually over.

I should feel relief. And I do. But sometimes, I also feel grief for the many evenings I spent frozen at the dining room table, caught in the maelstrom of my mind as I tried to document sessions while my kids laughed in the next room. To the therapist sitting in the maelstrom right now, know that you’re not alone. There are people fighting for you—for us—and for the right to do the work we love with the support we need to do it well.

The reality is that therapists are leaving this field. And it’s my belief, formed over years of clinical work and conversations with colleagues, that a disproportionate number of those are the neurodivergent practitioners, the ones carrying the invisible weight. When that practitioner walks away because the cost becomes too high, it isn’t only their loss. The client who finally felt seen by them loses something too.

We can’t afford that. Understanding what our colleagues carry, even when we can’t see it, must also be part of the work we do. That’s why this conversation matters. Not because the tools or accommodations are the point, but because the people who need them, don’t have them, and are made to feel guilty for using them are paying a cost our field never bothered to calculate.