Understanding ADHD (AI generated placeholder)
By Dr Torrance Merkle, GP · · ADHD
A grounded introduction to ADHD - what it is, how it shows up, and what neuro-affirming care looks like in practice.
Key takeaway: ADHD is a difference in how the brain regulates attention and effort, not a deficit of intelligence or willpower.
ADHD - Attention Deficit Hyperactivity Disorder - is one of the most misunderstood conditions in general practice. It is also one of the most common, affecting an estimated 5–8% of children and around 3% of adults in Aotearoa New Zealand.
Despite the name, ADHD is not a deficit of attention. It is a difference in how the brain regulates attention, effort, and motivation. People with ADHD can focus intensely - sometimes for hours - on things that genuinely engage them (a state often called hyperfocus). The difficulty is in directing and sustaining that focus on tasks that lack immediate novelty, urgency, or intrinsic interest.
Three Presentations
ADHD presents in three recognised ways:
- Predominantly Inattentive Presentation: Difficulty sustaining attention, following through on multi-step instructions, organising tasks, and managing time. People with this presentation are often quiet, daydreamy, and easily overlooked in school or work.
- Predominantly Hyperactive-Impulsive Presentation: Fidgeting, restlessness, difficulty sitting still, talking excessively, interrupting, or acting before thinking things through.
- Combined Presentation: A mix of both inattentive and hyperactive-impulsive traits - the most common presentation seen in clinical practice.
ADHD in Adulthood
Many adults come to my clinic having spent decades believing their challenges were character flaws: "lazy," "disorganised," "not living up to potential." Often, a diagnosis arrives after years of managing anxiety, depression, or chronic burnout that standard treatments haven't quite resolved.
In adults, hyperactivity often shifts inward - from physical restlessness to mental restlessness: a mind that won't quiet down, racing thoughts, and difficulty unwinding even when exhausted.
What Neuro-Affirming Care Looks Like
Neuro-affirming care starts with a simple premise: your brain is not broken; it works differently. Treatment is not about making you act or think like a neurotypical person. It is about:
- Understanding your patterns: Learning how your specific brain works - what drains it, what energises it, and where the friction points are.
- Evidence-informed tools: Medication (stimulants and non-stimulants) when appropriate, lifestyle modifications, sleep support, and cognitive strategies.
- Environmental scaffolding: Designing systems, routines, and spaces that accommodate your brain rather than fighting it.
If you suspect you might have ADHD, the first step is usually an open conversation with a clinician who takes the time to listen to your full story.