Why is shame often ignored in ADHD treatment?

PostedNovember 3, 2025

UpdatedNovember 5, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Shame is one of the most overlooked emotions in ADHD care. Many people living with ADHD experience deep self-criticism after years of feeling misunderstood or judged for their symptoms. Missed deadlines, emotional reactions, or struggles with focus often lead to feelings of guilt and inadequacy. However, according to the NHS, ADHD management continues to focus primarily on behavioural and attention-related symptoms. Emotional factors such as shame, self-blame, and self-stigma often remain under-discussed, even though they significantly affect treatment outcomes and overall wellbeing.

Understanding why shame is overlooked in ADHD

In clinical practice, shame tends to be invisible because it is rarely expressed openly. The NICE Guideline NG87 focuses on psychoeducation, medication, and behavioural management but offers limited direction on emotional support. This means clinicians often address inattention, hyperactivity, and impulsivity while emotional pain is left unacknowledged. According to the Royal College of Psychiatrists, stigma and shame are key barriers to recovery, yet remain under-addressed in standard ADHD pathways.

Peer-reviewed studies support this view. Research published in Frontiers in Psychiatry (2025) found that repeated criticism, unmet expectations, and emotional dysregulation contribute heavily to shame for people with ADHD. Similarly, a review in The Lancet Psychiatry (2024) found that treatment continues to prioritise symptom control over emotional healing.

The impact of unaddressed shame

Shame can have a lasting effect on self-esteem, relationships, and help-seeking behaviour. The BMJ reports that this emotion often develops early in life, reinforced by constant negative feedback at school or at home. When unacknowledged, shame can lead to avoidance, perfectionism, or withdrawal. The ADHD Foundation explains that this cycle of self-criticism and stigma is not only emotionally damaging but can also make treatment less effective.

Charities such as ADHD UK advocate for greater focus on self-acceptance and emotional education within ADHD care. They emphasise that recognising shame as part of the condition allows people to approach recovery with understanding rather than self-judgement.

Towards more holistic ADHD care

A growing body of research in PubMed (2024) and Mayo Clinic suggests that integrating therapies like CBT, compassion-focused therapy (CFT), and psychoeducation can help address shame directly. These approaches encourage emotional awareness, empathy, and self-forgiveness, helping individuals develop healthier self-perceptions alongside symptom management.

Key takeaway

Shame remains an under-recognised but central part of ADHD. Evidence from NICE, RCPsych, and international research shows that while traditional treatment focuses on symptoms, emotional recovery is essential for true wellbeing. By addressing shame openly through therapy, psychoeducation, and peer support, ADHD care can become more compassionate, effective, and life-changing.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.