Sarah West I Certified ADHD Coach

18/12/2025

Why traditional therapies often don’t work for neurodivergent brains

I’ve had my fair share of therapy and counselling over the years.

While parts of it were supportive, it never quite led to lasting change. I struggled to remember or complete the homework, found it hard to stick with structured exercises, and often left sessions feeling as though I was failing at something that was meant to help.

At the time, I assumed the problem was me.

What I understand now is that many traditional therapeutic approaches were developed with neurotypical processing styles in mind. They often rely on consistency, sustained attention, abstract reflection, and self directed follow through, all of which can be particularly challenging for people with ADHD or other forms of neurodivergence.

This does not mean therapy is ineffective or unhelpful, but it does mean it is not always the right fit.

For neurodivergent individuals, support often needs to be practical, flexible, and grounded in an understanding of how our brains actually work. Approaches that are neuro-affirming focus less on fixing or correcting, and more on working with strengths, differences, and real life challenges. They prioritise collaboration, compassion, and strategies that are achievable and meaningful.

When I eventually worked with someone who understood ADHD, I did not need to justify my experiences or translate my struggles. The support recognised lifelong patterns, executive function differences, and the impact of shame and self criticism. That understanding made it possible to create change that felt sustainable, and to develop a much kinder relationship with myself.

If you have tried therapy, counselling, or coaching and it did not help, this is not a personal failure, it may simply mean you were not offered support that was designed with neurodivergent needs in mind.

If this resonates, you are very welcome to share your experience in the comments, or pass this on to someone who might need to read it today.

16/12/2025

If you are a woman navigating ADHD and perimenopause or menopause, my monthly newsletter is written with you in mind.

Each month I share honest reflections from my own lived experience, along with clear and accessible information about ADHD and hormonal changes. My aim is always to be real, grounded, and genuinely helpful, so you have a space that supports you rather than overwhelms you.

In each edition you will find:

• new blog posts on ADHD and perimenopause
• information that helps you understand what is happening in your brain and body
• practical insights from my ADHD coaching work
• upcoming coaching availability
• details of events, webinars, and resources
• supportive guidance that you can use straight away

This newsletter is an informative space where you can gain clarity, feel understood, and connect with information that makes sense of your experiences.

If this resonates with you, you can sign up through the link in my bio or on my website. I would love you to join the community.

Sign up here: https://mailchi.mp/sarahwest-adhd.com/newsletter

Website: www.sarahwest-adhd.com

15/12/2025

The loneliness of ADHD and friendships

Friendships and connections with others has been one of the hardest parts of my life, long before I ever knew I had ADHD. I often felt like I was watching other people connect with ease while I hovered on the outside trying to work out how to step in. I saw people maintaining friendships effortlessly and wondered why making and maintaining connections with others was so hard for me.

And these days social media can make that heartache feel worse, especially when you frequently see big friendship groups, shared milestones, and women posting about friends they have had since childhood as it can highlight a loneliness that many of us carry.

I have always struggled with small talk. I worry constantly about saying the wrong thing, or that what I am saying is either too much or not enough, and I often leave conversations replaying every detail in my mind. The days of rumination after a social event, convinced that I had upset someone or given the wrong impression, felt overwhelming and exhausting. Before my ADHD diagnosis, I genuinely believed this was a personal character flaw.

What I know now is that ADHD was shaping so much of this as it affects social cues, emotional regulation, conversational flow, confidence, and the executive function needed to keep in touch. And then there is RSD, as the fear of rejection can make every silence or slight shift in tone feel painful. You want connection, but you protect yourself by pulling back, and that push and pull is something so many women recognise once they finally understand their ADHD.

Perimenopause can intensify all of this as our hormones can heighten emotional sensitivity and overwhelm, and is often when women start putting together the bigger picture of what has been happening for years.

Understanding why these patterns show up can be the first step towards building relationships that feel safer, clearer, and more sustainable. It is never too late to learn new ways of connecting and to find friendships that honour who you are.

10/12/2025

So, what exactly is ADHD coaching?

ADHD coaching helps you understand how your brain works and supports you to create practical strategies that fit your life. It is not therapy. It is a collaborative process focused on making meaningful change now and building the future you want.

Good ADHD coaching is strengths based. It helps you recognise your abilities, understand what gets in the way, and develop tools that genuinely suit you. A coach acts as a thinking partner who helps you explore goals, notice patterns and build confidence.

Because coaching is an unregulated field it is important to ask about a coach’s training, whether their programme was accredited or ICF regulated, and how they work. Someone with nothing to hide will be happy to answer your questions. It is also worth looking at their website and testimonials so you can see their approach and experience.

Not all ADHD coaching is the same. Some courses last only a few days, while others involve months or years of specialist training, mentoring and assessment. Check whether the training was ADHD specific and whether the school meets recognised professional standards.

If you are choosing an ADHD coach, you might want to ask:
• Where did they train, and was the programme ADHD specific
• Do they have regular clinical supervision and what does their professional development look like
• What approach do they use, and is it strengths based
• What relevant experience or specialist knowledge they bring
• How in depth their training, mentoring and assessment were
• What their website and testimonials show about client experience

A well trained coach will be completely comfortable answering these questions. High quality ADHD coaching should feel safe, collaborative and grounded in real expertise.

04/12/2025

ADHD assessments in crisis once again, as new BBC investigation reveals the scale of the problem

The BBC has reported that adult ADHD services across England are now shutting their doors to new NHS patients because demand has become unmanageable. Fifteen areas have closed their waiting lists entirely and another thirty one have tightened their criteria, making it even harder for adults to access assessment or support.

For many women in midlife this will come as no surprise. I hear every week from those who have finally recognised their symptoms, built up the courage to speak to their GP, and then discover they face years of waiting. The BBC found that the average wait for an adult already on a list is now eight years, which is an extraordinary length of time for anyone to be left without answers or support.

Prof Anita Thapar, chair of the NHS England ADHD taskforce, called these findings disturbing and warned of the risks for patients. Her upcoming report highlights something many of us already know, that ADHD remains under-diagnosed and under-treated, and that the system needs urgent reform. The recommendations include better training for frontline staff, more joined up working across sectors, and broader involvement from community teams such as GPs and pharmacists.

Some areas are beginning to innovate. Surrey, for example, is piloting a scheme that trains private GPs to deliver NHS assessments to ease pressure on overstretched services. But the overall picture remains deeply challenging for adults seeking help, particularly women whose symptoms have been missed for decades.

If you are navigating this landscape and need support while you wait, coaching can help you understand your symptoms, build strategies, and feel less alone during an already overwhelming process.

If you would like to find out more about how I support women in this situation, you are welcome to get in touch.

https://www.bbc.co.uk/news/articles/c4gpl150ze4o

A BBC investigation finds that a host of areas in England are closing waiting lists and others are rationing care.

01/12/2025

Why perimenopause is a double whammy for women with ADHD

I know first hand how my ADHD became significantly worse when I hit perimenopause, and so many women I speak to say the same. ADHD affects dopamine regulation, which influences focus, motivation, emotional regulation, and executive functioning.

During perimenopause this becomes even harder because our hormones and how they support dopamine start to fluctuate.

Oestrogen
• Supports dopamine production and receptor activity
• Fluctuations make dopamine harder to regulate
• This can worsen focus, motivation, emotional stability, and overwhelm

Progesterone
• Influences mood and emotional steadiness
• Luteal phase drops can increase anxiety, irritability, and mood swings
• These changes intensify ADHD related emotional reactivity and stress sensitivity

Testosterone
• Contributes to energy, drive, and cognitive clarity
• Declines can lead to reduced motivation, slower processing, and fatigue

Together
• ADHD already challenges dopamine regulation
• Perimenopause disrupts the hormones that support dopamine
• This creates a genuine double whammy for many women

This is why so many women find their ADHD harder to manage during perimenopause and why the right support matters.

If this resonates with you, I’d love to hear your comments below.

27/11/2025

The effects of ADHD and PMDD on women's health

Premenstrual Dysphoric Disorder (PMDD), is a severe hormone related condition that remains widely misunderstood. Each month it caused significant mood changes, anxiety, and physical symptoms for me, long before I knew it had a name. The emotional crash was profound and the heaviness affected every part of my life. It was only in recent years that I realised how closely these experiences aligned with ADHD, which suddenly made sense of why those weeks were so much harder to manage.

PMDD symptoms peak in the late luteal phase, when oestrogen drops and progesterone first peaks then falls. For women with PMDD the brain becomes unusually sensitive to these changes, particularly to progesterone’s metabolite allopregnanolone which influences the GABA and serotonin systems and can heighten irritability, anxiety, and emotional reactivity (Schiller et al 2016). For women with ADHD this pattern is often intensified because oestrogen enhances dopamine production, release, and signalling, helping the brain use dopamine more effectively. As oestrogen falls, ADHD traits such as emotional reactivity, reduced tolerance to stress, and poorer focus can become far more pronounced.

A new open access study in the British Journal of Psychiatry highlights this link clearly. Among 715 UK based participants aged 18 to 34, provisional PMDD affected
• 31.4 per cent of women with a self reported ADHD diagnosis
• 41.1 per cent of women who met ADHD criteria on the ASRS
• 9.8 per cent of women without ADHD

Risk was highest in women with ADHD plus depression or anxiety.

Although the study has limitations, the pattern reflects what many women describe. ADHD appears to increase vulnerability to severe premenstrual mood symptoms and coexisting mental health conditions can amplify that risk.

I spent years not knowing PMDD existed. Research like this is vital in helping us understand the links between hormones, mood, and ADHD, and in reminding clinicians to ask about cyclical symptoms when supporting women.

Have you been affected by PMDD? I’d love to hear your thoughts in the comments below.



References
Broughton T, Lambert E, Wertz J, Agnew Blais J 2025, ‘Increased risk of provisional premenstrual dysphoric disorder PMDD among females with attention deficit hyperactivity disorder ADHD, cross sectional survey study’, British Journal of Psychiatry, vol. 226, no. 6, pp. 410–417, doi:10.1192/bjp.2025.104.

Schiller CE, Johnson SL, Rubinow DR 2016, ‘The role of ovarian hormones in mood disorders’, Biological Psychiatry, vol. 80, no. 6, pp. 479–489, doi:10.1016/j.biopsych.2016.05.007.

24/11/2025

I met this lovely group of women in Exeter on Saturday!

I wanted to say a genuine thank you to Mel De Souza for inviting me to join a brilliant support group that she runs for women who have ADHD, it was such a privilege to spend time with these women and hear their stories.

We spoke about what it is actually like to live with ADHD during perimenopause, the long waits for assessment, the gap between what women know about themselves and what the system reflects back, and the quiet grief that comes with recognising how many years were shaped by something that was always there but not recognised.

We also touched on the ongoing invalidation many women still face, particularly when some healthcare professionals do not fully understand how ADHD presents in women or how perimenopause shows up in real life.

What stood out most was the honesty, kindness and support for each woman in that room, with women sharing experiences that have so often been dismissed or invalidated, recognising familiar patterns in one another’s stories and finding comfort and solidarity in feeling understood.

Thank you again to Mel and to everyone who came along. It reminded me, once again, why community matters so much and why these spaces are needed.

(Photo shared with consent)

19/11/2025

Why more research is urgently needed for women who have ADHD

So many women who I work with who are struggling with ADHD and the perimenopause also report having suffered from hormonal impacts during their lifetimes, such as PMDD and post natal depression.

Early studies suggest links between ADHD and PMDD, postnatal depression and anxiety, and increased difficulties during perimenopause and menopause.

Unfortunately, research in this area is still limited, with much of the current evidence being small scale, cross sectional, or based on self report.

There are several areas where we urgently need more high quality research, including:
• ADHD and postnatal depression, including whether women who experience this are more likely to be neurodivergent
• ADHD and PMDD, and why some women experience more severe premenstrual symptoms
• ADHD and the perimenopause or menopause, and why symptoms can intensify so dramatically
• Links between severe postpartum psychosis and ADHD or wider neurodivergence
• How hormonal changes affect emotional regulation, sleep, memory, and executive functioning
• How HRT may influence ADHD symptoms in midlife
• The experiences of women who suspect they have ADHD but remain undiagnosed during these transitions

These gaps raise an important question about whether women with ADHD or other forms of neurodivergence may be more predisposed to hormonal conditions.

Until we have clearer evidence, many women will continue to fall through the gaps, and stronger research is essential if we want to reduce misdiagnosis, improve clinical understanding, and build treatment pathways that lead to meaningful outcomes. We need evidence that reflects women’s real lived experiences rather than relying on outdated assumptions.

I would love to hear which research areas you feel are still missing and what you wish clinicians better understood about ADHD and hormones.

17/11/2025

I am so chuffed to share some exciting news!!

Last week I was named Start Up of the Year at the annual Devon Women in Business awards, with a highly commended recognition in the Customer Service Excellence category.

When I launched Sarah West ADHD Thrive Together, my aim was to create something meaningful for women navigating ADHD and perimenopause. I have put so much work into building a service that feels supportive, evidence based, authentic, and rooted in lived experience, so having this recognised means a great deal.

I started my business after one of the hardest periods of my life, when my ADHD and the perimenopause collided and everything fell apart. After starting HRT and getting the right ADHD support, things began to change, and I realised how many women were experiencing the same thing. Retraining as an ADHD coach became the natural next step, and my background as a senior nurse helped me create something grounded and genuine.

Since launching the business, I have met so many incredible people, collaborated with brilliant organisations, and built connections that mean a lot to me.

Thank you to every woman who has trusted me with their story and engaged with the work I am doing. You are the reason this business exists.

And thank you to Devon Women in Business for recognising the hard work and the future potential of what I am building.

Well done to all the finalists and winners. Devon has an amazing community of women doing important work, and it was a privilege to be there.

11/11/2025

Is the general understanding of dopamine and its effects on ADHD completely wrong?

Many people still believe ADHD is simply caused by “low dopamine.” But recent evidence points towards something more accurate and far more helpful.

Rather than a blanket shortage, research suggests that the dopamine system in ADHD is dysregulated (Badgaiyan et al., 2015, Sikström and Söderlund, 2022, MacDonald et al., 2024).

The baseline signal, known as tonic dopamine, can be lower, and the task-related bursts, known as phasic dopamine, can be more uneven or less well regulated (ADxS.org, n.d.).

A useful analogy is thinking of the brain’s dopamine system like a Wi-Fi connection. The signal is there, but it can be unstable, dropping in and out, or spiking at the wrong times. ADHD medication does not add dopamine, it helps the signal stay more consistent so the brain can use it more effectively (Badgaiyan et al., 2015).

This model feels more accurate and compassionate, especially for women in perimenopause and menopause, where fluctuating hormone levels create a double whammy, as not only is dopamine production affected, but also how it is used, taken up, and regulated in the brain (MacDonald et al., 2024).

Do you think this model makes more sense than the generalised “low dopamine” explanation that is often shared online? I would love to hear your thoughts.




References
Badgaiyan, R.D., Sinha, S., Sajjad, M. and Wack, D.S. (2015) ‘Attenuated tonic and enhanced phasic release of dopamine in Attention-Deficit/Hyperactivity Disorder’, PLoS ONE, 10(3), e0117530. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4589406/

MacDonald, H.J., Kleppe, R. and Szigetvari, P.D. (2024) ‘The dopamine hypothesis for ADHD: An evaluation of evidence accumulated from human studies and animal models’, Neuroscience and Biobehavioural Reviews, 156, pp. 318–330. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11604610/

Sikström, S. and Söderlund, G. (2022) ‘Stimulus dependent dopamine release in Attention-Deficit/Hyperactivity Disorder’, Psychological Review. Available at:https://www.gu.se/sites/default/files/2022-11/GS%20Psych%20Rev.pdf

10/11/2025

Is burnout more common in those who are neurodivergent?

A couple of years ago I hit a level of burnout that stopped me completely.

I had been holding too much for too long while working as a senior nurse, supporting my two neurodivergent children, running a home, and clearing the house of a close relative who had recently passed away. From the outside I looked organised. Inside everything was collapsing. Eventually my GP signed me off work and it took me months to recover.

Burnout is now recognised as a major issue and research shows neurodivergent adults experience it more frequently and more intensely than neurotypical adults.

One UK survey found that half of neurodivergent employees reported burnout compared with 38 percent of neurotypical workers (WTW, 2023). Another study found that more than 40 percent of neurodivergent workers were already experiencing burnout (Our Community, 2024).

Autistic burnout is increasingly understood as severe, long lasting, and linked to chronic stress and a mismatch between demands and available resources (Raymaker et al., 2020, National Autistic Society, 2023).

For women with ADHD the story is more complex. Masking, emotional load, late diagnosis, and hormonal changes all appear to increase burnout risk, though large scale studies focusing specifically on women are still missing (Hull et al., 2020, Nadeau, 2020, NICE, 2024).

Recovery can take months or even years for neurodivergent adults (Raymaker et al., 2020). The lack of large scale data makes it difficult to quantify exact timelines but the lived experience shows that it is not a quick fix.

Does any of this resonate with your experience? Have you lived through burnout yourself or seen it in someone close to you?
What helped your recovery or what support do you wish you had at the time?



References

Hull, L., Petrides, K. V. and Mandy, W. (2020) ‘The female autism phenotype and camouflaging’, Review Journal of Autism and Developmental Disorders, 7(4), pp. 306–317.

Nadeau, K. (2020) Understanding Women with ADHD. Washington DC: American Psychological Association.

National Autistic Society (2023) Autistic Burnout Guidance. Available at: https://www.autism.org.uk

NICE (2024) Menopause: diagnosis and management (NG23). London: National Institute for Health and Care Excellence.

Our Community (2024) Burnout Risk for Neurodivergent Workers Report. Available at: https://www.communitydirectors.com.au

Raymaker, D. M. et al. (2020) ‘Having a hard time is not unique to autistic people but the cause is: a qualitative analysis of autistic burnout’, Autism in Adulthood, 2(2), pp. 132–143.

WTW (2023) Global Benefits Attitude Survey. Available at: https://www.wtwco.com