The Question I Ask Every New Client — And What It Reveals About ADHD, Anxiety, and Your Nervous System

BY LIORA BAROOK, RP  ·  REGISTERED PSYCHOTHERAPIST AT INSPIRED WELLNESS

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There's a question I ask almost everyone who comes to see me, usually within the first session or two. It isn't a diagnostic question. It isn't about symptoms or history, exactly. It's this:

"When was the first time you remember feeling like you had to manage yourself really carefully?"

The answers are always different. Sometimes it's a specific moment — a classroom, a parent's face, a teacher's comment. Sometimes it's more diffuse, just a slow dawning realization that the way their brain worked wasn't quite like everyone else's, and that this was a problem to be fixed rather than a difference to be understood. But underneath the different answers, there's almost always the same feeling: the point at which someone learned to stop trusting themselves, and started managing instead.

The cost of "just try harder"

A significant number of my clients come in having lived most of their lives hearing some version of the same message: you're not trying hard enough. You're distracted. You're too sensitive. You're smart — so why can't you just focus?

For people with ADHD, anxiety, or both, these messages land differently than they're intended. They don't create motivation. They create shame. And shame — particularly the quiet, internalized kind that you've carried for so long you think it's just part of your personality — does something specific to a nervous system.

It keeps it on alert.

When your brain has learned early and repeatedly that its natural way of moving through the world is wrong, your nervous system adapts. It starts scanning for mistakes before you make them. It catastrophizes to stay ahead of the next failure. It drives you to over-prepare, over-explain, over-apologize — anything to stay one step ahead of the criticism it's learned to expect, even when no one is criticizing you.

This is what high-functioning anxiety paired with ADHD actually looks like. Not chaos. Compensation. And it is exhausting in a way that's very hard to explain to someone who hasn't lived it.

What ADHD and anxiety look like together

Here's something I find myself explaining often: ADHD and anxiety aren't simply two separate conditions that happen to co-occur. In a lot of people, they form a loop that feeds itself.

The ADHD makes certain tasks genuinely harder to start, sustain attention on, or follow through with — not because of lack of effort or intelligence, but because of the way the brain regulates dopamine and manages transitions. The anxiety shows up to interpret that difficulty as evidence of failure. The shame of the perceived failure makes the nervous system dysregulate further. A dysregulated nervous system makes ADHD symptoms worse. And the loop continues.

What this looks like in daily life can be subtle:

• Knowing exactly what needs to be done and still being unable to start it

• Hyperfocusing on things that feel interesting or urgent, while important tasks stay untouched

• Saying yes to things to avoid the anxiety of disappointing someone — then quietly resenting it

• Replaying conversations to find where you went wrong

• Resting, but not feeling rested — your brain still running in the background

• A pervasive sense that you're always slightly behind, always almost catching up

None of this is a character flaw. None of this is laziness. It's a nervous system that has been doing its best with an incomplete picture.

What therapy actually addresses

When I work with clients navigating ADHD and anxiety, we're not primarily working on strategies for getting things done. We're working on understanding what's happening underneath the surface — what the nervous system has learned, why it responds the way it does, and what it might be possible to do differently when you understand the why.

This often involves:

• Understanding the nervous system states that show up for you — and learning to recognize them in the moment rather than after the fact

• Separating what's ADHD, what's anxiety, and what's the interaction between them — because they each respond to different things

• Unpacking the shame layer — which is often the piece that keeps people most stuck, and which responds very well to being named and examined

• Building skills that work with your brain's actual wiring, not against it It's not about fixing something broken. It's about understanding how something works — and finally building a life that accounts for that.

A reflection to try this week

If you have a few minutes and a journal, try sitting with this question:

When did I first start feeling like the way I move through the world was a problem to be managed?

You don't have to have an answer. Sometimes just asking the question opens something up. Notice what comes — a feeling, an image, a memory, a sense of nothing at all. All of it is information.

You don't have to figure this out alone

If any of this has landed — the loop, the shame layer, the exhaustion of compensating for so long — that recognition matters. It's usually where things start to shift.

I'm at Inspired Wellness every Tuesday, and I'm currently accepting new clients. If you've

been thinking about reaching out, this might be your nudge.