Could It Be ADHD? Adult ADHD, Burnout & Getting the Right Support - But For Real podcast #52

What if the thing you’ve spent years thinking is a personality flaw…isn’t?

Maybe you have a good job. You pay your bills. You answer emails—eventually. Other people probably describe you as capable, responsible, accomplished, maybe even the person who always has their shit together. Meanwhile, keeping all those plates spinning requires an absolutely bonkers amount of energy. You procrastinate until panic finally generates enough adrenaline to get something done, you forget basic tasks unless they exist in three calendars and a reminder app, and somehow doing something for another person feels completely possible, while making your own dentist appointment keeps falling further down the list.

Does that mean you have ADHD? Not necessarily. Anxiety, depression, chronic stress, burnout, hormonal changes, sleep problems, and other factors can all create overlapping experiences—which is exactly why TikTok probably shouldn’t be handing out your diagnosis between GRWM videos.

In this episode of But For Real, we sit down with Dr. Chanel Thomas, a dual board-certified family and psychiatric mental health nurse practitioner and founder of Blue Sage Wellness, to talk about what adult ADHD can actually look like, why some people aren’t diagnosed until much later in life, what psychiatric medication can and can’t do, and why good mental healthcare has to consider the whole human being—not just a checklist of symptoms.

When “High-Functioning” Doesn’t Mean You’re Actually Okay

One of the biggest myths we unpack in this conversation is the idea that functioning well on paper automatically means everything is fine. Dr. Thomas works with many highly accomplished adults who still have jobs, friendships, relationships, families, advanced degrees, and impressive résumés. From the outside, their lives may look completely intact. Internally, though, it can feel more like treading water in eight feet of it: technically, your nose is still above the surface, but it wouldn’t take much for the whole operation to go under.

That internal experience might involve constant overwhelm, restlessness, trouble initiating tasks, chronic procrastination, forgetfulness, or needing external pressure before your brain finally decides something is important enough to do. A person may be extraordinarily reliable when someone else is counting on them and completely unable to summon that same energy for something they need to do for themselves.

The important distinction is that executive dysfunction isn’t exclusive to ADHD. Anxiety, depression, burnout, and other conditions can interfere with planning, memory, attention, motivation, and task initiation too. Rather than asking only, “Do I technically get things done?” a more useful question may be: “What does it cost me to keep getting them done, and is this sustainable?”

What Does ADHD Look Like in Adults?

A lot of us grew up with an extremely narrow picture of ADHD: usually a little boy who couldn’t stay in his seat, interrupted the teacher, and seemed to be bouncing off every available surface. Adults don’t always look like that—especially adults who have spent decades learning how to mask or compensate.

Dr. Thomas, who has ADHD herself, explains that adult hyperactivity may show up as internalized restlessness rather than visibly running around a room. Someone might fidget or rock, struggle to sit through a long meeting, need frequent movement breaks, interrupt people without intending to, lose the thread of conversations, or become intensely distracted when a phone notification appears. Other people become incredibly skilled at creating elaborate systems that keep everything functioning: calendars, lists, alarms, routines, external accountability, and carefully engineered environments.

Success in school doesn’t automatically rule ADHD out, either. Dr. Thomas asks patients to look back not only at whether they succeeded, but how they succeeded and what structures were supporting them. Were parents and teachers constantly reminding them what came next? Were honors classes challenging enough to hold their attention? Were sports, band, clubs, or a packed schedule providing constant movement and stimulation? Sometimes the difficulty becomes more obvious only after that scaffolding disappears—or after life becomes complicated enough that the old systems can no longer compensate.

ADHD, Burnout, Anxiety—or Something Else?

This is also where things get complicated, because struggling with concentration or executive functioning does not automatically equal ADHD.

Dr. Thomas emphasizes looking at the timeline and context of a person’s symptoms. Did these patterns exist much earlier in life, even if they looked different? Or did concentration problems appear after a major increase in stress, a period of burnout, changes at work, family upheaval, hormonal changes, or another significant life transition? It’s entirely possible for two people to have very similar experiences of brain fog, distractibility, exhaustion, and difficulty initiating tasks while having very different things happening underneath them. And in some cases, more than one factor may be operating at the same time.

That’s part of why a thoughtful evaluation matters. Diagnosis isn’t supposed to be a game of matching yourself to six Instagram slides and yelling “IT ME.” The goal is understanding the broader pattern: when the difficulties began, where they show up, how much distress or impairment they create, what supports have helped, and what else might explain them.

The Unexpected Grief of a Late ADHD Diagnosis

Getting an ADHD diagnosis later in life can bring tremendous relief. There’s finally language for experiences that may have spent decades being interpreted as laziness, irresponsibility, disorganization, lack of discipline, or simply being “bad at adulting.” But Dr. Thomas says another emotion often shows up almost immediately: grief.

Once someone has an explanation, they may start looking backward. What if I had known this when I was 15? Would school have been different? Would that relationship have gone differently? Would I have spent quite so many years believing something was fundamentally wrong with me? Dr. Thomas describes experiencing some of that grief herself after eventually being diagnosed and trying ADHD medication. Suddenly, tasks that had required enormous effort felt markedly different. It was validating—but also disorienting to realize how long she had been navigating life without understanding what was happening.

A diagnosis can provide useful information, but it doesn’t erase the years that came before it. Sometimes understanding yourself more clearly means making space both for the relief of finally having an answer and for the sadness, anger, or frustration attached to wishing you’d had that answer sooner.

What Psychiatric Medication Can—and Can’t—Do

Psychiatric medication still carries a lot of stigma. Some people worry that taking it means they’ve failed at coping. Others fear they’ll need it forever, lose their personality, become emotionally numb, or somehow take the “easy way out.”

Dr. Thomas’s approach is much less all-or-nothing. Psychiatric medication, she explains, isn’t a cure-all. The goal may be to make symptoms manageable enough that someone has more capacity to engage in the other parts of their care and their life. Therapy, relationships, coping strategies, environmental supports, sleep, resources, and the realities of someone’s circumstances don’t suddenly stop mattering because a prescription enters the picture.

She also emphasizes collaborative decision-making and patient autonomy. Rather than approaching psychiatry as “I’m the expert, here is your medication, see you later,” she walks patients through options, potential benefits and drawbacks, and how a particular medication might fit their actual concerns. Response can vary from one person to another, which makes ongoing assessment and communication important. Whether medication is useful temporarily, periodically, or longer term also depends on the individual. The important piece isn’t proving you can function without help. It’s finding care that makes your life more sustainable while still allowing you to participate meaningfully in decisions about your own body.

Why Culturally Affirming Psychiatric Care Matters

That sense of autonomy is especially important in Dr. Thomas’s larger philosophy of psychiatric care. At Blue Sage Wellness, she works extensively with Black and brown, queer, trans, and neurodivergent clients—people whose experiences may not fit the narrow picture of mental health conditions many clinicians were originally trained to recognize. For example, “masking isn’t always simply a strategy for appearing socially acceptable. For people with marginalized identities, learning to carefully manage their behavior can be connected to very real questions of safety and survival.

Dr. Thomas describes a decolonized and anti-oppressive approach to psychiatry as beginning with something deceptively simple: context. A list of symptoms never tells the whole story. What is happening in this person’s life? What did they grow up around? How does their family understand mental health? What role do race, gender, sexuality, religion, geography, finances, housing, relationships, community, or access to resources play in what they’re experiencing?

Someone can meet criteria for depression and also be dealing with housing insecurity. Someone can have anxiety while existing inside an environment that gives them legitimate reasons to feel unsafe. Someone can benefit from medication and still need community, financial resources, affirming relationships, therapy, and structural support. In other words, psychiatric treatment should involve more than identifying symptoms and handing someone a prescription. There is an entire human being sitting in the room.

Meet Dr. Chanel Thomas

Dr. Chanel Thomas is a doctorally prepared, dual board-certified nurse practitioner (FNP/PMHNP) and the founder, CEO, and clinical director of Blue Sage Wellness PLLC, a multi-state psychiatric group practice serving Tennessee, Kentucky, and New York. Blue Sage was created to provide culturally affirming, high-quality psychiatric care to communities that have historically been underserved or harmed by mainstream mental health systems, including communities of color, LGBTQ+ people, and neurodivergent individuals.

Dr. Thomas is also the founder of Aligned & Abundant, a clinician empowerment and conference platform, and the Flourish Collective, a practice incubator and coaching program designed to help licensed clinicians create sustainable, values-aligned practices. Her work integrates a decolonized approach to psychopharmacology, neurodivergent-affirming care, and—because apparently psychiatry is allowed to have a personality—plenty of anime, gaming, and geek culture.

Listen to the full episode of But For Real for our complete conversation about adult ADHD, masking, burnout, late diagnosis, psychiatric medication, anti-oppressive mental healthcare, the surprisingly complicated question of what it means to be “high-functioning”—and, of course, Chanel’s extremely reasonable campaign to convince everyone to watch all 1,200-ish episodes of One Piece.