Adjustments we see, and the ones we may miss

With thanks to our member, Paul Cullen, for this blog.

Recently, I broke two bones in my hand. It was a silly mistake, followed by a painful drive to the hospital, several hours in the emergency room, this has resulted in an operation on my hand and metal plates and screws fitted to my fingers. The verdict: no driving for six weeks!

This small accident has given me an unexpected insight — a brief immersion into a world where my capacity is suddenly and obviously reduced. I’m having to make unreasonable adjustments to my day-to-day life. I can’t work as I usually do. Everyday tasks are altered: brushing my teeth, getting dressed, tying my shoelaces. Even stirring a cup of tea feels awkward and unnatural. Everything has slowed down, and I have to factor in extra time to complete the tasks I need to finish.

Another interesting observation has been people’s offers of help. With my arm in a sling, they stop to ask:

“Can I help?”
“Would you like me to carry that?”
“Do you need a hand?”

Offers have come without me asking. The support is immediate and unprovoked, apparently prompted simply because I look like I may benefit from it.

Visible and Invisible Differences

When we think of disability or difference, the mind often jumps to physical examples — a wheelchair, a walking stick, an arm in a sling: a visible difference. My temporary situation has given me a glimpse into that reality.

Of course, having a visible difference doesn’t guarantee the right kind of support. For some, visibility brings not just offers of help, but also unwanted pity, patronising attitudes, or even discrimination. My point isn’t that one experience is easier than the other, but that visibility can change how quickly, and how willingly, others might recognise that some form of adjustment is needed.

In a few weeks, my hand will heal and life will return to normal. But in the meantime, I’ve seen how much easier it can be for others to respond with understanding when the need for support is obvious.

The contrast is striking when I think about my unseen difference: I am also neurodiverse. A number of years ago, I was diagnosed with attention and hyperactivity difficulties — what is also known as ADHD. The language around this is changing, as reflected in this article in The Lancet, “words are powerful and can be stigmatising”. The recent understanding and perception of neurodiversity is evolving, and is reflected in more compassionate and respectful language.

The diagnosis didn’t surprise me. It confirmed patterns I’d noticed for years, and which those close to me had gently (and sometimes not so gently) pointed out.

Yet, unlike a sling or a plaster, my ADHD is less visible. People don’t automatically see it, so they rarely offer adjustments unless I ask directly. Even then, the response can be inconsistent, depending on people’s understanding of how it can have an impact.

What ADHD Can Look Like

My attention and hyperactivity difficulties aren’t always clear to others. From the outside, they can look like laziness, forgetfulness, or even disinterest and indifference. At other times, they appear as distraction, over-enthusiasm about small things, or repetitive behaviours — sometimes tics, sometimes echolalia (repeating sounds or phrases).

Inside my mind, there’s a constant stream of dialogue and activity. It can leave me feeling lost in my own head, overwhelmed, agitated, or physically and mentally exhausted. There are bursts of intense energy, followed by bouts of lethargy. These fluctuations can be hard for others to understand, even if they know about my diagnosis.

And unlike a visible injury, my differences don’t attract unprompted offers of help. No one says:

“Do you need a moment to gather your thoughts?”
“Am I giving you too much at once?”
“Would you like me to repeat the question?”

Support for my ADHD often depends on me explaining what I need — something that can feel exhausting in itself.

The Therapist’s Perspective

As a therapist, this has made me reflect on how I notice and respond to differences in my clients. Working online, I might spot physical cues: glasses that suggest visual difficulties, or a plaster-covered arm that might make typing challenging. These signs prompt me to adapt — perhaps by avoiding text-heavy exercises or allowing more time for certain tasks.

But with hidden differences, the cues are subtler or absent altogether. There’s no “plaster for the brain” to signal that someone might need a slower pace, less stimulation, or a different way of processing information.

Technology can help. I’m writing this using voice-to-text software, which is surprisingly effective, but there’s no instant tool that automatically adapts to ADHD in a conversation. When I’m feeling overstimulated, excited, or flat, I still have to manage those moments in real time, often while keeping my outward presentation in check. On video calls, I’m mindful of toning down my gestures and energy so I don’t come across as frenetic or overwhelming. I’m especially aware of this when working with clients with ADHD or other unseen differences.

An understanding of neurodiversity and difference has helped me consider my own experience and, in turn, the perspective of others with ‘unseen’ differences.

Adjustments We Don’t See

This experience has left me thinking about the kinds of adjustments we all make, both those imposed by circumstance and those we impose on ourselves.

When my difference is visible, other people adjust for me without much prompting. When it’s hidden, it sometimes feels like I’m expected to adjust to the world around me. That means moderating my energy, masking certain behaviours, or quietly working through overstimulation. In those moments, I’m often being less myself than I naturally am, simply to meet the expectations of a “typical” environment.

And I wonder: how often do we miss opportunities to extend compassion because we can’t see a need?

Asking Makes the Difference

When differences are visible, attitudes may lean towards immediate help — but that help is not always helpful or welcome. When they are invisible, reasonable adjustments usually require explicit communication, and even then, they may not happen.

The truth is, regardless of whether a difference is visible or hidden, adjustments can make a world of difference. The simplest way to find out what’s needed is to ask:

“Would anything make this easier for you?”
“How do you prefer to work through this?”
“Is there something I can change to help?”

These questions cost nothing. They don’t require specialist training. Yet they can transform an interaction from one of misunderstanding to one of understanding and connection.

A Small Act, A Big Impact

If there’s one thing my broken hand has taught me, it’s how powerful it is when others recognise a need and respond — even if only in small ways. But it’s also shown me the gap in how we respond to hidden differences.

● You don’t have to see a sling to know someone might be carrying a weight

● You don’t have to understand their full diagnosis to offer flexibility

● You don’t have to wait until they ask to extend kindness.

Consider how you respond to both visible and invisible differences in others. A small inquiry can open the door to compassion, understanding, and tolerance. And sometimes, that’s the most reasonable adjustment of all.

References:

The power of words: respectful language in ADHD research. The Lancet Psychiatry. doi: https://doi.org/10.1016/s2215-0366(25)00167-1.

Kelly, Ken (2020). Counselling Clients with ADHD. Counselling Tutor. Available at: https://counsellingtutor.com/counselling-clients-with-adhd/

ADHD Health Clinic. (2025). Unveiling the Mask of High Functioning ADHD. Available at: https://adhdhealthclinic.co.uk/video-article/unveiling-the-mask-of-high-functioning-adhd/

Mclaney, H. (2024). 305 – Reasonable Adjustments in Counselling. Counselling Tutor. Available at: https://counsellingtutor.com/reasonable-adjustments-in-counselling/

(Image of author aided by Chat GPT)

Updated September 2025