By Dr Simone Stedmon

For many years when people have talked about homelessness, the focus has been on the visible challenges: housing shortages, financial instability, mental health struggles, substance use etc. What is less visible, but becoming increasingly recognised, is the role that neurodiversity can play in someone’s journey into, through, and out of homelessness, and it was great to see so many neuro-affirming presentations and considerations at the Pathway conference this year.  

Increasingly prevalent is the consideration of Attention Deficit Hyperactivity Disorder (ADHD), which is often described through its most recognisable traits, such as difficulties with attention, impulsivity, emotional regulation, and in executive functioning. For many people this can create day-to-day challenges, but for people experiencing homelessness these traits can compound existing pressures. Tasks that require planning, sustained attention, or follow‑through, such as attending appointments, completing forms, or managing benefits, are already difficult under stress and for someone with ADHD, they can feel insurmountable. This can lead to a cycle of missed opportunities, unintentional non‑compliance, and increased vulnerability; this is captured fantastically in a new model of understanding being developed by Lucy Hartland-Grant, which was shown at the Pathway conference.  

As highlighted in their seminar, raising awareness of ADHD for people experiencing homelessness is important as statistics show the rates of ADHD are higher in this marginalised population than the general population. Awareness encourages compassion instead of judgement, not just for the person at the centre who may have felt that there was something ‘wrong’ with them their whole life, but also for the workers who are alongside them, giving them a new understanding of what does or does not work, and ways of moving forward. 

However, as important as awareness is, we also need to tread carefully. Trauma, particularly from early childhood, can mimic ADHD symptoms and it’s easy to misinterpret what we’re seeing, particularly when not specifically trained in diagnostic profiling. When someone is already marginalised, misinterpretation can do real harm. 

For people experiencing homelessness, we know that there are significantly higher rates of adverse childhood experiences and being homeless itself often leads to further traumas in adulthood. 

Trauma can produce symptoms that look almost identical to ADHD. Hypervigilance can look like distractibility. Emotional overwhelm can look like impulsivity. Chronic stress can impair executive functioning just as profoundly as a neurodevelopmental condition. If someone is living in survival mode, then their brain will be doing what it can to keep them safe and whilst this can look like ADHD, it’s not the same thing - although there will also be people who have both ADHD and a history of trauma.  

If we rush to label trauma responses as neurodevelopmental disorders, we risk missing the root cause of someone’s distress and putting the onus on something ‘medical’ and internal, rather than understanding someone within the context of their life story.  As the Power Threat Meaning Framework would suggest, we need to be framing ‘distress’ as ‘what’s happened to you?’, rather than ‘what’s wrong with you?’  

This is why diagnosis in homelessness settings is so complex. It’s not that ADHD isn’t present - it absolutely is - but the line between neurodivergence and trauma response is blurred.  Instead the question should become, ‘how do we support people effectively without over‑diagnosing, pathologising, or making assumptions?’ 

The answer is simple. Build systems that are neuro‑friendly for everyone, and the need for certain diagnostic clarity becomes less pivotal. 

What if support systems were designed to be accessible to people with ADHD and people living with trauma and people who are simply overwhelmed? 

Neuro‑friendly design doesn’t need to be complicated, and can include things like: 

  • Clear, simple communication 
  • Flexible appointment systems 
  • Visual reminders and step‑by‑step guidance 
  • Calm, low stimulus spaces 
  • Predictable routines 
  • Support with organisation and planning 
  • Non‑judgemental responses to missed appointments or delays 

Reasonable adjustments don’t just help people with ADHD, they help anyone navigating instability; they reduce cognitive load, increase engagement, and create environments where people feel safe enough to participate.  From a mental health perspective, breathing and grounding techniques help regulation, and let’s normalise having fidget toys in the room and regular breaks for people that need them. 

When systems are built this way, diagnosis becomes less of a gatekeeper. People don’t need to prove they have ADHD to access support that works for them. They don’t need to fit neatly into a category to be treated with understanding. And service providers don’t need to become amateur diagnosticians to offer effective help.  Support should be shaped around individual need.  When people feel understood and accommodated, they’re more likely to engage with services, build trust, and take steps toward stability.  If we make services neuro‑friendly for all, then diagnosis becomes a tool, not a requirement. 

In the end, the goal is simple: to build systems where every person, regardless of their neuropsychological profile, has the best possible chance to engage, recover, and rebuild.