Living in the Gap: Reflections on ADHD, Shame, and Perfectionism

ADHD, Shame, & Perfectionism: Living in “The Gap” between Ability and Performance

PESI Digital Seminar

(Took Course 2026)

One of the most painful and least visible aspects of ADHD is the gap between ability and performance. Many people with ADHD know what they are capable of—and yet repeatedly find themselves unable to meet expectations, deadlines, or internal standards in consistent ways. Over time, this gap often becomes fertile ground for shame, grief, anxious perfectionism, and rejection sensitivity.

This PESI seminar offered language and structure for something I see frequently in both clinical work and lived experience: the emotional toll of chronic executive functioning challenges, and how easily that toll can be overlooked when treatment focuses solely on skills, strategies, or medication.

Core Themes from the Course

Rather than framing ADHD as a problem to be optimized away, this training emphasized an often-missed therapeutic opportunity: supporting clients in working through loss and shame that are “baked into” the ADHD experience.

Key areas explored included:

• The emotional impact of living with persistent executive challenges

• How shame and perfectionism shape self-understanding and treatment engagement

• The ways impulsivity and high internal standards can coexist—and conflict

• How clinicians may unintentionally miss shame cues during assessment

The concept of “living in the gap” was especially resonant—the chronic discrepancy between what someone knows they can do and what they are able to consistently perform in real-world conditions.

Why This Training Was Meaningful

What stood out most was the explicit focus on grief and loss—loss of imagined selves, lost opportunities, strained relationships, and the erosion of trust in one’s own abilities. These experiences are often normalized or minimized, yet they deeply shape how clients relate to themselves and to care.

The course also highlighted how shame can quietly influence:

• Diagnostic assessment

• Resistance to treatment

• Overcompensation through perfectionism

• Avoidance or disengagement when expectations feel unattainable

Learning to recognize “red flags” for shame during the clinical interview felt especially important, as shame is often expressed indirectly—through humor, minimization, intellectualization, or self-blame.

Practical Tools and Clinical Considerations

The seminar offered several practical strategies for working with shame and perfectionism in ADHD clients, including:

• The self-esteem abacus as a way of understanding fragile self-worth, looking at how you are in relationship to different aspects of your identity. A visual was of considering where in your life you want to grow.

• Consider the positive characteristics of ADHD and how we can highlight them in our lives.

• Tonglen practice and self-compassion exercises to soften shame responses

• Early identification of shame or grief related resistance

• Case-based application to integrate these tools thoughtfully

I appreciated that the course also addressed the limitations and risks of these techniques, emphasizing clinical judgment and collaboration rather than one-size-fits-all interventions.

A Reflective Closing

This training reinforced something essential: ADHD is not just about attention, organization, or productivity. It is also about identity, loss, and how repeated experiences of falling short—despite effort—shape a person’s inner narrative.

Supporting ADHD clients means making room for both skill-building and grief work. It means slowing down enough to listen for shame beneath perfectionism, and to validate the emotional reality of living in the gap between ability and performance.

This course offered meaningful language, structure, and tools for doing exactly that.