“My autism is extremely invisible,” Lehmann says. “Society has more tolerance for a child having a meltdown but when an adult male who doesn’t look disabled does it, it comes across as very threatening.”

Recently on a work trip, Lehmann’s flight was delayed, causing his “Jenga tower of functioning” to come tumbling down. He kicked a trash can in frustration, attracting the attention of a heavily-armed police officer. Lehmann’s mother stepped in, explaining, “My son has autism. I’ve got this.” The officer took a step back, ready but waiting, as Lehmann calmed down.

Lehmann has had enough negative encounters with law enforcement — cornering him, cursing at him, shaming him — to know this was a best-case scenario. He’s terrified about what could have happened if he hadn’t had a traveling companion, or if the officer was more forceful. He wonders what the outcome might have been if he’d been Black.

The duty of law enforcement is to protect and serve, but when they encounter people with disabilities, too often the result is harm instead of help. Adults and teens with autism, ADHD, and other neurodevelopmental disorders appear to be at a heightened risk for negative outcomes every step of the way in the criminal justice system, from first police contact to questioning and detainment, to jail, trial, and beyond. Mishandled interactions can result in everything from distress and humiliation to jail time, or even death.

[Read: What the Americans with Disabilities Act Means For You]

While no comprehensive data exists on the collective outcomes when people with disabilities encounter police, we do know that neurodivergent individuals are over-represented in the carceral system. Rates of ADHD are six times higher among inmates than in the general public,¹  and rates of intellectual and developmental disabilities (including autism) are four times higher.²

Law Enforcement and the Neurodivergent: Unique Risks

Neurodivergent people face challenges with law enforcement as victims, witnesses, and especially as suspects. For individuals with autism, common behaviors like stimming, avoiding contact, or meltdowns arouse suspicion, which can lead officers to shout commands or make physical contact. This, in turn, intensifies sensory overwhelm and anxiety, making compliance less likely, not more.

Similarly, people with ADHD may have trouble following commands, because of impulsivity or distractibility, and this behavior can be viewed by police as uncooperative or disrespectful. An individual’s hyperactivity and restlessness, exacerbated by confinement to a chair in a small room, might be perceived as a sign of guilt. Working memory problems, time blindness, and memory distrust syndrome may cause a person with ADHD to have difficulty accurately answering questions or to reply, “I don’t know” to even simple questions such as: “Is this the road you live on?” Police may misinterpret this as evasiveness, another possible sign of guilt.

[Read About the Mom Spearheading Police Training on Autism]

In all these cases, what might have begun as a harmless situation can escalate quickly. “Officers that can’t identify the signs of disability may over-utilize force, may make an arrest for a situation that doesn’t call for one,” explains Texas Police Sergeant James Turner, who spent nearly a decade heading the Crisis Intervention Team (CIT) training in Austin, Texas.

Heightened Threats for People of Color

For neurodivergent people of color, the perils of an interaction with police are even greater. Black Americans are killed by police at twice the rate of White Americans, according to the Fatal Force Database, which has been tracking deadly police shootings since 2015.

Stephon Watts, a Black 15-year-old with autism in Illinois, was one of these victims. Watts’ parents called 911 to help respond to their son’s meltdown, but the arrival of the police only escalated Watts’ distress. Police fired two shots, killing Watts in his own home. In 2021, Illinois passed the Stephon Watts Act, also called the Community Emergency Services and Support Act (CESSA), which requires emergency responders to send mental health professionals to respond to mental or behavioral health calls.

Devastating stories like these keep Evelyn Polk Green, M.S., Ed., up at night. Past president of ADDA (Attention Deficit Disorder Association) and CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), Green says that as a mother to Black sons with ADHD, she worries about all the things that any mother of a person with ADHD worries about in a police encounter. “It’s just multiplied exponentially by all the other things that we already have to worry about on top of it,” she explains. “Unfortunately, so often law enforcement is ready to jump to the absolute worst conclusion and with Black and brown kids, it’s even worse, because they often automatically assume they’re up to something.”

Disability Awareness Training on De-escalation Techniques

Experts agree: training is the essential first step in ensuring better outcomes. “Most people call 911 when they don’t know what to do. We have to be properly equipped in that moment to handle that crisis,” says Sergeant Turner. “We are problem solvers but we have to have the tools.”

Those tools are exactly what David Whalen, project director for Niagara University First Responder Disability Awareness Training (DAT), aims to provide. The DAT is an eight-hour comprehensive training that covers victimization, Americans with Disabilities Act (ADA) compliance, interface with CIT, interaction skills, proper language and specific information on identifying and understanding a dozen disabilities including ADHD, autism, Tourette’s syndrome, dementia, and epilepsy.

Sergeant Turner’s disability awareness training was received during a 40-hour CIT training, required for all cadets in Texas. CIT training addresses how to support people experiencing a mental health crisis, and Turner hastens to clarify: “People with disabilities are not mentally ill, though they can have that issue as well.” Because some of the techniques (including de-escalation) overlap, disability awareness is often folded into CIT training.

Key topics include:

• Recognition of Disability: Officers learn common signs and symptoms of disabilities. Not all individuals can self-identify, and some choose not to. Proper identification of disability prevents officers from jumping to erroneous conclusions, including that the person is intoxicated, and allows for ADA accommodations.
• De-escalation Techniques, including:
  • Giving the individual space and time to respond. Many encounters with disabled individuals take a tragic turn simply because of the speed at which they unfold, creating unmanageable (and often unnecessary) distress. “You don’t always need to rush up on them,” says Turner. “You need to ask yourself, what are the risks vs. benefits of delaying action?”
  • Appropriate communication is essential. If someone with autism is distressed or experiencing sensory overwhelm, for example, a loud, commanding voice may cause further overwhelm. Adjusting tone and pace of speech, or using a pad and pen or hand signals, might be appropriate. Sometimes, Turner says, the key might be to call a family member to ask for specific guidance about support.
  • When force is unavoidable, using less lethal tools like tasers and pepper spray can save lives.
• Connect with Community Resources: Often, Whalen says, it is invaluable for officers to help individuals pursue longer-term support. Turner agrees: “We are not the experts. We just need to know who the experts are.”

“Fighting for Crumbs of Funding”

It’s clear that training works to improve outcomes. Yet there’s enormous variability in how much, if any, disability awareness training police officers receive, since it’s largely determined on a local level.  Too often, Whalen says, training only happens as a term of a settlement after a person with disability, or their family, sues the police for wrongdoing.

This was the case in Maryland; the bill that now requires disability awareness training for all police officers — through the Ethan Saylor Alliance — was created only after a 26-year-old man with Down Syndrome was killed when sheriff deputies tried to forcibly eject him from a movie theater where he neglected to buy a ticket.

“It would be beneficial to have something mandated at the national level but you have got to have the funding to support implementation,” says Leigh Anne McKingsley, senior director of Criminal Justice Initiatives at The Arc. “This issue of disability justice has been bumped down the priority list, and we’re fighting for crumbs of funding to bring about the exposure and education we need.”

Beyond Training: Community Resources

Training is crucial, but McKingsley says: “You can’t just expect training to take care of everything,” This is why, as part of its training, The Arc’s Pathway to Justice program assembles Disability Response Teams (DRT). These are multidisciplinary planning teams that bring together law enforcement, people with disabilities, attorneys, victim advocates, and disability advocates to collaborate in an open dialogue.

“The mandate is, on the day of training, the DRT starts making a plan of action moving forward,” McKingsley says. That includes brainstorming how to address the most glaring gaps in support and services both short and long term, and figuring out how to expand disability training in the community.

Sergeant Turner, who served on a DRT in 2019, agrees that bringing together police officers and people with disabilities leads to better policing. “Anytime someone calls 911, well, it’s probably not the best day of that person’s life,” Turner says. “Showing what a person with a disability looks like when they’re not in crisis is important.” Lehmann agrees: “Get-togethers with fun activities allow police officers to see the human side of disability, and they give that context.”

On the flip side, Lehmann points out, these community events help people with disabilities familiarize themselves with police officers in a calm environment, alleviating anxiety and setting the stage for better outcomes.

To truly tackle the problem though, McKingsley says, we have to understand its contours more fully, and this requires research, which is currently scarce. “Data would help us better evaluate the training, to know what strategies work and why,” he says. “The more we can show how often these encounters are happening, the more we can bolster our ability to go to local and state entities for action.”

Detained by Police? Keep This in Mind

If law enforcement stops you with questions, remember these three key pieces of advice from Rosemary Hollinger, J.D., founder of Partner Up, LLC:

1. First, pause. It’s important to not say the first thought that goes through your mind.
2. Tell the officer you have ADHD. Under the ADA, you’re entitled to reasonable accommodations, including modified questioning, fidgets, frequent breaks, and access to your medication.
3. Before you answer questions, make sure to have someone you trust, such as a lawyer or family member, with you to figure out exactly what happened. You must be truthful and accurate with police, so if you are forgetful and have time blindness, it’s essential to have a lawyer or trusted person with you to support you.

ADHD and the Risk of False Confession

Susan Young, Ph.D., a clinical psychologist in London, has conducted extensive research about people with ADHD in the criminal justice system. One study in which she was involved found that people with ADHD were at an increased risk of making a false confession, and the more severe the person’s ADHD, the greater the risk.³

If police don’t recognize that an individual’s difficulty following commands, sitting still, and answering questions is a result of ADHD, they may misinterpret these behaviors as evasive and guilty, explains Young. This may cause police to detain the person for even longer, which in turn exacerbates symptoms — particularly if the person’s ADHD medication has worn off. It’s a vicious, dangerous cycle which creates desperation.

“There’s all this anxiety; they want to get out,” says Young, who adds that sometimes, people with ADHD will choose to proceed without an attorney present, because they can’t bear to extend the process at all.

“They just want to leave,” Young concludes. “And they’ll say anything.”

The study concluded that safeguards for people with ADHD must be “put in place to prevent miscarriages of justice.”

Law Enforcement and Neurodivergent Justice: Next Steps

• Read: Crime, Punishment, and Redemption for My Son with ADHD
• Q&A: Recently Diagnosed, ADA Information
• Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children
• Upcoming Webinar: AuDHD Guidance – Why Autism Is So Difficult to Diagnose in Women and Girls with ADHD

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Young S, Moss D, Sedgwick O, Fridman M, Hodgkins P. A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med. 2015 Jan;45(2):247–58. https://doi.org/10.1017/S0033291714000762

²   Bureau of Justice Statistics, Disabilities Among Prison and Jail Inmates, 2011-2012 (U.S. Department of Justice, 2015), tables 4 and 5, http://www.bjs.gov/content/pub/pdf/dpji1112.pdf.

³ Gudjonsson, G. H., Gonzalez, R. A., & Young, S. (2021). The Risk of Making False Confessions: The Role of Developmental Disorders, Conduct Disorder, Psychiatric Symptoms, and Compliance. Journal of Attention Disorders, 25(5), 715-723. https://doi.org/10.1177/1087054719833169

Why am I like this? Why is everything such a struggle?

These are the questions that would plague me as soon as I’d wake up. There would be an avalanche of tumbling thoughts accompanied by fruitless resolutions to do better today than I did yesterday and most of the days of the past 50 years of my life.

Shoulds and have-tos mounted before I even sat up in bed. Procrastination began immediately. Today, I’d proclaim, I’ll start getting ready as soon as I have my coffee. But… I didn’t. Merely getting into the shower was a battle. By the time I was ready, I was already running behind. Again.

Most of the days in my life looked like this. I’m an adult, I’d tell myself. I’ve been an adult for decades. So why can’t I ever manage to plug my intentions into my motor cortex and just DO things without an epic struggle through resistance?

As Brené Brown told Tim Ferriss: “Midlife… is not a crisis. It’s a slow, brutal unraveling.” For most of my life, cycles of procrastination and panic-induced productivity got me through things — more or less. But when I reached midlife, burnout was increasingly winning these battles. My old constant companion, anxiety, was just sort of there, hanging out like the parasite it was. Cranked up to 11, yes, but what good was it if it could no longer motivate me like it used to?

The Midlife Shift

Today, when I wake up, there’s no wave of anxiety, no dread of getting out of bed. I pour a cup of coffee and sit at my window, watching the birds. I take my time in the morning. My one rule for early mornings is to not engage in screen time right after waking. I sit and sip and let my mind wander.

[Download This Free Guide to Menopause and ADHD]

After journaling and meditating, it’s time for breakfast. I get ready at my own pace. My morning routine takes a long time, but I can afford to take my time. I schedule my days to allow it, because this is what my mind and body want. This sets the tone for the day.

Then comes work. I step gently through my to-do list, taking breaks when I need to. I switch tasks, working for a short block at each. The pacing is enough to prevent boredom and frustration, while still giving each task enough time to make some progress. I’m so much more consistent than I used to be; I make a little progress on each project each day. No more default procrastination, unable to start a task until I’m right up against — or past — an appointment or a deadline, then relying on intense stress to push through.

What changed?

An ADHD Diagnosis After Menopause

I was diagnosed with ADHD at the age of 52. Like many women with ADHD, I was diagnosed after menopause, when a drop in hormones makes symptoms much more apparent. Despite no medical professional ever spotting it before, my ADHD, as my diagnostician put it, “isn’t subtle.” He had to walk me through a meltdown over the phone when I couldn’t get through the questionnaire for my evaluation.

I’ll never forget the sense of gratification and relief I felt as I looked at his report. I read his clinical judgments for the degree of impairment for each symptom: “Severe.” “Severe.” “Severe.” Or sometimes, “Moderate to severe.”

[We Demand Attention: A Call for Research on ADHD and the Menopausal Transition]

After learning what having ADHD really meant — being wired for executive functioning difficulties — I was finally able to be compassionate and accepting toward the way I operated. My struggles and limitations started to make sense.

Starting Over

I tried a thought experiment: What if I start to regard all my supposed flaws and weaknesses — my absentmindedness, my inability to focus, the way I was always running late, how desperately hard it was to start any task — as features I simply have to work with, with no moral condemnation attached to them?

This was a major reversal from the way I had previously moved through my life. This meant starting over with a mindset that I hadn’t had since almost before my earliest memories. And with that, everything shifted.

I started to schedule around my energy levels, instead of what I thought I “should” be able to do. For example, I stopped thinking of 40-hour (or more) work weeks as somehow being optimal. Instead, I asked myself what I could do with part-time hours, so that I could live without constant burnout.

By understanding executive dysfunction and the constant fatigue of working with a very messy high-octane brain, I radically dialed back my demands of myself. I learned to work within my window of tolerance.

I stopped thinking of my energy limits as temporary obstacles, to be dismissed or plowed through. This was my wiring. It’s not going to change. This is what I have to work with.

Midlife ADHD and Menopause: Next Steps

• Free Download: Women, Hormones, & ADHD
• Read: ADHD Impairment Peaks in Menopause
• Read: Hormonal Changes & ADHD — A Lifelong Tug-of-War

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

I pack my things into my mini backpack and out the door I go. This is the beginning of a 4.75-mile rumination out in beautiful nature, with a quarter mile at the end reserved for noticing and enjoying said nature — 112 minutes of rumination and 8 minutes of awe.

Life is good. The weather is clear and welcoming. The trail is all mine. These are perfect conditions to start my dive into a deep, negative, ruminative trance. Soon I’ll be sucked into an intricately engineered inner-dialogue of ADHD angst, despair, and huffy ire — exactly what you’d want to be doing on a walk through the open-air beauty of the outdoors.

Not.

My Ruminations: Negative ADHD Thoughts Galore

My ADHD ruminations are usually born from a simple thought that bugs me just enough to spur further thought. Soon this little bug-thought grows into a goliath insect that lumbers like a creepy thing beside me for most of my precious time on the trail. Life is short. Trail walks are even shorter. Ruminations are hungry wasps that will eat up all my time if I let them.

My walking ruminations tend to be hypothetical conversations with people in my life — central or peripheral. I invent their words and my responses to them. None of it is real, it’s negative or positive, and it continues unabated because it feels impossible to halt.

[Read: 9 Calming Strategies for a Racing, Restless Mind]

At times, my ruminations are practice-talk for the future, which can be a good thing. I might practice what I’d say in a personal conversation, an ADHD coaching session with a client, or a presentation. These are helpful. Other times, these imaginary dialogues bring me down because they trash the opportunity to be positive. They invent and reinforce worst-case scenarios. They also trick my brain into thinking that my life really is a negative soup — all based on a complete fabrication.

It’s a Pattern: Putting a Stop to Negative Thoughts

Ruminations take over my mind and it feels as if I have no choice — but I do. But how do I choose if I don’t always realize I have options?

In the book ADHD 2.0, Edward Hallowell, M.D., and John Ratey, M.D., explain how our ADHD brains spend more time in the Default Mode Network (DMN) than does a non-ADHD brain. This DMN is where we generate our creative thinking — for better and for worse. My active DMN is what the trees along my walking trail can thank for my loud kvetching as I pass by.

But I knew all this and yet kept walking and fretting. Then, one day, a wave of nostalgia hit me when a song came on my phone during one of my rumination walks. It was a song I listened to during my COVID walks when the world shut down. Just as it did on those pandemic walks, the tune sparked in me a practiced response: teary-eyed sadness.

[Read: How to Stop Overthinking Things — A User’s Manual for Your ADHD Brain]

Then it hit me: Wait a second. There is no sad situation right now. COVID and that challenging time is over. That song was sparking an old, habituated response and it dawned on me that this was akin to what my ruminations do. They spur in me a practiced response to something that isn’t there. It’s a mirage, fake, not true. It showed me how far from reality my mind can stray, and how easily and quickly it gets there.

“Steph,” I said, “you don’t have to practice this response all the time. You don’t have to practice it at all.”

So, on that walk, I didn’t. I let it go. I squelched the beginnings of a new rumination. I quieted my mind because suddenly I saw that my reality was quite peaceful and secure. There were trees and birds. There was sun and a special time I could spend in nature. In that moment, I moved from ruminator extraordinaire to grateful me because, for once, I could just be without the struggle. I can’t describe how freeing that was.

Ruminating Thoughts and ADHD: Next Steps

• Free Download: 9 Truths About ADHD and Intense Emotions
• Read: How to Stop Catastrophizing — A Guide for ADHD Worriers
• Read: ADHD Lessons from Ultrarunning — Accept Help and Support Your Needs
• Read: Putting a Stop to Toxic Thoughts

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The Benefits of Play

Play – engaging in a fun, amusing, entertaining, activity for the joy of it – is an effective way to boost the feel-good hormone dopamine that so many ADHD brains crave. Dopamine reduces stress and brings calm, promotes creativity and cooperation, and even reduces inflammation. Play can also individuals help break out of hyperfocus, which can lead to ADHD burnout if left uninterrupted. Play allows the body and mind to rest, process, and restore its energy to make it through another day.

Fitting in Play

Play isn’t just for children. It’s as important as everything else on your to-do list. But what counts as play? According to Peter Gray, Ph.D., the psychologist and author, play is:

[Read: The Perils of All Work, No Play]

• self-chosen and self-directed
• intrinsically motivated rather that outcome based
• guided by mental rules that leave room for creativity
• imaginative
• conducted in an alert, active, but relatively non-stressed frame of mind

The possibilities for play, it seems, are endless! All things creative and artistic fit – from playing an instrument and painting to building puzzles and making up games. Still, integrating play through the day can seem impossible with a busy schedule. In her TEDx Talk “Play: The Cure for Burnout,” Acey Holmes, CEO of BoredLess, suggests weaving play into everyday situations and responsibilities to make them interesting or entertaining. Some ideas include the following:

• Listen to your favorite music while doing chores or work duties – and perhaps break out in dance while you’re at it.
• Institute play breaks in between tasks. One of my clients loves the Paint by Number coloring app to let her mind wander creatively through the day. Setting an alarm may prevent your mind from wandering so far off track that it can’t return.
• In the spaces where you get work done, introduce appealing scents and imagery you find fun or inspiring.
• Equip your workspace with toys (anything from LEGOs to fidgets) that light up your brain.
• Play a harmless prank on family members to get everyone’s laughter going.

Whichever way you integrate play into your life, know that it is a powerful way to manage stress and increase productivity and joy — ADHD or otherwise. Even if things feel overwhelming, try looking for at least one way to play each day. You may be surprised by how easy it is to rediscover play once you pay attention to it.

Portions of this post were inspired by my book: Powered by ADHD: Strategies and Exercises for Women to Harness Their Untapped Gifts.

How to Be Playful: Next Steps

• Read: 7 Keys to Living a Happy Life with ADHD
• Read: 5 Ways to Play Away ADHD Boredom
• Read: Are You a Player?

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

References

Quintero, Olga L., et al. “Autoimmune disease and gender: plausible mechanisms for the female predominance of autoimmunity.” Journal of autoimmunity 38.2-3 (2012): J109-J119.

Brauer, K., Scherrer, T., & Proyer, R. T. (2021). Testing the Associations Between Adult Playfulness and Sensation Seeking: A SEM Analysis of Librarians and Police Officers. Frontiers in psychology, 12, 667165. https://doi.org/10.3389/fpsyg.2021.667165

Distance runners anticipate difficulties and know to support themselves in any way possible to get to the finish line. It’s a given – they don’t think twice about it and don’t get hung up on it, either.

In our daily lives, especially as folks with ADHD, we fall into the trap of thinking we don’t need help, or that we’re wimpy if we accept help or create supportive structures for ourselves. Others don’t need this, we think.

Here’s that flawed logic applied to running: Why does the newbie runner need to stop and rest every half mile? The ultrarunner can go many miles before needing to stop. Therefore, the newbie must be a wimp, or worse, incapable.

A non-runner might assume this of a newbie, but ultrarunners know this couldn’t be farther from the truth. An early runner has needs, just as a later-stage runner does. Needs are needs.

[Read: Silence Your Harshest Critic — Yourself]

Once five miles becomes easy-peasy for the early runner, they realize they only arrived at that point because they gave themselves what they needed to be someone who can run five miles. With that experience, they’ll readily tell the next newbie runner to make sure to stop and rest the legs and heart every half mile. It’s the only way to get to five miles.

Needs are Needs: When Ultrarunning Meets Real Life

This logic – of supporting our needs to become who we want to be – applies to anything and everything. If we accept a tutor to help us, then eventually we’ll be someone who got through a class instead of one who didn’t. If we fully show up to therapy or coaching, then we eventually become someone who tackles the challenges in front of us instead of skirting them. If we externalize the content of our brains with systems, we become someone who forgets less rather than someone who continues to forget.

Guess who all these early-stage self-supporters become? People who make inroads into becoming the kind of person who has wins, and those wins beget more wins. The more support, the more wins.

I got to the point in my abilities as a runner that I would have said yes, without a second thought, if you asked me to run a 50-miler the following weekend.

When you read the prior sentence, did you picture me as someone who was so trained that I needed a lot less than an early-stage runner? I’ll let you in on a secret: I was a running diva. I had far more available at hand than an early-stage runner could imagine was possible. The more experienced I got, the more I learned how much support was out there to take for myself — and I took it.

[Read: My 25 Rules for Life — a Practical Cure for ADHD Shame and Stagnation]

I say this all the time to people: Do you think successful people have more support or less? They have far more, and it’s because they’re more likely to ask for it and give it to themselves.

Why would it be any different for us when the road to success means we’ll need to support our ADHD and account for our needs?

It wouldn’t.

The Long Haul with ADHD

Remembering to hand in work, showing up on time at work, getting out of a rabbit hole, staying on task, organizing our workspace, regulating our emotions — these are our daily five-mile runs.

Graduating from school, nabbing a promotion at work, becoming an accomplished person, becoming a person who has practiced options for staying calm in stressful situations — these are our long-distance runs.

The only way to become a champion — in anything — is to give ourselves what we need to push through. As you run your own race, take any and all support without question, without apology. That’s a champion mindset.

ADHD Life Lessons: Next Steps

• Read: 20 Rules to Live By — My ADHD Life Guide
• Read: Sports Psychology Tricks That Work for ADHD Brains
• Read: Your Strengths Inventory — Repairing Self-Esteem After an ADHD Diagnosis

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

“Someone with imposter syndrome feels like a fraud or a phony,” writes Sharon Saline, Psy.D. “You doubt your abilities and successes, believing that your mistakes and moments of imperfection are proof that you’re not an intelligent person.”

According to Saline, imposter syndrome, rejection sensitive dysphoria (RSD), social anxiety, and perfectionism – all common among individuals with ADHD – can be traced back to one thing: a core belief of deficiency.

Answer these questions to see whether you show signs of imposter syndrome, and to what degree. Find more resources on imposter syndrome at the end of this self-test.

The questions in this resource were informed, in part, from the ADDitude article titled “You Are Enough: How to Counteract Imposter Syndrome, Perfectionism, and RSD” by Sharon Saline, Psy.D., and from research literature on imposter syndrome. ^{1 2}

Time is Up!

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Can’t see the self-test questions above? Click here to open this test in a new window.

Imposter Syndrome: Next Steps

• Read: When Perfectionism Stems from ADHD – Challenging the Fallacy of “Not Good Enough”
• Read: You Are Not the Sum of Your ADHD Challenges
• Read: Why ADHD Masking Is a Form of Self-Sabotage
• Read: Fear of Failure Holds Me Back. How Do I Let Go of Past Mistakes?
• Watch: How to Interrupt the Cycle of Self-Sabotage

Sources

¹ Huecker MR, Shreffler J, McKeny PT, et al. Imposter Phenomenon. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585058/

² Chandra, S., Huebert, C. A., Crowley, E., & Das, A. M. (2019). Impostor Syndrome: Could It Be Holding You or Your Mentees Back?. Chest, 156(1), 26–32. https://doi.org/10.1016/j.chest.2019.02.325

For individuals with ADHD who menstruate, fluctuating estrogen and progesterone across the menstrual cycle invariably impact ADHD symptoms, emotions, and functioning. We know this to be true, but there is almost no research validating this relationship. So, we arrive at this conclusion using available research on how hormonal changes affect the body, along with anecdotal information and clinical observations of patients with ADHD.

But how hormonal fluctuations affect your ADHD symptoms  — and even medication efficacy — is for you to learn and discuss with your doctor.

[Get This Free Guide: Women, Hormones, and ADHD]

ADHD Symptoms Through the Menstrual Cycle

Estrogen and progesterone are produced in the ovaries, among other places in the body. These hormones easily pass through the blood-brain barrier to access the brain, which is filled with receptors that are involved in emotional regulation and cognitive functioning. Note that dopamine, which is heavily implicated in ADHD, is modulated by estrogen.

Through the menstrual cycle, which lasts 28 days on average, estrogen and progesterone levels rise and fall as the body prepares for possible pregnancy. Day 1 through Day 14 marks the follicular phase, where estrogen levels rise and rise, peaking at ovulation. After this point comes the luteal phase, where progesterone levels rise, and estrogen levels fall quite steeply before stabilizing at a low level. In this hormonal environment leading up to menstruation, women generally report more symptoms of depression, anxiety, stress, sleeping problems, binge eating, cognitive difficulties, memory problems, and other symptoms of premenstrual syndrome (PMS).¹

If your ADHD profile comprises traits like low energy levels, inattention, and anxiety, then the follicular phase, when estrogen is highest, might offer a welcome boost of energy, good mood, and clarity. In the luteal phase, you may suffer tremendously with PMS or its more severe form, PMDD, which disproportionately impacts women with ADHD.^{2 3 4}

If your ADHD profile comprises impulsivity and hyperactivity, high-estrogen states may be the most challenging part of each month for you. This is because high estrogen levels could cause a surge in positive emotions that may increase the likelihood of engaging in risky, sensation-seeking behaviors.²

[Read: PMS and ADHD — How the Menstrual Cycle Intensifies Symptoms]

Medication Efficacy Through the Menstrual Cycle

Many individuals with ADHD who menstruate report differences in symptom severity and, thus, stimulant efficacy across the menstrual cycle.^{2 5} Research on this front is limited, but it’s a valid hypothesis that fluctuating hormonal status can influence the effectiveness of ADHD medication. In the low-estrogen luteal phase, for example, some individuals may find that their ADHD medication doesn’t work at all, which only worsens functioning. For those who face increased risk for risky behaviors in the high-estrogen follicular phase, it’s possible that a medication dose can suddenly be too high (as estrogen and dopamine potentiate each other) further increasing the risk for these behaviors and other side effects.

Tailoring medication dosages to hormonal status — known as cycle dosing — could be key for optimizing treatment.^{2 5} Tracking your cycle will give you powerful insights into how hormonal fluctuations influence your ADHD symptoms, medication effectiveness, and overall functioning. With this data, you’ll be in a better position to talk to your doctor about enhancements to your treatment plan to improve your health and wellbeing.

ADHD and Periods: Next Steps

• Free Workbook: Track Your ADHD Symptoms During Your Menstrual Cycle
• Read: Women, Hormones, and ADHD
• Read: “PMDD Has Affected My Whole Life.”

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app co-founded by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry, 30(2), 100–117. https://doi.org/10.1097/HRP.0000000000000329

² Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

³ Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005

⁴ Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and behavior, 158, 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

⁵ de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

What’s it like to live with two neurotypes with overlapping and sometimes opposing traits? How do features commonly associated with autism — like strict adherence to routines, special interests, and stimming — harmonize or clash with ADHD features like hyperfocus, impulsivity, and novelty-seeking? How do common experiences with social functioning and masking show up? Here’s what ADDitude readers told us about the AuDHD experience and what they wish the world knew about living with autism and ADHD.

“I often feel like a living contradiction. I want order but cannot maintain it. I want to be systematic and precise but struggle with it, which leaves me constantly feeling not good enough (to my own standards) and like I can never quite ‘get there.’” — Samantha, Australia

“They require opposing needs sometimes. For example, I will often need a schedule to get things done, but a schedule that is too strict will feel conflicting. Generally, though, they help me have a unique and creative outlook on life. I am a hard worker and both good with the details and making quick connections. I can see to the heart of things. Being AuDHD doesn’t make my life as hard as being in a fundamentally ableist world does.” — Kaz

“They both amplify my executive functioning differences and sensory challenges. Medicating my ADHD also allows me to ‘push through’ some of my autism differences, which often leads to burnout and sleep issues. Sometimes my traits are in conflict, like wanting to take my time and be perfect but not having the attention span to do so. My ADHD brain signs me up for more than my autistic brain can deliver at times and vice versa.” — Dan, Australia

[Get This Free Resource: Autism Evaluation Checklist]

“When I do not have to box myself into typical working patterns, I find that autism and ADHD become complementary partners. I can create intricate plans while maintaining creative curiosity and flexibility. In terms of creative projects, this works wonderfully and allows a productive organic flow. What I wish others understood about me is that it’s the rigidity of the world that’s stopped me expressing myself and being productive. If I’m given the space, I can do wonderful things. The suffering comes when all of this magic is inhibited by fear in doing things differently.” — Chris, United Kingdom

“When my adult son misses social cues or feels socially awkward because of his ASD, the rejection sensitive dysphoria from his ADHD kicks into high gear, creating a cycle of embarrassment and frustration.” — Heather, Wisconsin

“I find they conflict often. My autistic brain is very logical and controlled, while my ADHD brain is ‘Yay! Just do it!’ It is exhausting.” — An ADDitude Reader

“My ADHD wants a million things to hyperfocus on while my ASD is happy with one or two. My ADHD wants to do ‘all the things,’ my ASD gets overwhelmed by it. They’re constantly clashing, so I look for ways I can support one with the other.” — Sharyn, Australia

[Read: How Can I Get Evaluated for Autism as an Adult?]

“I have diagnoses of both autism and ADHD, but I view these less as things I ‘have’ and more as labels that can go on my medical records to legitimize my difficulties with attention, memory, self-regulation, and verbal communication. Neither label on its own nor the combination is totally accurate to describe my disability. I wish that people understood that, while my mannerisms, difficulty communicating my needs, and difficulty regulating my own behavior may seem childlike, I’m a mature adult. Ideally, I would like support with these skills without being infantilized as I frequently feel I am.” — An ADDitude Reader

“I’m 51 and only started with ADHD medication this year. I’m a master at masking, and over all of these years I was able to find a balance between the two to function for the most part in ‘normal’ society. When I started Ritalin, it was magic for my ADHD symptoms, but what I didn’t see (but my psychiatrist and those around me did) was that my autism came out in full force. It was terrible for me at work, affecting relationships with colleagues negatively as well as with my husband. So I was switched to another medication, which frankly doesn’t work so well at all, but still sufficiently dampens my autistic traits. I am by no means expecting perfection, but I have yet to find a balance with which I’m satisfied.” — An ADDitude Reader

“My symptoms make me somewhat of an outcast, especially as an adult, in most situations. Both disorders cause me to miss social cues or misunderstand them. It’s likely why I constantly overshare. I am incredibly fidgety and stim all the time. I am always looking for some kind of dopamine-producing situation, so I’m easily distracted and/or bored and I hyperfocus a lot. Some benefits of being AuDHD include hyperfocus, love of menial tasks, calming down by stimming, ease in talking to new people, and sympathy/empathy for others.” — Jordan, California

“Not understanding myself and what AuDHD is — that is what hurts my mental health the most. I think I would value myself and my quirks more if I understood myself better from a neurodivergent perspective rather than a broken neurotypical one. I was diagnosed late and I’m struggling to accept that my life didn’t have to be this hard.” — CJ, Australia

“The biggest challenge with autism is spending lots of time figuring out what everyone means or why they behave in certain ways and how I’m meant to respond. Combined with ADHD and trying to get through the day with the jumble in my head and a brain that never stops, I’m exhausted a lot of the time. Exercise really helps. I’ve given up wanting or needing others to understand me.” — An ADDitude Reader

“I live with both ADHD and autism. I am very newly diagnosed and I am still working through all of the self-forgiveness that comes with realizing that my underachievement in life, emotionality, super-strong empathy, and easily-overwhelmed nature are not character flaws. I can see the benefits, such as being a very observant person who finds beauty in things that many people don’t tend to notice. I know I am lucky to feel things as keenly as I do but these traits also get in the way of feeling and acting ‘normally.’ I constantly wonder how other people have such thick skin. I also think that my ADHD — especially impulsiveness, big-picture thinking, optimism, and creative drive — tends to pull me out of bouts of depression that my autism would otherwise remain in. A tug of war is how it often feels, and if I look at my feelings/mood/outgoingness over a two-week period, some days will look the absolute opposite of others.” — Kellie

“Autism makes me an extreme rule follower. When ADHD impulsivity comes into play, it makes me angry with myself because I’ve ‘broken a rule.’ Both can play into agoraphobia and social interaction; At any point, I am either trying to either blend into the wall or thinking about how abnormal I am even as I try to chat and sound normal.” — Sandy, Massachusetts

“Autism makes some routine necessary. ADHD rebels against it. I have to make routines that allow me to change out parts. AuDHD keeps my life from becoming boring.” — Cassandra

“I was recently diagnosed with autism at the age of 63. I am female, so maybe that is why my diagnosis came late. I’ve known about my ADHD for many years. I didn’t always like myself, being so odd and all, but now I am fine with it. Actually, I don’t want to be like other people. I may be odd, but I am also gifted and you will not forget me. Getting older allows you to become who you were always meant to be, and that is very good.”. — Jane, Texas

AuDHD: Next Steps

• Self-Test: Autism in Adults
• Read: ADHD and Adult Autism – Symptoms, Diagnosis & Interventions for Both
• Read: “Could I Be Autistic, Too?” Signs of Autism in Women with ADHD
• Read: “How I’m Improving the Workplace for Adults with Autism”
• Get the Free eBook “The Truth About Autism in Adults”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Hours, C., Recasens, C., & Baleyte, J. M. (2022). ASD and ADHD Comorbidity: What Are We Talking About?. Frontiers in Psychiatry, 13, 837424. https://doi.org/10.3389/fpsyt.2022.837424

² Rong, Y., Yang, C-J, Jin Y, Wang Y. (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: a meta-analysis. Res Autism Spectr Disord. https://doi.org/10.1016/j.rasd.2021.101759

In my field of work, I see injustices often. My hyper-empathy and strong sense of justice drew me to this field, an area that gave me just the right amount of dopamine to help me manage well enough for many years – until things became really difficult and the stress and sadness mounted. I knew that my neurodivergent brain was making everything feel much more intense, but I wasn’t sure how to pull it all back.

One afternoon at home, burnt out, I knew I absolutely needed to clean my home despite a distinct lack of energy. I thought music would help, but this time, rather than put on Stevie Nicks, I selected a playlist at random and tried to power on. After a short time, I found myself dancing to the post punk rhythms of Siouxsie and the Banshees. My energy levels were up, and I suddenly gained the ability to do all the mundane demands I hadn’t been able to tackle for weeks.

Stumbling Into Punk Rock: A New Special Interest

I fell down a rabbit hole searching for more music that I thought might have the same effect. Cue my discovery of Riot Grrrl, grunge bands created by women, and feminist hardcore punk. In an instant, my world (and ears) became full of early ’90s bands like Babes in Toyland and Bikini Kill to more recent groups like War on Women, Lambrini Girls, and others with names too explicit to share.

Bands made up of women who fight for their voices to be heard, stay true to themselves, and don’t seem to care if they’re disliked? I had entered in to special-interest territory. I became absorbed in learning about the music, the women, and the culture they were promoting. At a time when I felt isolated and insecure and like I was losing a big part of my identity through my troubles at work, this music brought me joy and validation. It filled me with energy that I hadn’t felt for a long time and listening to it became the best and most important part of my day.

[Read: 13 Productivity Playlists to Center and Focus ADHD Brains]

Aside from the physical release of endless dancing, I found that the louder the music and vocals, the happier and calmer I felt. Any stress I was feeling reduced, and overwhelming thoughts about my inability to do something turned into figuring out how I could.

I decided to experiment with listening to something much louder. Inspired by the death and thrash metal gigs I attended in my early 20s, I found myself – now more than 10 years later – on my way, alone, to see a few hardcore punk bands at a DIY venue 50 miles away. I’d never been to a gig by myself, let alone one like this, and it gave me a buzz that ADHD just loves to pull me toward.

The evening of the gig, as I stood in the middle of the crowd and listened to the thrashing music, I experienced something I’d never experienced before: a quiet mind with no thoughts in my head. Peace. My mind was blown. Literally.

The Soothing Sounds of Hardcore Punk

I spent the next few months tracking the effects of this music on my feelings and behaviors and was amazed by the results. I found that I didn’t need as much sleep and was able to be active late into the night. I wasn’t as drawn to sugar and carbs. Overstimulation after a long day in the office was easier to tolerate, and moments of excruciating under-stimulation were few and far between. My ability to tolerate perceived rejection and criticism grew significantly. This music, it was clear, was making everything so enjoyable.

[Read: Music Therapy – Sound Medicine for ADHD]

This was not a life I was used to. It was something I had only experienced in short bursts. But here was punk music, my new special interest, giving me all the dopamine I needed to thrive. It was helping me behave in ways that were right for me, rather than being influenced by my barriers and my fears.

How do I use my special interest now to get the results I need? When I need a quick surge of chemicals to get me moving after waking up, Babes in Toyland’s Bluebell works every time. When I need to sleep, I’ll blast my thoughts away with Petrol Girls. When I’m feeling anxious or fearful at work and need to be brave, Double Dare Ya by Bikini Kill transforms my attitude and reminds me of my values. For those moments when I desperately need inner calm, I find it – in a raging hardcore gig.

AuDHD and Music: Next Steps

• Free eBook: The Truth About Autism in Adults
• Read: Does Music Focus Your ADHD Brain? Or Just Distract It?
• Read:Your ADHD Brain (Probably) Loves Brown Noise
• Read: How I Calm Down My ADHD Brain – 14 Quick De-Stressors

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The following four defense mechanisms commonly develop among individuals with ADHD:

Blaming

Blaming as a defense mechanism looks like making others responsible for the occurrence of an ADHD symptom and its consequences, as seen in the following examples:

Your child forgets that an assignment is due. The due date was posted and announced, yet they blame the teacher for not being clear enough about the deadline.

You arrive late to an event. You didn’t give yourself enough time to get there, yet you blame traffic or the slow driver in front of you for showing up late.

[Read: 7 Self-Defeating Behaviors That Aggravate ADHD – and How to Fix Them]

You forget to pay a bill. You blame your partner for mixing the bill with other papers, even though it was in your court to set a reminder for yourself to pay the bill – and put it on autopay.

Defensiveness

Responding in angry, confrontational ways that deflect from the issue rather than address it marks this defense mechanism. The following are examples of defensiveness:

Your teen arrived late to school and missed their first period class. You try to talk to them about it, but your child tells you to mind your own business or lashes out. Tensions rise.

Your partner mentions that you still haven’t cleaned out the garage like you said you would do for months now. You quickly get angry and deflect. “Well, you haven’t cleaned out your closet in a long time either,” you say. A fight breaks out, and everyone feels miserable.

[Read: Why You Lash Out — Sometimes for No Good Reason]

Minimizing

Minimizing occurs when you respond to complaints or disapproval about your ADHD symptoms by minimizing their effects on yourself or others. For example, you meet a friend half an hour later than you both planned. You notice that your friend is visibly upset, but you downplay your lateness, telling your friend “it’s no big deal.” Your friend gets even more upset, frustrated that you don’t seem to care about them or understand the effect of your actions.

Dishonesty

Not being truthful is a defense mechanism that causes lots of distress for families who are terrified about what it means about their child or partner’s character. But lying or stretching the truth, like other defense mechanisms, often come up in an effort to avoid shame and conflict. It’s also a method to save energy and avoid fatigue. (Living in a neurotypical world, after all, is exhausting.)

How to Break ADHD Defense Mechanisms

Let go of defense mechanisms by humbly owning up to ADHD symptoms as they arise.

• Know your strengths and areas of need. When do these defense mechanisms come up the most? What actions, no matter how small, can you take to manage the problem area?
• Apologize if you upset someone. As painful as it may feel to own up to an ADHD symptom, an apology shows others that you’re aware of how your actions – even if unintended – affected them. Be genuine in your apology. Say, “I’m sorry I made you wait. I should have gotten in the shower an hour earlier. I will work on that. I will text you ahead of time and let you know if I’m running late.”
• Seek to improve, not to perfect. If paying bills on time has always been a tough problem area, then a good goal would be to reduce how many bills are paid late in the next month. Aiming for improvement, not perfection, will take the pressure off and allow you to make more strides.
• Perfection doesn’t exist. ADHD symptoms and traits do not make you a bad person. Be kind to yourself and remember that there are many fabulous parts to you. Embrace your gifts and humbly acknowledge the frustrating parts and commit to working on them.

If you are the parent of a child or teen with ADHD, help them adopt the above strategies and heed these tips for parents, families, and partners:

• Take an empathetic lens. ADHD is a neurological condition that makes it hard to live up to the expectations of a neurotypical world. It’s why shame and defense mechanisms develop so quickly. Treatments and supports like medication, therapy, and coaching can help your child or spouse better manage symptoms and day-to-day challenges.
• Create an accepting environment where it’s safe to talk about ADHD and defense mechanisms. This encourages honesty and problem solving.
• Remain calm when bringing up an issue. Do not explode in anger or insult. If your partner left out a piece of wood with rusty nails near your dog’s walking area (as my ADHD husband once did), say, “I noticed you left out a piece of wood with sharp nails outside. That was upsetting and dangerous because it could hurt the dog. Please be more mindful of where you place items.”
• Be curious when symptoms go unmanaged. Together, think about how they can be better managed in the future. Look for improvement rather than expecting the issue to never happen again. Your child, for example, may still have moments where they conceal the truth to avoid punishment as a result of an unmanaged ADHD symptom. Your job is to create an environment where you won’t get upset if your child isn’t telling the truth, and work with them to manage the ADHD symptom in question.

ADHD Defense Mechanisms: Next Steps

• Free Download: How to Control Your Reactions
• Read: ADHD and the Epidemic of Shame
• Read: The Magical Thinking of ADHD Brains — and How It Drives Our Kids’ Lies

Susan Ciardiello, Ph.D., LCSW, is a psychotherapist and ADHD coach. She is the author of ACTivities for Group Work with School-Age Children and ACTivities for Group Work with Adolescents. Learn more about Dr. Ciardiello by visiting her website at www.drsusanciardiello.com

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

High-intensity exercise treats depression as effectively as do cognitive behavior therapy (CBT) and medication, according to a new study that found combining SSRIs, a type of antidepressant, with exercise improved depressive symptoms more than medication alone.¹

The systematic review and meta-analysis led by a research team from the University of Queensland, Australia, found that the more intense the physical activity, the more effective it was at managing depression. More specifically, vigorous exercises (e.g., running, interval training, strength training, mixed aerobic exercise) reduced depression symptoms in participants more than light physical activity (e.g., walking and hatha yoga), although the latter did provide some benefit.

These findings emerged from examinations of 218 randomized controlled trials, including 14,170 participants diagnosed with depression, to determine the effectiveness of exercise, psychotherapy, and antidepressants in treating depression.

When the researchers narrowed their analysis by demographics, they discovered that strength training and cycling positively impacted more women than men, and yoga or qigong provided more benefits to men than women. Yoga appeared more effective among older adults, and younger adults received better results from strength training. The duration and frequency of exercise did not affect the results.

The study also suggested that men appeared to benefit more than women from combining yoga, Tai Chi, or aerobic exercise with psychotherapy. Yoga and aerobic exercise combined with psychotherapy seemed more effective among older adults.

Participants gained the most benefits from group classes or scheduled exercises. The more autonomy participants had over their exercise programs, the weaker the outcome. “When provided with more freedom, the low self-efficacy that is symptomatic of depression may stop patients from setting an appropriate level of challenge (e.g., they may be less likely to choose vigorous exercise),” the study’s authors wrote.

The researchers cautioned that definitive conclusions are impossible to draw, and more studies are needed. “Our review did not uncover clear causal mechanisms, but the trends in the data are useful for generating hypotheses,” they wrote. “It is unlikely that any single causal mechanism explains all the findings in the review.”

“Exercise should be considered alongside traditional interventions as a core treatment for depression,” report author Michael Noetel, Ph.D., said in a press release. “No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression. Of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.”

Exercise and Depression

Members of ADDitude’s reader panel confirm several findings from the study published in The BMJ (British Medical Journal).

“Strenuous full-body aerobic activities like boxing, karate, swimming, or boulder climbing help me get my thoughts in the right place and boost my mood and energy,” one panelist wrote. “Physical activity also helps me fall asleep and feel less stressed overall.”

“Running helps with my anxiety and depression,” another reader said. “It’s like a vacation for my overstimulated brain.”

A recent retiree who goes to the gym six days a week for group fitness classes and strength training sessions with a personal trainer shares that physical activity helps him feel calmer and more focused. “Exercise gives me a sense of accomplishment and community,” he says. “It is truly my second medication.”

Exercise Benefits Children and Teens with ADHD

The benefits of physical activity are not limited to adults; exercise improves the mental health of children and adolescents with neurodevelopmental disorders (NDDs), including ADHD, learning and motor disorders, autism spectrum disorder (ASD), and intellectual disability, according to a recent systematic review and meta-analysis published in JAMA Pediatrics.²

The researchers found that high-frequency (more than 27) 40-minute sessions of physical activity significantly benefited cognitive function, psychological well-being (e.g., self-esteem, quality of life), internalizing (e.g., anxiety and depression), and externalizing (e.g., aggression and disruptive behavior disorders) behaviors in children and adolescents aged 5-17 years with NDDs. They examined 59 studies with more than 3,000 participants.

ADDitude caregivers recognized similar results from their children after participating in physical activities.

One reader takes their son to the YMCA at least three times per week. “Depression can really take hold of my 10-year-old son,” the parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

“My daughter has been playing hockey since she was young,” a reader said. “She says she can slow her brain down when she’s on the ice and think more clearly, and it’s as if her ‘ADHD evaporates.’”

“Intense cardio activities, like cross-country skiing and soccer, help my son burn off some of his boundless energy, and he gains self-confidence by being good at something nonacademic,” a reader said.

Another reader said, “My oldest is a distance runner. He is committed and gets up early to run his miles or workout. Running gives him that needed dopamine hit to keep his ADHD symptoms under control at the start of the school day.”

Incorporating Exercise in Depression Treatment Plans

A 2023 treatment survey of 11,000 ADDitude readers reaffirms both studies’ findings. Roughly half of the respondents who use this treatment rated exercise as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. Yet only 13 % of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37% of all respondents said physical activity was part of their treatment plan.

The BMJ study encourages clinicians to consider exercise a viable alternative to drug treatment or adjuvant for those already taking medication. “The findings support the inclusion of exercise, particularly vigorous exercise, in clinical practice guidelines for depression,” they wrote. “This may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

Sources

¹Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D. et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. doi:10.1136/bmj-2023-075847.

²Liu C, Liang X, Sit CHP. (2024). Physical Activity and Mental Health in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2023.6251.

Many ADDitude readers gravitate to volunteer opportunities that make a difference while harnessing their ADHD energy and creativity. Traits like hyperfocus, justice sensitivity, and compassion, our readers say, make them well suited to be of service.

The benefits of volunteering are plentiful. Being of service with like-minded people raises self-esteem and feelings of belonging, both crucial to warding off one of the most pressing public health issues of our time: loneliness.

“Service is one of the most powerful antidotes we have to loneliness,” said U.S. Surgeon General Dr. Vivek Murthy in his podcast House Calls. “When we help other people, that helps us feel connected to them in that moment, but it also reminds us that we have value to bring to the world.”

Here, ADDitude readers tell us how and why they devote their free time to volunteering.

The Power of Service for ADHD Brains: Benefits of Volunteering

To Increase Connections and Skills

“I volunteer for our church in different ways — being a greeter on Sunday mornings, cooking and serving meals for special events, distributing goods to those in need. Volunteering brings me out of my shell; I’ve met so many new friends.” — Gretchen, California

[Read: Resilience Begins with Responsibility — the Power of Service for Kids with ADHD]

“I volunteer on the committees of several community music groups in which I play, which gives me the benefit of having friends with shared interests and a chance to use my leadership skills. ” — Bronwyn, New Zealand

“Volunteering has helped me to get to know some of the people I serve alongside a bit better, so it definitely has that social benefit for someone like me who struggles a bit with social interactions.” — Trish, South Africa

To Raise Self-Esteem and Self-Efficacy

“My volunteer work makes me feel good about myself and useful. This is especially important to me because I don’t feel like my life has amounted to much, largely due to my ADHD. Before I retired, I was always underemployed and never found satisfying work. My volunteering connects me to other like-minded people with whom I enjoy working.” — Susan, New York

“Volunteering helps with self-esteem, drive, and purpose. It helps us lead meaningful lives. Many adults with ADHD have heard a lot of negative feedback over their lives, which can be debilitating and wearing. Volunteering helps them hone in on their strengths and shows them that their contributions are not only needed but also valued.” — Cheryl, Illinois

[Read: Perfect Is a Myth — and Other Self-Esteem Boosters]

“I volunteer as a Bible teacher. This is wonderful as it takes my focus off myself and makes me happy, as I remind myself and other people that we do not have to be perfect.” —Tanya, Australia

“I am 70 years old, and I am  in training to be a volunteer chaplain for first responders and for families/survivors of critical incidents. Volunteering, especially for those of us who are no longer tied to a full-time career, is very important for our sense of self-worth and provides us with the assurance that we are still needed. The opportunity to work and train with like-minded individuals and to give back to those on the front lines who serve and protect their communities helps me get excited about each day, even when my ADHD symptoms and other challenges wear me down.” — Cecelia

To Put ADHD Traits to Good Use

“I volunteer at the local elementary school. It gives me structure, and a never-ending stream of variety and stimulation. I feel like it’s an environment where the strengths of ADHD can really shine through. The kids love the energy and spontaneity and different ways of thinking about things, and the adults love that I bring a fresh perspective about their neurodivergent students. Besides, it doesn’t take long to pick out one of ‘my kiddos.’ It takes one to know one, and I love offering them both validation and tips. — An ADDitude Reader

“I volunteer at a Habitat for Humanity ReStore. My ADHD loves the novelty of all the new donations I process. I thrive on the organized chaos of preparing for the store to open: I hustle when the 11 a.m. opening looms! It’s also a great opportunity to be creative when staging an area.”— Michelle, Mississippi

“My enthusiasm is usually less out of place in volunteering. It also helps me to feel more useful in life generally.” — K, North Carolina

“I volunteer with kids. My ADHD helps me have the energy to engage, be spontaneous, not take myself so seriously, and be more childlike.”— Mia, Wyoming

To Explore New Worlds (Under No Pressure)

“Volunteering is a way for us with ADHD to be able to try different things or wear different hats. For example, volunteering at the library and the animal shelter are ways for me to feel a bit like both a librarian and an animal rescuer or vet assistant at once, without me necessarily having to settle on one or to need to go back to school.” — Helen, Arizona

“I volunteer as an usher at a local performing arts center. After welcoming ticket holders, I watch the performance, and I’m often left inspired. Because many ADHDers have multiple interests, volunteering is a superb way of getting involved with whatever we fancy at the time, without a huge commitment.” — Michelle, Mississippi

To Better Manage ADHD

“I taught Sunday school and directed a children’s choir. The benefits of staying busy far outweigh not having anything to do. The more activities I have going on, the better focused and organized I am. If I am not busy, I don’t get anything done and my time management goes right out the window.” — Kathleen, West Virginia

“I volunteer at my kids’ school by chaperoning field trips, proctoring tests, and assisting in the front office. I like that when I’m volunteering, I am focused solely on the task at hand whereas at home I jump from project to project, never completing anything!” — Erica, North Carolina

“When I get a chance to volunteer, it’s a lovely way to break away from my routine and remind myself that I can make friends anywhere. It also helps me learn new skills, which keeps me stimulated. Both of these factors help with my ADHD and the former also helps with my RSD.” — Kirsty, Oregon

“Volunteering in a variety of ways has given me opportunities to test my executive functioning and develop mechanisms to get things right, all while being in a low-pressure environment. (I’m not in danger of losing a job if I make a mistake or forget to do something while volunteering.)” — Trish, South Africa

To Make a Difference on Your Terms

“I worked with adult immigrants helping them learn English. The contact with others was beneficial both socially and mentally. It was challenging and provided me with variety and a sense I was making a difference.” — Kathy, Minnesota

“Being able to give back and help is so healing for me mentally. The injustices and cruelties of this world most definitely take a heavier toll on me because of my ADHD. Being able to walk away from a task or event knowing that I made a small difference helps.” — Heather, New Jersey

“I volunteer at a cat shelter, and I’ve found it satisfying because, unlike my demanding professional career, it is concrete, task-based work. I scoop the litter, refresh food and water, clean the kennels, and visit the cats. It involves little decision-making and multi-tasking. When I’m finished, I go home. I don’t have to be mentally agile, and yet I do meaningful work.” — Jean, Michigan

“In 1991, I founded and became president of the Attention Deficit Disorder Association of Missouri. We met twice a month and, at the end of the month, we had a speaker. We also had a lending library and a hotline. I also wrote a puppet show for children, teachers and anyone who wants to know about ADHD. This show won a medal from the governor. All of these things have greatly helped me learn more about my own ADHD and have taught me many ways I can help myself and my son, who also has ADHD.” — Barb, Missouri

“I volunteer often at my kids’ schools. When I worked a ‘real’ job, I couldn’t keep up. I was stressed and felt like a failure as an employee and a mother. Volunteering allows me to work at my own pace and decide which jobs I want to do or can handle. It allows me to feel accomplished. — Erin, Maryland

“I lead a small group for teenage girls, many of whom have ADHD or struggle with mental health challenges like ASD, anxiety, and depression. They’re all a bit different from the norm, which is what I love about them. I want to provide them with the kind of support, acceptance, and guidance that I wish I had when I was growing up. Educating myself on how best to facilitate this group is what led me to pursue my own ADHD diagnosis. Leading this group can be very challenging at times, but it’s also very rewarding and fulfilling to see the positive impact it has on these girls. The mental health benefit is great, because it helps me feel like I am impacting the world around me (in my own small ways) for good.” — Trish, South Africa

Interested in Volunteering? Heed These Reader Tips

“Find something that matters to you. Accept that your contribution may not be enjoyable but know that you’re making a difference.” — Kalena, Florida

“Put yourself and your skills forward and explain how you could be of benefit. Once you’re in, immerse yourself. Reflect from time to time on what is going well with volunteering and what you can improve.” — Mary, Australia

“Find an organization that can be flexible with the amount of time and level of activity you commit. That way you can make adjustments as needed before you get overwhelmed or regret your decision to volunteer. It should be a positive experience, not a burden.” — Jennifer, Missouri

“There is no shame in trying out various volunteer opportunities to see what works for you, your schedule, your internal motivations, and your experience. If you find someone who is happy volunteering, ask them what they do and don’t like about that role and organization, and compare that to what you are personally looking for.” — Cecelia

Where ADDitude Readers Volunteer

• churches and faith-based organizations
• hospitals and mental health/wellbeing groups (e.g., addiction recovery centers, crisis centers, survivors of domestic violence, CHADD, grief support)
• animal shelters, sanctuaries, zoos (e.g., horse sanctuaries, Sea Turtle Preservation Society)
• neighborhood homeowners association
• recycling, clean up, and beautification groups
• housing programs, shelters, and food banks/meal delivery services
• local, state, and national parks, conservation groups
• art organizations, libraries, and museums (e.g., film festivals, performing arts centers, historical societies)
• schools and youth organizations (e.g., Girl Scouts, Boy Scouts, PTA, alumni associations)
• sports and athletic organizations (e.g., school teams, Special Olympics)
• political and civic organizations

Benefits of Volunteering: Next Steps

• Read: The Cure for Adolescent ‘Negativity Loops?’ Community Service
• Read: 7 Keys to Living a Happy Life with ADHD
• Read: Are You Ducking and Dodging the Connections You Need Most?

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The truth is that ADHD is genuinely debilitating at times. For example, I’ve spent all day writing this, but it was originally meant to be a 10-minute edit.

There are days when I struggle with ADHD impulsivity in ways that seemingly mess up my life, even when I’m being careful and working on managing my impulses. I take responsibility for my actions, but I’ve also beaten myself up for years over past mistakes. These blips and slips do not represent who I am, my skills, or my true character.

[Do I Have Hyperactive Impulsive ADHD? Take This Test]

The Mistakes You Don’t Make

Neurotypical people tend to notice our mistakes first and, to a lesser degree, our ‘surprising’ success stories. What they don’t see are the mistakes and blips we stop ourselves from making. Most of our personal progress in managing our ADHD symptoms is invisible to others, but that doesn’t mean we should ignore or discount it. Even small steps in the right direction deserve recognition.

For example, I have a habit of saying things that come out the wrong way when I’m nervous. I’ll see the other person’s eyebrow go up, assume the worst, panic, and try to dig my way out. This has — and never will — work, especially at work.

To solve this, I stop, close my eyes, open them again, make eye contact, and say, “Sorry, that came out wrong, and now I feel a bit silly.” Then I smile, which is a positive cue, and ask a related question to regain the flow of the conversation.

Most people would shrug off this interaction, but when it happens, I know I’ve made progress. I try, in those moments, to recognize that I’m spending time and effort addressing ADHD traits that matter.

[Download This Free Guide to Managing ADHD and Intense Emotions]

Is It Worth Getting Upset?

Impulsive mistakes don’t define me; neither do first impressions and strangers’ opinions. Over time, I’ve learned to recognize and understand the difference between a royal screw-up that will have a long-term effect on my life and things that are just normal human errors or behaviors that temporarily irked someone.

Think about your past dramas. Do you still talk to the people whose opinions kept you up at night for months? Do you even remember what you actually said? Was it really that important to you or to them?

Chances are that awkward, little mortifying moment was the funniest part of the person’s otherwise boring day. It probably made you quite endearing to them, but you’re assuming the worst because a lifetime of criticism has exacerbated your RSD and accentuated your sensitivity.

Instead, I’d encourage you to embrace and try to enjoy your silly ADHD moments for what they are. You are not the first person to giggle at a funeral or accidentally interrupt an exciting conversation because you want in. Being a bit embarrassed is quite cute, and it’s okay to be nervous and feel silly. Everyone does it, and everyone puts ‘their foot in their mouth.’ If anything, you’ve probably replaced all the stress and tension in the atmosphere, and with some humanity and joy, and that is an invisible victory unto itself.

Embracing ADHD Impulsivity: Next Steps

• Read: “Riding Motorbikes and Contemplating Death with ADHD”
• Learn: When ADHD Impulsivity Jeopardizes Your Job and Friendships: 8 Expert Tips
• Download: How Mindfulness Helps Counteract Impulsivity

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.