At 44, when I was diagnosed with ADHD, my neuropsychologist warned me that telling my family about it, given the personal background I provided, might not be the wisest idea.

Before I brought up ADHD to my family, they never questioned my previous medical diagnoses: migraines, a root canal, COVID-19, two bunionectomies, and two staph infections. My understanding of my health conditions was never challenged until it came to ADHD, when a single family member politely undermined my medical diagnosis, my grasp of reality, and my intelligence.

Why the ADHD denial?

To Deny ADHD Is to Uphold a Fraught Reality

Those who dismiss ADHD, I gather, often do it as an act of self-preservation. To deny ADHD is to avoid uncomfortable truths about opportunity and success.

From the moment small children can comprehend language, adult authority figures tell them that if they follow specific steps, a particular outcome is very likely or guaranteed. “Work hard, and you’ll get good grades.” “Success is no accident.”  “Practice makes perfect.” This rigid, unforgiving logic is the very foundation of the American Dream and a common justification not to help each other. Athletes, actors, musicians, authors, artists, scientists, and other recipients of professional honors, wealth, and prestige will parrot the same talking points.

[Read: Why It Hurts When Neurotypicals Claim an “ADHD Moment”]

My parents and teachers reiterated these adages too. All of my siblings ardently followed this advice, and they were richly rewarded for their legitimate hard work: private boarding schools in England, Ivy League graduate degrees, high incomes, networking with wealthy families, and professional achievements.

Not for me or the other one in 20 children in the 1980s who had ADHD, though.

The people who champion these simplistic platitudes don’t realize or account for the fact that learning isn’t that simple for those of us who are wired differently. If an undetected and untreated developmental disability stymied my academic and professional achievements – instead of my alleged lazy, unmotivated, unintelligent, and scatterbrained behaviors – then the reality for my family and all the other people who genuinely think they worked hard is shattered.

Despite steps to mitigate the effects of disability discrimination, this country still wrestles with the fact that not all opportunities for success are equal, especially in highly competitive, driven environments. Most upsetting is the fact that ADHD runs in families, meaning that “bad” genetics can threaten to upend one’s previously positive self-image and long-held beliefs about intelligence. The inability to accept reality, such as loved ones clinging to stigma over facts, takes hold in families and denies the possibility for compassion, empathy, and proper treatment.

Covert Denial and Faux Concern

I’ll give these skeptics and critics some credit: they know outright denials or rejections of an ADHD diagnosis are no longer socially acceptable. They really don’t want to appear brazenly ignorant by contradicting a widely recognized neurodevelopmental disorder.

[Read: “Is ADHD Really Real?” 6 Ranked Responses to ADD Skeptics]

What’s the “better” response? Very respectful, palatable contradictions that are cloaked in faux concern and passive-aggressive denial. “Being fidgety is normal in children, but now it’s a ‘condition!’” “The inability to focus and concentrate probably isn’t really ADHD.” “All of this ADHD nonsense is only a flashy trend.” “Is the rise in diagnoses social media’s fault?” In my case, I got the question, “Did you take this, um, ADHD test online? Because that’s not how diagnostic testing works.”

ADHD skeptics and critics don’t want to face the fact that one of the driving reasons neurotypical people flourished in life is because academic and workplace environments are mostly set up so only neurotypical people could thrive and prosper.

If there had ever been a proactive, organic nationwide movement to acknowledge and understand disabilities and work to equalize the playing field, then the Americans with Disabilities Act and the Individuals with Disabilities Education Act wouldn’t need to exist. Thankfully, legally mandated disability accommodations expand the chances of success to more people in the workplace, classroom, and other fields. However, with change comes unpredictability. Insecurity and fear drive prejudices and make ADHD accommodations difficult to obtain.

As for my family member who repeatedly attacked the credentials and professional licensure of the neuropsychologist who diagnosed me, I eventually got somewhat of an apology. “I think it’s really good you found ADHD. All of… that seems to be helping you.” I had no idea I had it so good.

ADHD Is Real: Next Steps

• Free Download: How Common Is ADHD in Adults?
• Read: The Definition of ADHD — Myths & Truths
• Read: The Controversy That Was Adult ADHD

Maria Reppas lives with her family on the East Coast. Visit her on Twitter and at mariareppas.com.

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“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

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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

Allyship serves as a powerful antidote to stigma and bias — and it comes in many forms. To understand what kinds of support are most meaningful, we asked ADDitude readers who are members of the neuroqueer community to tell us what makes a true ally. Here’s what they said:

“A loyal ally speaks up and shuts down derogatory conversations even when a targeted party isn’t present. I’m proud to be that person for people who need support.” — Christine, Ontario

“A true ally is someone who listens to you and does not judge. I’m a woman who is gay and has ADHD. As a child, I had one particular teacher in high school who took me under her wing and supported me through very turbulent times as a teenager.” — Sally, Australia

“A true ally is someone who doesn’t project rejection. People with ADHD already have plenty of that and LGBTQIA people are set up to experience that even more strongly and frequently.” — An ADDitude Reader

[Read: The Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth]

“My mom. I was accepted always, no matter what. I realized that I fall on the queer spectrum only after her passing, but the unconditional love and acceptance I experienced from her as a kid made me not give a single crap if others didn’t accept me as an adult.” — Marla, New Jersey

“There is a social group that acts as ‘adopted’ family members for LGBTQIA community members who have been shunned by their biological families. This group shows up to events such as graduations and weddings to cheer you on. Being treated with so much kindness and compassion stops the shame spiral of feeling unworthy of love and happiness.” — FJ, Ontario

“School staff that make the environment hostile to bigotry.” — An ADDitude Reader

“I am bi and have ADHD, and I’m grateful that my friend group is full of other LGBTQ+ and neurodivergent people.” — Kelsie, Mississippi

[Read: “We Are Who We Are. There’s No Shame in That.”]

“I’m a member of the LGBTQIA community and my best allies have been good listeners who make space for me to figure out how I feel and what I want to do with my life.” — Meg, North Carolina

“The people who have been the most supportive are people who deeply understand the neurodivergent experience and have taken time to listen to me and understand what it’s like to have that experience with the added layer of queerness. It’s so much more complex and all-consuming than I think non-queer and neurotypical people can realize.” — Charles, Pennsylvania

“A true ally is one who genuinely wants people to express who they are.”  — Pamela, Quebec

How to Be a Neuroqueer Ally: Next Steps

• Read: All My Friends Are Neurodivergent — and Wonderful
• Read: Happily Neurodivergent — at Last
• Read: Coping With the Stigma of 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.

In other words, it’s critical for college students and others who recently moved out on their own to develop reliable medication management routines without parental scaffolding — and to advocate for their own health care needs at the doctor’s office.

[Free Resource: 2024 Scorecard of ADHD Treatments]

Here is the advice I give to my young adult patients:

• Incorporate medication administration into your daily routine. Use alarms or reminders on your phone, or associate medication with specific daily activities (e.g., breakfast or brushing teeth). Use a pill organizer to keep track of doses.
• Understand the expected effects and potential side effects of ADHD medication, and the likelihood that ADHD symptoms will return if doses are skipped. Also know that ADHD medication reduces the risk of substance use and improves productivity at work and in school.
• With your provider, brainstorm ways to adjust your routine to better support medication maintenance. Discuss different medication options, such as long-acting versus short-acting formulations.
• Regularly monitor medication effectiveness and side effects. Keep track of changes in symptoms or adverse reactions. Talk to your doctor about these and any other challenges with your medication regimen, concerns about mixing your ADHD medication with other medications or substances, difficulties adhering to the prescribed schedule, or struggles with getting timely refills from your pharmacy.
• If you experience significant side effects, worsening symptoms, or recognize a change or deterioration in your work performance, relationships, sleep, exercise routines, task management, or overall executive functioning skills, it’s important to tell your health care provider.

ADHD Medication Management: Next Steps

• Download: Get Control of Your Life and Schedule
• Q&A: ADHD Medication — Side Effects, Dosages, Precautions & More
• Read: How to Treat a Teen Self-Medicating 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.

It’s been a year of new chapters for Jessica McCabe, the creator, writer, and star of the popular YouTube channel “How to ADHD.” In January, she published her first book, How to ADHD: An Insider’s Guide to Working with Your Brain (Not Against It) (#CommissionsEarned), which quickly became a New York Times bestseller. And in March, she became a new mom.

McCabe has been called the fairy godmother of ADHD by the iconic Ned Hallowell, M.D. “The world has been waiting for this book,” he says of her debut work.

ADDitude had a candid conversation with McCabe just weeks before she gave birth. We talked about her experience and dedication to writing her book.

The Writing of “How to ADHD”

ADDitude: Jessica, I found your book to be incredibly thorough, helpful, and empowering. You synthesized the most important research and insights on ADHD, while also living with the executive function challenges that you were writing about. How did you do it?

Jessica: It was my dream to write and finish this book. I am not somebody who finishes long-term projects. I dropped out of community college. I dropped out of massage school. I got distracted from, quit, or was fired from a ton of jobs.

[Watch ADDitude’s Webinar with Jessica McCabe: An Insider’s Guide to Working with Your ADHD Brain]

This is the first time I intentionally entered and completed a long-term project. It helped a lot that I already knew this information because I’d been learning about how my brain worked and where my challenges lay, and the strategies to support them.

ADDitude: What strategies did you use to manage this project?

Jessica: It was supposed to take me a year to write this book, but the first strategy I tried did not work at all. I asked the publisher in a meeting if I could get extra time because I knew I was going to need it. I got a lot of blank stares.

My next strategy was one of my favorites: working backward. I plugged in everything I needed to do over the course of the year. I also know that I tend to hyperfocus, so I gave myself four weeks during that year to just not work on the book or the YouTube channel, so that I wouldn’t die. I was like, “I don’t know what will happen if I hyperfocus on a project for a full year, but I’m pretty sure it’s not healthy. So let me give myself breaks.”

I also built in accountability. I told my editor, “I need you to be looking at each chapter as we go.” So I met with her regularly, and that accountability helped a lot.

I was still a few months late on the final project. But I just stayed in communication with my editor, letting her know, “I’m going to be a little bit late on this,” or “I need more time to edit that.” And she was really good about working with me and also letting me know, “We can’t give you any more extensions. We need this to be done at this point.”

There was a lot of communication, accountability, and planning ahead. I’m still in shock that it got done.

[Read: Everyday ADHD — Quirky Productivity Hacks for Easily Bored Brains]

ADDitude: You have a whole chapter on hyperfocus. Can you tell us more about the breakthroughs and exhaustion that came from this common ADHD trait?

Jessica: There’s a lot in my life that I would not have accomplished if it were not for hyperfocus. I do see it as a potential strength. But it can also be a problem because we can neglect our needs. I try to set up my environment or my time in such a way that I can slip into hyperfocus and take advantage of that really deep flow, but at the same time, put guardrails around it so that I don’t do permanent damage to myself. We know that a lot of people with ADHD end up with chronic pain and fibromyalgia [due to] neglecting our self-care, and part of that is because of hyper focus.

ADDitude: You wrote in the book that, when you started creating your How to ADHD videos, your plan was to research the condition so you could learn how to overcome your own ADHD struggles and become the person you were supposed to be. But by the end of your book, you land in a really different place. Can you tell us about that journey?

Jessica: At first, I thought, I can still have all these neurotypical goals and have this neurotypical life and have a clean house and a clean car and keep in touch with friends. I just have to do it in a way that’s ADHD-friendly. I was willing to accept that if my brain works differently, I might have to do things differently. But I wasn’t yet willing to accept the limits of using tools and strategies. No matter how many tools you have, the challenges are still there.

I still don’t have a clean car. I finally realized I need a housekeeper. I came to a place of acceptance, and it helped.

How to ADHD: Next Steps

• Free Download: Your ADHD Dopamine Menu Template
• Read: Get More Done with a Body Double
• Read: 8 Rules of Wellbeing — An Aid Kit for Women with ADHD
• Read: “I Don’t Need to Be Fixed!” Epiphanies of Self-Acceptance from Adults with ADHD
• Find: ADHD Specialists and Clinics Near You

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.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Hormonal contraceptives (HC) may help stabilize the fluctuations in estrogen and progesterone that occur during the menstrual cycle and in perimenopause that are particularly impairing for neurodivergent women, however research has found a correlation between some types of oral HC use and higher rates of depression in women with ADHD.

The impact of sex hormones, including estrogen and progesterone, on ADHD symptoms in women has only recently become the subject of scientific inquiry. A recent study found that various ADHD symptoms wax and wane depending on the menstrual phase. Researchers found that estrogen has a protective effect for both cognition and emotional regulation, and that ADHD symptoms tend to worsen when estrogen drops. ¹

These findings are reflected in the lived experience of ADDitude readers. In a recent survey, a full 98% of respondents reported experiencing hormone-related changes in cognitive function and/or mood, including changes in focus, attention and memory as well as emotional regulation.

Oral HC, or birth control pills, typically contain synthetic estrogen and progesterone. In addition to preventing pregnancy, they are often used to treat heavy menstrual bleeding, painful cramps, irregular periods, polycystic ovarian syndrome, and acne. In addition, some clinicians prescribe oral HC to stabilize hormone levels in women and treat premenstrual syndrome (PMS) and/or premenstrual dysphoric disorder (PMDD), which impact two-thirds of women with ADHD, according to an ADDitude survey.

Until recently, the implications of oral HC use for women with ADHD were entirely uninvestigated, however a recent study published in Journal of the American Academy of Child and Adolescent Psychiatry (JAACP),² revealed that:

• Women with ADHD who used combined oral contraceptives (COC) or progestogen-only pills (POP) had more than five times the risk for depression compared to women without ADHD who did not use hormonal contraceptives.
• This elevated risk was not found among women with ADHD who used non-oral HCs, such as hormonal IUDs or progestogen implants. These women had the same risk of developing depression as did their non-ADHD counterparts.
• This elevated risk was also not found among women without ADHD who used oral HC.
• Women taking HC for medical reasons (heavy bleeding, irregular periods, PCOS) were twice as likely to develop depression as those who took it primarily to prevent pregnancy. Taking HC for medical reasons was more common in women with ADHD than it was in women without ADHD.

“Systemic hormonal contraception contains progestins that inhibit the ovulatory cycle and thereby ‘smoothens’ the hormonal profile, but it may also mimic the negative mood symptoms experienced from natural progesterone during the luteal phase of the menstrual cycle,” explains Lotta Burg Skoglund, M.D., Ph.D., a lead author on the study. “However, most women do not experience these negative mood effects and, somewhat counterintuitively, some progestins may even alleviate symptoms of PMDD.”

An ADDitude survey of nearly 5,000 women revealed that 93% of respondents aged 45 and older experienced elevated and aggravated ADHD symptoms in perimenopause and/or menopause. More than half of these women said their ADHD symptoms — including feelings of overwhelm, procrastination, and memory issues — had a “life-altering impact” in menopause. We know that for hormone replacement therapy (HRT) can effectively alleviate common symptoms of menopause, such as hot flashes, mood lability, and insomnia, and it may offer other benefits.

“Studies show that HRT, if initiated within 10 years of menopause, reduces all-cause mortality and risks of coronary disease, osteoporosis, and dementia,”³ explains Jeanette Wasserstein, Ph.D., in the ADDitude article, “Menopause, Hormones & ADHD: What We Know, What Research is Needed.” “Overall, recent research suggests that the risk in using any type of HRT is lower than previously reported in literature.”

Research has revealed heightened risk for some cancers associated with some forms of HRT, so Wasserstein highlights that a thorough consultation with a medical provider is critical before beginning HRT.

What We Don’t Know

No studies have probed the implications of HRT use for climacteric women with ADHD and we know very little about the potential benefits or risks of HC for women with ADHD.

“ADHD is a common illness, but few studies have looked at the association of hormonal stages and ADHD symptoms,” write the authors of a systematic review of sex hormones, reproductive stages, and ADHD published in Archives of Women’s Mental Health.⁴ “Notably, we did not find any studies investigating ADHD symptoms in other female physiological states such as pregnancy or menopause or looking at the response of patients with ADHD to hormonal treatments such as hormone replacement therapy.”

The small puzzle pieces of existing data are surrounded by questions. Why, for example, did women with ADHD on oral HC experience far higher rates of depression while those on hormone implants or IUDs did not? Until more research is conducted, researchers are left to theorize.

“It may be that, when taking oral birth control, women with ADHD might be extra susceptible to forget to take their birth control pills or may take them irregularly, causing hormonal fluctuations that may destabilize mood,” explained Skoglund in her ADDitude webinar, “The Emotional Lives of Girls with ADHD.” Also, a woman’s hormonal levels will fluctuate during assumed pill-free intervals.”

Some anecdotal reports suggest the use of oral HC, which minimize hormonal fluctuations, may improve ADHD symptoms in some women.

“I was surprised and amazed by the extent to which my focus and my executive functioning improved since I started hormonal birth control,” said Silvia, an ADDitude reader in Italy. “I totally reshaped my life: I decided to start coaching people again, joined a company and am thinking of going back to university again to obtain a second degree. I don’t experience mood swings anymore and I feel less exposure to RSD.”

These anecdotal reports offer promise. But without research, clinicians lack a solid foundation of data to make treatment recommendations.

“We need to find out why some women feel better with oral contraceptives and others feel depressed,” says J.J. Sandra Kooij, M.D., Ph.D. “It is about hormone sensitivity, and how hormones interact with neurotransmitters such as dopamine in women with ADHD, but exactly what drives this difference is still unclear.”

Given a total lack of research studies, there is virtually no reliable science regarding the risks and benefits of HRT for peri- and post-menopausal women. Among the many questions that remain unanswered are the following:

• Does HRT improve symptoms of ADHD in climacteric women?
• Does HRT pose unique risks, either physiological or psychological, to women with ADHD?
• Does HRT impact the efficacy of stimulant or non-stimulant medication for ADHD?
• Are there women with ADHD for whom oral HCs mitigate ADHD symptoms? If so, what is known about this patient profile that can help clinicians make treatment recommendations? What types of oral HCs are most effective and least disruptive for this group?
• What factors account for the increase in depression in some women with ADHD on HC? If oral contraceptives are taken daily as indicated, does the risk decrease?
• Does oral or non-oral HC impact the efficacy of stimulant or non-stimulant medication for ADHD?

Why It Matters

Hormonal contraceptives are among several first-line treatments for PMS and PMDD, which impact women with ADHD with heightened frequency and intensity.⁵ Symptoms of these mood disorders are frequently debilitating, and include suicidal ideation. A comprehensive understanding of possible treatment options for these women could significantly improve quality of life and reduce the risk of self-harm.

Reliable, well-tolerated contraception is also critical for girls and women with ADHD because they are six times more likely to give birth as teenagers compared with women without this diagnosis, according to a recent study led by Skoglund. ⁶

These dramatically heightened rates of unplanned pregnancy were also found in the groundbreaking Berkeley Girls with ADHD Longitudinal Study, led by Stephen P. Hinshaw, Ph.D., professor of psychology at the University of California, Berkeley. “By the time they reached their mid to late 20s, about 43% of the BGALS participants in the ADHD group had one or more unplanned pregnancies,” Hinshaw told ADDitude.

Research has found that experiencing unwelcome psychological side effects is the most commonly reported reason for the discontinuation of hormonal contraception, a decision which could have far-reaching implications.⁷

“Unwanted pregnancy undermines women’s schooling, health and social status and is directly linked to the negative psychosocial impact of ADHD on health, autonomy, academic performance, and quality of life,” Skoglund says. “Averting underage parenthood through effective contraception methods will likely benefit women’s education, empowerment, health and quality of life, their families, offspring, and society from a health economic perspective and have broad and public health benefits, extending far beyond the targeted group.”

What ADDitude Readers Tell Us

Hormonal contraceptives earn mixed reviews from readers, some of whom find them helpful in balancing mood and reducing ADHD symptoms; others report that HC use increases in anxiety, irritability and depression, among other intolerable side effects.

“Hormonal birth control affected me so negatively that I went off of it. It was highly disruptive to my mood and overall wellbeing,” says Jen, a reader in Utah. “I don’t mess with the hormones — even though they love to mess with me.”

“I had an IUD for 7 years. Within a few days, I could not believe the change in my mood. I felt more emotionally even and steady than I had felt in years,” shares ADDitude reader Anne.

“My PMDD was exacerbated by any hormone preparation, including the pill. The low-dose Mirena was an absolute nightmare for me,” says Nicole, an ADDitude reader. “I’m so hesitant to try anything to manage impending menopause, which has me ever more on edge, and I’m not sure yet how to advise my teen on these matters.”

“I started birth control due to PMDD. The mini-pill has been fantastic for my ADHD. I have fewer hormonal fluctuations,” says Karen, an ADDitude reader in Idaho. “I can finally rely on myself to be functional every day (as long as I get enough sleep and take my ADHD meds).”

“I detested the combined pill. It wrecked my mental health, and gave me dangerous migraines),” offers another ADDitude reader. “I was still disorganized, unmotivated with the added bonus of all the physical and mental downsides of the combined pill.”

ADDitude readers often report improved brain fog, memory issues, and mood swings while on HRT, though some say their doctors resist prescribing hormone replacement.

“As I approach menopause, my ADHD symptoms have worsened exponentially — severe memory and concentration problems, plus brain fog, mood swings, acne, sleep problems, fatigue. I’ve been barely able to work for almost a year now,” says Jennifer, an ADDitude reader in California. “I begged my doctor for HRT, but they won’t prescribe it since I’m not technically in menopause yet. They put me back on the pill to see if that would help, but it didn’t help at all with any of my current symptoms and gave me terrible cramps and made me feel crappy the whole time.”

“I am really glad to be on estrogen HRT because it is preventing the double-whammy of menopause and ADHD, at least for now,” says Jaime, an ADDitude reader in North Carolina.

“I have recently started on hormones for women in (peri)menopause, and the horrendous brain fog I’ve been dealing with for the past 18 months has lifted a great deal,” says Isabella, an ADDitude reader in the Netherlands.

“I am postmenopausal, and take estrogen replacement daily,” says Amy, an ADDitude reader in Michigan. “I think my ADHD is worse on days that I miss my dose of estrogen.”

What ADHD Experts Say

Given the known relationship between fluctuating hormones and ADHD symptoms, researchers must explore how we can safely employ HC and HRT to ameliorate both mood and cognitive symptoms.

“Given the increased risk of depression in women with ADHD, which may be further increased by oral HC use, future clinical trials on contraception need to include women with mental health problems, including ADHD, to guide prescribers on the best available choices for these women,” write the authors of the JAACP study.

“In medicine, women are still understudied because they are considered less reliable research subjects than men, due to hormonal changes during the lifespan,” explains Kooij in “Hormonal Sensitivity of Mood Symptoms in Women with ADHD Across the Lifespan.”⁸ “Women with ADHD have been even more understudied, while exactly their hormonal mood changes and increased severity of ADHD urgently need our research attention.”

“Females with ADHD are usually excluded from studies on contraceptive effectiveness and tolerability,” Skoglund explains. “As contraception is a burden for women to carry due to male methods being less effective, lack of knowledge on how different contraceptives affect women with ADHD may create an undue burden.”

Next Steps

• Contribute to research on the impact of perimenopause and menopause on ADHD symptoms by completing ADDitude’s ADHD in Menopause survey.
• Download this free resource: ‘Interventions for Treating ADHD During Perimenopause and Menopause’
• Read these new recommended reads on menopause:
  • The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence, by Lisa Mosconi, Ph.D.
  • The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts, by Mary Claire Haver, M.D.

HRT, Birth Control & ADHD: Related Reading

• Q: “Can Hormonal Birth Control Cause Depression?”
• Women, Hormones, and ADHD
• Depression Risk Higher for Women with ADHD on Birth Control: Study
• Menopause, Hormones & ADHD: What We Know, What Research is Needed
• Hormonal Changes & ADHD: A Lifelong Tug-of-War
• PMDD Has Affected My Whole Life
• PMS and ADHD: How the Menstrual Cycle Intensifies Symptoms

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹ 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). ISSN 0018-506X. https://doi.org/10.1016/j.yhbeh.2023.105466

² Lundin, C., Wikman, A., Wikman, P., Kallner, H. K., Sundström-Poromaa, I., & Skoglund, C. (2023). Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 665–674. https://doi.org/10.1016/j.jaac.2022.07.847)

³ Langer, R. D., Hodis, H. N., Lobo, R. A., & Allison, M. A. (2021). Hormone replacement therapy – where are we now?. Climacteric : The Journal of the International Menopause Society, 24(1), 3–10. https://doi.org/10.1080/13697137.2020.1851183

⁴ Camara, Bettina, et al. “Relationship between sex hormones, reproductive stages and ADHD: a systematic review.” Archives of Women’s Mental Health, vol. 25, no. 1, Feb. 2022, pp. 1+. Gale OneFile: Health and Medicine

⁵ Ali SA, Begum T, Reza F. Hormonal Influences on Cognitive Function. Malays J Med Sci. 2018 Jul;25(4):31-41. doi: 10.21315/mjms2018.25.4.3. Epub 2018 Aug 30. PMID: 30914845; PMCID: PMC6422548.

⁶ Skoglund C., Kopp Kallner H.,,Skalkidou A. et al. Association of attention-deficit/hyperactivity disorder with teenage birth among women and girls in Sweden. JAMA Netw Open. 2019; 2e1912463 https://doi.org/10.1001/jamanetworkopen.2019.12463

⁷ Lindh I., Hognert H., Milsom I. The changing pattern of contraceptive use and pregnancies in four generations of young women. Acta Obstet Gynecol Scand. 2016; 95: 1264-1272 https://doi.org/10.1111/aogs.13003

⁸ Kooij JS. Hormonal sensitivity of mood symptoms in women with ADHD across the lifespan. Eur Psychiatry. 2023 Jul 19;66(Suppl 1):S23. doi: 10.1192/j.eurpsy.2023.92. PMCID: PMC10417850.

But if you’ve tried some of these ADHD interventions with limited success and ended up feeling like you “failed” at treatment, rest assured that you did not -— and you’re not alone in feeling this way.

In ADDitude’s recent treatment survey, we asked 11,000 readers about their experiences with 10 different kinds of treatments for ADHD, from medication to meditation. Readers shared what worked and what didn’t, plus stories of how painful the process of finding effective treatment can be, especially for those with rejection sensitive dysphoria (RSD), perfectionism, or feelings of shame.

“I felt as though I flunked mindfulness because I couldn’t pay attention for that long!” said one ADDitude reader. Another shared: “I felt like I was failing in talk therapy when I couldn’t talk in straight lines or remember what I had just said.”

Robyn, an ADDitude reader in Canada, simply said, “I always feel like I’m failing.”

[Read: ADHD and the Epidemic of Shame]

Feelings of Failure, Easily Triggered and Intense

Many people are quick to blame themselves when supplemental therapies don’t work as rapidly or as well as they’d hoped. This instinct has everything to do with the wiring of the ADHD brain, explains Tamar Rosier, Ph.D., in the ADDitude article, “Silence Your Harshest Critic — Yourself.”

“Neurotypical people have prefrontal cortexes that act like a butler. ‘Sir,’ the butler calmly says, ‘your keys are on the table.’ Or ‘Madam, you must leave now if you want to be on time,’” Rosier explains. “Instead of a tranquil butler, individuals with ADHD have an angry neighbor threatening them with his shoe. ‘If you lose your keys again,’ he yells, ‘I’ll throw this at you!’”

Zak, an ADDitude reader in Florida has experienced this first-hand: “My doctor is still working with me to get the meds correct and I feel at times it’s my fault; that I am the one whose body is not adjusting.”

[Download: 2024 Scorecard of ADHD Treatments]

For many, these feelings of falling short or failing to meet expectations are amplified by RSD, which triggers intense emotional sensitivity and pain, explains William Dodson, M.D., LF-APA in “How ADHD Ignites Rejection Sensitive Dysphoria.” “For people with RSD, these universal life experiences are much more severe than for neurotypical individuals. They are unbearable, restricting, and highly impairing.”

This description resonates with ADDitude reader Calvin in Florida. “When I have tried things like mindfulness, exercise, or therapy, I have not had success and I just felt awful,” Calvin says. “I thought mindfulness might help to end the snow-piercer-like train that lives in my head, but instead I felt like a child unable to do a simple concept.”

In addition to the neuroscientific factors that play a role in triggering feelings of failure, a long history of negative experiences exerts a powerful force, says J. Russell Ramsay, Ph.D., ABPP, clinical psychologist.

“Adults with ADHD are often more susceptible to feelings of failure and defeatism when undertaking new endeavors,” Ramsay explains. “This is likely due to past experiences with setbacks, which often result in criticisms. This, in turn, makes adults with ADHD sensitive to the first signs that something seems to not be going well.”

Clinical psychologist Sharon Saline, Psy.D., agrees, adding: “These past struggles resemble a thousand paper cuts per day and accumulate over time into larger wounds which leave sensitive scars. Feelings of shame and not measuring up haunt folks and make it tougher to try new things.”

How to Reframe Feelings of Failure

Experts agree that to optimize treatment for ADHD, trial-and-error is essential. The “error” part of that process can be demoralizing, but it is critical. To discover interventions that work, you’ll have to try ones that don’t — and knowing that from the get-go can be helpful.

“It is important to normalize setbacks as a part of the process of establishing new habits. It is rarely, if ever, a straight line,” Ramsay says. “Reframing a new habit as a challenge or as an experiment is important, as is setting up realistic expectations.”

“I have a hard time planning and sticking to a good regular habit, like exercise and mindfulness meditation. I used to get so aggravated with myself, and feel helpless,” says an ADDitude reader. “My therapist has taught me to not make a big deal of it and simply get back on track.”

Fine-tuning the therapies, lifestyle changes, and medications that best address your particular constellation of symptoms — and dealing with the emotional fallout of that process — is hard work, make no mistake. You can make that hard work a little easier by being kind to yourself, says Saline.

“Treat yourself with compassion, understanding that change usually involves forward motion along with some backsliding,” Saline urges. “Stumbling, regrouping and trying again is part of living for everybody—ADHD or not.”

 Fear of Failure & Treatment: Next Steps

• Read: You Are Worthy of Self-Compassion – How to Break the Habit of Internalized Criticism
• Read: “My Fear of Failure Becomes Paralyzing Perfectionism”
• Free Resource: Understanding Rejection Sensitive Dysphoria

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.

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.

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 addition to draining limited reservoirs of stamina, time, and patience, the monthly ordeal of searching for stimulants often includes upsetting encounters with pharmacy staff. Among ADDitude readers who use ADHD medication, 38% report that they’ve been made to feel like a “criminal” or “addict” when trying to obtain their prescribed medication. They share stories of encountering wariness, annoyance, and even downright hostility at the pharmacy, all of which exacerbates an already exhausting ordeal. In some cases, this refill process is so fraught with negative emotion that readers report re-thinking their decision to take medication at all.

You’re not alone if you have been made to feel judged, embarrassed, or interrogated. Here, readers vent about experiences they’ve had while trying to locate prescribed stimulants in the middle of an unprecedented shortage.

“For the love of all that is holy and all that is not, the pharmacies need to stop treating us like we are addicts. Yes, I am desperate to get my ADHD medication. But it is not so I can abuse it or sell it! It is because I desperately need the medication that makes my brain work well enough so that I can keep my job, so that I don’t make mistakes that might be dangerous, like getting distracted driving. Treating us, every single time, like we are possible criminals? It just makes everything so much harder.” —An ADDitude Reader

“I have to meet with the pharmacist each time I pick up my prescription, as if I don’t know what the medication does. It’s extremely embarrassing and it makes me debate whether I need to take it at all. Because I’m Black, there’s an additional layer to the stereotype of being ‘on drugs.’” –Paris, California

[Read: How the Adderall Shortage Is Casting a Long Shadow on ADHD Treatment]

“I compare it to making a heart patient run a marathon before filling their medicine. They are asking us to do the hardest task (that the medicine helps us with) and then they look at you weird for making the mistakes that ADHD causes! It usually ends in tears monthly.” —Brandy, Louisiana

“I’ve had pharmacies tell me to “take my drug-seeking somewhere else” when I called to ask if they had 10 mg Adderall in stock. Others have commented that I ‘don’t look like the kind of person who uses this,’ as though ADHD has a ‘look?’” —Mel, Idaho

“I had to have the pharmacist speak to one of the techs once because she made a comment about ADHD being a ‘made up’ thing. I was incredibly offended and was made to feel ashamed.” —Jennifer, Colorado

“I feel uncomfortable each time I have to get my prescription filled — a prescription that helps me function and not self-medicate as I used to prior to my diagnosis. It is incredibly frustrating!”  — An ADDitude Reader in Tennessee

[Read: “This Cannot Be the Price We Pay to Function.”]

“It’s a crappy process that I repeat for myself and both of my kids. I feel like I am begging for meds; it makes me feel looked down on and judged.” —Sarah, Washington

“I feel like a criminal every time I call a pharmacy. Often, I just go without, instead of feeling like a criminal.” —Mary Kate, Massachusetts

“I have to mentally prepare myself before I call the pharmacy because I never know how they’ll react. Phone calls are one of my biggest anxiety triggers, so it’s been really difficult to manage.” —Rachel, Kansas

“The pharmacy often has to revalidate the prescription, which makes me feel like I am being monitored for misuse. Increased inaccessibility makes me second-guess my choice to get medication assistance for my ADHD.” —Isabella, Ohio

“If you call for a refill a day early, you can get labeled as a drug-seeker. If something isn’t working or isn’t helping, I can’t talk to my doctor the way someone might be able to do with a sprained ankle.” —An ADDitude Reader

“We have never had a problem misusing our medications or being over-prescribed, and yet most mainstream pharmacies act like we’re trying to do something wrong when filling these prescriptions. I worry about my child not being willing to deal with this when they get older if they still need these medications.” —An ADDitude Reader

“My medication was out of stock everywhere and when I called around, the vast majority of pharmacies were very cold and callous about it and treated me like I was a crazy person for asking questions. They acted like if I needed ADHD medication I must be abusing it. Absolutely zero empathy for the fact that you can’t access a prescribed medication you need.” —An ADDitude Reader

Adderall Shortage: Next Steps

• Free Download: 2024 Scorecard of ADHD Treatments
• Read: Call to Action! Speak Up to End the ADHD Drug Shortage
• Read: The Real Reason ADHD Medication Supply Is Lagging Demand
• Hub: Stimulant Shortage

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Adults and caregivers reported that the process of searching for the right medication — the one with highest efficacy, fewest side effects, and covered by insurance — is often frustrating, but essential. Persevering through the often confusing, time-consuming, and inconvenient process leads to better management of ADHD symptoms in the end for most. Here, ADDitude readers share their experiences, both the bothers and benefits of trialing medications.

“There was one person in an ADHD support group who made a comment that changed my life. She mentioned that the seventh medication she tried was the right one for her. That made me decide to give medication a second chance, and try a few more. I could not have finished my Ph.D. without it.” — Heather, Canada

“Trial and error is generally a nightmare. School is not the best place to observe how a new med is or isn’t working; teachers usually don’t have the time, energy, or patience to report back accurately. We also had to change formulations several times due to the whims of insurance.” — An ADDitude Reader

“There are not enough resources to help people navigate going on and off medications while trialing. How long should I be on it? What about side effects? How does this relate to hormone changes throughout the month for women?” — Madeline, UK

[Download: Free Guide to Hormones & ADHD in Women]

“Medication trials have taken so long because our doctors are scared to do anything. It’s something that should be done quickly to find the optimal dose but they keep us in limbo because they’re not confident in their ADHD knowledge. We’re having to wait and wait and wait while our kids are struggling. It has a ripple effect on our entire household.” — An ADDitude Reader

“The process of trying out one medication after another slowly and methodically is very difficult to manage for most people who have ADHD.” — Tyler, California

“It was 10 years before I found a medication that helped me more than it made me feel worse. It’s important to kick a medication if it’s not working, even if it has worked previously.” — Juniper, Oregon

[Read: The ADHD Medication Stopped Working! How to Troubleshoot Treatment]

“Trial and error is hard. Then you find a medication that works and the manufacturer stops making it or the generic version, and you have to start the whole process again. So frustrating.” — An ADDitude Reader

“Finding the right match for children takes time and clear communication with schools and caregivers, which is sometimes very difficult.” — An ADDitude Reader

“I don’t feel that I have found the right medication yet. I’m very sensitive to medication and side effects also make it difficult to try different ones.” — An ADDitude Reader

“I have a really hard time tracking my symptoms and noticing changes on my own.” — Ashley, Minnesota

“The process of finding the right one can be very frustrating, but it’s worth being patient.” — Ali, North Carolina

“I wish there were easier ways to find the right medications for people with ADHD rather than trial and error.” — An ADDitude Reader

“Be patient. Give the medication time as you adjust dosage. Try other types if you need to. Everyone is different, and when you find the one that works, it is life changing in a fabulous way!” — Marcia, New York

“I’m hopeful that neuroscience will someday be able to treat ADHD without endless failed attempts with medication.” — An ADDitude Reader

Medication for ADHD Trial and Error: Next Steps

• Read: How Do We Know the Treatment Is Working?
• Read: Time to Switch to a New ADHD Medication?
• Watch: How to Optimize ADHD Medication – Achieving Better Symptom Management
• Learn: ADHD Medication Options – Stimulants, Non-stimulants & More

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 comments below are a true testament to the difference a trained provider can make in your ADHD journey. These ADDitude readers recall interactions with clinicians who made them feel seen and understood… and offer hope to those adults and caregivers who are struggling to get their needs met.

Patient-Provider Relationship: Positive Interactions

“As soon as I met my current psychiatrist, we clicked. I felt like she understood my symptoms and my struggles right from the beginning. It has made it easier to trust her with details about how my meds are helping or not helping — knowing that she will believe me.” — Jenna

“We had a really great mental health/psych evaluation years ago. The provider wrote a very wonderful story for my child to help him understand his diagnosis. It was based on the animal character to which my son related best. My son, sadly, picked a Sasquatch, which just about broke my heart. He said it was because he liked to just be left alone. The provider wrote a story about how the Sasquatch elders would help him to not be so alone.” — Katie, Oregon

“When talking with my new gynecologist about hormone replacement therapy, I advised her I may need a higher dose of Estradiol due to ADHD. She was unfamiliar with the ADHD-estrogen relationship but said she was always interested in learning more. I sent her a few links to studies (the scant few available so far), and we were able to develop a few options for treatment in conjunction with my ADHD meds.” — Paulette

[Free Class: ADHD Treatment Guide for Adults]

“…My son’s psychiatrist turned to me and said, ‘Your son has a neurodivergent brain. It’s like his brain processes information in a different language.’ We had recently been in a foreign country, so it was easy to compare. That wonderful psychiatrist was the start of our journey to understanding and providing appropriate support for our burnt-out teenager.” — Karen, New Zealand

“When we connected with our new psychiatrist, it was the first time we felt ‘seen’ and understood by someone. With a complex diagnosis of ADHD and autism in an extremely bright child, it was difficult to get someone to see [my son’s] difficulties. Once we realized she got it, it was such a relief. She said, ‘We have a lot of work to do…but we’ll get there. Don’t worry.’” — Leslie, Pennsylvania

“When talking to a psychologist for stress management, he just tossed out that I had ADHD. I had suspected it for a long time, but I felt like someone had finally noticed why things were so stressful.” — Ann, California

“When I finally got to see a psychiatrist, who confirmed my suspicion that I had ADHD (at age 35), I felt very validated. My family doctor had just put me on antidepressants, which didn’t work for me at all. It was great to know I wasn’t actually crazy.” — Claire, Canada

[Read: “Here’s How I Found an ADHD Specialist Near Me.”]

“We hired an occupational therapist to help our son with self-regulation. She saw all the good things in our son that we didn’t see due to the impulsivity issues he was having at school, summer camps, etc. She really helped us to see him for the amazing child he is and opened our eyes to the curiosity behind behavior that got him into trouble.” — Tiffany, Canada

“When my son was in elementary school, the school counselor had a wonderful relationship and bond with him. During a meeting at school, she told me: “Everyone focuses on his behavior challenges, but I want to acknowledge his personality and what a bright and caring kid he is. Yes, he has lots of challenges, but he’s also a great kid. Don’t forget that.” This was after a serious incident involving my son. I felt that she was really on our side and truly cared about him. The others in the meeting were talking negatively about him; she stood up for him.” — An ADDitude reader

“For me, it was a counselor at a crisis center. This was before my ADHD diagnosis, and I was in a depression/anxiety crisis in which my significant other had called 911. The police response took me to this center, and the counselor on duty (it was after midnight and she was the only one there) happened to be the most amazing fit for me. I usually would resist speaking to counselors in these settings, but something about her had me feeling comfortable enough to be honest. She said things that ‘clicked’ and got my wheels turning, which propelled me to seek out a diagnosis. Two months later, I was finally getting the correct diagnosis of ADHD, and my life changed forever.” — Laura, Oregon

The Patient-Provider Relationship: Next Steps

• ADDitude Directory: Find an ADHD Specialist Near You
• Free Guide: 25 Things to Love About ADHD
• Deep Dive: ADHD’s Pediatrician Problem

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.

“How to ADHD” is a powerhouse. Since launching her YouTube channel in 2015, Jessica McCabe has attracted more than 1.6 million subscribers to her smart, insightful, shame-blasting videos about living with a neurodivergent brain. For many people, Jessica is the face and heart of ADHD.

Diagnosed with ADHD at age 12, Jessica lost things constantly, couldn’t finish projects, and felt like she was investing more effort than everyone around her while falling further and further behind. By her early 30s, she was broke, desperate, and determined to find answers by hyperfocusing wholeheartedly on ADHD research. An actor by trade, she began recording videos to make sense and keep track of what she was learning about her ADHD brain and, in the process, found a community that was also searching for answers and understanding.

Last month, Jessica released her first book, also called How to ADHD. In this special conversation with ADDitude editors, Jessica will discuss themes from her book, including the following:

• The key she has discovered to navigating a world not built for the neurodivergent brain
• How the ADHD acronym is misleading and unhelpful for people who have plenty of attention but an inability to focus that attention
• The economic cost of not treating ADHD, especially in women
• How she’s learned to pay attention to time in new and effective ways that improve self-time management
• How to counteract sleep comorbidities like obstructive sleep apnea, insomnia, sleepwalking, excessive daytime sleepiness, and more

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO.

Living with ADHD: More Resources

• Download: The Ages & Stages of ADHD
• Sign Up: 5-Week Guide to Building Healthier Habits
• Read: ADHD Needs a Better Name. We Have One.
• Read: “Happily Neurodivergent — at Last”

Obtain a Certificate of Attendance

If you attended the live webinar on February 13, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Jessica McCabe is the creator, writer, and star of the YouTube channel How to ADHD. Since its founding in 2015, the award-winning channel—widely respected by treatment providers, ADHD researchers, and especially the ADHD community—has provided scientifically backed and experientially affirming information on how people with ADHD might work with their brains. Her work has been featured by The New York Times, The Washington Post, ADDitude magazine, Today online, Upworthy, and more.

Listener Testimonials

“So inspiring to hear how this speaker designs her life in the ways that support her well-being and strategies that enable her to accomplish the goals she has set for herself.”

“I’ve loved Jessica McCabe for a long time. As a parent who does not have ADHD, her insights into what my child might be experiencing have been invaluable. I ordered her book during the webinar and can’t wait to get started.”

“As a 53-year-old woman who was diagnosed with ADHD when I was 51, it was validating to hear Jessica talk about the challenges she experienced growing up. The last couple of years have been very hard and very enlightening. I look forward to reading Jessica’s book.”

Webinar Sponsor

The sponsor of this ADDitude webinar is….

Accentrate® is a dietary supplement formulated to address nutritional deficiencies known to be associated with ADHD. It contains omega-3 fatty acids in phospholipid form (the form already in the brain). This Brain Ready Nutrition supports attention, focus, and emotional balance. | fenixhealthscience.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Self-sabotage may manifest as the negative self-talk and behaviors that hold you back from reaching your goals. Behaviors linked to ADHD — procrastinating on tasks, taking unnecessary risks, aiming for perfection, always trying to please others, listening to that critical voice in your head that says you’re not good enough — can wreak havoc on relationships at home, at work, and with friends.

In this webinar, you will learn:

• About the patterns of behavior that hold you back from making progress, including perfectionism, procrastination, people-pleasing, and risk-taking
• How certain emotions, thoughts, and beliefs drive those self-defeating behaviors
• About strategies to interrupt the cycle of self-sabotage
• How to develop new habits that lift you up

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO.

Self-Sabotage with ADHD: More Resources

• Read: 10 Corrosive Thoughts That Are Holding You Back
• Download: Scripts to Manage Anger & Reactivity
• Get: The Emotions of ADHD
• Read: 6 Pieces of Life Advice from ADHD Coaches

Obtain a Certificate of Attendance

If you attended the live webinar on February 15, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Tamara Rosier, Ph.D., has been a college administrator, a professor, a high school teacher, and a faculty developer. As founder of the ADHD Center of West Michigan, she leads a team of professionals to provide resources for individuals and their families after they receive a diagnosis of ADHD. In her coaching, she helps her clients understand their thinking processes in order to develop more confidence, smoother communication, closer relationships, and increased academic or work success. She is a board certified coach and is the president of the ADHD Coaches Organization.

Listener Testimonials

“It was brilliant to see my self-sabotaging behavior broken down into its components with ways of dealing with them. Thanks so much.”

“I don’t have ADHD, but this presentation was extremely helpful for me. I have many of the same issues discussed!”

“This was insightful, funny, and useful. Many thanks to Dr. Rosier for taking the time to share her expertise with us. She has very lucky clients.”

Webinar Sponsor

The sponsor of this ADDitude webinar is….

Inflow is the #1 app to help you manage your ADHD. Developed by leading clinicians, Inflow is a science-based self-help program based on the principles of cognitive behavioral therapy. Join Inflow today to better understand & manage your ADHD.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Google Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy