Nearly two-thirds of ADDitude readers ages 18 to 29 report feeling lonely “always” or “often,” according to a new survey of 4,170 adults with ADHD. Living or working with others made little difference; 89 percent of these young adults say they feel lonely even then. Only 19 percent say social media makes them feel more connected. In contrast, 46 percent of people ages 68 to 77—the demographic traditionally associated with social isolation — reported the same levels of loneliness.

“My ADHD makes it hard to remember to reach out or respond,” wrote one 28-year-old woman with inattentive ADHD, “but rejection sensitive dysphoria hits hard when I’m not reached out to or responded to, even though I acknowledge that hypocrisy. ADHD also makes it hard to leave the apartment (time management, overwhelm at what it takes to leave, energy to be social, executive function difficulties, etc.), so even if I’m invited, I find reasons to cancel.”

“For me, ADHD and loneliness impact one another,” wrote one survey respondent. “Now I neither want relationships nor do I have the energy to keep up the masking necessary to navigate relationships. It requires too much effort.”

When ADHD Symptoms Lead to Loneliness

The stories of social isolation shared by ADDitude readers were reflected in the findings of a recent meta-analysis of studies investigating whether young people with ADHD experienced greater loneliness than their neurotypical peers. The review of 20 studies, involving about 6,300 participants, concluded that people with ADHD who were younger than 25 had significantly elevated levels of loneliness due, in part, to mental health struggles, including anxiety and depression, and to “feeling different” because of their ADHD. Researchers called this an “important problem” of which clinicians should be aware for early identification and intervention, according to the study published in February in the Journal of Attention Disorders.¹

“I feel too quirky and awkward,” wrote one survey respondent. “I’m fun at first, but quickly become too much for others. I want there to be less of me.”

[Read: “Why Don’t I Have Any Friends?”]

For more than three-quarters of ADDitude survey respondents, feelings of loneliness are tied directly to ADHD symptoms, manifestations, and repercussions. According to the survey, the most common ADHD-related roots of loneliness include:

• low self-esteem: 67%
• rejection sensitive dysphoria (RSD): 65%
• social anxiety: 64%
• poor working memory: 63%
• “masking” who they really are: 59%
• executive dysfunction and disorganization: 57%

The Painful Toll of Loneliness

Loneliness correlates to mental health problems for 78 percent of adults with ADHD, who also report high levels of anxiety (65%) and depression (61%), among other comorbid conditions. For two-thirds of survey respondents, loneliness has led to toxic relationships, substance abuse, self-harm, binge eating, excessive spending, and porn addiction.

Among ADDitude readers who say they “always” or “often” feel lonely, only 26 percent live alone. Retirement, lonely marriages, physically limiting health conditions, and strenuous caregiving responsibilities were often cited by older survey respondents, who say that late ADHD diagnoses contributed to their loneliness as well.

“Grieving the loss of what I perceived as a ‘good’ life after my ADHD diagnosis made me feel like a failure,” wrote one older adult. “I cannot undo the damage or ill feelings caused by my past actions, and this recognition has caused me even more pain.”

[Read: The Science of Loneliness]

“When I feel lonely,” said one survey respondent, “I want to reach out, but I usually don’t because:

1.  ‘Out of sight out of mind’ has left too much time between interactions, and I feel shame over this.
2. When no one reaches out to me, or if I reach out and get no immediate response, RSD kicks in and I’m immediately overwhelmed with self-loathing.
3. I dwell on each previous interaction and why this person may be harboring ill feelings toward me.
4. Depression asks, ‘What’s the point of interaction? It’ll just exhaust you.’”

Causes of Loneliness For People with ADHD

More than half of the adults surveyed say they have trouble making and keeping friends for the following reasons:

• feeling overwhelmed
• fearing rejection
• experiencing social anxiety
• receiving few social invitations

“It’s a cruel loop,” one survey respondent said. “I feel safe when alone, so, much of the time, it’s a relief. But then, the loneliness is crushing.”

Coping with Loneliness

A spate of startups like the United Kingdom’s Timeleft and Friender are joining the veteran app Meetup in efforts to facilitate online connections that lead to real-life interactions. Some apps invite groups of strangers to meet for dinner at a specific time and place. Others work more like platonic dating apps where users scroll profiles before making plans. And some draw people together over common interests.

More than two-thirds of people say they feel less lonely when they reach out and connect with others in person, or via text or phone call. They also successfully alleviate loneliness through the following:

• physical touch: 62%
• engaging in a hobby: 58%
• spending time with their pet: 56%
• working with a therapist: 52%

“Letting the Mask Slip“ in Neurodivergent Friendships

More than half of adults surveyed say they relate better to, and feel less lonely around, other neurodivergent adults.

“Being with other neurodivergent folks validates my experience of living with ADHD,” wrote one survey respondent. “There’s less judgment.”

Said another adult with ADHD: “In a neurodivergent group, I don’t feel weird, and I can let my mask slip. It is less taxing and there is less of a chance of me freaking out later over social mistakes I might have made.”

Loneliness and ADHD: Next Steps

• Read: Birds of a Feather: The Joy of Neurodivergent Friendships
• Read: “How Do You Keep From Being Socially Isolated as an ADHD Adult?”
• Read: “Why Don’t I Have Any Friends?”

Sources

¹Jong A, Odoi CM, Lau J, J Hollocks M. Loneliness in Young People with ADHD: A Systematic Review and Meta-Analysis. J Atten Disord. 2024 May;28(7):1063-1081. doi: 10.1177/10870547241229096. Epub 2024 Feb 23. PMID: 38400533; PMCID: PMC11016212.

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“Social interactions rely on a complex orchestration of brain functions, from understanding another person’s point of view, recognizing their emotional state, feeling their emotional pain, and so on. Difficulties with any of these can affect our ability to connect to others,” says Ellen Lee, M.D., associate professor of psychiatry at the University of California San Diego. “The emotional pain and stress of loneliness can also take a toll on our brains.”

Lee was the corresponding author of a systemic review of 41 studies, involving 16,771 adult participants, examining the neurobiology of loneliness. Researchers in those studies used brain imaging and other scans to identify the differences in the brain structure and function of lonely people. The findings showed that some people were hard-wired for loneliness in the same way that some are hard-wired for anxiety.

Loneliness is defined as the emotional discomfort one feels when their need for intimacy and social connection goes unmet.

In the lonely participants, abnormal structure and/or activity was discovered in the prefrontal cortex, which mediates emotional regulation and inhibitory control; the insula, which plays a role in emotional pain and self-awareness; and in other parts of the brain. The review was published in the journal Neuropsychopharmacology in 2021.¹

[Test Yourself: How Severe Is Your Loneliness? Take This Quiz]

Lee says it’s possible that brain changes associated with ADHD, depression, and anxiety can lead to feelings of prolonged loneliness because people tend to withdraw from social interactions when they have low mood or other symptoms.

“Researchers are starting to study these links to understand if improving loneliness could be a way to improve these symptoms,” she says.

Lonely Brains Process the World Differently

In a study published in the journal Psychological Science in 2023, researchers discovered that lonely people viewed the world differently from each other and from nonlonely people. Using fMRI scans to examine neural responses to stimuli (videos) and other methods, the researchers also administered a loneliness scale and survey to evaluate the 66 study participants.²

They found that loneliness was associated with structural and functional differences in regions of the brain, and the researchers said their results remained significant even after controlling for individuals’ reported numbers of friends.

“Lonely people process the world idiosyncratically, which may contribute to the reduced sense of being understood that often accompanies loneliness,” the researchers said in the study. “In other words, we found that nonlonely individuals were very similar to each other in their neural responses, whereas lonely individuals were remarkably dissimilar to each other and to their nonlonely peers.”

The researchers said the findings “raise the possibility that being surrounded predominantly by people who view the world differently from oneself may be a risk factor for loneliness (even if one socializes regularly with them).”

Those findings echo the lived experience of many adults with ADHD who report feeling a sense of isolation due to their perceived difference. “I mostly feel like a dolphin in a sea of stingrays,” an ADDitude reader says. “I never meet people with whom I have anything significant in common, and with whom I can forge solid, lasting friendships.”

[Read: How to Make Friends As an Adult With ADHD]

The Evolutionary Function of Loneliness

Stephanie Cacioppo, Ph.D., a behavioral neuroscientist whose research seeks to understand how people experience different emotions, says evolution has sculpted the human brain to respond to biological mechanisms like hunger and thirst. Hunger, she says, is triggered by low blood sugar and motivates us to eat. Thirst helps us find water before we become dehydrated. Pain encourages us to take care of our body.

“Loneliness alerts us to potential threats, and damage to our social body, and in doing so, increases our motivation to bond with others,” says Cacioppo, author of Wired for Love. “It’s the brain’s way of telling you: You’re in social danger, you’re on the periphery of the group, you feel left out, misunderstood, you need protection, inclusion, support, and love. One of the most important things that love can do, it turns out, is shield us from the ravages of chronic loneliness.”

Cacioppo says it’s not uncommon for people to mask in the company of others when they don’t feel a sense of connection.

“Masking is totally understandable from a neuroscientific perspective,” she says. “The best solution is to stay authentic. Authenticity is the key to connectivity. Building connections with people while staying true to yourself can be a buffer against loneliness.”

How to Deal with Loneliness

Cacioppo offers several strategies to address chronic loneliness, encapsulated by the acronym G.R.A.C.E.:

Gratitude: Every day, write down five things you truly appreciate. Science shows that expressing gratitude improves emotional wellbeing.

Reciprocity: If you know someone who feels lonely, ask them for help or for advice. Showing respect can give a lonely person a sense of worth and belonging that decreases feelings of isolation.

Altruism: Helping others, and sharing your knowledge, will give you a feeling of self-expansion that is similar to what people experience when they are in a love relationship.

Choice: The tricky thing about loneliness is that, to some extent, it’s self-fulfilling. The more you think you are lonely, the more you are. To break the spiral, shift your mindset and choose to be curious about how you can make meaningful connections.

Enjoy: Smiling and sharing good times (or good news) with people helps reduce loneliness and increase happiness.

How to Deal with Loneliness: Next Steps

• Read: The Big Heart Approach to ADHD Acceptance & Self-Love
• Read: Are You Feeling Lonely?
• Read: Feeling Antisocial? Alone? Both? 3 Common ADHD Friendship Challenges
• Read: 13 Tips for Feeling Connected

Sources

¹ Lam JA, Murray ER, Yu KE, Ramsey M, Nguyen TT, Mishra J, Martis B, Thomas ML, Lee EE. Neurobiology of loneliness: a systematic review. Neuropsychopharmacology. 2021 Oct;46(11):1873-1887. doi: 10.1038/s41386-021-01058-7. Epub 2021 Jul 6. PMID: 34230607; PMCID: PMC8258736.
² Baek, E. C., Hyon, R., López, K., Du, M., Porter, M. A., & Parkinson, C. (2023). Lonely Individuals Process the World in Idiosyncratic Ways. Psychological Science, 34(6), 683-695. https://doi.org/10.1177/09567976221145316

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If you’re a mom who is raising children with ADHD, you may have complicated feelings about Mother’s Day. You may feel unnoticed and left out on this day, as the unique challenges and joys of caring for a neurodivergent child aren’t often widely represented. A “thank you” from your little one would be wonderful, you say. Then again, you also recognize that your child may have trouble expressing their thoughts and how they really feel about you, much less planning and executing breakfast in bed.

So this one’s for the amazing moms who are always in their kiddo’s corner, no matter what. The heartfelt thanks your kid would give you if they had the words (even if they accidentally forgot about Mother’s Day)? They’re all here:

[Read: What ADHD Moms Really Want This Mother’s Day]

5 Things Your ADHD Kiddo Really Means to Tell You on Mother’s Day

1. Thank you for understanding me. “Mom, you always try to understand me, even when I’m all over the place. I know it’s not always easy, but you make me feel like I’m okay just the way I am.”

2. I appreciate how you keep me organized. “The way you help me stay organized and on track is a lifesaver. Your checklists and reminders really help me, even if I don’t always show it.”

3. I admire your calmness. “When I get overwhelmed or upset, you stay so calm. It helps me feel safe and helps me calm down, too. You have this magic way of making everything better.”

4. I’m sorry for the tough days. “I know there are days when I really test your patience, and I’m sorry. Thank you for sticking with me through the tantrums, the meltdowns, and everything else.”

[Read: “Dear Mom of a Newly Diagnosed Kid with ADHD”]

5. Thanks for believing in me, even when I don’t believe in myself. “You always believe I can do great things, even when I mess up or get distracted. Knowing that you believe in me makes me feel like I can do anything.”

They might not thank you this Mother’s Day, but someday they will — whether through their words or actions. Until then, I’m here to remind you just how much you mean.

Mother’s Day & ADHD Families: Next Steps

• Read: 10 Thoughtul Mother’s Day Gift Ideas
• Read: “To My Kids: A Love Letter from Your Scatterbrained, Unpredictable, Truly Lucky Mom”
• Read: Overwhelmed Mom Syndrome — It’s a Real Thing
• Read: What Your Child Would Tell You About ADHD If They Had the Words

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.

Sometimes it can be difficult to tell when a relationship has crossed a line from supportive to controlling. Let’s examine the differences between these two types of relationships, including how they relate to ADHD.

Signs of a Supportive Relationship

In a supportive relationship, partners emphasize individual autonomy (the ability to make your own decisions) and independence, encouraging each other to pursue personal interests, goals, and friendships outside the relationship. Both partners respect each other’s space and neither seeks to dominate or control the other. When decisions are made together, they consider the needs of both partners. For example, partners may discuss treatment for ADHD together, but the ultimate decision is entrusted to the partner with ADHD.

Respect is fundamental and communication is open, honest, and non-judgmental. Partners feel comfortable expressing their thoughts, feelings, and concerns without fear. Partners strive to understand each other’s perspectives and seek mutually beneficial solutions. ADHD may be seen as an issue, but it is never “weaponized” against a partner.

Supportive relationships encourage mutual emotional growth and development. Partners encourage and celebrate each other’s achievements and milestones. Each partner actively supports the other in their personal and professional activities, including involvement in ADHD-related groups or communities.

[Is Your Relationship Toxic? Take This Self-Test to Find Out]

Signs of a Controlling Relationship

In a controlling relationship, there is often a significant power imbalance. One partner seeks to control the other, dictating decisions and actions. A partner who attempts to address a power imbalance often gets belittled or ignored. The controlling partner may also use manipulation or coercion to maintain control.

A controlling partner may isolate the other from friends, family, or other sources of support in an effort to create dependency, making that person reliant on them for validation and decision-making. A controlling partner may tell the person with ADHD that they don’t need treatment and were easier before getting help.

Trust and transparency are often lacking in controlling relationships. The controlling partner may show jealousy, monitor the other person’s activities, or demand constant reassurance. The controlled partner may need to hide aspects of their life to avoid conflict.

Controlling relationships discourage emotional growth or interests that threaten the power imbalance in the relationship. The dominant partner may actively discourage the other person from pursuing personal interests, goals, or treatment for ADHD. A controlled partner who has a healthy support system and who is receiving effective treatment is more likely to leave a controlling relationship.

[Get This Free Resource: Manage ADHD’s Impact on Your Relationship]

A supportive relationship improves the wellbeing of both partners, whereas the power imbalance in a controlling relationship is damaging. Recognizing these differences is crucial for creating healthy, fulfilling connections with others.

Controlling Relationships and ADHD: Next Steps

• Read: The Gaslighting Risk — Why Adults with ADHD Are Particularly Vulnerable to Manipulation
• Read: “How I Recognized an Abusive Relationship from the Inside”
• Read: Why Do Toxic Relationships Swallow People with ADHD?
• Listen: “Gaslighting, Love Bombing & Beyond — How to Recognize (and End) Toxic Relationships with ADHD”

Stephanie Sarkis, Ph.D., is a clinical specialist in child and adolescent counseling.

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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.

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.

And if ADHD runs in that family, the jam is not only juggling family life, health, and career, but also managing executive dysfunction, emotional dysregulation, and the complicated needs of other neurodivergent family members — diagnosed and otherwise. As “sandwiched” ADDitude readers tell us, this complex time of life is full of strain and overwhelm.

“The stress of being a mom to neurodivergent children, an employee, and a wife on top of caring for my mother seems absolutely unbearable at times. I don’t understand how others manage it all.”

“I am feeling overwhelmed with my role as a parent of an ADHD child while seeing changes in my own parents as they age.”

“My own ADHD is making it exponentially more difficult to assist my 90-year-old parents, both of whom I suspect have ADHD, as well as my three grandchildren, all diagnosed with ADHD.”

No matter the composition of your family’s sandwich, use the following strategies to reduce stress and practice self-compassion while you pull double or triple caregiving duty.

[Download This Free Parenting Guide for Caregivers with ADHD]

Sandwich Generation Strategies for ADHD Adults

1. Set boundaries.

Boundaries are tricky because they’re tangled up with cultural, personal, gender, and familial expectations. You may feel immense pressure to make others happy, even at the expense of your own happiness. Rejection sensitive dysphoria and perfectionism may amplify feelings of failure as you try to do it all. As uncomfortable as it may feel, setting boundaries is a skill you must learn and practice to prevent burnout and improve your wellbeing.

• It doesn’t have to be a hard “no.” Find alternative ways to politely decline or adjust a situation. Say, “Let me sleep on it and get back to you,” “Mom, I have to call you back after I have dinner,” “Can I take a rain check?” or “That sounds wonderful, but unfortunately, I won’t be able to help this time.” Practice declining offers in a low-pressure environment, like at a store when the cashier tries to upsell you.
• Be firm where you can be. Mute your phone or disable certain notifications. Question whether something really needs your attention now. If you work from home, consider creating color-coded signage that communicates your level of availability. Have conversations when needed about hot spots. For example, if you experience stress when your parents show up unannounced, talk to them about calling ahead or dropping by only on certain days of the week.
• Guilt will come up, but it doesn’t mean that you’re doing something wrong. You’re simply in unfamiliar territory. Be kind to yourself and know that you can feel the guilt and still choose to protect your boundaries.

 2. Know your hot spots.

Not all sandwiched caregivers feel the same squeeze. Identify your personal hot spots, such as interruptions, noise, clutter, food prep, emotional reactions, and/or transitions. Name your most nagging daily challenges — the ones that send ADHD symptoms into overdrive — and brainstorm steps to manage them.

For example, if grumpiness at the end of your workday clouds your evening mood, take 10 full, uninterrupted minutes to do a breathing exercise or a relaxing activity when your workday ends. Self-awareness alone can help mute your inner critic as you try to juggle it all.

[Read: How I Calm Down My ADHD Brain — 14 Quick De-Stressors]

Work with family members to identify and address their hot spots, too. For example, ask your teen to spend five minutes organizing a small section of their room when energy supply is high, not at the end of the day when ADHD medication has worn off.

3. Carve out time to do what helps you feel regulated.

Get serious about scheduling self-care time in your calendar. Self-care is anything that helps you feel calm and gathered, like non-negotiable buffer time between tasks and activities, a morning walk, a hearty breakfast, talking to a friend, reading or listening to an audiobook for 15 minutes, and even taking the time to make your bed (especially if clutter overwhelms you).

4. Don’t rush to problem-solve or cheerlead.

Validation — simply listening to and acknowledging how you or a family member else is feeling — usually lowers the volume on big emotions in ADHD households. Your child may feel devastated that they flunked their math test, but rather than rush to cheerlead (“Oh, I know you’ll do better next time!”) or suggest solutions like tutoring, start by saying something like, “I hear that you’re feeling disappointed right now, right? It totally makes sense that you feel this way because you studied so hard.”

 5. Use all available supports to lessen the burden.

Support comes in many forms, like asking a friend or family member to body double or help with a particular area of caregiving, leaning on a community program for adult or afterschool care, or using paid services like subscription meal kits, cleaning services, or a virtual assistant if financially feasible. As you decide which resources to utilize, remember that your time and energy are resources, too. Also, when you accept someone’s help, understand that they may not do it your way — and that’s fine.

6. What would you say to a friend?

Dual caregiving while managing your own life (and ADHD symptoms) is objectively difficult. Like other sandwiched adults, you likely aren’t giving yourself enough credit for juggling all that you do.  You may over-identify with mistakes, fixate on what you haven’t done, and think that you’re failing. You may feel as though things only get done when you beat yourself up.

When your inner critic pipes up, take a moment to practice self-compassion by asking yourself, “What would I say to a friend going through this?” Chances are that you’d never judge a friend the way that you judge yourself. Keep this question on a sticky note and place it on your mirror as a daily reminder. Remember that it’s possible to be compassionate and productive simultaneously.

7. Accept what you cannot change.

No, you did not ask to be in the middle of a complex, neurodivergent sandwich. But here you are. To guard your wellbeing, follow this credo: accept what you can’t change, change what you can, and know the difference.

You may not recognize your habit of claiming responsibility for things well outside of your control. You may feel it’s your duty to make your stubborn parents believe that ADHD exists and that it runs in your family — a common complaint I hear among sandwiched adults in neurodivergent families. Conversation after conversation, article after article, your parents may still choose to deny that your child has ADHD, that you have ADHD, or that they themselves exhibit symptoms. This is distressing, but remember that you’re doing your best and that accepting your current reality doesn’t mean that you’re siding with your parents or giving up.

When you focus on where you can make a difference and what you can relinquish, it will be much easier to disengage from energy siphons and find reasonable solutions for all the ingredients in your sandwich.

Sandwich Generation and ADHD: Next Steps

• Free Guide: ADHD in Older Adults
• Self-Test: 10 Questions to Reveal Parental Burnout
• Read: When ADHD (Literally) Runs in the Family
• Read: 12 Ways to Build Strong ADHD Families

You Are Not Alone: Additional Resources

• AARP Family Caregiving
• CDC – For Caregivers, Family, and Friends
• Family Caregiver Alliance
• Working Parent Burnout Webinar (from The Ohio State University)
• ADDitude – ADHD Support Group for Parents
• ADDitude – ADHD Support Group for Adults
• CHADD – Find a local ADHD support group

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Squeezed in the Sandwich Generation: How to Manage ADHD in Yourself, Your Children, and Your Elderly Parents” [Video Replay & Podcast #490] with Danna McDonald, RMFT-SQ, RSW, which was broadcast on February 8, 2024.

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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.

Neurodivergent minds like ours are prone to oversharing because we love to immediately zing with people. We enjoy giving, sharing, and feeling like someone is our best friend after five minutes of meeting them. We want to convey to others that we’re an open book. That we’re sincere and authentic. A lifetime of challenges with social skills and making friends can also drive us to overshare in a desperate bid for connection.

Even if you exude high-quality friendship material, oversharing, as you and I both know, isn’t the best way to show it. In fact, it often backfires.

Curbing your habit of oversharing will come with time, but doing so requires lots of patience. Use these eight strategies to help you reel in your speech and share mindfully.

How to Stop Oversharing

1. Get to the root of it. Think back to moments when you’ve shared too much. Did you do it because you couldn’t stand the silence? Because you were nervous and dysregulated during the social interaction? Because you underestimated your intimacy level with the person or group? Did you even realize it was happening, or did someone point it out to you? Is it a combination of factors? Recognizing circumstances and situations that lead to oversharing is the first step to breaking the habit.

[Free Download: Become a Small Talk Superstar]

2. Go into “social spy” mode. Not sure what counts as oversharing? Try picking up on what others share about themselves and the varying degrees of familiarity in a group. Notice the unspoken rules that govern these conversations, and how others respond when someone discloses a detail about themselves. If a trusted friend of yours was part of the conversation, ask them later if they felt someone overshared, and compare your answers.

3. Gamify it! Challenge yourself to ask a certain number of questions before you start talking about yourself. You’ll reduce your chances of oversharing and be in a better position to bring up relevant topics for discussion.

4. Think, “How much do I trust this person?” Before you share an aspect of your personal life, pause and consider your level of familiarity with the person. Are they a friend, or are they becoming a friend? Put yourself in their shoes: If they were to share with you what you’re about to share with them, would it make you feel uncomfortable, given your current level of familiarity? (Tip: Carry something in your pocket to remind you of this question!)

5. Assess your emotional state to gauge your susceptibility to oversharing. A heightened or dysregulated state may make you more likely to, for example, vent to the receptionist about an earlier fight you had with your spouse as you check in for your doctor’s appointment.

[Read: Said too Much? How to Deal with Regret and Shame]

6. Practice telling tighter stories. There’s nothing wrong with sharing stories. But you risk oversharing if you tend to go off on a tangent. Before you share, ask yourself: “What do I want others to take away from my story? What’s its point?” If you catch yourself going down the rabbit hole mid-conversation, don’t fret. Gently steer yourself back and chuckle it off.

7. It doesn’t have to be all or nothing. Perhaps the detail or story you want to share verges into oversharing territory. Rather than throw it out completely, use it to inspire a more neutral talking point.

8. Don’t beat yourself up. Changing a habit takes time. Each time you enter a conversation, remember that you’re in practice mode. You’re not expecting perfection; you’re just working on a small piece of the puzzle. You’ll have good days, and you’ll have days when you’ll tell the person at the post office your life story. That’s okay. Tomorrow you’ll do better.

How to Stop Oversharing: Next Steps

• Free Download: The ADHD Friendship Guide for Adults
• Read: Is Your ADHD Causing Social Slip-Ups?
• Read: Don’t Just Talk, Communicate

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “An Adult’s Guide to Fostering Friendships with ADHD” [Video Replay & Podcast #478] with Caroline Maguire, M.Ed., ACCG, PCC, which was broadcast on November 2, 2023.

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.

On the flip side, mothers were portrayed as multitasking heroes who kept their families and homes from falling apart. Sure, these are stereotypes, but they’re mostly grounded in real-life expectations. Women are supposed to be the tidy, organized, and dependable ones. When you need help with homework, Mom’s the first one you ask. When you can’t find something, Mom knows where it is. When you need a special cake for your birthday, Mom can make it just right.

For a woman like me who struggles with ADHD, these expectations can be painful. Daddy is the one who keeps things running around here. He’s the organized and calm one. I do a lot. But if it weren’t for him, we’d have ice cream melting in the refrigerator.

[Read: “Housekeeping Is Not Motherhood.”]

I’m fairly traditional. I worked from home with my kids for years by choice. I wanted to cook their meals from scratch, but I almost always left out a crucial ingredient. I was there every time they pulled out a new board game, but I had a hard time sitting down and reading the instructions. I took them to fun places, but it was never a stress-free event. This mama forgot water bottles, diapers, wet wipes, and validation tickets. At some point, I realized I was the Dumb Dad.

For a long time, guilt and feelings of inadequacy plagued me. Not anymore. I’m so grateful to have a husband who grounds me. And with his support, I’m learning self-love.

The Dumb Dad may be bumbling, but he’s also adored. The kids never hold his cluelessness against him because his benevolence is clear. As my kids get older, they’re learning that their mom struggles with some things. And they know that it’s perfectly okay.

I’ve stopped trying to follow recipes or fix remotes. I’m focusing on the things I do well. I’m showing my daughter with ADHD all the tips I’ve learned to make life easier. I’m teaching her about civics and history, where I thrive. I’m hyperfocusing when my children need it, whether they’ve got a mysterious rash or someone needs to convince the city to put crossing guards at the school. I’m dancing and singing to all the kids’ songs because I’m a goofball like them and I know all the words.

I’m not the most organized mom, but I love my children more than anything on this earth. And they know it.

Gender Stereotypes and ADHD: Next Steps

• Read: The Motherhood Myth Is Crushing Women with ADHD
• Read: A Self-Care Guide for Moms with ADHD Raising Kids with ADHD
• Read: 12 Hurtful, Misogynistic Comments Women with ADHD Hear
• Read: To My Kids — A Love Letter from Your Scatterbrained, Unpredictable, Truly Lucky Mom

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.

Q: “What are the causes of postpartum depression? As an expectant parent with ADHD, what should I know about factors that increase risk for postpartum mood disorders? How can I protect myself after I have my baby?”

The causes of postpartum depression (PPD) and postpartum mood disorders are complex and combine differing sources for different people. These sources are not always fully understood. Genetic and biological factors, including dramatic hormonal fluctuations after birth, are thought to play a major role. However, hormones or biology alone do not fully explain why someone might develop a postpartum mood distress or disorder. While no parent is immune to developing PPD or other postpartum mood disorders, the following psychological and psychosocial factors are known to increase risk for these conditions: ^{1 2 3 4}

• a history of depression or anxiety
• experiencing depressive/anxious/high stress symptoms during pregnancy
• a history of trauma
• a history of significant mood changes during menstruation
• a history of significant reactions to sleep deprivation
• an unwanted pregnancy
• a lack of social supports, particularly stress in a primary parenting partner relationship
• social isolation
• a lack of access to basic needs
• low socioeconomic status

[Take This Self-Test: Signs of Postpartum Depression]

Black women and individuals of other ethnic and racial groups who have been historically under-resourced and overlooked also face higher risk for postpartum depression, largely because of expressed concerns not being adequately tended to by the helping professions. ^{5 6}

The ADHD-Postpartum Depression Link

Recent studies show that ADHD is a risk factor for PPD. A 2023 study found that mothers with ADHD, even those without a history of depression, are 24% more likely to be diagnosed with PPD than are mothers without ADHD.⁷ This link may be partly explained by increasing rates of first-time diagnosis of ADHD among adults, and among women in particular of childbearing age ⁸, which is likely contributing to better identification of individuals with ADHD who have developed postpartum depression.

Another 2023 study of more than 773,000 women who gave birth found that about 25% of women with ADHD were diagnosed with anxiety disorders postpartum compared to 4.6% of women without ADHD. In addition, about 17% of women with ADHD had PPD compared to 3.3% of women without ADHD.⁹ Researchers are still working to understand what underscores the disproportionate link between postpartum depression and ADHD. Both ADHD and postpartum depression and anxiety disorders represent challenges in self-regulation.

Frequent Screenings Are Key for Postpartum Parents

Though about one in eight women or birthing parents — and as many as one in 10 fathers or caregiving partners — develop a postpartum mood disorder, ^{6 10} these conditions are still largely overlooked. In a live ADDitude webinar poll, about 70% of respondents said their doctor missed their symptoms of postpartum depression. In a separate poll, about 45% of ADDitude readers said they wouldn’t be able or aren’t sure if they’d be able to identify postpartum depression in themselves or in others.

[Free Download: The Facts About Major Depressive Disorder in Women]

Frequent screenings are the most powerful tool for early detection of PPD and other postpartum mood disorders. Early detection is important to curb the development of severe forms of postpartum mood disorders. While postpartum mood disorders typically onset within three weeks of a child’s birth, they can develop through the first postpartum year. Screenings, therefore, should occur all through the first year after childbirth. Like most women and birthing parents, you likely won’t see your OB-GYN after your six-week postpartum appointment. In that case, your primary care provider and pediatrician should screen you.

At the same time, it’s critical that you know the signs of PPD and other postpartum mood disorders. Do not wait to talk to your doctor(s) if you think you show any of the signs. Insist on formal screeners, especially if you have a risk factor for PPD.

Postpartum Depression: Next Steps

• Free Download: Hormones & ADHD in Women
• Read: Postpartum Care for Mothers with ADHD
• Read: Healing Through Parenting — The Key to Postpartum Depression Recovery

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

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 Stewart, D. E., & Vigod, S. N. (2019). Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annual Review of Medicine, 70, 183–196. https://doi.org/10.1146/annurev-med-041217-011106

² Beck C. T. (2002). Revision of the postpartum depression predictors inventory. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN, 31(4), 394–402. https://doi.org/10.1111/j.1552-6909.2002.tb00061.x

³ Buttner, M. M., Mott, S. L., Pearlstein, T., Stuart, S., Zlotnick, C., & O’Hara, M. W. (2013). Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Archives of Women’s Mental Health, 16(3), 219–225. https://doi.org/10.1007/s00737-012-0323-x

⁴ Choi, K. W., Houts, R., Arseneault, L., Pariante, C., Sikkema, K. J., & Moffitt, T. E. (2019). Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: Testing postpartum effects in a longitudinal birth cohort. Development and psychopathology, 31(1), 143–156. https://doi.org/10.1017/S0954579418000032

⁵ Onyewuenyi, T. L., Peterman, K., Zaritsky, E., Ritterman Weintraub, M. L., Pettway, B. L., Quesenberry, C. P., Nance, N., Surmava, A. M., & Avalos, L. A. (2023). Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression. JAMA network open, 6(11), e2342398. https://doi.org/10.1001/jamanetworkopen.2023.42398

⁶ Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2

⁷ Bartelt K, Piff A, Vitek G, Barkley E. Maternal ADHD Correlated with Increased Risk of Postpartum Depression. Epic Research. https://epicresearch.org/articles/maternal-adhd-correlated-with-increased-risk-of-postpartum-depression.

⁸ Russell J, Franklin B, Piff A, Allen S, Barkley E. Number of ADHD Patients Rising, Especially Among Women. Epic Research. https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women. Accessed on March 18, 2024.

⁹ Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

¹⁰ Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605

Postpartum Depression: Key Takeaways

• Postpartum depression is characterized by significant emotional challenges that affect the parent-child bond.
• Hands-on parenting, not separation, is essential in powering recovery from postpartum depression and in repairing bonds.
• Self-care and other coping strategies are an important part of postpartum depression recovery.

The Fourth Trimester: What No One Talks About

The first few months after a baby is born — sometimes called the “fourth trimester” — is a critical time for the emerging parent-infant relationship. You and your newborn are rapidly adjusting to a new way of life, a reality that is often complex and unexpected.

• You may feel ambivalent. We’re told that pregnancy and parenthood should be happy and joyous, but experiencing mixed feelings after a baby arrives is common — and normal. You might well not feel the rush of falling in love that you might have expected.
• You may have held unrealistic expectations of your baby. There may be a disconnect between the baby you imagined or wished for and the baby in front of you.
• You may feel overwhelmed. Like many expectant parents, you might have imagined your new baby smiling and cooing all the time. But newborns more often cry and fuss and sleep as they learn to regulate (and do so with help from parents). The round-the-clock care babies require, which invariably disrupts sleep and daily routines, is a major adjustment for any parent.
• You may feel worried about your baby’s health and wellbeing, about your emotions about your baby, and your emerging parenting skills.
• You are likely sleep deprived. You are learning to care for a newborn during a period of acute disruption of your sleep.
• You may feel discouraged. Especially if your baby is fussy or requires special caregiving needs, you may struggle with feeling successful as a parent and emotionally attached to your baby.
• You may feel under pressure to return to work and make childcare decisions and arrangements.
• There may be friction in the parenting partnership or lack of partnership if you’re a single parent.

These common factors — combined with dramatic hormonal fluctuations following childbirth — can increase risk for postpartum depression (PPD) during this critical stage.

Characterized by persistent and acute feelings of sadness, guilt, irritability, anxiety, and lethargy — well beyond the baby blues — PPD is a condition that interferes with your wellbeing and how you bond with your baby. It is important for your health and wellbeing – and the healthy development and wellbeing of your baby – for you to seek and accept help. You deserve relief!

PPD is treatable, and a major aspect of recovery happens by virtue of the parent-infant relationship. Getting help from others for the care of your baby is crucial in the newborn period, especially if you are experiencing signs and symptoms of PPD. But it is also very important to spend time with your baby as well, since your relationship with your little one will help you recover from distress. With PPD, this process deserves support.

[Take This Self-Test: Could You Be Experiencing Postpartum Depression?]

Postpartum Depression Treatment: Parenting Is Essential to Healing

PPD and other postpartum mood disorders affect neural pathways responsible for driving parenting and attachment behaviors. This explains, in part, why you may have trouble bonding with your baby.

Too often, parents recovering from PPD believe they must distance themselves from their baby because they’ve been told PPD is “not good” for the child. Such messaging can feel devastating to a new parent, especially if you already struggle to feel close to your baby and have low confidence in your parenting.

While separation may be initially required for parents experiencing severe PPD (especially with postpartum psychosis), reunification should happen as quickly as possible. Parenting should never be separated from the PPD healing process, as active involvement in caregiving has the potential to “reset” the brain.¹ Your chances of experiencing positive, successful parenting moments — which are key to repairing bonds with your baby and raising confidence in yourself as a caregiver — can only happen through interaction.

Working with a healthcare provider who specializes in parent-infant or dyadic therapy in PPD is especially helpful. Your provider can facilitate “moments of meeting,” typically through your baby’s behaviors, that bring you closer and rewire the way you see your baby.

[Read: Postpartum Care for Mothers with ADHD — A Guide for Clinicians]

Especially if you’re recovering from acute PPD, you may require extra support for navigating the demands of parenting and of your own healing. Your provider may help you with self-regulation so you can support your baby’s regulation. You may learn how to soothe your baby, so they are available for social engagement, opening the way for those crucial moments of bonding that allow you to feel the joy in parenting to which you — and your baby – are entitled.

Postpartum Depression Treatment: Additional Coping Strategies

Your provider may have prescribed medications and/or therapy as part of your PPD treatment. As you recover from PPD, make sure the following strategies also become part of your healing process:

• Find peer support. Connect with at least one other parent who is experiencing or has experienced PPD or a postpartum mood disorder. Reflecting upon and sharing your experience with PPD and how it has affected you can be immensely healing.
• Engage in physical activity and movement, focus on nutritious meals, and stay hydrated. These are all cornerstones of the healing process.
• Establish routines and rituals to bring structure and order into your family’s life.
• Manage stress by engaging in mindfulness practices, breathing/relaxation exercises, and joyful activities, among other healthy habits.
• Sleep is vital to prevent symptoms of PPD from worsening. Understandably, sleep is scarce when caring for a baby. Know that your baby can become accustomed to bedtime routines and rituals as soon as they leave the hospital. A soothing bedtime routine can help your child move toward longer stretches of sleep, which can help you avoid sleep deprivation — a critical step in your recovery.

Postpartum Depression and Parenting: Next Steps

• Free Download: The Facts About Major Depressive Disorder in Women
• Read: Postpartum Mood Disorders — Do You Know the Early Signs?
• Research: ADHD Increases Risk for Postpartum Depression, Anxiety
• Watch: The Unspoken Truths of Postpartum Depression

Additional Resources

• Postpartum Support International
• MGH Center for Women’s Mental Health
• Postpartum Progress
• The Seleni Institute
• La Leche League International

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

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.

¹ Pajulo, M., & Kalland, M. (2013). Mentalizing-based intervention with mother-baby dyads. In N. E. Suchman, M. Pajulo, & L. C. Mayes (Eds.), Parenting and substance abuse: Developmental approaches to intervention (pp. 282–302). Oxford University Press. https://doi.org/10.1093/med:psych/9780199743100.003.0014

Though loneliness is a tangled knot with many threads, for the neurodivergent, many of the contributing factors relate to a lack of understanding and empathy from others. Eighty percent of readers reported that ADHD contributed to their feelings of loneliness. Specifically, they pointed to the following contributing factors:

• Masking who they really are: 60%
• ADHD stigma or misunderstood symptoms: 43%

But breaking through this darkness was a bright beacon of hope: Half of readers shared that they relate best to other neurodivergent individuals. We asked them to tell us about these neurodivergent friendships and they shared stories of stimulating, dynamic relationships with tons of shared experiences and humor and little judgment and nonsense.

These accounts show how neurospicy friendships can help address loneliness by banishing stigma, masking, and criticism.

[Read: 10 Covert Signs of a Toxic Friend]

“Being with other neurodivergent folks validates my experience of living with ADHD. There’s less judgment between us as well and we don’t need to mask around each other.” —Siobhan, Canada

“Without meaning to, I have realized that most of my friendships are with neurodivergent people. I love to hang out with other ‘weird’ people. They make me feel safe.” —Sarah, Canada

“It often feels like I am an Apple computer in a Windows world. Meeting and recognizing others with similar processors make me feel less flawed and less alone or odd.” —J.P., United Kingdom

[Read: What Type of Friend Are You? How ADHD Influences Friendships]

“It’s such fun interacting with someone as scatty as I am. We strike sparks off one another.” —Anne, South Africa

“There’s no need to worry about switching conversations often, there’s an understanding of the struggles, there’s no need to explain behavior. All of this results in less guilt or shame.” —Rukki, Australia

“I have ADHD, and one of my sisters has OCD, and dyslexia. We are inseparable, and always have been. We ‘get’ each other like no one else in this world. We are the yin and yang.” —Mary, Illinois

“I don’t have to mask as much around other neurospicy folks due to them normalizing some of my behaviors.” —Lyza, Michigan

“Other bright ADHD folk are catnip to me: fast-paced, interesting conversations and no judgment, cocked eyebrows when we speak of having had many jobs, having moved around frequently, having tried and deserted many hobbies, etc. Too often, ‘normies’ can feel a bit dull, sterile, linear.” —Lesley, United Kingdom

“I feel more understood, and am able to have deeper conversations about interesting things (not needing to manage small talk and uninteresting conversations).” —Emily, United Kingdom

“My bestie and I can have odd, disjointed conversations and still understand each other, partially because we have a long history and because she’s also neurospicy.” —Sarah, Vermont

“All healthy and successful relationships with friends or partners are or have been fellow neurodivergent individuals.” —Aspen, Wisconsin

“I am shocked at how many of my closest friends are neurodivergent. It seems that we have flocked together, probably because we are birds of a feather.” —An ADDitude reader, California

Neurodivergent Friendships: Next Steps

• Watch: 7 Secrets to Making and Keeping Adult Friends
• Read: “I Found My Neurodivergent Safe Space, Where ‘Socially Awkward’ Is the Norm.”
• Self-Test: How Severe Is Your Loneliness?

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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.

Many parents today are raising their children differently than they themselves were raised. In a recent ADDitude poll, about 70% of respondents said they were using a “very different” or “somewhat different” parenting style from the one their parents used with them.

The generational divide is deepened by our evolving understanding of neurodivergence — brain-based differences that affect how someone behaves, thinks, and learns. ADHD, autism, learning differences, and other conditions that tend to be identified in childhood all fall under the umbrella of neurodivergence. Many of these now-commonplace diagnoses were not always recognized and effectively treated in prior generations.

Neurodivergence: Then and Now

Like parenting, societal views of differently wired individuals have also changed significantly. Historically, people whose brains work differently were not celebrated for their neurodivergence; instead, educators and caregivers focused solely on remediating their apparent deficits. Today, we know that our families and communities are made richer by our individual differences. And we understand that leveraging strengths — while also providing constructive support — is critical for neurodivergent children.

Today, we know a lot more about the science of various brain-based conditions. We know that these conditions are not characterological, meaning an aspect of one’s personality, or caused by “bad” parenting. Advocacy from organizations and individuals has helped reduce stigma around neurodivergence and encouraged more schools and institutions to adopt diversity, equity, and inclusion initiatives. Meanwhile, technological advances — like autocorrect or text-to-speech capabilities — have helped reduce the strain of day-to-day functioning for neurodivergent individuals, who can sometimes feel like a square peg in a round hole. And we can’t overlook the role of social media, which has allowed many neurodivergent people and their families to find community and belonging.

[Get This Free ADHD Parenting Guide — Strategies for Kids, Tweens & Teens]

The Best Parenting Style for Your Neurodivergent Child

Parenting styles of the past emphasized obedience through harsh discipline and strict enforcement of the rules. This style of parenting is generally known as authoritarian parenting and its techniques, we now know, can cause distress and are linked to maladaptive behaviors. Children, especially neurodivergent children, do not respond well to this form of parenting.

On the other hand, permissive parenting, characterized by high levels of warmth and little to no limit setting, isn’t what our children need either, as this can also lead to negative outcomes. The parenting style with the greatest benefit is in the middle; authoritative parenting combines warmth and limit setting. It’s a dynamic that fosters the parent-child relationship while also providing children with the structure they need for positive development.

From establishing routines to reinforcing positive behaviors and providing appropriate consequences for misbehavior, authoritative parenting offers various strategies to meet your child’s unique needs. Use this parenting guide to look up the most effective strategies for neurodivergent children. You may need to apply these strategies more frequently, over longer periods, and with the help of a mental health professional to best meet your child’s needs.

Neurodivergent Parents of Neurodivergent Children: You’re Doing an Excellent Job

As an adult who was only recently diagnosed with ADHD, how can I help my child when they’re emotional and overstimulated if I also feel the same way?

How do I get my child to follow a regular routine when I myself have ADHD and cannot follow a regular routine?

How do we implement these parenting strategies when they are so unfamiliar to us? It feels incredibly overwhelming when we have ADHD that was never properly addressed in our own childhoods.

[Read: “The Best Neurodivergent Parenting Tips I’ve Ever Received Are…”]

I don’t need to tell you that parenting is hard, especially if you are a neurodivergent parent raising a neurodivergent child and using different approaches than your parents used on you. As a psychologist who helps parents manage ADHD in their children, please hear me when I say that you are not alone, and that you are doing a wonderful job. Acknowledge the progress that you’ve made and are making. Set small goals for yourself and celebrate the small wins. Build and rely upon your support network and take care of yourself — one of the most important behaviors you can model for your child.

Parenting Styles: Next Steps

• Sign Up: Behavioral and Emotional Skills Training from the Child Mind Institute
• Join: ADDitude’s ADHD Support Group for Parents
• Read: Brick Wall, Jellyfish, or Backbone — What Type of Parent Are You?
• Learn: Moms and Dads — Lets Turn All Those Can’ts Into Can-Dos

Additional Resources

• Taking Charge of ADHD: The Complete, Authoritative Guide for Parents by Russell A. Barkley, Ph.D.
• Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship by Russell A. Barkley, Ph.D., Arthur L. Robin, Ph.D., and Christine M. Benton
• The Kazdin Method for Parenting the Defiant Child by Alan E. Kazdin, Ph.D
• The Everyday Parenting Toolkit: The Kazdin Method for Easy, Step-by-Step, Lasting Change for You and Your Child by Alan E. Kazdin, Ph.D.

The content for this article was derived from the ADDitude webinar titled, “Parenting Styles That Work for Neurodivergent Children” [Video Replay & Podcast #481] with Caroline Mendel, PsyD, which was broadcast on November 29, 2023.

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.

Loneliness, according to the CDC, is “feeling like you do not have meaningful or close relationships or a sense of belonging.”² In a recent ADDitude survey of 4,170 adults with ADHD, nearly two-third of respondents aged 18 to 29 reported feeling lonely “always or often.” Many readers cited executive dysfunction, rejection sensitive dysphoria (RSD), masking, and low self-esteem among several ADHD-related sources of loneliness.

Answer the following questions to gauge your own feelings of loneliness. Share your results with a licensed mental health professional. Find resources to combat loneliness at the end of this self-test.

If you or someone you know is in crisis and needs help, dial or text 988 to connect to a trained counselor from the Suicide & Crisis Lifeline. Call 911 if you or someone you know is in immediate danger.

This self-test was drafted by ADDitude editors and informed, in part, by the UCLA Loneliness Scale (Version 3), the Campaign to End Loneliness Measurement Tool, and the De Jong Gierveld Loneliness Scale. This self-test is designed to measure loneliness and it is intended for personal use only. This self-test is not a diagnostic tool.

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How to Deal with Loneliness: Next Steps

• Take Action: Try the Surgeon General’s 5-for-5 Connection Challenge
• Read: 13 Tips for Feeling Connected
• Read: The Art of Forming Adult Friendships
• Read: When You Feel Antisocial
• Read: How to Practice Gratitude

Sources

¹ Our epidemic of loneliness and isolation: the US Surgeon General’s advisory on the healing effects of social connection and community. 2 May 2023. US Department of Health and Human Services. www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf.

² Centers for Disease Control and Prevention. Loneliness. https://www.cdc.gov/howrightnow/emotion/loneliness/index.html

Do you sometimes drown in shame over how long it’s been since you last reached out to a friend? Do you cringe as you remember your last conversation with your friend, eons ago, when the ball was in your court to respond? “There goes another friendship” you think to yourself. The thought of reaching out now, after all this time, makes you want to run and hide.

Life happens. We all juggle so much all the time, and ADHD executive dysfunction subjects others, even those who are important to us, to the dreaded realm of “out of sight, out of mind.” When it happens, you catastrophize. “I’m so bad at keeping in touch,” you think. “No wonder I have no friends.”

[Read: Why Can’t I Make and Keep Friends?]

You may think that your friend wants nothing to do with you. But what if I told you that your friend would probably be thrilled to hear from you, even if it’s been a while?

It doesn’t have to be a half-hour phone call or a video chat. A text or a quick DM via social media works just fine. You may feel uncomfortable when you reach out, but I promise that you’ll feel much better after taking this small but important step. Your friend’s reaction, I hope, will pleasantly surprise you. (Just think about how thrilled you’d feel if an old friend reached out to you.)

Then, use these tips to check in more consistently with friends.

• Whether it’s a certain time of day or the first Saturday of every month, set a schedule around checking in with friends. Use a calendar to set check-ins as recurring events.
• Incorporate check-ins into your existing habits and routines (i.e., habit stacking). Plan to send a text, an email, a voice note, or any other form of communication while you wait for the bus, make your coffee, commute to and from work, and in between other established routines. (Put a sticky note on your coffee maker or program your phone to remind you to check in.)
• Re-break the ice with reference to an inside joke. Say, “I saw this and I thought of that time…”
• Take advantage of holidays, birthdays, and other milestone moments to reach out to friends. Put these important events on your calendar.
• If your friend mentions something coming up — like a medical appointment or a job interview next week — add it to your calendar to remind you to ask about it when the time comes. (Or, better yet, bring it up in your weekly standing meeting.)
• Don’t be afraid to explain your communication habits (including challenges and needs) to your friends, with what I call “communi-splation.” Say, “Hey, I sometimes forget to text back and I’m prone to falling off the radar, but I’m working on it. I do want to see you soon, so please keep texting me about it.” You’ll help others gain insight into you while showing that you’re truly interested in being their friend.

How to Keep in Touch with Friends: Next Steps

• Download: The ADHD Friendship Guide for Adults
• Read: Do You Need a Friendship ‘Do-Over’?
• Read: Make Time for Close Friends Every Week

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “An Adult’s Guide to Fostering Friendships with ADHD” [Video Replay & Podcast #478] with Caroline Maguire, M.Ed., ACCG, PCC, which was broadcast on November 2, 2023.

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.