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

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

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

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

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

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

Law Enforcement and the Neurodivergent: Unique Risks

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

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

[Read About the Mom Spearheading Police Training on Autism]

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

Heightened Threats for People of Color

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

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

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

Disability Awareness Training on De-escalation Techniques

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

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

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

Key topics include:

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

“Fighting for Crumbs of Funding”

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

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

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

Beyond Training: Community Resources

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

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

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

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

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

Detained by Police? Keep This in Mind

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

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

ADHD and the Risk of False Confession

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

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

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

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

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

Law Enforcement and Neurodivergent Justice: Next Steps

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

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

Sources

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

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

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

Officer Yancey offers her perspective, as a mother and a police officer, on ensuring the safety of community members with autism and other invisible disabilities.

Q: What worries you most when you think about your son with autism, or others with disabilities or mental health concerns, encountering the police?

Nationwide, many people, particularly African Americans, have been injured or killed by police officers because of misunderstandings about autism, mental illness, or other conditions. Officers are too quick to get physical, from giving a command to drawing a gun. Where is the in-between?

When my son hears sirens or loud noises, he shuts down and grabs his ears. Sometimes he’s in so much pain, he says that he can’t even hear you speaking. What if an officer is talking to him and he shuts them out, and they misconstrue that as being rude or non-compliant? What if he starts flapping his arms, and they think he is violent?

[Self-Test: Signs of Autism Spectrum Disorder in Children]

Q: How have you benefited from disability awareness training?

I received training to learn how to understand and respond to people with autism. They gave us a lot of insight: statistics, what to look for, and better ways to approach someone when we’re called to a scene.

I learned that people with autism tend to gravitate toward bodies of water, and this can lead to drownings. In Sleepy Hollow, we’re on the Hudson River, so that opened my eyes.

Q: Tell us about the H.E.A.R.T.S. registry you developed.

H.E.A.R.T.S. is a voluntary registration program for people in the community with autism, dementia, and other conditions. You register your loved one by filling out a questionnaire, giving us (first responders) information, so we can make things better when we respond to a call. The questionnaire asks for the person’s address, school, emergency contact, and about fears, favorite things or places, and actions or words to avoid. A parent might write, “My son has an infatuation with trains.”

[Download: The ADHD-Autism Link in Children]

Q: How does a registry help first responders support people with autism?

When we get a call from a mom who says that her son is a little out-of-control, we can check to see if they’re on the registry. If so, the desk officer can tell the dispatched officer, “No lights, no sirens,” so we know not to spook the kid. The responding officer can call the desk and get more information.

If a person is missing, it helps us locate them. A little girl who had autism and was nonverbal was signed up. One day, someone called in and said they saw a child in pajamas in the middle of winter on a busy roadway. Because her picture was in the registry, the officer identified her right away and reunited her with her family.

Autism Awareness: Next Steps

• Upcoming Webinar: AuDHD Guidance: Why Autism Is So Difficult to Diagnose in Women and Girls with ADHD
• Free Download: Free Autism Evaluation Checklist
• Read: ADHD, Anxiety, and Autism — Your AAA Guidebook
• Read: Autism vs. ADHD — A Parent’s Guide to Tricky Diagnoses

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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

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Health Insurance Plans: High-Deductible vs. Low-Deductible

Employer-sponsored health plans generally include high-deductible plans and low-deductible plans. With the former, you pay less in premiums but more out-of-pocket for medical care and prescriptions before your insurance kicks in to cover eligible costs.

In traditional low-deductible plans, you pay higher premiums, but the carrier covers a copay or coinsurance on your office visits and certain prescriptions. Your deductible is tapped only for services like surgery, emergency room visits, MRIs, and so on. Under these plans, you typically copay for medication and therapy sessions.

[Free Download: What to Ask Before Starting ADHD Medication]

Drawbacks of High-Deductible Plans for ADHD Patients

The higher your deductible, the lower your premiums. For people with ADHD, this is usually not the best option. (However, if you have a Health Savings Account (HSA) or a Flexible Spending Account (FSA), a high-deductible plan may be worthwhile because it will let you set aside pre-tax dollars for certain health care costs. More on that below.) Generally, high-deductible plans are not advised for these reasons:

• You’re unlikely to put the money saved from lower premiums toward your health care. Also, many folks with ADHD are reluctant to seek routine health care. If they must pay out-of-pocket to see a provider, their motivation won’t improve.
• You may avoid preventive care and end up spending more in the long run. A copay-based system generally helps you to spend less on medical care and keeps you healthier.

HSA vs. FSA

Many employer-based insurance plans offer these options. HSAs are attached to high-deductible plans. If you contribute more than you spend on health care costs in a year, you can roll those funds over year after year and build a sizable nest egg.

FSAs, on the other hand, do not typically roll over to the next year; you must spend the funds during the policy year or lose them. But if you have a sudden expense early in the year, you can typically pay for it with an FSA because these accounts are usually fully funded at the beginning of the policy year (then paid back over the next 12 months through an employee’s pre-tax payroll deduction). By contrast, the HSA can pay only what has been saved.

[Free Resource: Treatment Strategies You Haven’t Tried]

Prescription Discount Programs and Medication Discount Cards

Before you start any brand name medication for ADHD (or anything else), go to the manufacturer’s website and see if they offer a discount program (find a list at additu.de/medsavings). This is not the same as an after-market coupon, like GoodRx. Those can be helpful too, but typically only for generics.

How Does Health Insurance Work: Next Steps

• Free Webinar: How to Get, Afford, and Refill Your Prescriptions With Minimum Hassle
• <Read: Doing Battle with Your Insurance Company
• Read: Can Insurance Companies Discriminate Because of ADHD?
• Find: ADDitude Directory — Affordable Care Near You

Wes Crenshaw, Ph.D., is a licensed psychologist in Kansas and co-author of ADD and Zombies: Fearless Medication Management for ADD and ADHD.

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One of the greatest gifts, and challenges, of this life stage is the freedom to explore and choose — in personal and professional realms. This is liberating, but if you’re a young adult with executive functioning deficits, dealing with housing, roommates, work, and relationship issues can be stressful.

Advice for Young Adults with ADHD

Follow these six rules for transitioning to independent living:

1. Pay your bills on time. Set up bill-pay reminders or automatic payments. Use a budget app to track how you spend money. Shop with cash only to limit impulsive purchases. Understand credit card terms and the importance of a good credit score. If you need help making a budget, ask experienced friends, your parents, or other caring adults.

2. Show up when you are expected. Give yourself more time than you think you’ll need (or even plan to arrive early). Use analog clocks, watches, and timers to manage time effectively. Use calendars to remind yourself of events and responsibilities.

3. Set routines. Create habits and schedules to support your health. Exercise regularly to improve ADHD symptoms, memory, and mood; eat a balanced diet; and stick to a regular sleep schedule.

[Get This Free Download: Get Control of Your Life and Schedule]

4. Notice your emotional triggers. Whether it’s a stomach knot or sweaty palms, pay attention to signals that indicate strong emotions before they escalate. In a calm moment, make a list of soothing activities to help you reset. Breathing techniques, stepping outside, or going to the bathroom to splash water on your face are a few ideas.

5. Learn to communicate effectively. Conflict happens. In tense conversations with friends, housemates, and colleagues, it’s important to communicate without blame and to listen without judgment. When your housemates are up until 2 a.m. on a work night, drinking and gaming loudly in the living room, rushing out of your bedroom to yell at them won’t help. You could ask them nicely to lower the volume or ask for a meeting the next day to express your frustrations using this formula: “I feel __________ when you __________ because __________ .” The goal is to reach a good compromise.

6. Be smart about dating. After you’ve connected with someone (online, at a party, or elsewhere), meet them at a public place you already know. Tell friends where you are going and with whom. Despite your ADHD go-with-the-flow impulses, don’t go home with them or bring them to your home right away. Give yourself time to evaluate this person, and let your friends meet them, too.

Advice for Parents of Young Adults

When decision-making moves from parents to adult children, the road turns rocky in new ways. The dilemma for many parents of young people with ADHD is this: When should I express my concerns about their choices or risky behaviors?

Parental authority and influence decrease dramatically as our children age. By the time they reach their 20s, a parent can only say and do so much. Then it’s time to let go.

[Read: ADHD Independence-Building Strategies for Parents]

Here are a few ideas to help parents foster connection and independence:

• Listen with genuine curiosity. Acknowledge what you hear. Before you respond, reflect on what you are going to say. Are you about to tell them what to do? If so, how can you reframe your suggestion as a question?
• Pick your battles. Agree on your role in giving reminders, for example, and the circumstances under which you will say nothing. Separate your anxiety from theirs. Wait 24 hours to process an upsetting issue so everybody cools down enough to have a conversation.
• Trust your kids. What did you want most from your parents? I wanted my parents to stop asking questions about how I was going to use my college degree and to trust the process of my explorations. Your kids will figure it out, ultimately, just as you did.

Watch for Warning Signs

You want to respect your adult child’s space, but you also want to be able to identify concerning behaviors or situations when they appear. Here are red flags that may signal trouble ahead:

• Substance use: Young adults with ADHD face an increased risk for substance abuse. Promptly address any signs of substance misuse, such as appearing impaired, experiencing problems meeting obligations at work or at school, or withdrawing from important activities.
• Anxiety at work: Watch for signs of workplace stress, and help your child brainstorm coping mechanisms. Maintain open communication about your young adult’s occupational challenges, including job stability and performance.
• Career planning: Is your college student exploring suitable career paths with access to accommodations? Ask about exploratory conversations with educators and career counselors.
• ADHD treatment: Do missed appointments or lost items suggest that your child is not consistently managing their ADHD medication? Encourage them to maintain steady treatment and secure support through therapy and academic or occupational accommodations.

Embracing Independence with ADHD: Next Steps

• Free Download: Securing ADHD Accommodations in College
• Read: Enabling vs. Supporting – Helping ADHD Kids Be Independent
• Read: 5 Life Skills Every Young Adult with ADHD Should (Eventually) Master

SUPPORT ADDITUDE
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When administered at carefully selected dosages in clinical settings, and combined with therapy before and after treatment, psychedelics have been found to provide rapid relief from some of the most painful and difficult-to-treat mental health conditions. Ketamine is being used for depression and suicidality in clinical trials. MDMA is treating severe post-traumatic stress disorder (PTSD), and psilocybin is being used for treatment-resistant depression, alcohol use disorder, and more.

However, important questions remain about the long-term efficacy and safety of psychedelics, as well as patient suitability. Several large-scale studies are now under way to address these concerns, including the first-ever phase 3 clinical trial on psilocybin-assisted therapy — the largest randomized, controlled, double-blind study on the drug, with more than 800 participants. Initial results are expected this summer.

How Do Psychedelics Work?

Research shows that psychedelics improve many neuropsychiatric disorders, but the way they work is less clear. Functional MRIs and laboratory studies offer possible explanations:

• Ketamine binds to NMDA receptors in the brain, increasing levels of a mood-regulating neurotransmitter called glutamate.¹
• MDMA increases oxytocin, dopamine, and other chemical messengers related to positive emotions.²
• Psilocybin stimulates the brain’s serotonin 2A receptors, appearing to decrease activity across the default mode network.³

But these biochemical explanations don’t tell the full story, says Gül Dölen, M.D., Ph.D., professor of psychology and researcher at University of California Berkeley’s Center for the Science of Psychedelics. Psychedelics only reliably improve psychiatric conditions when administered with therapy. “Therapy is the context to get the cure,” Dölen explains. “You can’t take MDMA and go to a rave and expect it to cure your PTSD.”

Indeed, when taken on their own, psychedelics aren’t hugely effective, according to studies; therapy unlocks the drugs’ enduring benefits. Also, there are serious risks to taking the drugs without medical supervision.

[Read: The Truth About Lion’s Mane, Psychedelics & Caffeine]

A Brand-New Framework

Most psychiatric medications must be taken daily, often for a lifetime. By contrast, a single dose of certain psychedelics paired with therapy can result in full-blown remission. This claim appears too good to be true when viewed through the traditional “biochemical imbalance” model of neuropsychological disease that has dominated the field for the past 50 years. “The idea is that depression, for example, is a biochemical imbalance in serotonin,” Dölen says. “So, we’ll restore serotonin levels with a pill, and you’ll get better.”

But what if there were an approach that treated depression by restoring the fundamental ability to learn (and unlearn) behaviors and ways of thinking, and not by raising serotonin levels? It’s an entirely different framework for understanding neuropsychiatric disorders — the learning model — and Dölen says it’s the best way to comprehend how psychedelics work.

Psychedelics act like master keys unlocking what scientists call “critical periods” of learning—specific times when individuals have a heightened ability to soak in new information. During brain development, these are the critical windows in which we acquire vision, language, motor development, and more. And after these critical windows close, they remain locked.

Or so we thought.

Psychedelics Restore Child-Like Learning

In a study that involved giving mice MDMA, Dölen found that the drug unlocks a critical period for social reward learning, restoring adult mice to child-like levels of openness for social development.⁴ Dölen’s next study uncovered the potential of all psychedelics—including LSD, psilocybin, ketamine, and ibogaine—to open these critical periods.⁵

[Watch: “Psychedelic Therapy for Mood Disorders: Research & Potential”]

“This is a big deal,” says Dölen. “And if it’s true, it’s going to revolutionize things, but only if we understand what a critical period is. It’s not that you take a pill and you speak Japanese. It’s that you take a pill and you restore the ability to learn Japanese.”

The drugs open the mind to learning. The therapy provides the learning itself.

“Patients talk about how they had an epiphany, how the trip enabled them to see how they’d built their lives around a foundational myth that wasn’t true, whether about their relationship to other people, their personality, their deserving to be in the world,” Dölen says. The post-trip therapy, in turn, allowed them to identify how that myth led to maladaptive ways of interacting with the world, and understand how to integrate that knowledge into their daily lives.

The potential of psychedelics to re-open critical periods has far-reaching implications. Dölen’s lab is exploring the possibilities of treating conditions like stroke and blindness with psychedelics through a project called PHATHOM (Psychedelic Healing: Adjunct Therapy Harnessing Opened Malleability).

“Psychedelics are not going to be the magic bullet that fixes everything, but we’re excited about the possibilities,” Dölen says. “Being able to restore child-like learning is a major therapeutic opportunity.”

Psychedelics Therapy and Mental Health: Next Steps

• Self-Test: Symptoms of Depression in Adults
• Free Download: Signs of Depression That May Surprise You
• Read: Real Stories of Using Ketamine for Depression, Anxiety, PTSD

Nicole C. Kear is Consumer Health Editor at ADDitude.

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 Matveychuk D, Thomas RK, Swainson J, Khullar A, MacKay MA, Baker GB, Dursun SM. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol. 2020 May 11;10:2045125320916657. doi: 10.1177/2045125320916657. PMID: 32440333; PMCID: PMC7225830.

² Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-

³ Smausz R, Neill J, Gigg J. Neural mechanisms underlying psilocybin’s therapeutic potential – the need for preclinical in vivo electrophysiology. J Psychopharmacol. 2022 Jul;36(7):781-793. doi: 10.1177/02698811221092508. Epub 2022 May 30. PMID: 35638159; PMCID: PMC9247433.

⁴ Nardou, R., Lewis, E.M., Rothhaas, R. et al. Oxytocin-dependent reopening of a social reward learning critical period with MDMA. Nature 569, 116–120 (2019). https://doi.org/10.1038/s41586-019-1075-9

⁵ Nardou, R., Sawyer, E., Song, Y.J. et al. Psychedelics reopen the social reward learning critical period. Nature 618, 790–798 (2023). https://doi.org/10.1038/s41586-023-06204-3

Being an older adult with ADHD is a double whammy. In addition to older-age loneliness, we struggle with maintaining old friendships and making new friends in our later years. Building and maintaining relationships requires skills that are often impaired by ADHD — initiating contact, making and noting plans on a calendar, and showing up on time. Many older people with ADHD have told me, “I talk too much,” or “I annoy everyone by interrupting, but if I don’t interrupt, I’ll forget what I wanted to say.”

What can we, as older adults with ADHD, do to fight the looming loneliness of our 60s, 70s, 80s, and beyond? Think structure, strategies, and support.

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

Prevent Loneliness with Structure, Strategies, and Support

• Find an environment with structure. Adults with ADHD function best within structure. Consider moving to a community that plans activities designed for older adults. You won’t need to organize anything, and no one will be upset if you run a few minutes late. Some senior centers also provide many of the same kinds of planned activities.
• Develop strategies to keep in touch with people. I often encourage older adults with ADHD to make it a daily habit to reach out to a friend or relative. Send a text, message friends on social media, or make a phone call. Set up a daily walk with a neighbor. It will keep you socially connected and provide exercise and exposure to nature and sunshine.
• Interact with other neurodivergent people your age. Socializing with a group of people who get and accept you can be emotionally supportive and validating. It may also improve your mood and decrease your social anxiety.
• Need help making changes and decisions that will help you re-establish ties with friends and family? Working briefly with an ADHD coach or therapist may be the catalyst you need to reconnect with your social world.

How to Deal with Loneliness: Next Steps

• Download: Free Guide to ADHD in Older Adults
• Read: “I Feel Utterly, Hopelessly Alone.”
• Read: The Loneliest Generation
• eBook: ADHD After 40

Kathleen Nadeau, Ph.D., is the author of Still Distracted After All These Years. (#CommissionsEarned)

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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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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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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

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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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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.

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It is indefensible how little is known about ADHD in women today. Research is nearly non-existent in the way ADHD symptoms change with the hormonal fluctuations of puberty, pregnancy, menopause, and beyond. And experts who study ADHD are deeply concerned — outraged even — about the persistent lack of research on a population that is chronically underdiagnosed and misdiagnosed.

“For decades, girls and women with ADHD have missed out on critical interventions to help manage their ADHD symptoms, primarily because they have largely been left out of ADHD research studies,” says Julia Schechter, Ph.D., co-director of the Duke Center for Girls and Women with ADHD. “Females with untreated ADHD have been put at higher risk for depression and anxiety, intimate partner victimization, and risky sexual behaviors resulting in teen and unplanned pregnancies. Research devoted to girls and women with ADHD is not only an issue of equity but of life or death for some.”

Here, leading experts weigh in on where research is critically needed to guide accurate diagnosis and effective treatment of ADHD in females.

ADHD Research Priority: Defining Sensitive and Precise Screening Tools

Julia Schechter, Ph.D., co-director of the Duke Center for Girls and Women with ADHD

There are numerous research topics related to girls and women with ADHD that deserve thorough investigation. Three specific areas of research that span the life course include:

1. Developing more sensitive and precise screening tools that can better identify girls and women who may have ADHD and require comprehensive evaluation. Many screening tools — particularly those that are freely available — ask raters to report on overt behaviors that align with DSM-5 criteria. Yet, this approach may not be as effective for girls and women. Females with ADHD often compensate for and “mask” their symptoms, making it difficult for observers to rate how frequently a symptom is occurring or whether it is present at all. Research can also focus on developing additional prompts that could be incorporated into existing tools to help raters consider how symptoms may present differently in girls and women (e.g., more likely to be hyperverbal rather than hyperactive). Once developed, these gender-sensitive tools need to be free to use, easy to implement, provide gender or sex-based norms, and be interpretable by those without specialty mental health backgrounds (e.g., teachers, pediatricians).

2. Investigating the role of hormones in ADHD symptom expression in girls and women. This research should examine hormonal levels across the reproductive lifespan including puberty onset, menstrual cycle, pregnancy, postpartum period, and menopause, and post-menopause.

3. Assessing the degree to which girls and women with ADHD require additional or unique treatment approaches. For example, studies can investigate the efficacy of ADHD medication type and dose for girls and women and whether medication effectiveness might interact with hormone levels. With regard to behavioral treatments, research questions might include whether additional modules of CBT for ADHD or behavioral parent training potentially targeting emotion dysregulation could enhance the effectiveness of these psychosocial interventions. In addition, research can explore whether there are certain treatment delivery formats, such as group therapy (vs. individual therapy), that might be more effective for girls and women with ADHD.

[Join Our Call for Greater Research on Women with ADHD]

ADHD Research Priority: Why ADHD Exacts a Greater Toll on Women

Ellen Littman, Ph.D., clinical psychologist and co-author of Understanding Girls with ADHD

The overarching research question is: Why does ADHD exact a far greater toll on women? Why have researchers refused to explore the dramatic sex/gender differences in outcomes — and how can we compel researchers to care?

Here is the most urgent research needed to improve care for females:

• Studies that will increase recognition and understanding of the widest continuum of presentations, complex trajectories, hormonal mediation, cumulative mood-based impairments, and severity of outcomes.
• How do cycling hormones impact all aspects of female behavior and impairment —including PMS and PMDD (premenstrual dysphoric disorder), and the postpartum, perinatal, and menopause stages?
• To what degree do isolation, shame, and despair lead to self-harm and earlier mortality in females?
• How can we identify symptoms earlier in girls?

These findings will provide a basis for revised, inclusive diagnostic criteria and rating scales to assess internalizing symptoms, functional impairments, masking, and symptom proliferation after puberty.

ADHD Research Priority: Understanding the Core Symptoms of ADHD in Women

Maggie Sibley, Ph.D., psychologist, and researcher at the University of Washington School of Medicine

• What are the core symptoms of ADHD in girls and women across the lifespan?
• What is the typical trajectory of onset for ADHD in girls and women?
• What are the key points of intervention for women with ADHD (in terms of times in their lives and domains of impairment)?

[Survey: How Does Your Menstrual Cycle Impact Your ADHD Symptoms?]

ADHD Research Priority: The Impact of Hormonal Fluctuations on Women with ADHD

J.J. Sandra Kooij, M.D., Ph.D., founder, and chair of the European Network Adult ADHD

• Why do some women feel better with oral contraceptives and others feel depressed?
• How do hormones interact with neurotransmitters, such as dopamine, in women?
• What is most helpful for women with PMDD: an antidepressant, increased stimulant dosage in the last week of the cycle, taking birth control pills, or a progesterone antagonist? Same for perimenopausal women with ADHD: Which treatment would be best?
• Why do women with ADHD have higher rates of polycystic ovary syndrome, which is associated with fertility problems and hormonal disturbances, and primary ovarian insufficiency, which is associated with early-onset menopause?

ADHD Research Priority: Sexual and Reproductive Health for Females with ADHD

Lotta Borg Skoglund, M.D., Ph.D., author, associate professor at Uppsala University, Department for Women’s and Children’s Health, principal investigator at GODDESS ADHD, and author of ADHD Girls to Women

• Are negative sexual and reproductive outcomes and functional somatic symptoms more prevalent in females with ADHD compared to females without ADHD and how are they influenced by age at diagnosis and ADHD treatment?
• What daily life challenges do females with ADHD experience, and are negative sexual and reproductive outcomes and functional somatic symptoms related to low daily life functioning?
• What barriers do females with ADHD face regarding their sexual and reproductive health?
• How are cyclic variations of hormones during the menstrual cycle or the use of hormonal contraceptives related to:
  • ADHD symptom levels
  • Use of ADHD medication
  • Comorbid and functional somatic symptom levels
  • The effects of ADHD medication

ADHD Research Priority: Treatment Efficacy for Women with ADHD

Kathleen Nadeau, Ph.D., author of Still Distracted After All These Years

• ADHD, mood, and menses: Following adolescent and young adult women through several monthly menstrual cycles to report issues related to mood, focus, memory, and emotional regulation.
• Better DSM profile: Conducting a large-scale survey of high school girls, female college students, and adult women with ADHD to tell us their biggest struggles so that, at the very least, the next updated Diagnostic and Statistical Manual of Mental Disorders (DSM) can incorporate these features for females.
• Efficacy of treatment: Asking women with ADHD to rate the effectiveness of treatment with stimulant medication, psychotherapy, group therapy, and lifestyle changes—sleep, exercise, and stress-busting activities.

ADHD Research Priority: The Transition Points That Predict Impairment Versus Resilience for Girls

Stephen Hinshaw, Ph.D., distinguished professor of psychology at the University of California, Berkeley, and author of Straight Talk About ADHD in Girls: How to Help Your Daughter Thrive

• What are the transition points — psychological, family- or school-related, community-wide — that predict impairment versus resilience for girls with ADHD as they transition through adolescence to adulthood?
• What are the pros and cons of social media-related promotion of ADHD information for women, leading to valid diagnosis and treatment?
• What are the pros and cons of self-reported screenings, with the potential for receiving mail-order stimulants?
• What are the strategies and supports that help teen girls and women with ADHD thrive?

ADHD Research Priority: Gender Differences in ADHD

Dawn K. Brown, M.D., owner/CEO of ADHD Wellness Center and Mental Healthletics

• Gender differences between the presentation and coping mechanisms of girls and women with ADHD compared to boys and men.
• The adverse long-term outcomes of untreated or inadequately managed ADHD in women, including academic underachievement, unemployment, relationship difficulties, inappropriate treatment, and increased risk of substance abuse and mental health disorders.
• How society’s expectations of gender roles e.g., cultural norms around femininity, such as the pressure to be organized and focused, may influence ADHD presentations and exacerbate the challenges faced by women with ADHD
• How fluctuations in hormone levels across the menstrual cycle and during pregnancy can impact ADHD symptoms in women.
• How the combination of  ADHD and hormonal-related conditions (e.g., PMS, PMDD, and PCOS) can lead to an overlooked diagnosis and can complicate treatment in women.
• Recognizing and addressing comorbid conditions in women with ADHD, such as depression, anxiety, and eating disorders.
• How ADHD can significantly affect academic, professional, and financial success in women.
• The interplay between ADHD symptoms, parenting stress, and family dynamics of women with ADHD who are parents of children with ADHD.
• How stigma, lack of awareness, and gender bias continuously contribute to delays in diagnosing ADHD in women.

ADHD Research Priority: The Impact of Perimenopause and Menopause on ADHD Symptoms

Jeanette Wasserstein, Ph.D., clinical assistant professor of psychiatry, at the Icahn School of Medicine at Mount Sinai

An ADDitude survey found that an enormous number of women are diagnosed with ADHD during the perimenopausal and menopausal years and that those who were previously diagnosed experienced a worsening of symptoms. These observations correlate with a period of significant underlying hormonal changes. Since ADHD is a neurodevelopmental disorder thought to be typically present during the childhood or teen years, this apparently ‘new onset’ or worsening of ADHD implies an important role for sex hormones in the expression of some ADHD symptoms.

Such observations also imply that there may even be two types of women who are diagnosed with ADHD during this period: Those who were borderline ADHD their whole lives but did not meet criteria until their symptoms worsened and those who are entirely ‘new onset.’ Unfortunately, almost no research exists regarding the role of hormones on ADHD during the climacteric. Since women represent 50% of the world’s population and all will experience menopause if they live into their 60’s the impact of perimenopause and menopause on ADHD symptoms is an enormously unrecognized and important topic in global female health.

ADHD Research Priority: Diagnostic and Treatment Gaps for Women of Color

Sharon Saline, Psy.D., clinical psychologist and author of  What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life

• Addressing diagnostic and treatment gaps for women of color, including common cultural issues and difficulties with access to care.
• Developing tools for earlier detection of ADHD in girls, teens, and women including more effective options for detecting the internalizing, inattentive symptoms.
• Examining the connection between the rise of peri and post-menopausal women and how estrogen and progesterone affect the dopamine and norepinephrine receptors and pathways in the brain.
• Exploring how the socialization and gender identity of women affect the increased accounts of perfectionism, imposter syndrome, and low self-esteem.

ADHD Research Priority: Early Identification of ADHD in Girls and Women

Andrea Chronis-Tuscano, Ph.D., professor at the University of Maryland and director of the UMD ADHD Program and UMD SUCCEEDS College ADHD Clinic

• How can we raise awareness about ADHD in girls and women among parents, teachers, pediatricians, and other healthcare providers so they can be identified earlier and get the help they need?
• How can we support women through the transition to parenthood so that we can help not only them but also their children who are at risk for ADHD?

ADHD Research: Next Steps

• Download: Free Menstrual Cycle Workbook for Women with ADHD
• Read: Why Research Is Needed on Sex Differences in ADHD
• Read: The Fate of Females with ADHD Is Improving Too Slowly

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.