Females are more likely than males to have complex presentations of ADHD, potentially leading to delayed diagnosis and treatment, according to new research published in the Journal of Attention Disorders. The study found that females with ADHD are more likely than males to have inattentive ADHD, are diagnosed at older ages, and have higher rates of anxiety and depression diagnoses both before and after their ADHD diagnoses. ¹

The retrospective observational study was conducted using data from four U.S. health databases. The researchers sought to explore the relationship between sex as well as ADHD subtype and diagnosis timing. They also hoped to assess whether receiving an ADHD diagnosis had an impact on pre-existing diagnoses of depression and anxiety in women and girls, who receive treatment for these comorbidities at higher numbers.

Age of ADHD Diagnosis Rates by Sex and Subtype

The study revealed:

• The average age of ADHD diagnosis by gender:
  • Females:16 to 29 years
  • Males: 11 to 23 years
• Across both sexes, the average age of diagnosis by ADHD type:
  • Inattentive Type: 17 years to 27 years
  • Hyperactive impulsive Type: 10 years to 20 years
• Females were substantially more likely than males to be diagnosed with inattentive ADHD

How Mood Disorders Fit Into the Diagnostic Picture

• Females were twice as likely as males to have depression or anxiety diagnoses and treatments in the year before their ADHD diagnosis.
• Females were more likely than males to receive new diagnoses or treatments for depression or anxiety in the year following an ADHD diagnosis.
• The number of females with pre-existing depression or anxiety diagnoses with symptoms that did not continue after their ADHD diagnosis was higher than the number of males. In these cases, ADHD may have been misdiagnosed as anxiety or depression.
• Patients with inattentive ADHD were more likely to receive a prior diagnosis of depression or anxiety:
  • Inattentive ADHD: 13% to 18% (depression) and 17% to 26% (anxiety)
  • Hyperactive impulsive ADHD: 5% to 12% (depression) and 9% to 20% (anxiety)

Repercussions of Delayed Diagnosis

The study’s finding that females are diagnosed five years later than males, on average, together with other key data points lead researchers to conclude that diagnoses in females tend to occur “only once ADHD symptoms become more severe,” and underscores the importance of addressing this gap in health equity.

The consequences of undiagnosed ADHD are dire, especially for women.

“Women who live undiagnosed until adulthood experience significant negative outcomes in the areas of self-esteem, social interaction, and psychosocial wellbeing beginning in childhood and continuing into adulthood,” concluded the authors of a systematic review of research published in March 2023. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD.” ²

A female ADDitude reader explains the lived experience of late diagnosis this way: “I have lived with the misleading belief that I was a loser, lazy, incompetent. What are the long-term impacts of these self-defeating beliefs?”

The Complicating Presence of Mood Disorders

The connection between ADHD and mood disorders, including depression, is well-established. According to a recent study in BMJ Mental Health: ³

• People with ADHD are 9% more likely to have MDD
• An MDD diagnosis increases the risk for ADHD by 76%

These findings are echoed in the responses to a recent ADDitude survey of 6,810 adults, which found that 72% reported having anxiety and 62% having reported depression.

In addition to the over-representation of mood disorders among individuals with ADHD, previous research has documented that women in general are twice as likely as men to suffer from MDD and General Anxiety Disorder (GAD).

While rates of mood disorders are unequivocally higher among women with ADHD than either men with ADHD or women without the condition, the new study lends credence to what many women have reported anecdotally: They are also more likely than men to have ADHD initially misdiagnosed as depression or anxiety.

“Because of stigma and thoughts related to gender role presentations, when females do present with ADHD symptoms, it can be thought that it’s more likely due to anxiety or depression, because those are presentations that people are used to seeing in females early on,” explained Dave Anderson, Ph.D., in the ADDitude webinar “ADHD Then and Now: How Our Understanding Has Evolved.” “So, people say, ‘She’s distracted because she’s anxious or sad,’ not because she has ADHD. That’s something that we’re actively trying to fight, even in clinician bias.”

The new study, and research like it, helps shed light on the unique toll exacted on women by ADHD. More investigation is desperately needed, explains Dawn K. Brown, M.D., in the ADDitude article, We Demand Attention! A Call for Greater Research on Women with ADHD.

“Further research regarding these topics is indeed crucial,” Brown explains. “By conducting in-depth investigations into the gender-specific nuances of ADHD presentation and impact, healthcare professionals, policymakers, and advocates can promote greater awareness, understanding, and tailored support for women with ADHD.”

Read on to learn about the Top 10 research priorities detailed in ADDitude’s groundbreaking, cross-platform initiative : We Demand Attention! A Call to Action for Greater Research on Women with ADHD.

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  Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241251738

²  Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645-657. https://doi.org/10.1177/10870547231161533

³  Meisinger, C. & Freuer, D., (2023) Understanding the Causal Relationships of Attention Deficit/Hyperactivity Disorder with Mental Disorders and Suicide Attempt: A Network Mendelian Randomisation Study. BMJ Mental Health. doi.org/10.1136/bmjment-2022-300642

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

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

Why the ADHD denial?

To Deny ADHD Is to Uphold a Fraught Reality

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

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

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

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

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

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

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

Covert Denial and Faux Concern

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

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

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

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

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

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

ADHD Is Real: Next Steps

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

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

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.

“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

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.

New research proposes that ADHD may increase the risk of gaming disorder (GD) in college students, hindering academic success and sleep. ¹

The study, published in the journal PLOS ONE, reported that 35.7% of college students with GD display ADHD symptoms compared to 23.3% of students without gaming disorder.

Gaming disorder is a mental health condition marked by excessive and compulsive engagement in Internet games, which can significantly disrupt relationships, school, and work. The behavior must be present for at least 12 months (or shorter in severe cases) to receive a GD diagnosis.

After surveying 383 university students in Lebanon, the researchers determined that ADHD symptoms directly affect academic performance and indirectly increase the risk of GD. Among students classified as high academic performers with GPAs of 3.2 and above, only one met the criteria for symptoms of GD or ADHD.

“The absence of GD and ADHD symptoms among high academic performers suggests that academic engagement and success may be protective factors against these conditions,” the study’s authors wrote. “Alternatively, it may be that the symptoms of these disorders disrupt academic performance, which would be consistent with the negative correlation observed between disorder prevalence and academic excellence.”

Gaming behaviors may distract college students from academics as they prioritize playing video games over studying. The study reported that students with a gaming disorder spend more time gaming on weekdays and weekends than do those without the disorder. “The correlation between GD and gaming hours, particularly on non-school days, suggests that free time may exacerbate gaming behaviors, potentially leading to disorder,” the study’s authors wrote. “This finding has practical implications for the management of GD, as it highlights the importance of structured time and alternative leisure activities as part of the therapeutic approach.” ²

Gaming Disorder Affects College Students’ Sleep Habits

According to the researchers, GD also impacts students’ sleep quality and duration. On average, students with GD sleep 6.1 hours; 64.3% wake up in the middle of the night to game. In comparison, those without GD sleep between 6.8 to 7.2 hours, with negligible nocturnal awakenings for males and none for females.

“The high incidence of nocturnal awakenings in the disordered gaming group (DGG) to continue gaming is a concerning trend that warrants attention due to the critical role of sleep in cognitive function, emotional regulation, and overall health,” the study’s authors wrote. ³

Findings also indicate that ADHD is more predictive of GD in females than in males, though other factors beyond ADHD may contribute to the development of GD, especially in females. These results echo a study published in June 2023 in the Journal of Attention Disorders. That study found a staggering 82% of individuals with GD had ADHD; more than half of the participants with ADHD (57%) had GD. ⁴

Why Gaming Appeals to College Students with ADHD

Why are students with ADHD symptoms more susceptible to gaming and, consequently, gaming disorder?

“From escapism and socialization to competition, video games are highly engaging, reinforcing, and stimulating by design,” said Jeremy Edge, LPC, IGDC, during the 2023 ADDitude webinar, “Addictive Technology and Its Impact on Teen Brains.” “Prolonged, excessive exposure to immediate rewards and dopamine hits in gaming may diminish the number of dopamine receptors in the brain over time, which can lead to tolerance and further stimulation seeking. ⁵ Gamers who are motivated by both escapism and achievement and who consider gaming part of their identity, are most at risk for problematic or disordered gaming.”

While the PLOS ONE study suggests a strong link between ADHD symptoms and GD, the study’s design does not establish causality and relies on self-reported data, which may introduce bias. In addition, the prevalence of ADHD in the sample is also higher than typical epidemiological estimates.

“More longitudinal studies are needed to clarify the causal relationships between ADHD and GD and to track how these relationships evolve,” the study’s authors wrote.

Edge emphasized that anyone showing signs of gaming disorder should talk to a doctor or mental health professional. “While still a growing field, help for technology addiction is available and ranges from psychotherapy and inpatient treatment clinics to recovery programs, support groups, and even medication,” he said.

Sources

¹ Hawai, N., Samaha, M. (2024). Relationships of Gaming Disorder, ADHD, and Academic Performance in University Students: A Mediation Analysis. PLOS ONE. https://doi.org/10.1371/journal.pone.0300680

² Buono, F.D., et al. (2020). Gaming and Gaming Disorder: A Mediation Model Gender, Salience, Age of Gaming Onset, and Time Spent Gaming. Cyberpsychology, Behavior, and Social Networking, 23(9): p. 647–651. https://doi.org/10.1089/cyber.2019.0445

³ Bourchtein, E., Langberg, J.M., Cusick, C.N., Breaux, R.P., Smith, Z.R., Becker, S.P. (2019). Technology Use and Sleep in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. J Pediatr Psychol. https://doi.org/10.1093/jpepsy/jsy101

⁴ Hong, J. S., Bae, S., Starcervic, V., & Han, D. H. (2023). Correlation Between Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder or Gaming Disorder. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231176861

⁵ Sussman, C. J., Harper, J. M., Stahl, J. L., & Weigle, P. (2018). Internet and Video Game Addictions: Diagnosis, Epidemiology, and Neurobiology. Child and Adolescent Psychiatric Clinics of North America,27(2), 307–326. https://doi.org/10.1016/j.chc.2017.11.015

The most urgent and important areas of medical research on women with ADHD include the following:

1. Hormonal Influences: Understanding how hormones impact ADHD presentation and treatment in girls and women
2. Aging and Cognitive Decline: Investigating the connection between aging, cognitive decline, and ADHD in post-menopausal women with ADHD
3. Misdiagnosis and Late Diagnosis: Exploring the unique harms of misdiagnosis or later-in-life diagnosis of ADHD in women
4. Executive Function Challenges: Studying how executive functioning challenges (e.g., organization, prioritizing, time management) manifest in girls and women with ADHD

These research priorities emerged from the interim results of a survey conducted by the Duke Center for Girls & Women with ADHD last month. The online survey asked respondents to rank 46 unique health research according to their personal importance, revealing broad consensus among women of various ages and socioeconomic backgrounds. To date, 1,350 people have completed the survey.

For women with ADHD in their 20s, 30s, and 40s, the top research priority was understanding the role of hormones in ADHD symptoms and treatment. Women aged 51 and older prioritized research on the interplay between ADHD, aging, and cognitive decline after menopause.

These findings complement those of ADDitude’s recent survey of 705 women with self-reported ADHD, 69% of whom said their quality of life would be most significantly impacted by research on “how the hormonal changes of perimenopause and menopause affect ADHD symptoms.” The survey respondents also expressed frustration by the historical lack of recognition of ADHD in women and girls.

“Surely I’m not seeing something that the actual scientists can’t,” wrote one ADDitude reader in response to an Instagram post calling for greater research on hormones and ADHD. “We know that dopamine levels are directly correlated with estrogen levels. It seems obvious that the Estrogen Rollercoaster we live on would have a huge impact on our symptoms, no?”

Among post-menopausal women who completed the Duke Center’s survey, their research priorities shifted to also include studies on the psychological, emotional, and long-term health implications of late diagnosis, including:

• The impact of ADHD on girls’ and women’s beliefs about themselves
• Specific considerations for therapy for women who were diagnosed with ADHD later in life

“I was an older woman (60+) when I realized that ADHD is real and that I have it,” wrote one respondent to ADDitude’s survey on research priorities. “I have lived with the misleading belief that I was a loser, lazy, incompetent… What are the long-term impacts of these self-defeating beliefs? Where does one this old go for help this late in life?”

Another woman lamented clinicians’ failure to understand, diagnose, and treat women for ADHD. “Most people going through menopause have not been allowed to have ADHD according to the DSM,” the woman said in response to an Instagram post calling for greater research on menopause in women with ADHD. “When we were kids, we had to be male and physically hyperactive [to get an ADHD diagnosis]. Born female before the late ‘80s, you had to be a sodding unicorn to be diagnosed. Seeing as we’ve only been in the club for a few years, why would anyone think to have looked?”

Quantifying ADHD Research Needs

Of the 1,350 survey responses included in the Duke Center’s early results, 1,128 came from adult women who self-identified as living with ADHD. The majority of these women were White, lived in mostly urban or suburban regions, and reported that they did not experience significant financial hardship. A third of the sample were of “childbearing age” (i.e., ages 24-40), more than half were in their 40s and 50s, and 37% were 60 and older. A small minority (2%) were “young adult” women (ages 18-23).

The majority (N=429, 38%) of the sample identified as not yet starting menopause, 35% (N=392) were perimenopausal or in menopause, and 285 respondents (25%) identified as being post-menopausal.

Research Priorities for Girls with ADHD

More than 400 survey respondents identified as being a parent of a daughter with ADHD. The Duke Center used their responses as a proxy for the top child-specific research priorities for girls with ADHD, which included the following:

1. Investigating the reasons why girls with ADHD experience heightened rejection sensitivity
2. Exploring how teachers’ understanding of ADHD presentation in girls can be different from boys, and how this unique presentation impacts identifying and supporting girls with ADHD in school
3. Understanding the impact of social development delays in girls with ADHD
4. Studying the challenges of identifying, supporting, and advocating for girls with ADHD in education settings
5. Researching effective learning environments, teaching approaches/school accommodation, and strategies for girls with ADHD

Other Notable Findings

Women in their 20s and 30s were the only respondents to rank “unique medication concerns for girls and women with ADHD” as one of their top priorities. They also identified “workplace accommodations and strategies that are most helpful for women with ADHD” as especially important, a theme that was not prioritized as highly by other groups.

Post-menopausal women were in the only group to rank “impact of ADHD on girls’ and women’s beliefs about themselves” as one of their top four priorities.

Given that 90% of the sample of adult women with ADHD identified as White, and 95% identified as non-Hispanic, the researchers were unable to examine whether different races or ethnicities prioritized themes differently. Additional recruitment of more diverse groups is under way.

Research by the Duke Center for Girls & Women with ADHD is supported by a Patient-Centered Outcomes Research Institute (PCORI) Engagement Award (EASCS-26478), which aims to learn from girls and women living with ADHD — as well as from the people who love and support them — about the research areas that are the most important to them. The center’s mission is to advance education about the unique needs of girls and women with ADHD across the lifespan.

ADHD Symptoms in Adult Women: Related Reading

• Women, Hormones, and ADHD
• Hormonal Changes & ADHD: A Lifelong Tug-of-War
• PMS and ADHD: How the Menstrual Cycle Intensifies Symptoms
• Menstrual Cycle Phases and ADHD: Why Cycle Syncing Is Essential
• High and Low Estrogen Exacerbate ADHD Symptoms in Females: New Theory

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

Top 10 Research Priorities According to ADDitude Experts, Readers

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

Register to reserve your spot for this free webinar and webinar replay ►

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ADHD and autism share many symptoms. Yet the Diagnostic and Statistical Manual of Mental Disorders (DSM) allowed for ADHD and autism to be diagnosed in the same person only 11 years ago. Before 2013, the DSM did not recognize or allow for a dual diagnosis. Since then, research and clinical understanding of AuDHD have evolved.

However, we still don’t have an evidence-based, standardized approach to diagnosing and supporting adults, women, and gender-diverse individuals with AuDHD. Clinical consensus, stakeholder perspective, and increasing empirical research suggest that ADHD and autism are spectrum conditions that present differently across development and genders, making accurate diagnoses and treatment both challenging and vital.

This presentation will explain the ways in which ADHD and autism overlap and how they can present differently in children and adults — and across genders. In this webinar, you will also learn:

• About how AuDHD is diagnosed in children and adults
• How autism can look different from childhood to adulthood and across genders
• About the association between autism and gender diversity
• Why autism is so easily missed and misdiagnosed, especially in girls and women, and the consequences of that
• About the myths and misinformation about autism in adults and girls and women
• About what your medical and mental health providers need to know and how you can help them make an accurate diagnosis
• Future directions in diagnosis and treatment

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker

Dr. Karen Saporito is a licensed clinical psychologist who has been in private practice for over 20 years. She provides care to a wide range of clients with varying issues, but has a particular interest and specialty in diagnosing and supporting children and adults with ADHD and autism spectrum disorder. She is passionate about educating medical and mental health providers, as well as clients, about the different presentation of girls and women with neurodevelopmental disorders. Karen has been a member of APSARD for several years and serves on the APSARD Adult ADHD Guidelines Committee and the Diversity Committee.

ADHD & Autism: More Resources

• Sign Up: The Clinicians’ Guide to Differential Diagnosis of ADHD
• Self-Test Video: What Does Autism Look Like in Adults?
• Read: Signs of Autism in Women with ADHD
• Read: An Open Conversation with Temple Grandin, Autism Advocate

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

Closed captions available.

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

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

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

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

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

The Midlife Shift

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

[Download This Free Guide to Menopause and ADHD]

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

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

What changed?

An ADHD Diagnosis After Menopause

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

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

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

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

Starting Over

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

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

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

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

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

Midlife ADHD and Menopause: Next Steps

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

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

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)

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

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

For most of my life, I did not have the knowledge I needed to understand myself and counterbalance pervasive negative messaging that made me feel inherently defective and ashamed. Post-diagnosis, it still takes a lot of effort to notice and rectify harmful, anti-neurodivergent messaging from those close to me and from wider society.

I’ve been on a journey to drain my seemingly bottomless pool of shame, and it’s not a linear process. There are days I revert to child-me, hiding in my bathroom, feeling small, powerless, and voiceless. What helps me is to speak to that little girl and tell her all the things I wish I heard growing up — things that would have helped me break the difference = shame equation that crystallized in my young mind.

Dear Younger Self: What All Girls with ADHD Need to Hear

1. You are strong. Strength is not the absence of fear. Strength is having fears and going outside your comfort zone anyway. It takes strength and courage to show your vulnerability. Your differences, challenges, and even your perceived blunders are signs of strength and determination!

2. There’s no singular “right way” of doing things. There are many ways to do things and many paths to get you where you want to go.

[Read: What Are the Consequences of Late-Life ADHD Diagnoses for Women?]

3. Some things are super hard, and you can ask for help if you need it. Asking for help doesn’t mean you are a failure, or that you are weak or a burden to others. I know you want to push through all on your own, because people always tell you to “try harder” or “have more discipline,” which makes you feel guilty. To be honest, that’s bad advice because they don’t know how hard you’re trying. I really need you to not be so hard on yourself, to learn to ask for help – everyone struggles with some things in life and it’s OK. And when you find yourself struggling, remember that you have plenty of other strengths and skills to celebrate!

4. Trust yourself! Your intuition – it is trustworthy. Your feelings – they are valid. Your voice – you don’t need permission to use it, and it’s OK to struggle to express yourself verbally; it’s something that takes practice and you’ll get better at it.

5. Shame tells us to hide. Don’t. Look it in the eye, say no, thank you, and tell it to leave. I know you try hard to be a “good girl” and make your parents proud, but it’s OK to break out of the mold and color outside the lines. You have a right to claim space. You have things to show and teach the world! Let people know the real you!

6. You are not alone in your feelings. If you feel lonely, insecure, or misunderstood, chances are others do, too! Sometimes you can have a lot of feelings, and it can be tough to contain them all. When you share how you feel, it helps you make sense of your emotions. And you give others the chance to help you, and to share their vulnerabilities.

[Read: 42 Raw Confessions from Women with ADHD]

7. It’s a beautiful thing to be a sensitive soul. You feel things deeply, you tune into people’s emotions, and wear your heart on your sleeve. That’s not a bad thing, though it does mean you can feel hurt and rejected when others don’t treat you the way you want to be treated. Just remember people have different levels of sensitivity. Some people struggle to be sensitive, while you have easy access to this quality and the gifts it presents, like being creative and empathetic.

8. Don’t try to be like everyone else. It’s normal to want to fit in with others, especially when you are growing up. But people love you for who you are. They love your light, your creativity, your uniqueness. Continue being your playful self!

9. You don’t need to be perfect to be loved. You are enough. Just the way you are. Enjoy the process rather than focusing on the results. Embrace imperfection — it will teach you to let go of self-criticism. It’s totally OK to be imperfect and to fail, and you will still be loved and accepted for who you are.

10. I am proud of you. Your value is not in what you achieve, but in who you are as a person. Your heart and your spirit. I am proud of who you are. I am proud of you for always trying things even though they may be hard for you.

11. I love you!

Spoiler alert: I still struggle and I don’t have it all figured out. I still need to repeat these nuggets of advice to myself each day. But the imaginary exercise of speaking to my younger self has helped me to understand where my limiting beliefs came from and to choose the words that help change my narratives.

Unlearning ingrained thought patterns is hard work. But repeating these things to myself and being my own advocate has made me kinder to myself and more authentically me. I hope it helps you, too.

I also made a comic about this very topic! You can read it in full here.

Healing Your Inner Child: Next Steps

• Read: “Dear 10-Year-Old Me, Just Be You.”
• Join ADDitude’s Call! We Demand Attention on Sex Differences in ADHD
• Read: Stop the Cycle of Shame for Girls with ADHD
• Read: How to Raise a Self-Confident Daughter

Illustrations courtesy of Juliette Yu-Ming Lizeray.

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.

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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Children and teens with ADHD are most likely to be bullied at school than their neurotypical peers. Why? ADHD symptoms and behaviors like impulsivity, trouble detecting social cues, low self-esteem, and executive function deficits make them easy targets.

What you might not know is that bullying and abuse can physically harm a child’s brain architecture and function. The neurological scars are visible on brain scans.

What’s empowering and inspiring is that all brains benefit from neuroplasticity, which means they are shaped by environment and by practice. Learn about the strategies that can help your child with or without ADHD better cope with and respond to bullies. The more parents, teachers, and coaches understand about how brains may suffer from bullying and abusive conduct, the better equipped they will be to prevent, protect, and respond to these harmful acts.

In this webinar, you will learn about:

• The ADHD symptoms and behaviors that may make children with the condition a target
• The different forms of bullying, and the harmful physical impact that each may have on a child’s brain structure and function
• Strategies and practices to repair the neurological scars from bullying and abuse
• Practical and actionable interventions for strengthening the brain and restoring holistic health

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker

Jennifer Fraser, Ph.D., is an award-winning teacher of 20 years and the author of four books. Her latest book, The Bullied Brain: Heal Your Scars and Restore Your Health, tackles all forms of bullying and abuse to examine how they impact the brain. (#CommissionsEarned) She also writes a regular series for Psychology Today called “Bullied Brain,” which explains the important but little-known research into just how much bullying and abuse can physically hurt brain structure and function.

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

Bullying, Trauma, and ADHD: More Resources

• Download: Secrets of the ADHD Brain
• Get: The ADHD Guide to Making & Keeping Friends
• Read: 13 Trauma-Informed Teaching Strategies for Educators Today
• Read: How to Protect Your Child From Cyberbullying

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

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