Working with a gender identity therapist was really helpful. She gave great advice, and we had weekly homework. One week, it might be to make a big effort to use the right pronouns. The next week, it might be to reach out to a family member and tell them about the new name, in front of Ashe to show them that we were supportive. At the beginning, Ashe would get upset when I or Ashe’s dad used the wrong pronouns, but they learned to accept that people are going to make mistakes. The therapy lasted a year, and Ashe’s confidence increased as we went through that.

“It All Made Sense:” An Empowering Diagnosis

At the end of 9th grade, Ashe’s therapist suggested a neuropsych. We knew Ashe had trouble at school — struggles with taking tests and keeping focus, but because they were such a likable person, teachers always gave them the benefit of the doubt. It really wasn’t until high school that we saw their grades drop drastically. The tests kept coming back failed. Assignments were not getting handed in on time.

It was unclear to us what was going on. Depression and anxiety run in the family so we were concerned about that, but Ashe had started to do their own research and they said, ‘I think I might have ADHD.’”

Ashe was right: the neuropsych revealed ADHD. It turned out that the anxiety Ashe was feeling came from the ADHD not being managed. The testing was reassuring, and validating. It all made sense. Ashe thought, ‘This is what I’ve been experiencing. Let me try to get everyone in my life to work with this.”

[Read: ADHD in Teens – Your Guide to Warning Signs & Treatments for Adolescents]

I know sometimes when kids with ADHD explore gender, parents can wonder: are they just being impulsive? Ashe is very quick to make decisions and can be very impulsive. But you’re not in your kid’s head, so you have to step back and support them while you see where it goes.

A Surprising Journey

The evolution of the gender journey was surprising. As Ashe moved through high school, after working with the gender therapist, they became really confident in themselves. They started wearing skirts and embracing what we would think of as more feminine presentation, but they were very clear that when they wear a dress, it doesn’t mean they’re a girl. As Ashe has grown older and more knowledgeable and confident, they’ve really learned to love their body. For me, that was a lovely surprise because there can be a lot of body dysmorphia during this kind of gender journey.

The name change was the hardest part for me. Ashe was not the name we gave them. They wanted a more neutral name that they felt suited them better. It hurt at first to not be a part of that process, but looking back and seeing the whole journey, I understand that ‘Ashe’ is the name they feel is them. Now it’s really strange to think back on the dead name, which we do have to use from time to time for legal stuff.

[Read: How to Support a Teen with ADHD Who Is Questioning Their Gender]

In the beginning I asked Ashe a lot, “Can you explain it to me?” Then I stopped, because I realized that I had to do the work of learning, myself — listening to podcasts, reading articles. It shouldn’t necessarily be the child’s responsibility to make you understand.

Support Now. Understand In Time.

I also realized that I didn’t really need to understand in order to support. I figured out that the understanding would come, one day, down the line. But what needed to happen, in that moment, was just support.

The relationships, including friendships, that Ashe has formed are extremely deep and supportive. Ashe now has a boyfriend, and they’ve been together for two years. They have amazing communication for a bunch of 19-year-olds, the way they talk about how to address each other and physical touch and what’s okay with that. There is a lot of really open communication and I think it comes from both of them being so comfortable with who they are.

A lot of people push down who they are — whether that’s gender or sexuality or neurodivergence. But seeing Ashe embrace themselves, I’ve thought, wow, everyone should know as much as they can about themselves — their neurodivergence, gender identity, sexuality. It can open you up to being so much more authentic, and fulfilled.

Gender Diversity and Neurodiversity: Next Steps

• Watch: Gender Diversity and Neurodiversity – How to Support a Child, Teen, or Young Adult with ADHD as They Explore Gender
• Read: How to Be a Neuroqueer Ally
• Read: The Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth

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In fourth grade, my favorite teacher led an activity where we had to describe to our peers how to make a peanut butter and jelly sandwich as if they were aliens who had never heard of such a food. As bright fourth graders, we started by telling the other group to “put the peanut butter on the bread.” As you can imagine, the instruction was so vague that my peers, who were only following directions, placed the entire peanut butter jar on top of the bread, which was not our intention. “Working and communicating together in groups can be challenging,” my teacher told me. “Did you learn anything from this?”

Working in groups – and socializing in general – can be especially challenging for kids with ADHD. ADHD is not so much about knowledge-based deficits as it is about performance-based challenges. A lot of us know how to socialize and we understand what’s right and wrong, but we struggle when we need to display our social skills. That’s why it’s so important to practice skills in real time, and why it’s even more important for parents to support and replicate skill-building at home.

The following are three social skills activities I have found help children with ADHD because they can be practiced in a social-skills groups with same-aged peers AND outside of the office with the support of parents:

“LEGO My Creation”

The first strategy, derived from an activity book by Jennifer Cook O’Toole, is written for parents, clinicians, and educators of autistic children. Given the overlap between autism and ADHD, this resource may be helpful more broadly.

[Get This Free Download: A Friendship Guide for Kids with ADHD]

The goal behind this communication activity resembles that of my PB&J fourth grade bit. During the activity, children sit back-to-back and each pair is given identical LEGO pieces. In each pair, Child #1 creates a structure with the pieces while Child #2, still turned the other way, waits. Then, Child #1, who built the structure, practices clearly and patiently communicating what they created to Child #2, who is blind to what Child #1 created. Child #2 has to try to build a replica using only Child #1’s verbal description. Both partners can only see and compare structures at the end of the activity. Before the activity, clinicians and/or parents should discuss helpful tips for easier communication, and children should also be coached and given direct feedback during the activity.

I like this activity because, even if it turns out to be very difficult for the pair, it will likely serve to increase awareness of situations in which children may be misunderstood and need to explain things more clearly. Other versions of this same activity, like drawing, can help with clarifying thoughts and with communicating more effectively.

Two tips I’ve learned in my practice with neurodivergent youth: Make sure the LEGO pieces are large and simplify the task for them as much as you can. The goal is to teach them something, but also to make the task attainable and fun, so if the structure is too difficult to describe, that may suck the fun out of the activity and make the game unnecessarily stressful.

Spin the Confidence Wheel

Many of the neurodivergent pre-teens and teens with whom I work say they want to increase their confidence in social situations. Enter the Confidence Wheel, an activity I derived from my exposure therapy work with anxious youth. Each slice of the wheel is filled in with a unique social anxiety exposure or situation based on the child’s specific triggers. When the wheel stops, the child has to engage in the social anxiety exposure indicated. (For so much of anxiety, the only way out is through.) After discussing the rationale behind this activity and receiving some core coping skills, the child engages in the social anxiety exposure with the support of their social skills group and clinician; they can also practice outside of the office with parental support.

[Read: 5 Ways to Reframe Anxiety for Your Worried Teen]

I like this one because it is applied – it pushes the child to actually DO something rather than just discuss a skill, and it can be practiced with parents’ support. After all, it will be difficult to engage in real-life social skills practice if anxiety is holding them back.

Winging it with Improv

Improvisation has so many social skills built into it — changing and adapting personas based on context, getting used to quick cognitive shifts, following what others are saying, staying on topic – that can help neurodivergent youth rehearse in a funny and supportive environment.

Improv classes, programs, clubs, and camps are everywhere – another benefit of this activity. As individuals with ADHD, we need humor and movement to stay sane, and improv provides both. Here’s a display of one improv activity I’ve seen work well with neurodivergent preteens and teens: LiveKellyandMark.

In each of these activities, we encourage adolescents to interact with others in real time while facing their social fears in fun, supportive environments. These exercises and contexts teach them to love themselves for who they are while opening their minds to new strategies for becoming the best versions of themselves.

Social Skills Activities: Next Steps

• Read: Social Smarts — The Teen Years
• Read: Building (Real) Friendships in the Age of Social Media
• Watch: The Social Reboot – Helping Tween and Teen Boys with ADHD Make Friends

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How to Be a Neuroqueer Ally: Next Steps

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

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

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

[Free Resource: 2024 Scorecard of ADHD Treatments]

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

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

ADHD Medication Management: Next Steps

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

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

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

“Procrasti-cleaning” is most appealing when I’m faced with a project that isn’t clear-cut. Cleaning feels like a comparatively easy win. If I spend five minutes tidying up my desk, it will look visibly improved. Five minutes of writing, however, doesn’t always leave me feeling like I’ve made any progress.

Having an easily distracted brain doesn’t help. As someone with ADHD, I spend a lot of my day modulating my attention. I notice, and then subsequently choose to ignore, many potential distractions. These distractions come from within (e.g., the spark of new ideas, recalling items on my to-do list) and elsewhere (e.g., stray socks on the floor, dirty dishes in the sink).

[Read: Why the ADHD Brain Chooses the Less Important Task]

It takes a lot of energy to keep focused on a task that doesn’t excite me. I can feel my thoughts ping-ponging, bouncing around the walls of my head. My mind desperately seeks anything – even cleaning – on which to latch.

Giving in to procrastination, even if it’s in the form of something productive like cleaning, doesn’t usually feel good. But one day – when facing another complex project that I dreaded – I asked myself, what if I give into my impulse to escape, but for a limited period?

I set a timer for 10 minutes and went on a cleaning and organizing spree. I let myself go wherever I felt, addressing anything that triggered me: a napkin that had fallen on the floor, laundry that needed to be put away, unpaid bills, texts that needed to be sent.

After the timer rang, I got to work on some writing. I felt noticeably calmer and focused because my space was tidier and less distracting. And having a small win from cleaning gave me the dopamine boost I needed to sit down for less linear work.

[Read: Stop Dodging That Dreaded Task! 9 Ways to Halt Avoidance Procrastination]

I now follow this practice regularly, especially after dropping off my youngest at preschool, when I have a couple hours to get some higher-level work done. Starting off my free time with puttering allows me to clear my mind and space first, which inevitably makes the rest of my time more productive.

Another benefit to The 10-Minute Putter? It feels a bit like unmasking. A lot of us with ADHD (women, especially) have learned to mask our stereotypically ADHD characteristics because they make us seem less responsible, intelligent, or successful. When I putter, I get to operate however I want, without the usual confines to which I restrict myself.

The next time you have a daunting project or a moment in which you don’t know where or how to start, I invite you to pull out a timer and putter (or procrasti-clean) for 10 minutes. I hope it helps you unleash more momentum, focus, and creativity in your work and life.

Productive Procrastination and ADHD: Next Steps

• Free Download: How to Stimulate Your ADHD Brain When Dopamine Dips
• Read: When Procrastination Is OK
• Read: How to Set Intentions to Crush Procrastination

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

The 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

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.

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.

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.

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

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The ongoing shortages of generic ADHD medications and chemotherapy drugs are addressed in new draft legislative proposal released on May 3 by Senate Finance Committee Ranking Member Mike Crapo (R-Idaho) and Chair Ron Wyden (D-Oregon), who said the proposed legislation would “tear down regulatory barriers that are preventing families from accessing critical drugs like those needed to combat ADHD.”

The draft legislation was announced on the same day the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association (CHA) sent a letter to the U.S. Department of Health and Human Services and Drug Enforcement Administration expressing their continued concern about the ongoing stimulant medication shortages.

“Families that rely on generic stimulant medications have been disproportionately affected by the ongoing stimulant shortages,” the letter said. “This situation only exacerbates existing health disparities among economically disadvantaged families who are enrolled in Medicaid and CHIP.”

The proposed legislation establishes a Medicare Drug Shortage Prevention and Mitigation Program, wherein hospitals, healthcare providers, group purchasing organizations, drug manufacturers, and others could earn payment incentives for improving their purchasing and contracting practices across the supply chain for generic drugs, including generic versions of ADHD medications such as Adderall and Vyvanse. The proposed legislation would also limit inflationary rebates under the Medicaid Drug Rebate Program (MDRP) for certain generic drugs susceptible to shortages.

“It is unacceptable that America is consistently running out of affordable and essential generic medicines,” Wyden said in a press release. “Once again, monopolistic middlemen have put market power and profit over families’ healthcare.”

Associations Urge Government to Address ADHD Medication Shortage

In their letter on ADHD medication shortages, the AAP, AACAP, and CHA call on the federal government to “convene all relevant stakeholders for a forum to discuss the impact these shortages are having on patients, families, and their providers and identify actionable solutions that will alleviate these shortages.”

“Pediatric providers, including child and adolescent psychiatrists, pediatricians, and children’s hospitals, along with the patients and families they serve, face an insurmountable struggle with stimulant medication shortages,” the letter said. “Untreated ADHD can contribute to worsening mental and behavioral health disorders, including mood and substance-use disorders, unintended injuries resulting from ADHD-related impulsivity and long-term impacts on relationships-building, educational achievement, and professional success. Parents and families may also be negatively impacted by the disruption that untreated ADHD can cause in the home, school, and work environments.”

According to the American Society of Health-System Pharmacists (ASHP), 323 medicines are currently in short supply, the highest number of ongoing and active drug shortages since the organization began tracking data in 2021.

ASHP reported that “new DEA quota changes, along with allocation practices established after opioid legal settlements, are exacerbating shortages of controlled substances (12% of all active shortages).” The Drug Enforcement Agency (DEA) classifies stimulant ADHD medications, such as Adderall and Vyvanse, as “Schedule I,” which indicates drugs with a high potential for abuse.

FTC, HHS Seeks Public Input on ADHD Medication Shortage

The Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS) are seeking public input to understand how the practices of pharmaceutical middlemen contribute to drug shortages and impact patients, hospitals, healthcare providers (including small healthcare providers and rural hospitals), pharmacies, generic manufacturers, and other suppliers.

Sixty-three percent of the more than 6,200 public comments already submitted mention ADHD.

The deadline to submit public comments is May 30, 2024. Add your testimony at Regulations.gov.

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.