“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

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.

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.

“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

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.

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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.

Closed captions available.

The lives of girls and women with ADHD are jeopardized by exponentially higher rates of self-harm, suicidality, and intimate partner violence, as compared with their neurotypical counterparts or with neurodivergent boys and men.

“ADHD in girls portends continuing problems through early adulthood that are of substantial magnitude across multiple domains of symptomatology and functional impairment,” write the authors of the Berkeley Girls ADHD Longitudinal Study (BGALS) follow-up study.¹ “The sheer range of negative outcomes is noteworthy; the most striking include the high occurrences of suicide attempts and self-injury in the ADHD sample, confined to the childhood-diagnosed combined type.”

What We Know About Self-Harm

This is an arresting statistic, particularly considering how self-harm and suicidality have spiked in adolescent girls in general. The most recent CDC Youth Risk Behavior Survey (YRBS) report found that 1 in 10 girls has attempted suicide, and 1 in 3 of girls seriously considered suicide during the past year, which is an increase of nearly 60% from a decade ago.

Research suggests that neurodivergent girls face a significantly higher risk for self-harm than do neurodivergent boys, or neurotypical people of any gender. A 2020 study in European Child & Adolescent Psychiatry found that the rate of self-harm was four times greater in females than it was in males (8.7% vs 2.2%).²  A 2022 ADDitude survey found reports of self-harm among 18% of girls with ADHD versus 9% of boys with ADHD.

The correlation between teen girls with ADHD and self-harm is so strong that a 2021 study published in Child and Adolescent Mental Health proposed that all teen girls treated for self-harming behavior should be screened for ADHD:³ A full 83% of teen patients admitted to the hospital for self-harm were girls, the study found.

Indeed, early diagnosis and treatment of ADHD is critical to mitigating the risk of self-harm. “Girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide,” says Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.

What We Know About Intimate Partner Violence

Low self-esteem, high rejection sensitive dysphoria (RSD), and social skill deficits put women and girls with ADHD at heightened risk for intimate partner violence (IPV). A study published in the Journal of Abnormal Child Psychology found that: ⁴

• Girls with ADHD were five times more likely to be victims of physical intimate partner violence than non-ADHD girls (30% vs. 6%)
• Greater ADHD symptom severity in childhood was associated with increased risk for physical victimization

“Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships,” write the authors of the study. “Given the devastating impact of intimate partner violence, additional research on how to empower females with ADHD in their social and romantic relationships is greatly needed.”

What We Know About Substance Use

The connection between SUD and ADHD has been well-established through research. We know that:

• People with ADHD are three times more likely to develop an SUD then those without⁵
• 25% of adults with SUD have ADHD⁶ 
• SUD is often more severe in individuals with ADHD⁷

Among the general population, we know that teen girls are more likely to use substances than are teen boys. According to the CDC’s YRBS:

• Alcohol: 27% of teen girls reported drinking in the last month vs 19% of boys
• Vaping: 21% of girls reported vaping in the last month vs 15% of boys
• Illicit drugs: 15% of girls reported ever using illicit drugs vs 12% of boys
• Misuse of prescription opioids: 15% of girls reported ever misusing opioids vs 10% of boys

That said, studies on the prevalence of SUD among girls and women with ADHD have resulted in mixed findings. An elevated risk of substance use was found in a large-scale study led by Joseph Biederman, M.D.,⁸  however no such association was found in the BGALS follow-up.

Most recently, researched at the University of Minnesota conducted a study investigating how ADHD symptoms may influence substance use in women and men, and it found a stronger association between alcohol use and ADHD for young adult women than for young adult men.⁹

“The current study confirms that ADHD-associated risk for adult substance problems is consistently greater in magnitude for women,” the authors of the study write. “The presence of adult ADHD increases risk for substance problems in women more than men.”

What We Don’t Know

No research exists on the relative efficacy of interventions that may reduce the risks for self-harm, suicidality, intimate partner violence, and substance use among girls and women with ADHD. Without fully understanding where these threats begin and how they escalate, we cannot devise and adjust solutions.

The BGALS follow-up study found elevated risks of self-harm and suicidality only among girls with combined-type ADHD, and not among those with inattentive symptoms alone, which leads researchers to speculate that impulsivity is associated with higher risk. Researchers also posit that psychosocial factors, such as the teen’s environment, contribute to the likelihood of self-harm. Longitudinal research is needed, however, to confirm this.

“What are the transition points — psychologically, family or school-related, community-wide — that predict impairment vs. resilience for girls with ADHD as they transition through adolescence to adulthood?” asks Hinshaw. “What are the strategies and supports that teen girls and women with ADHD find most helpful in self-advocacy and thriving?”

In the British Journal of Psychiatry,¹⁰ Hinshaw and doctoral student Sinclaire O’Grady call for longitudinal research on long-term correlated outcomes, such as the development of borderline personality disorder, as well as research into the intergenerational transmission of risk for negative outcomes in the children of women with ADHD.

Further research is needed to answer the following questions:

• What are the specific predictors and mediators of the high risk for self-harm in girls and women with ADHD?
• Does screening self-harming teens for ADHD reduce the occurrence of self-harm?
• What, exactly, makes early adulthood a time of heightened risk for substance use issues, specifically for women with ADHD?
• What are the impacts of ADHD treatment on intimate partner violence victimization?
• What psychosocial interventions, specific to girls and women with ADHD, may mitigate risk of intimate partner violence victimization?

Why It Matters

Researching suicidality, self-harm, intimate partner violence, and substance abuse among women with ADHD will, quite literally, save lives.

A study led by Russell Barkley, Ph.D., published in the Journal of Attention Disorders, found that life expectancy was 13 years lower for patients with combined-type ADHD diagnosed in childhood and with persistent symptoms, relative to control children.¹¹

However, because of the severely limited number of females in the study, the findings are largely not relevant. No major study has investigated the impact of ADHD on life expectancy specifically in women.

With dramatically higher rates of self-harm and suicidality, as well as intimate partner violence, this research is desperately needed to protect women from bodily harm, as well as devastating emotional consequences.

What ADDitude Readers Tell Us

Feelings of loneliness, RSD, emotional dysregulation, anxiety, and low self-worth exert a crushing emotional burden — and prompt some readers to harm themselves, to abuse substances, and to maintain toxic relationships.

“I made poor choices that led to abuse,” says Debs, an ADDitude reader in the United Kingdom. “I’ve taken substances to make the pain less, and I have self-harmed to try to take away the pain.”

“The inner turmoil just seems to get louder and louder and more difficult to turn down, which leads to unhealthy ways of coping like self-harm to help manage the stress,” shares Laura, an ADDitude reader in Texas.

“I abuse cannabis,” explains ADDitude reader Elizabeth, in the United Kingdom.

“Sometimes I feel worthless and want to self-harm because of RSD, assuming I’m not loved by my loved ones.”

“I get myself in relationships that aren’t good for me as I’m just happy that somebody finally loves me despite my flaws,” explains ADDitude reader Annika in Germany. “Self-harm comes into play when I feel like a failure because the relationship is rocky, and I get invalidated or criticized.”

“I constantly feel like I’m failing, which makes the thoughts about self-harm pop up often, although I haven’t given in to those for a while now,” says Lizzy in the Netherlands.

“I drink a lot right now,” says Nicole, an ADDitude reader in Washington. “I know it is unhealthy, but it is the only way for me to cope.”

“I have a history of self-harm, which was sometimes brought on my intense feelings of worthlessness and loneliness,” shares an anonymous ADDitude reader.

What ADHD Experts Say

The long-term ravages of underdiagnosed and undertreated ADHD in women are dire — a matter of life and death in some cases. To develop effective interventions, research is essential.

“There is a critical need for studies into how increasing degrees of isolation, shame, and despair lead to self-harm and earlier mortality, exploring the relationships to early chronic trauma, impulsivity, poor self-care,” says Ellen Littman, Ph.D. “Research must respond to outcomes signaling such a significant public health crisis.”

“Too little is known about later-adult outcomes of females with ADHD,” write Hinshaw and O’Grady. “Overall, we contend that the extraordinarily high risk for self-harm incurred by girls with ADHD as they mature requires a shift in clinical perspective.”

“Girls and women with untreated or undertreated ADHD — or those who have been misdiagnosed with other conditions — have been put at higher risk for an array of negative outcomes including higher rates of depression and anxiety, intimate partner victimization, and risky sexual behaviors resulting in teen and unplanned pregnancies,” says Schechter. “Research specifically devoted to girls and women with ADHD is not only an issue of equity but a life-or-death issue for some girls and women.”

Self Harm & Intimate Partner Violence: Related Resources

• Suicide &Crisis Lifeline: Call or Text 988
  988lifeline.org
• National Sexual Assault Helpline: 1-800-656-HOPE
• National Substance Abuse Helpline: 1-800-662-HELP
• Stop Bullying

Related Reading

• Teen Girls Are Not Alright. ADHD Magnifies the Crisis.
• ADHD in Women and Girls: Why Female Symptoms Slip Through Diagnostic Cracks
• Why Do Toxic Relationships Swallow People with ADHD?
• Girls and Women with ADHD: Unique Risks, Crippling Stigma
• Substance Use Disorders and ADHD: 5 Key Facts and Additional Resources
• “If the Story of My Unplanned Pregnancy Helps Just One Person, It Was Worth Sharing.”

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 SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

² Ohlis, A., Bjureberg, J., Lichtenstein, P. et al. Comparison of suicide risk and other outcomes among boys and girls who self-harm. Eur Child Adolesc Psychiatry 29, 1741–1746 (2020). https://doi.org/10.1007/s00787-020-01490-y

³ Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

⁴ Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

⁵ Wilens T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. The Psychiatric clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8

⁶ Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 9–21. https://doi.org/10.1016/j.jaac.2010.09.019

⁷ Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956

⁸ Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Klein KL, Price JE, Faraone SV. Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biol Psychiatry. 2006 Nov 15;60(10):1098-105. doi: 10.1016/j.biopsych.2006.02.031. Epub 2006 May 19. PMID: 16712802.

⁹ Elkins IJ, Saunders GRB, Malone SM, Wilson S, McGue M, Iacono WG. Differential implications of persistent, remitted, and late-onset ADHD symptoms for substance abuse in women and men: A twin study from ages 11 to 24. Drug Alcohol Depend. 2020 Jul 1;212:107947. doi: 10.1016/j.drugalcdep.2020.107947. Epub 2020 Feb 27. PMID: 32444170; PMCID: PMC7293951.

¹⁰ O’Grady SM, Hinshaw SP. Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm. Br J Psychiatry. 2021 Jan;218(1):4-6. doi: 10.1192/bjp.2020.153. PMID: 33019955; PMCID: PMC7867565.

¹¹ Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders, 23(9), 907-923. https://doi.org/10.1177/1087054718816164

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

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

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

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

[Read: ADHD and the Epidemic of Shame]

Feelings of Failure, Easily Triggered and Intense

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

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

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

[Download: 2024 Scorecard of ADHD Treatments]

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

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

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

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

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

How to Reframe Feelings of Failure

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

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

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

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

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

 Fear of Failure & Treatment: Next Steps

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

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

ADHD traits such as distractibility and impulsivity may have benefited our ancestors as they foraged for food, and they continue to play a crucial role in how people with ADHD adapt and survive, suggests new research published in the journal Proceedings of the Royal Society B Biological Sciences.¹

University of Pennsylvania researchers recruited 457 study participants to play an online virtual berry-picking game. The goal was to collect as many berries as possible within eight minutes by hovering their cursor over bushes. The players could stay at a bush or move to another, which would incur a brief timeout.

Slightly less than half (45%) of the participants screened positive for symptoms consistent with an ADHD diagnosis, though this did not constitute a diagnosis because it was a self-reported assessment. Those participants spent shorter periods in each patch and achieved higher reward rates than did participants who did not exhibit ADHD traits.

The results indicated that populations with nomadic lifestyles that benefited from exploring tended to have genes associated with ADHD. Those ADHD traits continue to serve a function today.

“We speculate that ADHD serves as an adaptive specialization for foraging, thus explaining its widespread prevalence and continued persistence in the human population,” the researchers said. “This tendency to explore while foraging might extend to other behaviors such as cycling more frequently between information sources in the classroom or sources of stimulation in the home environment.”

While the study had limitations, the theory as to why ADHD exists — and prevails — may be validating for people with ADHD. Could ADHD traits needed for exploration, such as distractibility, impulsivity, or restlessness, help adults or children with ADHD adapt and thrive? Might this research help educate others about the condition? We asked ADDitude readers for their viewpoints.

“There Is Power in Understanding”

“Yes! I love this theory. I can see how flitting from berry bush to berry bush with my ‘Oooh, look over there!’ brain could have helped my clan thrive.”

“I find it very validating that we are ‘wired for survival.’”

“I absolutely think this theory can help educate others about the condition. However, it’s important not to minimize the struggles that come with ADHD because our modern world is geared toward neurotypical individuals. Put the ADHD mind in an environment it was made for (i.e., foraging), and it will thrive! We need to have a more inclusive view of ADHD and acknowledge both the struggles and the strengths.”

“I find this so validating! Our society and culture make me feel like I’m never good enough. I wish it were the norm to celebrate our unique strengths. We still have a long way to go, but I feel there’s a shift in that direction.”

“As an end-of-career psychotherapist, I got so excited when I read this research. There is power in understanding that we did (and do) indeed belong in the human circle.”

“I loved learning about this theory and that we would have been the ones to think outside the box and find solutions.”

“ADHD Traits Help Me Adapt and Thrive”

“I do feel like my ADHD traits have helped me adapt and thrive. Because of my restlessness and distractibility, I keep up with the latest information in my career. My impulsiveness has allowed me to take risks in my job and other areas of my life, which have turned out incredible (e.g., finding the love of my life, ending up in a career I never imagined that I love, etc.).”

“I travel and have moved a lot for work. If it weren’t for my ADHD, I wouldn’t be as successful as I am today and okay with constantly moving and changing my environment and structure.”

“Because of my ADHD, I have a much wider knowledge base on a self-reported assessment, which is useful when searching for an innovative solution to a problem. The downside is that my ADHD traits have hindered me from becoming an expert in a single subject.”

“Theories Are Great, But Attitudes Need to Change”

“I found the theory interesting and a little validating. I’d really like to see research on the potential evolutionary advantages of two other ADHD traits: hyperfocus and time-blindness.”

“I find it somewhat validating, but more often, I wish my brain would ‘get with the times.’”

“We live in a linear world. I’ve lost out on more jobs because I couldn’t give a linear answer in a job interview and seemed scattered and disorganized. Theories are great, but it’s the attitudes out there and stereotypes that need to change.”

“We Shouldn’t Have to Justify ADHD”

“Frankly, we shouldn’t have to justify ADHD based on a theoretical evolutionary advantage. I’m sick to death of having to sell the validity of disabled people as human beings to an uncaring mainstream. To be considered ‘fully human,’ the average neurotypical person does not have to demonstrate their utility (or the utility of people who shared their traits in the ancestral environment). I don’t think it’s great advocacy to lean on this stuff heavily today.”

“The theory sounds preposterous to me. Distraction, impulsiveness, and depression ruined what might have been a productive life worth living.”

“I don’t buy into the theory at all! Being distracted or impulsive while foraging for food means I’d get eaten first by the lion while those without ADHD would have run to safety.”

“This isn’t helpful. No matter what we tell ourselves to make us feel better, ADHD is not a positive trait. The people with ADHD that we see thriving in the media are the unicorns, not the norm. It won’t help educate others, but it will be a fun fact to tell my son, who has ADHD.”

“I don’t appreciate people saying that the things I struggle with daily are an evolutionary trait or ‘superpower.’ Living in the world with ADHD is hard, and it makes my life more difficult. I wish I didn’t have ADHD.”

“This theory is only validating if it leads to improvements or advances in treatment or ways to handle ADHD symptoms. Is it going to help me get stuff done? Will it help my child succeed in school, be a competent and caring adult, and have meaningful friendships? If not, it might be interesting to think about, but otherwise, it doesn’t matter much to me.”

Sources

¹Barack, D.L., Ludwig, V.U., Parodi, F., Ahmed, N., Brannon, E.M., Ramakrishnan, A.M., and Platt, M.L. (2024). Attention Deficits Linked with Proclivity to Explore While Foraging. Proceedings of the Royal Society B Biological Sciences.doi.org/10.1098/rspb.2022.2584.

Teenage girls who often ruminate exhibit patterns of brain activity different from their non-ruminative peers after encountering social rejection, according to new research published in Developmental Cognitive Neuroscience.¹ Increased activity was seen in the parts of the brain involved in developing self-concept, which researchers say suggests that ruminative teens internalize social rejection and integrate it into their view of themselves.

“Everyone experiences rejection, but not everyone experiences it in the same way,” explained Amanda Guyer, Ph.D., one of the study’s authors and associate director of the Center for Mind and Brain at the University of California at Davis. “Our results suggest that girls who tend to ruminate are experiencing more than just momentary sadness after rejection. They are deeply internalizing this negative feedback into their self-concept.”

The study, conducted by researchers at the UC Davis Center for Mind and Brain, involved 116 female participants, aged 16 to 19, who were asked to self-report their tendency to ruminate, defined by the study’s authors as engaging in repetitive, negative thought patterns. The participants were also asked to perform two tasks related to social selection. In their initial visit, participants viewed photos of 60 teens, and were prompted to select 30 they’d like to talk to online. At the follow-up visit, the teens were informed of which of those selected teens had chosen them, and which teens had not. While receiving this information, the teens received functional MRIs to measure blood flow and electrical activity in different areas of the brain.

Social Rejection Plus Rumination Impacts Self-Concept

The study showed that, among girls who ruminate, there was increased activity in the parts of the brain associated with developing one’s sense of identity and interpreting the intentions of others. This led researchers to conclude that ruminative teen girls tend to deeply reflect on the negative feedback of social rejection, incorporating it into their self-concept.

This type of emotional distress is frequently experienced by people with ADHD, among whom rejection sensitivity is common, and painful. “The emotional intensity of rejection sensitive dysphoria (RSD) is described by my patients as a wound.” explains William Dodson, M.D., in his ADDitude article “New Insights Into Rejection Sensitive Dysphoria.” “One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD.”

The pattern of brain activity revealed in the study also helps explain why teen girls who ruminate are compelled to analyze peers’ behavior, particularly social rejection, which researchers say “aligns with high ruminators’ need to understand a situation and their propensity to ask ‘why’-type questions.”

Rumination Taxes Working Memory

The study also found that rumination caused increased activity in the parts of the brain associated with working memory. Researchers believe that because ruminative teen girls are using much of their working memory to revisit negative social feedback, it may be harder for them to perform cognitive tasks that demand working memory.

For individuals with ADHD, who frequently struggle with deficits in working memory, this may cause additional strain on already limited resources.

Impact of Rumination on Mental Health

By demonstrating the neurobiological basis of rumination and its relationship to rejection sensitivity, the study reveals the importance of equipping teen girls with strategies to decrease rumination.

Left unaddressed, rumination, which is more common among girls than boys, is associated with a higher incidence of many mental and behavioral health challenges. Previous research has demonstrated that rumination is a risk factor for:

• Depression and anxiety²
• Substance abuse ³
• Self-injury ⁴
• Disordered eating ⁵
• Sleep problems ⁶
• Aggressive behavior ⁷

Rumination Intervention Strategies

To avoid these negative outcomes, the study’s researchers stress the benefit of interventions that break the rumination cycle.

“Our study suggests that it can make a difference to reframe their [teens’] negative experiences in a way that makes them feel better afterward instead of worse,” said Guyer.

These strategies may be particularly important for individuals with ADHD, among whom patterns of negative thinking are common.

“Obsessing and ruminating are often part of living with ADHD,” explains ADHD coach Beth Main in her ADDitude article, “ADHD and Obsessive Thoughts: How to Stop the Endless Analysis.” “No matter how hard you try to ignore them, those negative thoughts just keep coming back, replaying themselves in an infinite loop.”

Rather than attempting to ignore ruminative thoughts, Main suggests the following strategies:

• Re-frame the experience: Cognitive reframing involves identifying familiar negative thought patterns, and then shifting the way situations, emotions or experiences are viewed.
• Repeat a mantra: Positive self-talk in the form of a short, repeated phrase with a positive message, like “I am worthy of love,” can counterbalance the negative self-talk to which ruminators are prone.
• Redirect focus elsewhere: Attention modification through a healthy dose of distraction can help break a negative loop, particularly if it’s something that demands your full attention. Activities involving exercise or being in nature can be especially therapeutic.

Sources

¹ Yoon L, Keenan KE, Hipwell AE, Forbes EE, Guyer AE. Hooked on a thought: Associations between rumination and neural responses to social rejection in adolescent girls. Dev Cogn Neurosci. 2023 Dec;64:101320. doi: 10.1016/j.dcn.2023.101320. Epub 2023 Oct 30. PMID: 37922608; PMCID: PMC10641579.
²K.A. McLaughlin, S. Nolen-Hoeksema, Rumination as a transdiagnostic factor in depression and anxiety, Behav. Res. Ther., 49 (3) (2011), pp. 186-193.
³A. Grierson, I. Hickie, S. Naismith, J. Scott. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models.
⁴J. Ying, J. You, S. Liu, R. Wu. The relations between childhood experience of negative parenting practices and nonsuicidal self-injury in Chinese adolescents: The mediating roles of maladaptive perfectionism and rumination
Child Abus. Negl., 115 (2021), Article 104992.
⁵L.M. Hilt, C.A. Roberto, S. Nolen-Hoeksema. Rumination mediates the relationship between peer alienation and eating pathology in young adolescent girls. Eat. Weight Disord. -Stud. Anorex., Bulim. Obes., 18 (3) (2013), pp. 263-267.
⁶Y. Li, S. Gu, Z. Wang, H. Li, X. Xu, H. Zhu, et al. Relationship between stressful life events and sleep quality: rumination as a mediator and resilience as a moderator. Front. Psychiatry, 10 (2019), Article 348.
⁷K.A. McLaughlin, S. Nolen-Hoeksema, Interpersonal stress generation as a mechanism linking rumination to internalizing symptoms in early adolescents, J. Clin. Child Adolesc. Psychol., 41 (5) (2012), pp. 584-597.

Still, I ride a motorbike every day, knowing that the only laws that I cannot defy are physics and fate. One mistake and I’m injured — or worse. It may be a dark and uneasy truth, but it’s also quite liberating.

So why is a machine that I know may maim or kill me one day such a vital part of my life?

I think it has something to do with my ADHD. Riding gives me pure peace of mind, total focus, and a rush of adrenaline. There’s a single task and purpose: To get from Point A to Point B alive. It’s urgent for the sake of everything and nothing, making every journey and movement matter with an energy that defies fatigue. There simply is no room for error and no safety net beyond my reactions and skills as a rider.

I can feel the danger in the air pushing back on me as I choose to accelerate, a quiet demonstration of the immense power beyond my daring. Nothing else matters. No distractions, just me, a little music in my ears, and the ribbon of asphalt and the obstacles on it before me as I grip an explosive rocket nestled snugly against me. It puts me right there, right on the edge of oblivion. Every. Single. Time. (It makes grocery shopping rather dramatic, too.)

[Get This Free Resource: Secrets of Your ADHD Brain]

Love at First Bike

Something about me changed after I got on my first bike at age 14. I truly loved that feeling, the rollercoaster with no end. I needed it. I obsessed about bikes for seven years until I finally persuaded my parents to let me get one. They were beautiful and dangerous, like diving eagles. I’ve since ridden bikes through tropical storms and down hellish, tattered roads — never once wishing I’d bought a car.

When my last bike was stolen and destroyed, my heart shattered. I mourned her like a lost love. I felt naked somehow like the thieves had taken more than just a vehicle, but a part of me — a part that gives me license to feel really and truly free.

Risky Behaviors Help ADHD Brains Thrive

We live in a sensible society that can feel very restrictive for people with ADHD. Our society relies on rules and a degree of moderation to function. Everything is controlled, predictable, economically prosperous, safe, and in good order. I don’t have a big problem with rules; most make a lot of sense. However, this isn’t how our ADHD brains thrive. Rules discourage the risky behaviors that are like catnip for our dopamine-starved brains.

Every Sunday, I teach one-on-one swim lessons for children with autism and ADHD. In the two years I’ve been doing it, I’ve noticed that most of my neurodivergent students quickly outstrip their neurotypical peers once they’re allowed to skip ahead and face deep water directly. I’ve been tutoring a five-year-old girl with autism who now swims 25-meter lengths. She thrives because nothing I was trained to do in standard lessons worked, so I jumped in the water with her to keep her safe. With her mother’s consent, we bypassed the centre’s depth limit (The pool manager names his headaches after me!), and I gave her tasks to do while I followed her around the deep end. She instinctively adapts to mitigate the danger. She’s perfectly capable and happy, but if I teach her at the shallow end, it’s a completely different experience, and she won’t engage.

[Get This eBook: Emotions of ADHD]

Another time, I needed to teach a student with ADHD how to tread water to ensure he could survive out of his depth. After a few lessons together, I jumped into the deep end of the pool with a float and told him to fetch the rubber duck beside me. At first, he was a bit freaked out over the depth. Then he looked into the deep and said, “Give me a minute. I’ve not got Lord Duckington yet!” He got the duck, and he trod water for a full minute. Challenging him like that forced him to innovate, which he did successfully. He’s only eight years old, but what a man.

When the only real restrictions are the irrefutable, unforgiving, and yet totally fair and logical laws of nature, it puts everything else into perspective. The laws of nature are a beautiful thing for neurotypical minds. It’s literally sink or swim. Death, or the threat thereof, provides the ultimate boundary. In doing so, it simplifies things, making the often confusing (and sometimes trivial) reality of our broad social and economic structures so much easier to rationalize and understand.

Learn to ride a motorbike or swim (safely, with witnesses, please!) a little out of your depth (safely, or at least with witnesses, please!), and you’ll see what I mean.

Risky Behaviors and ADHD: Next Steps

• Free Download: Is It Adult ADHD?
• Read: Never Enough? Why ADHD Brains Crave Stimulation
• Read: ADHD Impulsivity in Real Life

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.

“Most of us don’t spend hours scrolling through social media because we think it’s a good use of our time; we do it because we are looking for the stimulation we need to function,” says Jessica McCabe, the creator and host of How to ADHD, a popular YouTube series, and author of the new book How to ADHD (#CommissionsEarned). “Unfortunately, the quick and easy sources of dopamine we tend to turn to often aren’t enough to satisfy that need. Or we hit the pleasure button on the same activity so many times, it stops being as fun.”

ADHD brains have lower-than-average levels of dopamine, a neurotransmitter that regulates the body’s pleasure and reward systems. As a result, dopamine-increasing behaviors are even more gratifying to ADHD brains.

“Concerns about time or consequences are dwarfed by the pursuit of pleasurable reinforcement,” explains Ellen Littman, Ph.D., a clinical psychologist. “These dopamine-deficient brains experience a surge of motivation after a high-stimulation behavior triggers a release of dopamine, but in the aftermath of that surge and reward, they return to baseline levels with an immediate drop in motivation.”

As this cycle continues, individuals with ADHD can spend hours doing an activity they don’t really enjoy.

[Get This Free Dopamine Menu Template]

This is like trying to fill a bucket with a hole in it, says Eric Tivers, LCSW, ADHD coach, CEO, and founder of ADHD reWired.

“Water comes into the bucket as fast as it goes out,” says Tivers, who discussed the dopamine drive of ADHD brains with McCabe in the How To ADHD video, “How to Give Your Brain the Stimulation It Needs.”

When dopamine is dipping, how can you resist the impulse to scroll it back up? “Just like it’s hard to make really good food choices when you are already hungry, it’s really hard to make good dopamine choices when you’re already low on dopamine,” McCabe says. “A person with ADHD has to figure out what those choices are, weigh them, figure out the steps involved, then initiate them, and, because the more satisfying dopamine choices usually take longer to set up, they have to tolerate the distress of being bored in the meantime.”

The solution, Tivers says, is to separate the planning from the choosing with a dopamine menu or ‘dopamine’ — a curated list of options that lightens the mental load of finding pleasurable, healthy activities to stimulate us when we need it most.

[Self-Test: Do I Have ADHD? ADD Symptoms in Adults]

McCabe suggests structuring your dopamenu with courses like a restaurant menu. Instead of ordering food, you select healthy, energizing activities from your menu, which is not

• a to-do list
• a cure for ADHD or burnout
• an alternative to medication or therapy

How to Build a Dopamine Menu

1. Design Your Dopamenu

First, brainstorm activities that typically boost your mood without inducing a hangover of regret or RSD. Then, slot the items into the appropriate menu categories (see below). If you’re stuck for ideas, check out the suggestions from McCabe and ADDitude readers.

Appetizers or starters. McCabe defines these as quick activities that don’t suck you in but still provide a burst of dopamine, such as

• one minute of jumping jacks
• drinking a cup of coffee
• listening to a favorite song
• eating a snack
• doing a few stretches or yoga poses
• taking a warm shower
• working on a crossword puzzle

“The bird feeder attached to our window is a surprising appetizer. There’s enough variety of birds in our yard that come at random intervals to give me a tiny burst of excitement, especially when my husband and kids are home because hearing their excitement is also a boost.” — Ariana

“Hugging my dog.” — An ADDitude reader

“A 30-second cold water blast at the end of my shower every morning gives me a quick boost.” — Bex

“Singing along to a song with familiar lyrics gives me an extra dopamine hit and occupies the part of my brain that isn’t focused on the task in front of me.” — Amanda

Entrées or main courses are more time-consuming activities. “These activities excite me and make me feel alive,” McCabe says. Potential entrée ideas are:

• playing an instrument
• filming a TikTok video
• walking the dog
• exercising
• journaling
• cooking or baking
• working on a hobby (e.g., needlepoint, crochet, coin collecting, etc.)

“My entrées are going for a brisk walk, listening to fast-paced music, and having an engaging conversation with friends.” — Amanda

“Puzzles. If I have the time and space, working on a jigsaw puzzle helps get my dopamine flowing.” — Sarah

“Taking a quick nap.” — Bethany

Sides are things you can do simultaneously to make boring tasks more stimulating, like

• listening to white noise
• playing a podcast
• using a fidget
• making a task more challenging, i.e., turning an activity into a game by setting a timer to see how fast you can accomplish a job
• enlisting a body doubling

“I love different ASMR (autonomous sensory meridian response) videos. If I need to be on the computer for a while, I’ll play one in the background.”— Elizabeth

“I have a few specific playlists (Happy Music, Good Energy, Latin American, etc.) that I reach for when I need to cook, shower, or do a task that is hard for me. I put in my headphones or turn up the volume on my speakers, and usually, the energy comes sneaking in as soon as I begin to smile, sing along, and feel like dancing.” — Michelle

“I prefer to listen to audiobooks that are interesting enough to keep my attention but don’t require so much focus that if I miss a sentence or two, I’ve lost the thread. Cozy mysteries fit the bill, especially a series where I am already familiar with most of the characters. I can listen while doing all sorts of normally un-fun stuff.” — An ADDitude reader

“I’ve found that mildly upbeat instrumental music not only puts me in a good mood but also creates a soundtrack for whatever I’m working on and a good pace for getting things done. It’s very reinforcing!” — Seth

Desserts often include activities that are easy to overdo, in part because they are easily accessible and provide a quick hit of dopamine. “It’s fine to eat dessert sometimes,” McCabe says. “It’s just good to be aware of when that’s what we are ordering because if that’s all we are eating, we’re probably not going to feel great.”

Examples of ‘desserts’ include:

• scrolling through social media
• texting
• spending time with someone who’s not really present
• watching TV
• playing video games by yourself

“Playing Candy Crush!” — Bethany

“Watching Reality TV shows.” — An ADDitude reader

“The New York Times game app.” — An ADDitude reader

Specials. McCabe also recommends creating a separate menu for ‘specials,’ that includes occasional, bucket-filling activities that may be less convenient, more expensive, or require planning. Items in this category may include:

• attending a concert
• taking a vacation
• going out to dinner
• seeing a play or comedy show
• visiting a nail salon
• getting a massage

2. Streamline Your Options

After completing your list of menu options, omit any that aren’t realistic for ADHD brains. “Whatever is on your menu should be something you’d actually ‘order’ and something you can actually ‘make,’” McCabe says. “Restaurants always take stuff off their menus; so can we.”

3. Prep Your Ingredients

“Restaurants prepare everything they reasonably can ahead of time, and we can do the same,” McCabe says. Prepping a menu idea makes it easier to accomplish. For example, McCabe puts her guitar on a stand near the couch so it’s visible and easily accessible. After watching TV at night, she switches to a YouTube workout video, so it’s the first thing she sees when turning on the TV in the morning.

4. Implement Barriers

McCabe encourages enforcing barriers to less healthy activities. The idea, she says, is to increase the number of steps involved in doing the things you want to avoid and to decrease the number of steps involved in completing your Dopamenu items. For example, McCabe put her phone charger away from her couch and deleted a social media platform from her phone. Before she can grab a snack, she must roll a D20 die and do whatever exercise matches the number from a list she keeps.

5. Play with Dopamenu Marketing

Most menus include enticing descriptions to get you to order, so should a dopamine menu. “You can make your dopamine menu pretty or funny,” McCabe says.

Make the final version visible and accessible. McCabe posts her dopamine menu on her coffee table, refrigerator, and office wall. Her phone’s lock screen displays a mini version. “Now, when I pick up my phone, I can see my other options,” she says.

Dopamine Menu Troubleshooting

If you get stumped when it’s time to ‘order,’ consider using a random choice generator website. You type in your options, and it selects one for you.

Using a dopamine menu doesn’t mean suddenly transforming your habits. “There’s something to be said about the familiarity, especially when we’re going through a crisis,” McCabe says. “But by preparing a menu in advance, we’ll have more options available when we need them.”

Struggling to develop dopamenu options could point to a more serious issue. “If you don’t know what you like anymore, then it’s time to see a doctor because the issue could be depression,” Tivers says.

Your Feelings Are Valid: Next Steps

• Read: 7 Self-Defeating Behaviors That Aggravate ADHD – and How to Fix Them
• Learn: The Dope on Dopamine Fasting: Expert Answers to Your Digital Detox Questions
• Read: Wasting Time on Social Media? 6 Ways to Stop ADHD Brains from Doom Scrolling
• Download: Get Control of Your Life and Schedule

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.

As someone who also feels emotions intensely (growing up, my parents called me Super Sensitive Sharon), I understand completely where you’re coming from when you question the validity of your feelings. When I have big feelings, I truly think that something is the matter with me. The typical thoughts in my head are, “What is wrong with me that I’m getting this upset? No one else seems to be reacting this way.” But as I’ve learned, and as I hope you’ll come to learn, there is nothing wrong with being sensitive. (It’s really helped me in my career as a psychologist.)

Your feelings are valid — RSD or not, neurotypical or not. You are entitled to have your emotions however you would like to have them. Is it true that your ADHD brain is wired to feel emotions more intensely? Yes. And we can’t talk about ADHD without bringing up emotional dysregulation, which also affects how you process emotions. It’s also the case that RSD makes it difficult to perceive responses neutrally; you may perceive injury or threat where there is none.

[Get This Free Download: Understanding Rejection Sensitive Dysphoria]

But penalizing yourself for feeling how you’re feeling is counterproductive. It’s much more helpful to normalize your feelings. More importantly, you can acknowledge your emotional reactions and still investigate them.

Checking in with a friend, partner, coach, therapist, or anyone who understands the type of brain that you have is a good, safe way to gauge your interpretation of a situation. Say, “This thing happened, and I’m not sure if I’m overreacting. What do you think in this situation? How would you feel if someone said this to you?” These conversations can help you reframe the situation. You may find that the remark someone directed at you was simply a thoughtless comment that bears no reflection on who you are. Or maybe the situation was that unfortunate; if that’s the case, focus on the fact that you survived it, and think about what you’ve learned from it.

Regardless of whether RSD is in the picture, I’d like to leave you with a parting thought by Maya Angelou: “You may not control all the events that happen to you, but you can decide not to be reduced by them.”

Your Feelings Are Valid: Next Steps

• Take This Self-Test: Rejection Sensitive Dysphoria Symptom Test for ADHD Brains
• Read: “I Can’t Handle Rejection. Will I Ever Change?”
• Read: How to Counteract Imposter Syndrome, Perfectionism, and RSD

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “RSD Toolkit: Strategies for Managing Your Sensitivities in Real Time” [Video Replay & Podcast #476] with Sharon Saline, Psy.D. which was broadcast on October 19, 2023.

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

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

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

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

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

Watch the Video Replay

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

Download or Stream the Podcast Audio

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

Living with ADHD: More Resources

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

Obtain a Certificate of Attendance

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

Meet the Expert Speaker

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

Listener Testimonials

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

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

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

Webinar Sponsor

The sponsor of this ADDitude webinar is….

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

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

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Apparently not. “Only 27 likes?” my brain scoffed. My mother-in-law’s voice rang in my ears: “Your expectations are your worst enemy.” I hate it when she’s right.

The truth is that she’s going to be right as long as I have ADHD, which, unfortunately (but, also fortunately), will be always. Rejection sensitive dysphoria (RSD) exists, and learning about it for the first time as a clinical psychologist allowed me to better understand my patients and finally name one of the most perplexing aspects of my own ADHD. I understood why I couldn’t handle rejection in all forms, including the rejection that is baked into social media use.

I’ll admit that the time I spent off social media was incredible. The world looked and felt brighter and clearer when I finally put down the phone and took a look around. But after seven years, social media has called me back – a desire that has caused equal parts confusion and intrigue.

I’m not back for the likes or validation. I returned because, as a psychologist who specializes in working with children, teens, and young adults, I have something to say to youth struggling with mental health challenges today. I want to be there for them, and I cannot be heard or reach youth, I fear, without using social media.

[Read: Compare & Despair – Social Media & Mental Health Concerns in Teens with ADHD]

Since re-entering the social media sphere and navigating the sensory overload that is YouTube and TikTok (I’m @drgillykahn on both platforms) I’m taking note of the healthy social media habits that are keeping me balanced – habits that may help you use social media in a healthy way, too.

1. Ask yourself why you’re using social media. You’re more likely to have positive experiences with social media if you tie its uses to a concrete purpose or value – like staying in touch with people you care about. Notice how you feel as you visit platforms and consider if the benefits outweigh the costs. It may be time to limit your use or get off certain platforms completely if social media is encouraging compare and despair, keeping you up at night, and anxiously attaching you to your phone.

2. Stick it to The Man. Think of social media breaks as a way to stick it tor the corporate giants who use you as pawns for consumerism and data collection. That’s another reason to use social media with intention, not passively. In other words, use social media in the same way that it uses you. Joke’s on you, social media!

3. Don’t be afraid to create physical distance from your phone. I remember the good old days when we had a landline and had to sprint across the house to answer the phone. Nowadays, it’s like our phones are fused to our hands. Unless you have a valid reason for keeping your phone near you, keep it in your bag, in another room, or out of sight somehow. If you must, build up to keeping your device away in 30-minute increments. Take it a step further by disabling notifications.

[Read: “My Phone Was My Drug”]

4. Remind yourself that social media is not real life. If you catch yourself in an RSD or comparison spiral after spending time on social media, ride out the wave of your emotions and then remind yourself that a lot of what you see on these platforms is simply not representative of reality. There aren’t beauty filters to activate on the fly in real life, for one, and most people only post the good part of their days, not the boring or negative stuff. Also remember that the relative anonymity of the Internet often emboldens users to post mean comments; don’t let this skew your perception of how interactions actually work in the real world. Your emotional responses to negative experiences online are valid, but keep in mind that platforms are designed to raise the volume on entertainment and drama while often muting sensitivity to, well, rejection sensitivity.

5. Let RSD inspire your posts. Shake things up by showing the world that being vulnerable is acceptable and admirable. Our heightened sensitivities should be nothing to be ashamed of. Allow yourself to be yourself on social media and consider sharing your emotional experiences in the moment. Who knows, maybe you will help someone recognize RSD in themselves and encourage others to spread support and acceptance of big emotions as a pertinent and underrecognized aspect of ADHD.

Healthy Social Media Habits: Next Steps

• Read: Wasting Time on Social Media? 6 Ways to Stop ADHD Brains from Doom Scrolling
• Read: I Need a Digital Detox. How Do I Break a Social-Media Habit?
• Read: Can’t Stop Clicking? Here’s How to Beat “Infomania”

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.

Emotion dysregulation, which research has shown to be a fundamental component of ADHD,^{2, 3} is one such symptom. Another is gender differences, particularly in females who tend to mask or internalize their symptoms.⁴ “There’s some research on whether there might be a completely different presentation [of ADHD], at least in females, with a different time of onset and a different level of severity,” said Dave Anderson, Ph.D., in a recent ADDitude webinar on understanding the evolution of ADHD.

If you could add any symptom to the DSM diagnostic criteria for ADHD, what would it be? The answers we received from ADDitude readers included many familiar ADHD behaviors like rumination, daydreaming, time blindness, insomnia, sensory sensitivity, anger, and anxiety. Some readers even suggested changing the name entirely.

“‘Attention deficit’ seems to be the exact opposite of my experience,” said Amanda, an ADDitude reader in Utah. “I cannot pull myself away from the things I am interested in! And hyperactivity represents such a small portion of diagnosed individuals (primarily boys younger than 12). It is only one of dozens of significant symptoms that affect the greater population.”

Below, ADDitude readers share the symptoms that they feel are central dimensions of ADHD. What would you choose to add? Tell us in the Comments section, above.

[Download: 3 Defining Features of ADHD That Everyone Overlooks]

ADHD Symptoms Not in the DSM

“I would love to see separate sets of diagnostic criteria for boys, girls, adult men, and adult women, because (generally speaking) ADHD can look quite different in each of those four groups. Yes, there is some overlap, but I don’t think it serves girls or adult men and women to compare them to a single ADHD picture, that of the stereotypical hyperactive young boy. The rest of us know that isn’t the only face of ADHD.” — Jen, Missouri

“I think the biggest thing I would like to see is more of a focus on emotional dysregulation and the intense emotions that you can feel as a symptom of ADHD. This is one of the main ADHD symptoms that I personally struggle with, and it was never recognized. I was misdiagnosed with bipolar as a teenager because my intense emotions were more associated with BD than with ADHD.” — Kate, Florida

“I’d make sure that comorbidities are noted more directly with the DSM diagnosis of ADHD.” — An ADDitude reader

“I believe today’s criteria don’t adequately address adult patients. The word ‘adult’ obliquely refers to patients age 17 and older, but ADHD may manifest differently in older adults. Our prefrontal cortex continues to develop into our mid-20s, does it not? Typically, career advances are met with increased responsibility and visibility, and ADHD traits can become more of an encumbrance further up the corporate ladder (as I learned in my 40s and 50s). Clinicians would likely benefit from a subset of criteria for adults 25 and older.” — Greg, Ohio

[Read: A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60]

“Feeling like you have multiple thoughts at once; thinking spherically as opposed to linearly.” — Sunshine, Colorado

“Apparently, sleep issues are a telltale sign [of ADHD] for young children, yet I read every sleep training book I could get my hands on when [my daughter] was a baby, and not one of them mentioned [ADHD]. I didn’t learn this until she was in high school, which I feel is not just criminal negligence by so-called sleep experts but a huge disservice to parents and to kids with ADHD who could be assessed earlier.” — Kelly, California

“The emotional regulation symptoms of ADHD are sorely lacking.” — An ADDitude reader

“The social impacts of ADHD and how it impacts the ability to maintain friendships is a big hallmark for me. In general, I wish the DSM had a great deal more nuance, especially when it comes to identifying ADHD in girls and adults.” — LeAnn, Wisconsin

“I would differentiate between symptoms that boys have versus symptoms that girls have.” — Tracy, New York

“Anything about sensory challenges. To me, this is actually what ADHD is all about: difficulty blocking out sensory input. ADHD encompasses the challenges and ways people deal with sensory overwhelm. The fact that the DSM — and as a result, many practitioners — don’t understand this is so frustrating. Without this understanding, they are missing so many people who are probably unable to get support.” — Katie, Maryland

“Communication lapses: The tendency [for my son] to think that he communicated something verbally because he already thought it in his mind. We’ve had many incidents where family dynamics were impacted by communication lapses. From his point of view, the communication happened even though nothing verbal was spoken, so the other person wasn’t in the know. This also happens with my spouse (who was diagnosed at 52 after our son).” — Julieann, Ohio

“Clumsiness — anecdotally, this is very common among ADHDers, even being accident-prone. I see this a lot in the chat rooms I frequent for ADHDers.” — Diane, New Hampshire

“If it is not already in there, I believe the aspect of emotional dysregulation and/or rejection sensitivity dysphoria is such a huge component of ADHD that gets so very little attention – especially when it comes to treatment for younger children. But even for me as an adult, when I learned about the term RSD and what it meant, it stopped me in my tracks and totally changed the way I looked at my ADHD.” — Geoff, Rhode Island

“I would add criteria under affective disorders relating to anxiety and personality disorders like BPD/OCD to ensure it isn’t ADHD before making one of those other diagnoses.” — Greg, Canada

“Include not recalling content in a conversation literally right after or immediately after the information is shared. I think my kids are ready to kill me; they have told me that they purposefully don’t talk with me that much because I never remember. It’s awful.” — Shannon, Ohio

“I would make sure that something like survivalist, problem-solver, or despiser of mundane tasks were all in there!” — Blythe, Oklahoma

“A ‘constant state of overwhelm’ would be one. Or ‘takes tons of effort just to exist.’” — Natalie, Pennsylvania

ADHD Symptoms Not in the DSM: Next Steps

• Download: Common ADHD Diagnosis Mistakes
• Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
• Watch: The Grave Consequences of Persistent Gender Role Expectations in ADHD
• Read: ADHD Needs a Better Name. We Have One.

Sources

¹ PsychDB. (n.d.) History of the DSM. https://www.psychdb.com/teaching/1-history-of-dsm

² Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H.. (2018). Emotional dysregulation is a primary symptom in adult attention-deficit/hyperactivity disorder (ADHD). Journal of Affective Disorders, 232, 41-47. https://doi.org/10.1016/j.jad.2018.02.007

³ Soler-Gutiérrez, A.M., Pérez-González, J.C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: a systematic review. PLoS One, 18(1), e0280131. https://doi.org/10.1371/journal.pone.0280131.

⁴ Young, S., Adamo, N., Ásgeirsdóttir, B.B., et al. (2020). Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20, 404. https://doi.org/10.1186/s12888-020-02707-9

The use of fMRI brain scans in ADHD research has helped scientists spot abnormalities in underlying neural networks and circuitries. Differences in the default mode network (overactivity) and frontostriatal circuits (underactivity) of the ADHD brain remain key findings.

“The default mode network (DMN) is one of the most fascinating and significant discoveries to come out of neuroscience in the past 20 years,” writes Edward Hallowell, M.D., in his ADDitude article, “ADHD’s Secret Demon — and How to Tame It.” “The DMN seems to be more active in those of us who have ADHD, and it may explain our tendency to make ‘careless’ mistakes. In fact, when using a functional MRI, you can predict a mistake 20 seconds before it is made by watching for activity in the DMN.”

The emergence of multiple large-scale, multi-site studies has called into question other previous conclusions from neuroscience research. In short, complex answers are replacing some of our more simple ones, and care is improving as a result.

“Large-scale, multi-site, open-science data sharing brings us closer and closer to the idea that we might discover either objective task-based markers or objective biological markers that would allow us to index risk for ADHD and make this not so much dependent on therapists’ subjectivity and the quality of a diagnostic interview,” Anderson said during his 2023 ADDitude webinar on the evolution of ADHD.

For more information about the evolution of ADHD research and diagnostic tools, watch Dr. Anderson’s free ADDitude webinar, “ADHD Then and Now: How Our Understanding Has Evolved.” Dr. Anderson is Vice President of School and Community Programs and former Senior Director of the ADHD & Behavior Disorders Center at the Child Mind Institute.

ADHD Research: Next Steps

• Download: Unraveling the Mysteries of Your ADHD Brain
• Read: 3 Areas of Research Advancing Our Understanding of ADHD
• Quiz: Check Your Knowledge — ADHD Myths vs. Reality
• Read: ADDitude’s Top 25 Reads for Professionals

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.