Sleep problems in children are associated with restless behavior and iron deficiency, two problems more common in patients with ADHD, according to a small study published in the journal Nutrients.¹

The study followed 199 patients referred to a Sleep/Wake Behavior Clinic between 2021 and 2023. It found that patients with ADHD were nearly twice as likely as their neurotypical counterparts to have restless leg syndrome (RLS). The most common psychiatric comorbidities among patients with sleep disorders included ADHD (46%), autism (45%), and anxiety disorder (41%).

Most patients in the study had an iron deficiency (94%), and 41% knew someone in their family who did. When comparing ADHD patients only, a family history of iron deficiency increased the patient’s risk of having RLS and insomnia.

“Recently, iron has received increasing attention due to its role in sleep disorders, as well as wake behaviors associated with mental health and/or neurodevelopmental disorders such as ADHD, autism spectrum disorder, and prenatal alcohol exposure/fetal alcohol spectrum disorder,” the research authors wrote.

RLS was the most common sleep disorder (74%) in the study, followed by:

• Chronic insomnia: 61%
• Signs of sleep-disordered breathing: 50%
• Restless sleep or PLMS: 30%
• Circadian rhythm sleep disorder (CRSD): 16%
• Probable painful RLS: 11%

Sleep and ADHD

Nearly three-quarters of children with ADHD experience a sleep problem or disorder.² For many children, sleep problems last into adolescence and can aggravate ADHD symptoms during the day.

“By the time they get into adolescence, we know that teens with ADHD are more likely than their peers without ADHD to get insufficient sleep on school nights,” said Stephen Becker, Ph.D., in his 2021 webinar with ADDitude, “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.”

“We’ve also shown that poor sleep impacts academics, including academic performance, organization, and lower grades based on report cards that we’ve acquired from schools and college institutions,” Becker said. “In some of our work with young teens, even after we account for a teen’s initial levels of depressive symptoms or oppositional behaviors, those teens who had sleep problems went on to experience an increase in depressive symptoms and oppositional behaviors over time.”

Restlessness, defined as the “urge to move,” was a strong risk factor for sleep problems in children with and without ADHD in the present study. Hypermotor restlessness and hyper-arousal are central to ADHD and RLS but are often missed in pediatric patients, according to the authors. Symptoms of restlessness are based on adult criteria and do not account for physical differences that may be present in children.

“Characterizing hyper-motor restlessness during sleep as a new diagnostic entity supports our understanding that disorders presenting with hypermotor restlessness and/or hyper-arousability need an in-depth phenotyping approach from a pediatric sleep medicine perspective,” the authors wrote.

Limitations & Future Research

Standard diagnostic evaluations for sleep disorders typically do not assess for iron levels, according to the authors. Testing iron levels using blood tests could help improve treatment outcomes, as many patients in the present study were shown to be deficient. The authors noted that iron supplementation is often an effective treatment approach.

Evening activities, screen time, stimulant medication, homework stress, and inconsistent sleep/wake times may also make it difficult for children with ADHD to wind down at night.

Patients ages 3 months to 23 years and/or their family members answered questions upon intake about bedtime habits, excessive daytime sleepiness, nighttime awakenings, routines, sleep-disordered breathing, quality of sleep, and other non-specific concerns. The Sleep Disturbance Scale for Children (SDSC) and ADHD Rating Scale-IV were also administered.

The study has several limitations, including the absence of a control group and a small sample size. Additionally, medication use was not controlled, and there was no distinction made between anemic and non-anemic individuals with iron deficiency, nor between maternal and paternal family histories. Future research should explore the causes of iron deficiency. Inadequate nutrition, inflammation, and malabsorption were listed as potential contributors to iron deficiency.

Findings associated with other psychiatric disorders, including autism, were also shared in the study and can be found here.

Sources

¹ Ipsiroglu, O.S., Pandher, P.K., Hill, O., McWilliams, S., Braschel, M., Edwards, K., Friedlander, R., Keys, E., Kuo, C., Lewis, M.S., et al. (2024). Iron deficiency and restless sleep/wake behaviors in neurodevelopmental disorders and mental health conditions. Nutrients, 16(18):3064. https://doi.org/10.3390/nu16183064

² Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med, 162(4):336–342. https://doi.org/10.1001/archpedi.162.4.336

I read these words shortly after I was diagnosed with ADHD at age 44. Those 15 words, which appeared in a book meant for ADHD families, left me stunned for weeks. They helped me understand my entire life experience far more than any other sentence – or any person, for that matter – ever had.

Growing up with undiagnosed ADHD, I was repeatedly labeled…

Lazy. Unmotivated. Smart but slacks off. Careless. Indifferent. Clumsy. Forgetful. Distracted. Sloppy. Listens but doesn’t follow directions. Doesn’t listen. Won’t listen. Stubborn.

Despite all evidence to the contrary and much work on my part to see myself differently, I still identify to some degree with the above labels. And I know that I’m not the only one. I think of the many women today who learn that they grew up with undiagnosed ADHD, and that girls today still struggle to get properly diagnosed with ADHD.

A diagnosis as a child would have been incredible. But beyond that, I wish I had grown up hearing the following words of encouragement – the things all girls with ADHD need to hear to build their self-esteem and avoid viewing their symptoms as character flaws.

1. “You’ll need to stand up for yourself over and over. And that’s OK.” Though things are getting better, ADHD is still stigmatized and misunderstood. What’s more, girls are still socialized and expected to be obedient and compliant. When we push back, it is viewed a lot differently than when boys do it. Assertiveness and self-advocacy, especially for girls with ADHD, are essential life skills that build confidence and self-reliance.

[Read: How to Raise a Self-Confident Daughter]

2. “We will stand up for you.” Self-advocacy only works if girls with ADHD know that trusted adults have their backs, too. Girls need to know they’re not alone when they stand up for themselves.

3. “Accommodations are a legal entitlement, not a favor.” Growing up, I had family members who genuinely believed that any accommodations, such as extra time on tests, were a way for lazy students to get out of doing schoolwork. Anything that was different “wasn’t fair” to the other students. What critics don’t understand is that a neurotypical environment is already inherently unfair to individuals with ADHD, and the reason we are chronically dismissed and overlooked is because our disability can be largely invisible. No matter how hard we try, most of us will never succeed without external support.

The reason the Americans with Disabilities Act (ADA) became law is to equalize the playing field for individuals with disabilities. My customized accommodations aren’t a special favor; they’re what I need.

4. “Other girls with ADHD need you as a friend.” Shame and isolation have a lot to do with why experts miss ADHD in women and girls. Throughout my entire childhood, every adult in my life blamed me for my symptoms, and my father told me that one of the reasons I struggled to make friends was because other kids knew about my poor grades.

[Read: Protecting the Emotional Health of Girls with ADHD]

But what girls like me need most of all are friendships with other girls with ADHD. Bonding over common problems, social challenges, and struggles at home and at school all reduce shame and stigma while building strong connections. Greater awareness leads to feeling confident in asking for help and support. Most importantly, I wouldn’t have felt so alone for so long.

5. “Other people don’t decide your value.” Throughout my entire life, I let my parents, siblings, teachers, doctors, and bosses decide my value based on their inaccurate and sexist views of me. Now that I know better — that I’m not fundamentally deficient — I want every woman and girl to hear this: No one else decides our value.

Don’t give your power away to someone who doesn’t have any idea about what living with ADHD is like, especially when they don’t care. We all have our strengths, and there are so many different ways for our talents to shine. But we’ll never realize that if we listen to our uninformed critics.

Girls with ADD: Next Steps

• Read: The ADHD Soul Shine Kit — Build Your Child’s Self Esteem
• Read: How to Protect the Emotional Health of Girls with ADHD
• Read: You Are Enough — How to Counteract Imposter Syndrome, Perfectionism, and RSD
• Read: You Are Not the Sum of Your ADHD Challenges

Maria Reppas lives with her family on the East Coast.  Her writing has been in the Washington Post, USA Today, Newsweek, New York Daily News, Ms. Magazine, and Business Insider.  Visit her on Twitter and at mariareppas.com.  

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

Onyda XR (clonidine hydrochloride), the first and only liquid non-stimulant ADHD medication approved in the U.S., and the only such medication with nighttime dosing, became available nationwide for the treatment of attention deficit hyperactivity disorder (ADHD) on October 1. ¹

The U.S. Food and Drug Administration (FDA) approved Onyda XR on May 24 as a monotherapy ADHD treatment or as an adjunctive therapy to approved central nervous system (CNS) stimulant medications in pediatric patients six years and older.

Tris Pharma developed Onyda XR with its proprietary LiquiXR® technology, which converts immediate-release drugs into extended-release formulations for once-daily dosing. Onyda XR is considered a centrally acting alpha2-adrenergic agonist medication that belongs to the same class of drugs as Guanfacine (Intuniv) and clonidine (Kapvay).

Patients with ADHD who experience adverse side effects from stimulants or who respond poorly to stimulant medications may find symptom relief in a non-stimulant medication. A systematic review and meta-analysis published in May by Neuroscience & Biobehavioral Reviews reported that non-stimulant medication is nearly as effective as stimulant medication at improving executive function in children, adolescents, and adults with ADHD. ²

Combination Therapy for ADHD

In addition, clinicians may prescribe Onyda XR along with a stimulant to treat ADHD symptoms. Combination therapy is becoming an increasingly popular option for patients who need longer durations of drug coverage than a stimulant dose can provide on its own or who hope to avoid common stimulant side effects.

“Most of the medicines we use for ADHD are safe in combination with other medications,” said Timothy E. Wilens, M.D., chief of child and adolescent psychiatry and co-director of the Center for Addiction Medicine at Massachusetts General Hospital, during the ADDitude webinar “Combination Therapy: Medication Strategies for Hard-to-Treat Complex ADHD.” “Certain combinations, such as stimulants plus clonidine or guanfacine, are FDA approved, and they wouldn’t be unless they were deemed effective and safe.”

Guanfacine ER (Intuniv) and clonidine ER (Kapvay), received FDA approval for the treatment of ADHD in patients 6 to 17 years old as monotherapy and as adjunctive therapy to stimulant medications in 2009 and 2010, respectively.

If a stimulant does not address symptoms at standard dosages, “it usually makes more sense to treat remaining symptoms with a second medication,” said Oren Mason, M.D., a physician at Attention MD in Grand Rapids, Michigan.

“Most adult patients in my practice who take extended-release stimulants need average to high dosages to achieve optimal symptom reduction,” Mason said. “They typically report 8 to 10 hours of medication benefit, and most require short-acting supplements to treat their evening symptoms. In contrast, most patients on combination therapy take low- to moderate stimulant dosages and report a duration of benefits of more than 12 hours.”

Mason said he finds that many adult patients using combination therapy decrease their stimulant dosages and experience fewer side effects than do patients taking only stimulants. “Waking up was less torturous, and getting ready for school was smoother,” he said. “Family life was better, without the meltdowns that many families accept as ‘normal’ as stimulants wear off.”

Anthony Rostain, M.D., M.A., professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, recommends that clinicians consider several factors before prescribing combination therapy.

“The important thing to keep in mind if you’re combining agents,” he said, “is to be sure that the patient understands how to use each one and how to dose each one. They need to understand the inherent challenges they’re going to face, and make sure you’re paying attention to the side effects that might emerge from the combination of stimulant and non-stimulant.”

The FDA based its approval for Onyda XR on studies of clonidine hydrochloride extended-release tablets, including two 8-week, placebo-controlled trials evaluating 256 patients, as well as a 40-week, placebo-controlled, randomized-withdrawal study evaluating the drug in 135 pediatric patients aged 6 to 17 years. ³, ⁴

According to Onyda XR prescribing information, the most common adverse reactions with the medication’s use as monotherapy include somnolence, fatigue, irritability, nightmares, insomnia, constipation, and dry mouth. The most common adverse reactions with its use as an adjunct therapy include somnolence, fatigue, decreased appetite, and dizziness. ⁵

Sources

¹Tris Pharma’s Once-Daily ADHD Medication, ONYDA XR (clonidine hydrochloride) Extended-Release Oral Suspension, Now Available in the United States. News Release. Tris Pharma. October 1, 2024. Accessed October 2, 2024. https://www.businesswire.com/news/home/20241001522635/en/Tris-Pharma–Once-Daily-ADHD-Medication-ONYDA-XR-clonidine-hydrochloride-Extended-Release-Oral-Suspension-Now-Available-in-the-United-States

²Isfandnia, F., Masri, S.E., Radua, J., & Rubia, K. (2024) The Effects of Chronic Administration of Stimulant and Non-Stimulant Medications on Executive Functions in ADHD: A Systematic Review and Meta-Analysis. Neuroscience & Biobehavioral Reviews; 162. https://doi.org/10.1016/j.neubiorev.2024.105703

³Jain, R., Segal, S., Kollins, S.H., Khayrallah, M. (2011). Clonidine Extended-Release Tablets for Pediatric Patients with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1016/j.jaac.2010.11.005

⁴Kollins, S.H., Jain, R., Brams, M., Segal, S., Findling, R.L., Wigal, S.B., Khayrallah, M. (2011). Clonidine Extended-Release Tablets as Add-On Therapy to Psychostimulants in Children and Adolescents with ADHD. Pediatrics. https://doi.org/10.1542/peds.2010-1260

⁵ Highlights of Prescribing Information. Onyda XR. FDA. Accessed May 29, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217645s000lbl.pdf

Weak. Needy. Helpless. Annoying. Thanks to social conditioning and outdated gender norms and decades of hits to our self-esteem, this is how some of us think we appear when we ask for help. But research and experience tell us otherwise.

Strong self-advocacy skills — i.e., the ability to ask for and secure support when it matters — is a strong indicator of success for people with ADHD. Everything from executive dysfunction to the emotional impact of ADHD and its comorbidities are made more manageable with the right kind of help. But the same ADHD characteristics that make assistance so important also make asking for it really tough.

So we asked ADDitude readers to share their experiences with self-advocacy and offer any tips, hacks, or hints that have helped them get helpful help. Here’s what they told us:

Why We Ask for Help

“I see requests for help as opportunities to build relationships and connections.” —Catherine, Washington

“When I ask for help, it makes me feel like a failure. But I remind myself that I need to set an example for my kids, so I will ask my husband for help by explaining that I need to prioritize something else so can he please cook dinner?” —Kate, Australia

[Read: The Fear of Failure Is Real — and Profound]

“I’m midlife and the gig of doing it all by myself is up: I have crashed and have to ask for help now. The trick is choosing relationships in every area of life with people who have high standards of relations, reciprocity, and compassion. I choose now, rather than hoping others will get me. It changes everything!” —An ADDitude Reader

“I think having a background in addiction recovery is an asset to ADHD coping. I am already aware that in some areas, I need support outside of myself. Therefore, I am already practiced in asking for support. I know that if I try to cope on my own, it may lead to unhealthy behaviors.” —Krysta, Canada

“I have a 15-minute rule. If I am stuck for more than 15 minutes, I ask for help. I instill this in my employees as well. Asking for help tells me that they are comfortable with communication, and humble.” —John, Florida

“If I notice my RSD is preventing me from asking for support, that often indicates that I’m not getting what I need from that relationship to feel safe.” —AJ, Utah

[Read: How ADHD Ignites RSD – Meaning & Medication Solutions]

How We Ask for Help

“I prefer typing out a text or email rather than orally asking for help, but if text/email is not an option, writing a script can help me prepare for a face-to-face request.” —Chandler, Pennsylvania

“Ask for something super tiny to get practice at asking for help.” —Katrina, Australia

“I have set up keywords with my husband, so when I say those words he knows I am feeling lonely and I need help.” —April, Oklahoma

“My ADHD can make me quite impatient, so I need to give people time to process my request, or take the action I’ve asked for. It helps to remember this isn’t rejection, and they don’t have to drop everything then and there in order to be willing to help.” —Trish

“To address loneliness, I have learned to say ‘I need a hug.’ Often it opens the door for me to share more about what is going on.” —Claire, Pennsylvania

“I identify a person with complementary skills, and I spontaneously contribute to our shared objective by doing the tasks they find laborious. The reciprocal task division follows naturally. Nobody has to ask, no gift debt is engendered. We are actively helping each other.” —Dettie

“I imagine that I’m giving someone good news when I’m about to ask for something I feel nervous about.” —Kelsie, Mississippi

“I have to just accept that asking feels awkward, and it probably always will.” —Sarah, Georgia

“I always express gratitude to any person who is willing to body double with me and I describe how it was helpful. For example, ‘You read your book while I was doing bills and I got sooo much more done. Thank you. Let me know when you are reading your next book.’” —An ADDitude Reader

“I offer help, often. That makes me feel better about asking for help. In my mind, I’ve kind of already paid for the help that I need by helping others, and now I’m cashing out.” —Helen, Maryland

“I practice a lot of ‘I statements,’ like, ‘I feel so overwhelmed by the number of tasks I have to do and I need extra hands.’ It’s not easy, but if you start with positive ‘I need’ statements, and practice, it’ll start feeling like second nature.” —Vanessa, Texas

“I try to set up check-ins with team members at work so it’s easier to ask for help while working on a specific project.” —Christina, Louisiana

“Give yourself 10 seconds of bravery. Start counting backwards from 10 and, before you hit one, say what you need to say to the person.” —Charlie, Australia

“Before asking for help at work, I always make sure to have a list made up of things I need help with. It shows my boss and team members that I have come prepared, with a plan.” —Melissa, Minnesota

“I have realized that I need to be very concise and direct when asking for help, instead of talking about how much I need help and giving reasons.” —An ADDitude Reader

“I use an app such as Goblin Tools to break down tasks, then I ask for specific help. I find that if I say I need help in a non-specific way, people are less ready to help, but if I say, ‘Can you declutter this one drawer please?’ then I’ll get help. The act of breaking the task down helps reduce my overwhelm, too.” —Laura, New Zealand

“One thing that helps is to talk to friends about what is going on, just to gauge what their capacity is for listening or coming up with solutions I am blind to. More eyes and brains on a problem are a good thing.” —Sarah, Germany

“With my teenager, it is mostly a choice-based, task-related ask: ‘Would you be willing to help me with Option A or Option B and at what time?’” —Kristen, Michigan

“At work, I have a personal checklist of resources to exhaust. If I can’t find the answers after doing due diligence, I reach out to an appropriate team member. Having researched on my end allows me to reach out with a more informed and confident ask for help.” —Sharon, Ohio

ADHD Self Advocacy: Next Steps

• Quiz: Rejection Sensitive Dysphoria Symptom Test
• Quiz: How Severe Is Your Loneliness?
• Download: The Emotions of ADHD

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

More than half of individuals with ADHD — and significantly more women than men — were diagnosed in adulthood, according to new data published in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).¹ These findings constitute the CDC’s first update on the prevalence and age of diagnosis for ADHD in nearly 20 years.

The CDC report, which found that 6 percent of U.S. adults have a current ADHD diagnosis, identified several gender-based discrepancies regarding the age of diagnosis. Sixty-one percent of women received their ADHD diagnosis during adulthood, compared to 40 percent of men. One-quarter of women received an ADHD diagnosis before age 11, compared to 45 percent of men.

“Taken together, these data highlight the significant public health burden of ADHD and challenges experienced by adults with this diagnosis,” said Greg Mattingly, M.D., president of the American Professional Society of ADHD and Related Disorders (APSARD), and Ann Childress, M.D., past president of APSARD, in an article published in Psychiatric Times.²

The MMWR analyzed data collected from the National Center for Health Statistics Rapid Survey System (RSS) from October through November 2023 on the prevalence, treatment barriers, and telehealth usage of adults with ADHD.

Consequences of Undiagnosed Adult ADHD

Once considered a childhood condition, ADHD is now recognized as one of the most common mental health conditions in adults, affecting men and women almost equally. ³,⁴ A new national survey of 1,000 American adults by The Ohio State University Wexner Medical Center and College of Medicine revealed that as many as one in four adults suspect they may have undiagnosed ADHD, however, only 13 percent have consulted a doctor about their suspicions. The researchers say the findings raise concerns that self-diagnosis may lead to incorrect treatment.

“In recent years, the number of adults diagnosed with ADHD has risen significantly – thanks, in part, to decades of research that has advanced awareness of ADHD as a lifelong disorder,”⁵ wrote APSARD secretary Maggie Sibley, Ph.D., in the ADDitude article, “Why We Need U.S. Guidelines for Adults with ADHD.” “Though ADHD is commonly detected in childhood, later-in-life diagnoses are providing clarity and relief for many adults with once unexplained, misunderstood, or overlooked lifelong struggles.”

Untreated adult ADHD symptoms may impair individuals personally and professionally, and they may exacerbate comorbidities like depression, anxiety, bipolar disorder, insomnia, substance use disorders, and trauma-related conditions. ⁶, ⁷

“ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated,” said Nelson M. Handal, M.D., DFAPA, in the ADDitude webinar, “New Insights Into and Treatments for Comorbid Depression” “It’s not difficult to see how untreated symptoms of ADHD — from impulsivity and emotional instability to poor planning and execution skills — compromise one’s ability to find success in school, work, relationships, and other parts of life.”

Even with an ADHD diagnosis, adults face barriers to care amid the ongoing stimulant shortage. Approximately 7 in 10 adults treating ADHD with stimulant medications reported difficulty obtaining their prescriptions, the CDC found.

The CDC’s findings suggest that telemedicine may improve access to healthcare and decrease systemic discrepancies in care. Nearly half of adults with a current ADHD diagnosis said they received some of their ADHD healthcare via telemedicine.

“These benefits must, however, be balanced with the need for thorough diagnostic evaluation and follow-up for both the in-person and virtual models of care,” said Mattingly and Childress.

“Some telehealth companies are under federal investigation for their prescribing practices, highlighting a need for clarity on appropriate practices for the prescription of stimulants – a first-line treatment for ADHD,” Sibley wrote. “APSARD’s forthcoming adult ADHD guidelines will address this urgent need for providers and patients alike — making evaluations more thorough, diagnosis more reliable, and treatment safer.”

Importance of Adult ADHD Guidelines

The Ohio State study and CDC data underscore the need for adult ADHD diagnosis and treatment guidelines, which APSARD is working to finalize by late this year or early 2025.

“These will be the first U.S. guidelines for the diagnosis and treatment of adults with ADHD, and they will provide a valuable framework of treatment for clinicians and families,” said Mattingly and Childress. “While many unanswered questions remain, these findings bring us one step closer to a deeper understanding of the needs of adults with ADHD.”

The impact of the APSARD guidelines may be felt most profoundly by adult women.

“Many women do not recognize that they have ADHD or seek evaluations until their children are diagnosed,” wrote Childress in an ADDitude article earlier this year. They are often treated for anxiety or depression that developed secondarily to ADHD. Helping clinicians recognize the difference in presentation of ADHD symptoms in women is important.”

Sources

¹taley, S.B., Robinson, L.R., Claussen, A.H., et al. Attention Deficit/Hyperactivity Disorder Diagnosis, Treatment and Telehealth Use in Adults – National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. MMWR Morb Mortal Wkly Rep. 2024;73(40)

² Mattingly, G., Childress, A. (2024). Clinical Implications of Attention-Deficit/Hyperactivity Disorder in Adults: What New Data on Diagnostic Trends, Treatment Barriers, and Telehealth Utilization Tell Us. J Clin Psychiatry; 85(4): 24com15592. https://doi.org/10.4088/JCP.24com15592

³Ayano, G., Tsegay, L., Gizachew, Y, et al. (2023). Prevalence of Attention Deficit Hyperactivity Disorder in Adults: Umbrella Review of Evidence Generated Across the Globe. Psychiatry Res; 328:115449. https://doi.org/10.1016/j.psychres.2023.115449

⁴Faraone, S.V., Bellgrove, M.A., Brikell, I., et al. (2024). Attention Deficit/Hyperactivity Disorder. Nat Rev Dis Primers; 10(1):11. https://doi.org/10.1038/s41572-024-00495-0

⁵Sibley, M.H., Arnold, L.E., Swanson, J.M., Hechtman, L.T., Kennedy, T.M., Owens, E., Molina, B.S., Jensen, P.S., Hinshaw, S.P., Roy, A., Chronis-Tuscano, A. (2022). Variable Patterns of Remission from ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry;179(2):142-51. https://doi.org/10.1176/appi.ajp.2021.21010032

⁶Kessler, R.C., Berglund, P., Chiu, W.T., et al. (2004). The US National Comorbidity Survey Replication (NCS-R): Design and Field Procedures. Int J Methods Psychiatr Res; 13(2):69–92. https://doi.org/10.1002/mpr.167

⁷Katzman, M.A., Bilkey, T.S., Chokka, P.R., et al. (2017). Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach. BMC Psychiatry. 17(1):https://doi.org/10.1186/s12888-017-1463-3

“It takes forever to get these coins when you’re playing,” he said, showing me the game. “I can spend $1.99 and get 800 coins, but only if I do it now! It’s 90% off, but the deal only lasts for 58 more minutes! Please, Mom?”

“Luca,” I said. “When a game tells you something is 90% off, that’s just marketing designed to make you want to spend money.”

“It’s working,” Luca said earnestly. “I do want to spend my money. And it’s my money.”

I sighed.

Luca’s request had come a few days after my husband and I opened a debit account for him and his older brother, Max, for their 9^th and 11^th birthdays, respectively.

“We told you your savings was your money,” I said to Luca. “But we also said we weren’t going to let you spend it on just anything, remember?”

[Self-Test: Could Your Child Be Showing Signs of Gaming Addiction?]

“This is not just anything. It’s only $1.99 and I’ve been playing this game for weeks and this is the best deal I’ve ever seen. Ever.”

“OK,” I finally said. “This is a yes.”

I pressed my thumb on the sensor to authorize the purchase and a delighted Luca raced off to show Max, my ADHD-wired firstborn.

This, my friends, is when all the trouble really started.

The Big Business of In-App Purchases

Max quickly appeared to demand a similar purchase in a game. Eager to allow my boys to exercise their decision-making muscles, I said yes. So when the boys showed up repeatedly in the following days with additional purchase requests, I kept saying yes.

Two weeks later, both boys had spent more than $150. I was getting very worried. Though I tried to dissuade or delay them each time they came to me, their interest wasn’t waning, even as they burned through their savings. But while Luca’s spending eventually slowed, Max’s didn’t. If anything, he was picking up speed — requesting more expensive purchases, more frequently.

[Read: Why Screens Mesmerize Our Teens — and How to Break the Trance]

This was very out of character for Max, who had previously been resistant to spending any money — preferring instead to save it and plot about spending it on completely age-inappropriate things, like spear guns for fishing. After his first in-app purchase, it was shocking to see how quickly he transformed from miser to spendthrift.

When Max came to me for the second time in a single day requesting to spend another $26, I decided I wasn’t prepared to let him spend all his savings.

“I think we need a circuit breaker here — a pause,” I told Max. “I think that I should say ‘no’ to in-app purchases for the next week. What do you think?”

Unsurprisingly, Max did not think we needed a circuit breaker.

We settled on this: Max still had the choice to go through with this particular purchase (which he did) and then we would have a 10-day “no purchases” circuit-breaker.

That original circuit-breaker temporarily slowed things down, but it did not completely quell his willingness to spend money.

I know our family is far from alone in these struggles. In moderation, in-app purchases can be an easy way to have a bit of fun in a game. But in-app purchasing has become a billion-dollar business. Many iPad games are sophisticated marketing machines that use gambling tactics and other predatory techniques to market directly to children. The dopamine rush of leveling up in a game after spending money is addictive and the consequences are profound. Some parents report that their kids have become secretive and deceitful — guessing or stealing passwords, using credit cards without permissions, resetting devices to restore permissions, and finding other workarounds that will enable them to keep clicking “purchase.” Our children with ADHD, who struggle with impulse control and regulation, are far less equipped to resist this powerful temptation.

So what can parents do? What do I recommend as a psychologist, as the mother of a demand-avoidant pre-teen with ADHD, and as someone who’s learned a lot about this the hard way in the last couple of years?

My first piece of advice: Keep this Pandora’s Box closed for as long as possible. If you haven’t yet started down this path, don’t.

• Invest in games, gaming systems, and subscription services such as Apple Arcade that don’t offer in-app purchases and/or show ads. They are worth the money.
• Make it a family norm early on that you don’t download games that offer in-app purchases.
• If and when you do download a game that offers in-app purchases, make it clear that you will never authorize any in-app purchases for this game. Take it a step further and disable in-app purchases on your child’s device.

If you ever do decide to allow your child to make in-app purchases, have some discussions first:

1. Set clear limits – but expect boundary-pushing. Establish how much money they have available to spend and how quickly they can spend it. Even with these limits, brace for fallout, pleas, and arguments when their money runs out, and plan ahead for how you will respond to that fallout.

2. Express your wants. The day that Max came to me twice to make an in-app purchase, I told him I had two wants. “I want to allow you to make your own decisions,” I said. “And I want to help you make wise decisions and teach you how to resist the powerful desire to buy things.”

3. Teach your kid about marketing tactics such as price anchoring, charm pricing, and the scarcity effect. When they come to you about a purchase, challenge them to spot the marketing tactics being used on them.

4. Talk to your child about other dynamics that drive in-app purchasing, such as chasing the dopamine buzz, the social pressure of keeping up with friends, the desire to make progress fast in a game, and so on.

5. Talk to your child about their ADHD brain. They should understand that impulse control challenges come with the territory, which makes it especially hard to resist the temptation to buy.

6. Invite your child to problem-solve when issues come up. Be open with your child about any concerning patterns or behaviors you’ve noticed regarding in-app purchases. Ask for their input as you find a viable way forward.

7. Experiment with different approaches and solutions to limit in-app purchases. Some ideas to get you started:

• X-day/week blackout periods
• weekly or monthly spending limits
• waiting periods for spending (e.g., wait 24 hours before making an in-app purchase)
• written agreements that include consequences for circumventing the rules

8. Don’t be afraid to feel your way forward.
Just because you’ve agreed to a measure doesn’t mean that you will do things this way and forevermore. In fact, don’t expect any solutions you negotiate to hold for longer than a couple of months. Expecting to revisit this issue regularly will help you be more patient and feel less frustrated.

The other day, I asked Max for advice he thought I should give other parents who are in this situation. “Just say no, and NEVER SAY YES,” he responded. “Basically, be way stricter with them than you’ve been with us.”

“But what about families like ours where we’ve already said yes sometimes?” I said. “What can you do then?”

“Well,” Max said, getting more creative. “Tell your kids that the currency for the game has changed, and you can’t get any of that new currency. So, it’s broken. You just can’t do it.”

“So… lie?” I asked. “Yes,” Max said. “Lie.”

In moments when we may be tempted to lie to our kids, I often wish we had in-parenting purchase options — for upgrading patience, boosting problem-solving skills, or short-circuiting conflicts. Alas, the game we’re playing as parents is a no-shortcuts quest.

In App Purchases: Next Steps

• Get This Free Download: Too Much Screen Time? How to Regulate Your Teen’s Electronics Use
• Read: 5 Tips for Teaching Children with ADHD to Manage Money
• Get This eBook: Positive Parenting Tips — ADHD Strategies for Improving Behavior

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Lead with Your Heart

Stick to talking about your passions. With an interest-based brain, you’ll be able to put your best foot forward — and see if you really zing with someone — when you focus on what excites you. If you’re into horror films, for example, share that with your date and see how they respond. You may learn that horror isn’t their thing, but true crime podcasts are. (And that’s how the conversation keeps going and stays somewhat on track.)

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Register for this free webinar and get an opportunity to ask your questions about dating. Plus, get the replay link to share.

Establish Clear Boundaries

Whether regarding first dates or small talk with colleagues and acquaintances, set clear rules for yourself about what you will and will not discuss. Consider these topics off limits:

• body fluids and functions
• odor and hygiene
• sexual history
• money
• medical history
• traumatic events and family histories

[Get This Free Download: Become a Small-Talk Superstar]

Devise Handy Summarizing Scripts

If you know that you’re prone to divulging too much information on a sensitive topic, like your rocky relationship with your parents, come up with a few phrases that satisfactorily capture the situation, like “I have difficult parents” or “I come from a challenging family.” These phrases say a lot, minus the details, which you’ll have a chance to share with your date if you do grow closer to them.

Bring It Back with a Laugh

Humor is fantastic for pivoting conversations when you realize you’re oversharing. Say, “Wow, I have had a lot of coffee today!” or “I definitely went down the rabbit hole there. Can we go back to what you were talking about?”

How to Not Overshare: Next Steps

• Get the eBook! The ADHD Relationship Guide
• Read: “5 Things I Learned from First Dates”
• Read: Dating Advice & Strategies for Adults with ADHD

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Oversharing and Underinvesting: The Social Traps That Snare ADHD Adults” [Video Replay & Podcast #496] with Caroline Maguire, M.Ed., ACCG, PCC, which was broadcast on March 14, 2024.

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Resilience isn’t so much a skill that individuals with ADHD need to build, but a fundamental part of their DNA. Working an 80-hour week while pregnant. Graduating college at age 43. Navigating unhealthy relationships. Staying strong when faced with mental and physical setbacks. These are just some examples ADDitude readers shared when asked for a time their (or their child’s) ADHD resilience truly shone. Read on for more stories of perseverance and grit.

Share your stories of ADHD resilience in the comments section.

“I lost my three-year-old daughter to a rare form of cancer. I remember wanting to die, too. A voice in my head said, ‘You have three other kids who need you to find a way to go on. Because if life hits them the way it’s hit you, they will know they can overcome.’” — Tracy, Canada

“I struggled with depression and anxiety in my first semester of college because of major imposter syndrome and ended up having to go home on medical leave for suicidal ideation. No one expected me (maybe not even myself) to get up the next morning and apply for a job. Hitting what seemed like rock bottom helped me find a hidden, gritty, scrappy fighter within me. I knew I needed time and experience outside of the academic arena to show me that there is more to life and that I have value and talent beyond what any classroom grade might assign me.” — Rebecca, Connecticut

“I failed out of college. Then, I took a semester off, went to community college, eventually enrolled in a four-year program, and graduated with a Bachelor of Science in accounting.” — Erin, Missouri

“Being diagnosed late in life, raising three kiddos with ADHD, surviving a high-conflict divorce, running a school, and navigating a teen through trauma and treatment — ADHD resilience, it’s a real thing.” — Katie, Arizona

[Get This Free Download: Secrets of the ADHD Brain]

“Having ADHD and dealing with setbacks has made my teenager resilient and allowed him to build strong boundaries. When he realized he was being mistreated by ‘friends,’ he recognized that their negativity was contagious and dangerous to his mental health because he was emotionally sensitive. Recognizing his sensitivity to unpleasant behavior gave him the motivation to end old relationships and seek out new ones that are positive and more rewarding. This is a life skill that more teenagers need to live happier lives.” — Jane, Tennessee

“I was told I might not be able to walk again. Yes, I suffered from depression, but I had small goals and kept going. I worked hard. I pushed myself (with my high expectations), and now I can walk with a walking stick. It was one of the most challenging things I’ve ever had to do. It has taken me years to get to where I am today. But I did it because I’m resilient and strong. I’m grateful. I’m proud. Thank you, ADHD.” — Sam, U.K.

“A childhood full of bullying, misunderstanding, and criticism drove me to seek out therapy. That self-exploration gave me an early advantage in self-acceptance and how to deal with others, especially in the decades when I went undiagnosed. I’m a veteran human being now.” — Dee, Canada

“I have fallen on my face so many times over the years, but each time, I climb back up and get a little more success — money, lifestyle, health, etc. I have endurance tattooed on my back (I should add resilience).” — Angie, Virginia

[Join the ADDitude Support Group for Adults with ADHD]

“I try to be resilient by giving myself grace when I forget things and try to complete multi-step tasks. I tell myself it’s ‘OK if I don’t get it right the first time.’ Allowing myself to try again took a long time to accept because I like to get things perfect the first time.” — An ADDitude Reader

“I taught a class of 16-year-olds who hated my guts. Going to work was like entering a war zone. My work colleagues could not believe how I kept going. At home, I also took care of my husband, who suffered from a work injury. I refused to give up. Former bosses still talk to me, and some former students smile and publicly say, ‘Hello.’ My marriage and career continue to thrive.” — Louise, Australia

“I have big emotional reactions to setbacks and rejection, especially involving others. Since learning more about RSD and ADHD, I try to allow myself to feel my feelings so I can build resiliency and move forward. I remind myself that, while people may not understand me, I know who I am.” — Ellen, Massachusetts

“My 10-year-old son faced significant challenges when he developed arthritis and severe asthma following a post-COVID infection. This condition made physical activities like running and playing soccer and basketball difficult, often leaving him in pain and short of breath. Despite his efforts, some teammates were unkind, telling him he was hopeless and suggesting he should quit. When he shared his feelings with me, he showed determination, leaving me in awe. He said, ‘I’ve heard what they’ve said, but I want to finish the season because I made a commitment. I’ll keep doing my best, stay positive, and not let their comments get to me. After the season, I’ll find an activity that better suits my abilities.’ True to his word, he persevered through the season and eventually discovered jiu-jitsu and ninja training, activities that he loves and excels at.” — Jo, Australia

“I have learned that my value is not determined by what I do or have not done or how much I weigh or what others say about me. I have learned to forgive myself and move on. I’m also not afraid of admitting and taking ownership of my mistakes. I try to teach my son this, too.” — Glenda, California

“I don’t know how I survived the five years of my life when I was pregnant, had two young sons, and worked in an industry where an 80-hour workweek was expected. As an ambitious advertising executive and new mother, I flew more than 100,000 miles a year, breast-pumped on the road, and stayed up until 3 a.m. working on new business pitches. I had no clue that I even had ADHD until this year!” — Tyra, Arizona

“I continue to write despite never finishing a single project. I have three unfinished novels, an overflowing drawer of unpublished poetry, and ideas for more. Despite the unsuccessful struggle to complete or publish any of this, I am actively working on a non-fiction book, mostly because I can’t not do it.” — David, Oregon

“I can think of several times in my adulthood where I was resilient: Going to nursing school at age 27, finishing at the top of the class, completing college at age 43, becoming licensed in the state and nationally as a nursing home director, and becoming a director of a bankrupt facility. Despite wanting to drown many times, my mind would rebound, and I kept swimming.” — Enola, Oklahoma

“I had five different majors in college. I spent my 20s jumping from job to job, unsure of what I was good at or wanted. I returned to school and got my Ph.D. at age 39. Ten years later, I am tenured and an associate dean at a major university. I work with people who know that they benefit from my ADHD superpowers and accommodate my less super ADHD symptoms. I regularly get to use my position to help neurodivergent students.” — Ted, California

“I co-founded a charter school 22 years ago. Keeping it on track through many challenges required a lot of perseverance.” — Morgan, California

Perseverance & Resilience: Next Steps

• Read: Building Resilience Begins Here – 6 Motivation Strategies for ADHD Families
• Download: How Well Are You Handling Stress?
• Read: “I Am What I Choose to Become!”

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Admittedly, ADHD brains do not typically excel at making — and following through with — plans. But they can expertly pivot and devise ingenious solutions on the fly when setbacks arise. Sometimes, these new, spontaneous plans result in opportunities and rewards that would have otherwise remained unfulfilled.

So, when a last-ditch effort to score a ticket to your favorite band’s show lands you backstage, or a late entry into a neighborhood Super Bowl pool means winning $750, you can thank your ADHD propensity for spontaneity.

Here, ADDitude readers share more stories of when they reaped the rewards of spontaneity.

Have you ever benefited from spontaneous decision-making or a failure to plan? Share your story in the comments.

Rewards of ADHD Spontaneity

“On a vacation with my husband a few years ago, I got rewarded for failing to plan. Upon arriving at the Mammoth Cave National Park, I realized that I needed to order tickets to tour the caves weeks in advance. As a result, we could only enter the public park areas. Once the initial ‘Oh no, we drove here and can’t go in’ feeling solidified into reality, it allowed for total spontaneity. We explored on our own and enjoyed a nice lunch. Instead of the trip being about the destination, it was about the journey. To this day, we still use the expression ‘It’s a Mammoth Cave day’ to describe how a failure to plan resulted in a good outcome.” — Lisa, Wisconsin

[Get This Free Download: 25 Things to Love About ADHD]

“I was given the task of planning the family vacation. I kept putting it off, paralyzed by the thought of wading through travel brochures and finding a deal within our budget. Three days before the holidays, I saw a local travel agency advertise a reduced-price trip to Florida for two weeks that was a cancellation. It turned out to be the holiday of a lifetime. My grown children still talk about it being the best trip ever!” —Jacinta, Lancashire, England

“When my kids were little, I took them on midnight runs to IHOP on their birthdays.” —An ADDitude Reader

“I forgot to submit my entry to a neighborhood Super Bowl pool and had to take the last block available. I ended up winning $750!” — Kate, Pennsylvania

“I wrote a poem for my parents’ 25th wedding anniversary in the bathroom of the banquet hall 20 minutes before the toast. It was so well received that my parents still gush about it 30 years later!” — Beth, Colorado

[Self-Test: Do I Have Hyperactive-Impulsive ADHD?

“After I finished an aerobics class at my health club, I asked for a job — and got it!” —Terri, Colorado

“Any sort of travel is always fun with a touch of spontaneity! I traveled alone in Thailand once, and I came across so many experiences and people just by winging it and wandering around!” — Kayla

“During COVID, I spontaneously moved to a new city without a job or knowing a single soul. In the three years since, this new place has offered me wonderful friendships, a career switch, and a more authentic life.” — An ADDitude Reader, Netherlands

“Despite being a huge fan of the band Wilco, I never followed through and bought a concert ticket when they came to town, and it sold out. On the day of the show, I went to the venue to search for a ticket. I started watching the soundcheck when a guy asked me what I was doing. When I told him I was trying to find a ticket, he said he was the show’s opener, and I could be his ‘roadie’ to get into the show. Afterward, he invited me and others, including Wilco members, for drinks. As I’m leaving, another guy asks me if he can catch a ride — and it turns out to be Leroy Bach, the multi-instrumentalist for Wilco at the time. Leroy invited me to Wilco’s Seattle show the next night. All of this happened because I failed to plan!” — Josh, Utah

“I met my husband on a blind date, and we got engaged two weeks later. We’ve been together 20 years.” — Vanessa, Australia

“One time at work, I did not sufficiently study the plan for a large project and could not contribute to the discussion. However, my ADHD brain spontaneously proposed a different and better solution that we used instead of the original plan.” — Allen, Michigan

“I randomly stopped at a neighborhood estate sale and bought a bag of costume jewelry for $1. After it was sitting in my drawer for three years, I finally took four or five gold pieces to a pawn shop. I made $300.” —Lisa, Virginia

“Being the mom of a 10-year-old, I can be rigid with plans to get everything done. But when I go off the list or veer from what we have planned, my daughter loves the spontaneity. An unplanned trip on our way home to get ice cream in a never-visited town recently was a lot of fun.” — Christine, Michigan

“During a deeply unhappy time at work, a recruiter called me out of the blue and offered me a job. Despite giving up a well-paid permanent position at a time when I struggled to make ends meet as a single parent, I took the position. It became one of the best moves I ever made.” — John, Yorkshire, U.K.

 “I convinced my husband to move us and our four young children to Greece. It wasn’t easy, but what a year or so we had!” —Julia

ADHD Spontaneity: Next Steps

• Free Download: Your Free Guide to All the Best Parts of ADHD
• Read: Who Says One Kind of Thinking Is Better Than Another?
• Read: Decision-Making Advice for Impulsive or Indecisive Adults with ADHD
• Blog: “Riding Motorbikes and Contemplating Death with ADHD”

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Since October 2022, thousands of individuals with ADHD have faced immense difficulty accessing prescribed stimulant medication – the treatment they need to function and lead healthy lives. No relief is in sight.

Make no mistake that the reason for the ongoing stimulant shortage has much to do with how stimulant medication itself is viewed. After all, the Drug Enforcement Administration (DEA) classifies stimulants as Schedule II drugs for their “high potential for abuse” and sets national drug quotas for these substances based on that classification.^{1 2} This drug quota is, arguably, a major factor driving the shortage.³

Like many psychiatrists, I have taken the Schedule II classification of stimulants at face value for most of my career. Prescription stimulants are Schedule II, so they must be very addictive. How do I know? Because they are Schedule II.

This circular thinking has stopped me – and likely others – from noticing the mismatch between this classification and what I observe clinically. And while it may seem like the Schedule II classification is set in stone, it isn’t. In fact, the Controlled Substances Act specifically states that organizations, or even individuals, may petition the DEA to reclassify a substance.⁴ Shouldn’t we at least question whether these medications belong in Schedule II?

Controlled Substances: What We Get Wrong About Stimulants for ADHD

The DEA classifies drugs into five distinct categories depending upon their medical use and potential for abuse or dependency. Schedule V drugs have the lowest potential for abuse, while Schedule I drugs have a high potential for abuse and no current accepted medical use.

[Read: “Stop Treating Us Like We’re Addicts!”]

While working as a community psychiatrist, I used to brace myself for the bad outcomes from prescription stimulants. After all, as Schedule II drugs, they sit way up in the DEA’s scale. But what I found was that carefully prescribed stimulants rarely caused issues, whereas other drugs deemed “safer” often did.

Take benzodiazepines, drugs that are used to treat conditions like anxiety and insomnia. With benzodiazepines, tolerance and dependence are common, the withdrawal syndrome is serious, and overdoses can be lethal, especially when combined with opioids. When used long-term, the taper can be rocky and often requires several months to complete.

Comparatively, standard prescription stimulant treatment has minor problems. Withdrawal syndromes are rare and brief. While I have seen occasional misuse, I haven’t seen prescription stimulant overdoses or use disorders. Rather, I’ve seen people gain control of their lives. They graduate college, they hold jobs, and their relationships improve. Early refill requests are rare.

People who are prescribed scheduled benzodiazepines rarely miss a dose and need no reminders. Most of my patients with ADHD, however, struggle to take medications every day and may forget to fill their medications on time.

[Read: “This Cannot Be the Price We Pay to Function.”]

For All Their Dangers

The stark difference in adherence between benzodiazepines and prescription stimulants likely reflects two things: the symptoms of ADHD itself and the fact that stimulant medications, when taken as prescribed, are much less reinforcing compared to benzodiazepines.

Just ask any child who takes Quillivant, a banana-flavored liquid form of methylphenidate, if they want their morning dose. Many will run, far. Beer and coffee are acquired tastes because the brain pairs their flavors with the good feeling that follows consumption. The ‘drug liking’ effect of alcohol and caffeine reinforces a desire for the taste — a phenomenon that hardly occurs when taking stimulants as prescribed for ADHD. Coffee and alcohol, despite their abuse potential and widespread use, are freely available to most of the public.

Benzodiazepines, for all their dangers, are Schedule IV. Meanwhile, prescription stimulants sit in the Schedule II Hall of Shame, along with fentanyl. Yes, fentanyl – a substance 50 times more potent than heroin and responsible for a majority of the thousands of overdose deaths in the United States in 2023.^{5 6} Surely, there must be a classification error here, right?

National overdose deaths involving prescription stimulants is difficult to track because of a coding issue that lumps prescription stimulants with illicit methamphetamines. Fortunately, one study separated the two by looking at substance-related death certificates from 2010 to 2017. Of the 1.2 million total deaths that involved substances, only 0.7% involved prescription stimulants, often used in combination with other substances. Methylphenidate-related deaths accounted for .02% (295) of all substance use-related deaths, or an average of 37 deaths per year.  Compared to methylphenidate, there were twice as many deaths involving pseudoephedrine (615), which does not require a prescription, and 160 times more illicit methamphetamine-related deaths (49,602).⁷

Stimulants Are Safe – and Life-Saving – When Used as Prescribed

The sparsity of stimulant prescription-related deaths may reflect their essential role in treatment. ADHD is associated with greater risk for accidents, injury, premature death, and suicide.⁸ Multiple studies suggest that treatment with prescription stimulants may lower the risk of these adverse and deadly events.^8-11

Unfortunately, the serious risks of illicit methamphetamine use can drive stigma and fear toward prescription stimulants. Many people with ADHD may be hesitant to start stimulants for concerns about heart problems and addiction. While illicit methamphetamine does cause major heart problems and is highly addictive, appropriate prescription stimulant treatment does not carry this risk.^12, 13 Even in overdose, major cardiovascular events are rare.¹⁴ Multiple studies also show that prescription stimulant treatment for ADHD does not increase the risk of developing a substance use disorder (SUD) and may even have a protective effect.^{15, 16}

Importantly, there are situations, namely non-oral misuse (e.g., snorting, smoking, or injecting), where prescription stimulants do have high potential for abuse. These routes allow stimulants to enter the brain rapidly and cause a rapid spike in dopamine. The faster and bigger the spike, the more intense the “high” or “drug liking” effect that will reinforce use. Oral routes, on the other hand, more slowly deliver drugs to the brain. This is partly why stimulants, when taken as prescribed, hold a much lower addiction potential.¹⁷

Most people with ADHD will never snort or inject their medications. People without ADHD usually won’t, either. Indeed, the Schedule II classification appears to be on behalf of a subset of people, with and without ADHD, who use stimulant medications non-orally. Arguably, a more tailored way to protect this group may lie on the diagnostic side — by taking a careful history, requiring drug screens in adolescents and young adults, and considering non-stimulants when the risks are too high. Many youth will also welcome a matter-of-fact discussion on substance use and harm reduction.

On Stimulant Misuse

A more common issue is oral prescription stimulant misuse — that is, taking someone else’s medication or too much of your own. A 2022 survey showed that 15% of college students reported taking someone else’s prescription stimulant at least once in their lifetime, but most did so less than once a month. Only 0.1% of students reported misusing prescription stimulants more than four times per month.¹⁸

Most college students report misusing prescription stimulants for perceived performance enhancement.¹⁹ The misuse pattern does not tend to escalate and is lower-risk in nature. This is likely because most students who misuse will only do so orally, which is much less addictive, and they are not using to get high. Some of this misuse may also be an effort to self-medicate. A 2010 study showed that prescription stimulant misusers were seven times more likely to screen positive for ADHD compared to non-misusing students.²⁰

To be clear, it is still a bad idea to misuse prescription stimulants. While the health risks do not appear to warrant schedule II classification, that does not mean “risk free.” All prescription medications carry risks, and risks can vary based on factors like dose, route, and the individual. What is safe for one person can be dangerous for another. For instance, someone with bipolar disorder can become manic from a prescription stimulant. Someone who regularly uses illicit methamphetamine may tolerate high doses of prescription stimulants whereas someone else may become agitated, psychotic or go into renal failure at a much lower dose.¹⁴

For those at higher risk for prescription pill misuse, there are also long-acting formulations that were designed to prevent non-oral use. For instance, Concerta (methylphenidate ER) has a hard outer coating that is very difficult to crush.²¹ This will deter most people. In addition, when studied in a group of adolescents with ADHD and an SUD, Concerta rated only one point higher than placebo in “drug-liking” effect.²²

Vyvanse (lisdexamfetamine) is another long-acting formulation that deters abuse. Vyvanse comes as an inactive prodrug and won’t activate until it is converted by an enzyme in the bloodstream. Even if someone snorts or injects it, it will still need to be converted to an active form in the body and will not produce a more rapid effect. Two “drug-liking” studies also suggest lower abuse potential with IV doses not differing from placebo.^{23 24} While a supratherapeutic oral dose had some “liking,” it also measured higher on “drug-disliking.”²⁴

Reclassifying prescription stimulants to a lower tier would more accurately reflect real-world data on addictive potential, health risk, and their public health benefit. Still, any reclassification to a lower tier carries the risk of fueling misconceptions about safety. Some may mistake reclassification as a green light to misuse. Misconceptions on safety may also drive the purchase of counterfeit pills. Make no mistake: Counterfeit prescription stimulants – which can be easily purchased online – kill people. These fake pills are made to look just like real prescription stimulants, but instead contain illicit methamphetamine and/or fentanyl, in unpredictable amounts. Taking even one counterfeit pill can be lethal.²⁵

Prescription stimulant misuse, as a whole, is a problem that deserves our attention. Targeted education needs to occur at the individual, family and school levels. This may include dispelling myths on cognitive enhancement, emphasizing the higher risk with non-oral use, and increasing awareness on counterfeit pills. When young people are taught the actual risks and realities of the current drug landscape, they are given a chance to make safer choices. This strategy is rooted in connecting with at-risk youth and can happen without interfering with the treatment of people with ADHD.

Schedule II Drugs: The Case for Reclassifying Stimulant Medication

Ensuring access to stimulant treatment is essential to the lives of millions of people with ADHD, and it benefits the public at large. While there is widespread oral misuse, the use does not tend to escalate. Non-oral use is higher risk, but less common and rarely fatal, making prescription stimulants an outlier in the Schedule II class.

Prescription stimulants are long overdue for reclassification. For those still on the fence, here is a more conservative approach: Start with rescheduling medications that have abuse-deterring properties, such as Concerta, Vyvanse, and their generic equivalents. By releasing these medications from the chains of Schedule II, more people with ADHD can live their lives.

Do you think prescription stimulants should be reclassified? Share your thoughts in the comments section.

Schedule 2 Drugs and Stimulants: Next Steps

• Read: Who’s Afraid of ADHD Stimulants?
• Read: The Real Reason ADHD Medication Supply Is Lagging Demand
• Read: “The DEA’s Manufactured Crisis”

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 Drug Enforcement Administration. Drug Scheduling. DEA.gov. https://www.dea.gov/drug-information/drug-scheduling

² 21 CFR Part 1303. https://www.ecfr.gov/current/title-21/chapter-II/part-1303

³ Committee on Oversight and Accountability. (May 14, 2024) Comer, McClain Probe Shortages of Schedule II Drugs, including Adderall. https://oversight.house.gov/release/comer-mcclain-probe-shortages-of-schedule-ii-drugs-including-adderall%EF%BF%BC/

⁴ Drug Enforcement Administration. The Controlled Substances Act. DEA.gov. https://www.dea.gov/drug-information/csa

⁵ Drug Enforcement Administration. Fentanyl. DEA.gov. https://www.dea.gov/factsheets/fentanyl

⁶ Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2024. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

⁷ Black, J. C., Bau, G. E., Iwanicki, J. L., & Dart, R. C. (2021). Association of medical stimulants with mortality in the US from 2010 to 2017. JAMA Internal Medicine, 181(5), 707–709. https://doi.org/10.1001/jamainternmed.2020.7850

⁸ Li, L., Zhu, N., Zhang, L., Kuja-Halkola, R., D’Onofrio, B. M., Brikell, I., Lichtenstein, P., Cortese, S., Larsson, H., & Chang, Z. (2024). ADHD pharmacotherapy and mortality in individuals with ADHD. JAMA, 331(10), 850–860. https://doi.org/10.1001/jama.2024.0851

⁹ Krinzinger, H., Hall, C. L., Groom, M. J., Ansari, M. T., Banaschewski, T., Buitelaar, J. K., Carucci, S., Coghill, D., Danckaerts, M., Dittmann, R. W., Falissard, B., Garas, P., Inglis, S. K., Kovshoff, H., Kochhar, P., McCarthy, S., Nagy, P., Neubert, A., Roberts, S., Sayal, K., … ADDUCE Consortium (2019). Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience and Biobehavioral Reviews, 107, 945–968. https://doi.org/10.1016/j.neubiorev.2019.09.023

¹⁰ Chang, Z., Quinn, P. D., O’Reilly, L., Sjölander, A., Hur, K., Gibbons, R., Larsson, H., & D’Onofrio, B. M. (2020). Medication for attention-deficit/hyperactivity disorder and risk for suicide attempts. Biological Psychiatry, 88(6), 452–458. https://doi.org/10.1016/j.biopsych.2019.12.003

¹¹ Chang, Z., Quinn, P. D., Hur, K., Gibbons, R. D., Sjölander, A., Larsson, H., & D’Onofrio, B. M. (2017). Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes. JAMA Psychiatry, 74(6), 597–603. https://doi.org/10.1001/jamapsychiatry.2017.0659

¹² Manja, V., Nrusimha, A., et al. (2023) Methamphetamine-associated heart failure: a systematic review of observational studies. Heart, 109:168-177. https://doi.org/10.1136/heartjnl-2022-321610

¹³ Zhang, L., Yao, H., Li, L., Du Rietz, E., Andell, P., Garcia-Argibay, M., D’Onofrio, B. M., Cortese, S., Larsson, H., & Chang, Z. (2022). Risk of cardiovascular diseases associated with medications used in attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JAMA Network Open, 5(11), e2243597. https://doi.org/10.1001/jamanetworkopen.2022.43597

¹⁴ Martin, C., Harris, K., Wylie, C., Isoardi, K. (2023). Rising prescription stimulant poisoning in Australia: a retrospective case series. Toxicology Communications, 7(1). https://doi.org/10.1080/24734306.2023.2174689

¹⁵ Quinn, P. D., Chang, Z., Hur, K., Gibbons, R. D., Lahey, B. B., Rickert, M. E., Sjölander, A., Lichtenstein, P., Larsson, H., & D’Onofrio, B. M. (2017). ADHD medication and substance-related problems. The American Journal of Psychiatry, 174(9), 877–885. https://doi.org/10.1176/appi.ajp.2017.16060686

¹⁶ McCabe, S. E., Dickinson, K., West, B. T., & Wilens, T. E. (2016). Age of onset, duration, and type of medication therapy for attention-deficit/hyperactivity disorder and substance use during adolescence: a multi-cohort national study. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 479–486. https://doi.org/10.1016/j.jaac.2016.03.011

¹⁷ Manza, P., Tomasi, D., Shokri-Kojori, E., Zhang, R., Kroll, D., Feldman, D., McPherson, K., Biesecker, C., Dennis, E., Johnson, A., Yuan, K., Wang, W. T., Yonga, M. V., Wang, G. J., & Volkow, N. D. (2023). Neural circuit selective for fast but not slow dopamine increases in drug reward. Nature Communications, 14(1), 6408. https://doi.org/10.1038/s41467-023-41972-6

¹⁸ The Ohio State University. (2022). College prescription drug study: Key findings. https://www.campusdrugprevention.gov/sites/default/files/2022-06/CPDS_Multi_Institutional_Key_Findings_2022.pdf

¹⁹ Faraone, S. V., Rostain, A. L., Montano, C. B., Mason, O., Antshel, K. M., & Newcorn, J. H. (2020). Systematic review: nonmedical use of prescription stimulants: risk factors, outcomes, and risk reduction strategies. Journal of the American Academy of Child and Adolescent Psychiatry, 59(1), 100–112. https://doi.org/10.1016/j.jaac.2019.06.012

²⁰ Peterkin, A. L., Crone, C. C., Sheridan, M. J., & Wise, T. N. (2011). Cognitive performance enhancement: misuse or self-treatment? Journal of Attention Disorders, 15(4), 263–268. https://doi.org/10.1177/1087054710365980

²¹ Cone E. J. (2006). Ephemeral profiles of prescription drug and formulation tampering: evolving pseudoscience on the internet. Drug and Alcohol Dependence, 83 Suppl 1, S31–S39. https://doi.org/10.1016/j.drugalcdep.2005.11.027

²² Winhusen, T. M., Lewis, D. F., Riggs, P. D., Davies, R. D., Adler, L. A., Sonne, S., & Somoza, E. C. (2011). Subjective effects, misuse, and adverse effects of osmotic-release methylphenidate treatment in adolescent substance abusers with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 21(5), 455–463. https://doi.org/10.1089/cap.2011.0014

²³ Jasinski DR, Krishnan S. Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers. Journal of Psychopharmacology. 2009;23(4):410–8
https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=8ead4bf37b0e1111a740fe2ce34ebced83085c3c

²⁴ Jasinski DR, Krishnan S. Abuse liability and safety of oral lisdexamfetamine dimesylate in individuals with a history of stimulant abuse. Journal of Psychopharmacology. 2009;23(4):419–27
https://journals.sagepub.com/doi/10.1177/0269881109103113

²⁵ https://www.dea.gov/sites/default/files/2021-05/Counterfeit%20Pills%20fact%20SHEET-5-13-21-FINAL.pdf

Procrastivity happens when you avoid a high-priority task by engaging in a lower-priority, less time-urgent activity. It can be tricky to tell if you’re in this state because the less-critical task you’ve escaped to (perhaps unwittingly) is still beneficial. Regardless, procrastivity is most often self-defeating and often hard to cease. Here, learn how to check in with yourself to ensure that you’re focusing on what’s most important.

1. Is the task on your to-do list?

It’s a straightforward question that will force you to be honest about how you use your time. It also underscores the importance of having a prioritized to-do list and an implementation plan for your tasks.

[Get This Free Download: The Eisenhower Matrix to Learn Prioritization]

Take the task of tidying your workspace. If this is not on today’s to-do list, and yet you’ve found yourself doing just that in lieu of other tasks, then it’s a clear-cut case of procrastination. But what if tidying your desk is on your list? If there is anything else on your list that needs more immediate attention and carries significant consequences if delayed or unfinished — like that major project due tomorrow — then you know that choosing to tidy is a form of procrastivity.

A prioritized list is not enough; you need an implementation plan that specifies not just what tasks you’ll do, but when and where. You can plan, for example, to put the finishing touches on your project at 2 pm. If you’re doing anything else at that time, then you’re procrastinating.

2. Are you rationalizing?

Procrastivity distorts your thoughts and tricks you into believing that you’re being productive. If you have any of the following distorted positive thoughts ¹ while engaging in a task, then you know it’s procrastivity talking:

• “I’ll just do this one thing first.”
• “I do better waiting until the last minute to start an important task.”
• “I can’t stop this task right now, might as well continue with it.”
• “Though this task usually sucks me in, I’ll just do it for a minute.”
• “I have plenty of time — I’ll just do one more thing before I jump to the other important task.”
• “Being impulsive is just part of who I am.”
• “I know I’m supposed to be doing something else, but I want to do this now.”

[Read: The Everyday Rationales That Let Procrastination In]

Practice checking in with your thoughts as you perform tasks. The more you do this, the more likely you’ll catch yourself when you do engage in procrastivity and get back on track.

Busy vs Productive: Next Steps to Combat Procrastivity

• Get This Free Download: Stop Procrastinating and Finish Your To-Do List TODAY
• Read: How to Finish What You Start
• Read: Why ADHD Minds Struggle to Meet Goals with Action

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Unraveling ADHD Procrastivity: How to Outsmart Procrastination and Improve Productivity” [Video Replay & Podcast #501] with J. Russell Ramsay, Ph.D., which was broadcast on April 18, 2024.

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

Sources

¹ Knouse, L. E., Mitchell, J. T., Kimbrel, N. A., & Anastopoulos, A. D. (2019). Development and evaluation of the ADHD Cognitions Scale for adults. Journal of Attention Disorders, 23(10), 1090–1100. https://doi.org/10.1177/1087054717707580

When solving a particularly sticky problem, it helps if your brain is adept at divergent thinking — that is, generating original ideas by considering diverse and unprecedented possibilities.

Unsurprisingly, neurodivergent brains tend to be aces at divergent thinking. Folks with ADHD tend to think fast, dream big, and innovate solutions that are totally unexpected and brilliant, making them perfect people to turn to when there’s a problem that stumps everyone else.

From software snafus to construction conundrums, tough problems are no match for ADHD brains. Here, ADDitude readers share their problem-solving success stories.

“When I was buying a new mattress, the sales person told me I needed to rotate it top to bottom, once a month. I’m a single mum and having to handle a double mattress on my own didn’t sound fun. I thought for a second and said, ‘Can’t I just rotate my body instead of the mattress?’ The person looked at me for a second and said “Wow, actually yeah. No one has ever suggested that before.” —Emma, Scotland

“I came up with this crazy idea to design costumes for my colleagues and I to wear to a presentation for the higher-ups that really made this project idea hit home. It was fun and effective.” —Jen, Ontario

[Read: 17 Things to Love About Your ADHD!]

“Door handle fell off. Fixed it with a shoelace and two pencils.” —Miriam, Ireland

“An ability to see patterns allowed me to devise a flow chart that simplified an admissions process in a mental health facility. It also allowed me to ‘see’ an element that might be missing during an intake interview. This led to better diagnosis and care.” —Rinda

“I am often coming up with suggestions that are totally logical to me and not to others. Yesterday, I helped a friend and her daughter hang something in the stairwell. I suggested using one ladder as a base to support for the other ladder, which made the job easy.” —Lisa, Washington

[Read: What I Would Never Trade Away]

“I fix all temporary problems in my house with painter’s tape. It makes a great seal, picture hanger, cable organizer, label. The only thing it can’t do is my taxes!” —Yvette, Canada

“As a nurse practitioner working in a student health clinic, I unleashed my creativity and developed an on-line reference for students that was wildly popular! —An ADDitude Reader

“I can make the simplest dish for lunch even when my fridge is almost empty.” —Boon, Malaysia

“ADHD has allowed me to find workarounds within proprietary software at work faster and more frequently than others. Sharing workarounds when something is broken helps stop productivity loss until a permanent fix is made.” —An ADDitude Reader

“I saved a deadline once with my ADHD thinking. Pre-internet, my East Coast publishing company discovered that we forgot to fact check an important detail with a federal government bureau that had closed for the day. While my bosses pondered disaster, I realized that all we had to do was call other branches on Pacific Time that were still open, to get the info. We made our deadline!” —Dee

“At my first real job I was given a task that regularly took people three days to do. I found a different way of doing it that got the same results but took one day.” —Erin, Missouri

“At work, colleagues were attempting to reorganize a room so that a light fixture was not accessible when you stood on the bed. They were discussing moving wardrobes when I came in and said, ‘Why not cut the legs off the bed?’ So, we did, much easier!” —Lisa, Wales

ADHD & Problem Solving: Next Steps

• Free Download: Your Free Guide to All the Best Parts of ADHD
• Read: Who Says One Kind of Thinking Is Better Than Another?
• Quiz: ADHD Myth or ADHD Reality? Check Your Knowledge
• Read: How My ADHD Makes Me a More Dynamic, Resourceful, Passionate Leader”

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

My 9-year-old son has always been a firework, from the very second of his surprise existence. If my pregnancy test could have displayed two zigzags instead of straight lines, it would have.

He has never followed the path well-trodden. Instead, he has swung from the trees shadowing its path, spinning and tumbling over it like a Ferris wheel free from its hinges. His brain is always busy. It darts and daydreams and never tells him to sit, breathe, and just be.

“I was the same as him when I was a kid,” my husband would say. “He’s just a little boy.”

He often spoke of marked similarities between them, and we thought our son had simply inherited a huge slice of his father’s personality. That this was just “them.” So we attributed his behaviors to that – a child who was beautifully energetic. If he wasn’t spinning or cartwheeling, he was singing or asking questions or making funny little noises. The only time he really rested was when he slept, when dreams took over and his compulsion to “fizz,” as he calls it, quelled.

Father and Son: Drawing ADHD Parallels

Analyzing my child’s behavior, helicoptering his nuances and traits, and researching “ADHD in children” until there was nothing left to Google came easy. Turning the lens to my husband, on the other hand, was trickier.

My husband flitted from job to job, struggled to prioritize, became easily frustrated with any task, and was unfocused. But we had gone through a fair chunk of sadness in the last few years — the death of one of our other sons, the loss of parents, our 9-year-old’s meningitis battle when he was a baby. I put my husband’s erratic nature down to stress and trauma.

[Read: “Let Me Tell You How ADHD Runs in My Family”]

All the while, the phone calls from my son’s exasperated teacher mounted, as did the sense that my son’s behaviors in school and at home were indicative of something bigger.

My mother-in-law was a special education teacher for many years. The more I called her to analyze my little boy’s behavior, the more parallels she’d draw between him and my husband. Eventually, the constant joke that they were two peas in a pod became a lightbulb moment for me. I made an appointment with an ADHD specialist – for my son and husband. Sure enough, after a careful evaluation, the specialist diagnosed both of them with ADHD in the same appointment. Their test scores were practically identical, she noted.

Like Father, Like Son

“How do you feel?” the specialist asked my son. She sat next to him on the floor as he clicked LEGOs together and bounced on his knees.

“Exhausted” he said. And my heart sank. Exhausted by trying to concentrate in school and being told off constantly, exhausted by coming home to homework cajoling, exhausted for being reprimanded for his impatience and other behaviors at the outskirts of his control.

[Read: “My ADHD Family Tree — Three Generations of Neurodivergence Revealed”]

I saw my husband’s face crumble a little as he knew that feeling all too well. And I realized that, as a wife and mother, I had failed them. To me, their behaviors were annoying, frustrating, and sometimes inexplicable. I had often said to my son, “Why is it always you? Why are you the one who always gets into trouble?” I sometimes dreamed of an easier marriage to a man who would stick at a job or for a man who would actually listen to me. I had no idea what either of them were going through. It was an incredibly emotional day for everyone.

We walked out of the specialist’s room with a deeper understanding of each other and a feeling that we can all start to be our truer selves.

Our ADHD Family

We’ve only recently entered the neurodivergent universe. We’re perched on a circling satellite looking into a place where words like “disorder,” “impulsivity,” and “disorganization” zoom by. But it’s other zooming words that captivate us — “spontaneity,” “creativity,” “courage.” We are going to run with these as fast as we can.

We’re not alone in entering this universe. We see many other families embarking on this journey, too. Some days we think we have a firm grasp on ADHD – and some days we don’t. And that’s OK, because all we can do is buckle up so the twists and turns don’t jolt the ones we love quite so much.

I would not change my son or husband for anything. We’ll bundle up all of the positives and challenges, stick them into our family jetpack, and navigate the steps, bounces, stumbles, and freefalls of this shared diagnosis together.

ADHD Family Ties: Next Steps

• Get This Free Download: ADHD Empowerment Month Calendar
• Read: 5 Ways to Build Bonds – A Guide for ADHD Dads
• Read: Helping Your Kids Find the “Awesome” in 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.

“My ADHD curiosity sends me down rabbit holes that cost me on occasion but, wow, the things I learn.” — John, Florida

The ADHD mind is not satisfied with ‘what’ and ‘where.’ As one reader told us, “I am a solution detective, always driven by the ‘why’ and the ‘how.’” And that natural intellectual curiosity regularly unlocks innovation.

Here’s how ADDitude readers answered our question, “How has your (or your child’s) curious ADHD brain fueled innovation, exploration, and/or opportunity?”

Share your own stories of where ADHD curiosity has taken you in the comments section!

Intellectual Curiosity: ADHD and the Desire to Know

“My child’s curiosity has fueled her soccer progression. She wants to know the ‘how’ and ‘why’ for every play, making her the best strategist on the field.” — An ADDitude Reader

“I saw a queue of people with instruments in Glasgow, Scotland. I couldn’t not ask what was going on! Turns out it was open auditions for a TV show, which I joined and went on to win. Completely serendipitous, but that seems to happen to me a lot. I question if it is serendipity or my curious ADHD mind pushing me toward these things my whole life.” — Emma, Scotland

“My child, who has ADHD, once wondered what was the best-tasting sugar substitute, or if they even liked sugar alternatives. Within the hour, they had set up a taste test for the entire family.” — Sara, New Hampshire

[Get This Free Download: Secrets of the ADHD Brain]

“I have always wanted to know how, what, where, and why things work. Over the course of my life, I have learned how to restore and play old violins, sing, lead a choir, write music and poetry, sculpt, draw, paint, collect and categorize insects, ride and train horses, raise peafowl and chickens, grow a garden, grow trees, and the list goes on and on. I follow maintenance and engineers around at work asking endless questions on how and why something does what it does. Everything is fascinating! I want to know EVERYTHING!” — Kathleen, Arizona

“A curiosity about what lies beneath the permafrost has given my son a silver lining to climate change. His passion is for dinosaurs and other beasts of another time.” — Tara, Canada

“In my job, I help people with mental, emotional, and physical disabilities find long-term employment. As an evaluator, I am the ‘digger’ — I really get to know each person I work with on a deep level. I use a variety of assessments to determine a client’s interests, skills, and aptitudes. My ADHD curiosity also allows me to morph into the appropriate mental and emotional state to meet the client where they are and develop trust, which is what I need to be successful at my job.” — SolLuna, Nebraska

“I have cataloged more than 150,000 articles in my 12-terabyte drive of ‘Dirk’s Knowledge.’ It’s more than an obsession, it’s a severe case of e-hoarding. I know many things about just about everything, but not enough to be specialized in anything.” — Dirk, Australia

[Read: On the Awesomeness of ADHD Creativity]

“I always fact-checked everything before I even knew what fact-checking was. It turns out that collecting facts isn’t just for fun! It can also help you get into a fancy school.” — Ted, California

“In my retreat business, curiosity plays a crucial role in shaping unique and transformative experiences. My ADHD brain constantly asks questions like, ‘How can we make this experience different?’ and, ‘Why do people respond to certain activities in certain ways?’ This drive to understand and explore leads to the creation of retreats that are not only distinctive but deeply impactful.” — Jo, Australia

“My curious ADHD brain has me constantly questioning ‘why,’ ‘how, and, crucially, ‘what if,’ which helped me to better understand the subjects I learned in college. My line of questioning made me a bit of a leader amongst my peers, since I asked questions that hadn’t occurred to others, which helped us all learn. My ADHD also helps me see patterns and meaning in things that others often miss, which helps give more meaning and understanding in my life.” — Rebecca, Connecticut   

“It helps that I grew up reading Agatha Christie books. It taught me to look for creative ways to fix problems and solve mysteries. I have had pretty good luck using psychology to understand what someone was thinking, which helps with problem solving. (Mostly in the form of helping to find lost things at work.)” — Cecil, Minnesota

“My ADHD gave me a hunger to learn before I even entered preschool. Today, it’s a fantastic asset in my editing career. I bring to the job not just hyperfocused attention to detail but also the curiosity and healthy dose of skepticism needed to ask, ‘Is that right? Let me check that’ or, ‘I wonder what other style guides say. I want to do a deeper dive into this.’” — Heather, Alabama

“As a writer and comedian, I don’t just want to know how something is done, but why it’s done. I want to know who benefits from it being done that way, what its history is, the people who make it happen, and what choices were made to get there. My thought process can be distracting, but my curiosity makes me feel more connected to the people and things around me. When I get my questions answered, I’m left with a huge filing cabinet of info to rummage through when I have a problem to solve.” — Nicole, Ohio

ADHD Curiosity: Next Steps

• Get This Free Download: ADHD Empowerment Month Calendar
• Read: The Tower of Bottles in My Kitchen — and More Proof of Creative ADHD Problem-Solving
• Read: 17 Things to Love About Your 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.

Art is Hayley Wall’s love language. Since Wall was a young child, she has found her footing as a communicator through drawing. Wall struggled academically as a child due to dyslexia and undiagnosed ADHD and autism, but she says, “What I did have was this gift where I could create images and I could tell stories.”

When Wall graduated from university and considered where to take her art, she was drawn to the topic of disability. “I was exploring the things I felt were important, the things that needed to be spoken about,” Wall explains. “My mom is disabled, so that’s been around me for a long, long time and it’s felt like people with disabilities are always the last to be thought of.”

Wall was asked to illustrate an article on chronic illness for the cover of Sick magazine, and then another on the same topic for It’s Nice That. These illustrations caught the attention of The New York Times, which commissioned Wall to illustrate a package celebrating the anniversary of The Americans with Disabilities Act. Her work became known for her signature bodies — large, gender-fluid forms, typically without faces, that exude strength, joy, and confidence.

As Wall’s art career gained momentum, so too did her personal journey to understand her own neurodivergence. Though Wall struggled with mental health challenges all her life, it wasn’t until she was 34 that she received a diagnosis of ADHD and autism.

Below, Wall shares her creative process, the challenges and joys of being a neurodivergent artist, and her commitment to a future that celebrates different minds and bodies.

[Read: “Happily Neurodivergent — at Last”]

Q: How did your diagnoses come about?

I’ve always wondered, ‘What’s wrong with me?’ and always struggled with my mental health. It was a feeling of being too much — too emotional, too sensitive, I always carried this feeling of, I just don’t fit in.

When I was 30, I sat down with my partner at the time, and was like, ‘I found this article about adults that have been diagnosed with ADHD and I’ve just done multiple quizzes. Can you do the quiz as well, please?’ They did, and they scored really low. I was like, ‘So you don’t do that? And that?’ It made me think, ‘OK, I think something’s going on.’ I approached my general practitioner, and from there, it took four years to get a diagnosis.

When I was 36, a year ago, I got diagnosed with autism and a mental health condition. I’m coming to terms with all these diagnoses and trying to understand how to navigate them. To me, what’s more important is not the label but just working out what I need.

Credit: Hayley Wall, illustrator

[Self-Test: Autism Test for Adults – Signs of ASD]

Q: When did your love of art begin?

I was a kid who bounced off the walls, I had so much energy. I wouldn’t shut up, and I would cry and scream. To calm me down, my parents would give me pens and paper and I would draw. It was the one time I was calm and focused.

Q: How does your ADHD inform your work?

After graduating, it took me 8 to 10 years to establish myself. I’ve done so many random jobs. I’ve worked as a nanny, in factories, in cafes. But running parallel to that was my hyperfocus, which kept me on track to pursue art. My hyperfocus is the reason I’ve been able to turn art into a career.

My work is all about bodies, usually gender ambiguous bodies. They are these big bodies that take up space — maybe because I’ve always felt really small and inferior. The bodies in my work are powerful. I can live through them.

The whole ‘taking up space’ idea is a big f&*k you to society for being like, ‘You have to be like this, or like that.’ It’s, ‘No, we can be whomever we want to be.’

Q: Can you tell us about your creative process?

A commission will come through and it’s like jumping on a roller coaster. There’s a voice that goes, ‘Here we go.’

I center myself and breathe to remove any negative voices and let the process take me.

As I read the commission, the visuals start coming, and my brain is joining dot-to-dots. I have a background in dance, and the dancing lives in my work now. Sometimes I’ll get myself or my friends into different positions and I’ll draw from that. I create loose, playful hand-rendered drawings and textures, and then I bring it onto my computer to work with.

Once I’ve got my concept down, I enter the most playful part of the process. I can enjoy coming to the end of the roller coaster nice and slowly.

Q: What’s the hardest part of your job?

The first bit of the process, mind-mapping concepts, is hard because I’ve got so many ideas, and I need to hone in. It’s the organization of thoughts that’s hard.

What crushes mind-mapping is impostor syndrome, a feeling I’ve carried of being inferior. I wish I was able to remove that saboteur voice that creeps in to say, ‘You’re not good enough,’ so I could just let my brain run free.

Q: What ADHD supports have you found helpful?

Freelance work is definitely hard because you don’t have HR, you don’t have colleagues to turn to. You are your absolute everything, and it’s really tough.
I was doing it for a long time all by myself, and I reached burnout. My mental health crashed.

In the UK, we are very lucky in terms of the benefits we get from the government. The ‘Access to Work’ program offers a sort of grant or reimbursement scheme to cover the cost of a support worker. It has been very helpful to me, and I’ve used that to have somebody support me through the admin tasks.
I never want to go back to a point where I’m trying to manage it all alone.

Q: Any advice for other artists with ADHD?

If you can tune into your voice and communicate your story, that’s when you’re going to create something nobody’s ever seen before.

Q: Where are you now on your journey of understanding your neurodivergence?

With the community I’ve found, I have a feeling of being able to unmask, to be my true self, to be able to be too much, weird, overly emotional, and sensitive.

Recently, I did a commission for a London museum and library called The Wellcome Collection. They asked me to respond to an article written by a person who was diagnosed with autism as an adult, and because this piece was so personal to my experience, I really wanted to place myself in the work. It was a three-part series: before, during and after diagnosis.

For the final image, I Photoshopped my face in quite a warped way onto the figure. I’ve hid behind my work for years, so to put my own face on this figure felt quite important. It was like, ‘I’m unmasking now. I’m showing myself. I’m allowing myself to actually come through. This is me.’

ADHD, Art, and Mental Health: Next Steps

• Read: Stifled Creativity and Its Damaging Impact on the ADHD Brain
• Read: Why ADHD Masking Is a Form of Self-Sabotage
• Read: “I’m Not Hiding My ADHD Anymore”

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.