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The ADHD Iceberg Explained: Hidden Symptoms, Challenges and Strategies

“ICEBERG! Right ahead!!!” 

 

Perhaps you remember this famous line from the iconic 1997 movie, “Titanic”, starring Leonardo DiCaprio and Kate Winslet.  The ship’s captain alerted the passengers and crew of the historic vessel that they would soon strike a nearby iceberg that had been largely invisible, with 90% of the hulking iceberg being obscured underwater. 

Within 30 seconds of sighting the iceberg, the ship made impact, sending the passengers and crew scrambling for safety amid the frigid waters.  Had they been able to see more than just 10% of the iceberg – what was  hidden below the surface –  and adjust their course, disaster might have been averted.   

While certainly an excellent scene in the movie, the lessons learned from the ship’s collision with the iceberg are also a glimpse into the visible and invisible challenges of ADHD.  The tip of the iceberg – the 10% we can see – represents behaviors and symptoms that are characterized as being “external”; meanwhile, the largest portion of the iceberg (what we can’t see) – represents those hidden symptoms and challenges that go unseen, characterized as being “internal”. 

To celebrate ADHD Awareness Month, I’d like to explore the less visible ways ADHD impacts our lives and relationships. Let’s break down the ADHD Iceberg (first coined and depicted by Chris A. Ziegler Dendy) and how to manage it. You’ll be able to avoid unforeseen dangers and have smoother sailing. 

 

The Iceberg We Can See – The External 

Externalizing behaviors are frequently seen in the classroom, at the workplace and at home. They are easily observable and measurable, typically manifesting in inattention, impulsivity, and hyperactivity. They are related to conscious executive functioning skills such as verbal, behavioral and emotional impulse control, organization, time management, initiation and prioritizing. In children and teens, we see this tip of the ADHD more in boys than girls in common behaviors such as fidgeting, talking too much, interrupting others, moving around the classroom and physical aggression.

In adults, externalizing behaviors can manifest as missed deadlines, trouble with finances, tardiness, disorganized living spaces, difficulty remembering important dates or events, interrupting others, talking too much, job instability and strained relationships.

 

The Iceberg We Can’t See – The Internal 

Internalizing ADHD behaviors are characterized as being less observable to others and frequently rely on someone’s self-report of their challenges in managing them. These internal traits include a restless or wandering mind, low self- esteem, distractibility, inability to sustain attention, trouble with shifting or flexibility, overwhelm, limited self-awareness, poor working memory and shame. 

Both types of these challenges exist in some form for everybody with ADHD. What’s under the surface of the water often shows up in combination with anxiety or depression, especially in   girls and women with inattentive ADHD. Since these traits are less disruptive in a classroom, girls are less likely to be referred by educators which accounts for why women are one of the largest groups seeking ADHD diagnoses today. Dealing with all of these issues requires patience, sensitivity, and a genuine desire to understand the “whole person.” 

 

Masking and the ADHD Iceberg

When the symptoms of ADHD remain hidden within the ADHD iceberg model, people rely on a  coping response called “masking.” Both children and adults can engage in masking behaviors.  Masking allows the person to conceal how their condition affects and limits their functioning. 

ADHD masking is about conforming to neurotypical standards to avoid the shame and stigma related to being neurodivergent. It typically develops as a coping tool in childhood that continues into adulthood even though it may no longer be useful. Over time, masking becomes tough to maintain and prevents people from sharing who they really are.

 

The Consequences of Masking and the Unseen ADHD Iceberg 

“I appear very organized to the outside world, but only because I spend an immense amount of time and energy putting everything together.” Cady, age 36

 

Masking with ADHD, while initially useful, may actually delay or sabotage a formal diagnosis and inadvertently foster the development of mental health issues such as anxiety or depression. Keeping symptoms of ADHD submerged and pretending they don’t exist to the outside world takes a great deal of energy. Diagnosed individuals who knowingly hide their challenges often worry profusely about being exposed and fear potential rejection or judgment. 

Avoiding the unseen ADHD iceberg often exacerbates perfectionism and imposter syndrome. Going above and beyond, overpromising more than you can deliver and feeling overwhelmed in the process, you may hope to distract others from the inadequacy you deeply feel. In addition, years of intentional or unintentional masking can muddy one’s sense of self so you lose track of who you really are. Hiding the challenges of living with ADHD interferes with your ability to accept the brain you have, take pride in your strengths, and do more of what works.

 

 

4 Tips to Navigate the ADHD Iceberg

 

  1. Celebrate Strengths: Encouragement to focus on your strengths provides the space for you to be proud of who you are and embrace neurodiversity. It helps you to avoid the narrative that ADHD is something that bothers others, and should be hidden. It reduces the pressures to conform to others’ ideals. Some strengths of living with ADHD include: being energetic, spontaneous, enthusiastic, curious, creative, having quick thinking, being able to hyper-focus on what you love to do.
  2. Begin Journaling: Writing in a journal can help you process emotions and gain insight into your experiences. Your needs – and potential solutions – will become apparent as you consider these questions:
          1. If you weren’t masking, what else would you be doing?
          2. What obstacles or fears interfere with sharing your true self?
          3. How do your personal expectations help to maintain the submerged part of the ADHD iceberg? 
          4. How can you make different, genuine choices in your behaviors or responses at home, at work or with friends? 

3. Change Your Focus:  Many people overcompensate for the deficits they think they have by overcommitting, overpromising, denial or avoidance. The negative self-talk that often accompanies masking can be shifted with paying attention to what is working. I recommend that you write or dictate three good things that happened in your day, ending with something you are grateful for each night before going to sleep. These positive items can be simple or complex. For example: 1) I wore my favorite shirt today; 2) I got the kids to school on time; 3) My boss liked my report. I’m grateful for the latte I had after lunch. This will take some practice but there’s research that shows this process really works. 

4. Practice self-compassion. Treat yourself the way you would act with a close friend, a child or a beloved pet. Be kind, forgiving and understanding. Your masking developed to assist or protect you in the past but it may no longer be necessary. Hiding who you really are makes it impossible for you to obtain the assistance you need to be successful and share the wonderful parts of yourself with the world. Instead of judging yourself for being less than, cut yourself some slack. Put on your cloak of courage and learn to love your challenges instead of submerging them.

5 Practical Tips to Overcome Perfectionism and Writer’s Block FAST

Dear Dr. Saline:

“As a research scientist I struggle a lot with writing and perfectionism. Previously I could write pages and now I find myself getting stuck waiting for an idea to be “perfect” before I could write it down. Like there are so many thinking traps for me to unlearn to help me get to the writing part. I’d love your advice on how to deal with this so I can write more easily.”

Sincerely,

Ramon

Dear Ramon:  

Many adults with ADHD struggle with perfectionism, especially when it comes to writing. Writing is especially challenging for people of all ages with ADHD because it uses all executive functioning skills simultaneously. In fact, as a “recovering perfectionist” myself who is currently wrestling with writing the initial chapter of my next book, I truly understand the challenges you describe. 

Perfection is a Myth

On ‘Taking Control: The ADHD Podcast’ with Nikki Kinser and Pete Wright, I shared some of  my professional and personal experiences  with perfectionism. Perfectionism is a coping tool that most people develop over the years to manage anxiety. We want to get things just right so nothing unpleasant–like disapproval, failure or criticism–occurs and something positive–like praise or approval–does. According to the American Psychological Association (APA), perfectionism is the tendency to demand of others or of oneself an extremely high or even flawless level of performance – above and beyond what is required by the situation. Perfectionism includes striving towards impossibly high goals and can be characterized by rigid, black-or-white thinking. If something isn’t perfect or close to it, it’s horrible and not worth doing. These thoughts and feelings will make writing anything nearly impossible. How can you be creative and let ideas flow with these unreasonable expectations? You can’t. 

Aiming for perfection in any area of life is harmful to your sense of self. It thwarts your ability to share your unique gifts and talents with the world. You may be excited to get started on writing an article but then once you start writing, it doesn’t seem to come together as you’ve imagined so you stop. Or, you can’t quite settle on the ‘best’ idea for the piece so nothing happens. One ten year old boy I worked with had ADHD, anxiety and a disorder of written expression. He told me: “I sit there and I sit there and I can’t get anything down on paper. I have ideas but nothing seems right. It’s really bad.” He was not only frustrated but also angry with himself for not being able to produce what he wanted. It was a double whammy. 

Two Types of Perfectionism

There are two types of perfectionism: adaptive and toxic. Adaptive perfectionism supports motivation, persistence and productivity. You get started on a task and stick with it until completion because you want to do a good job. You are able to express yourself athletically, artistically, academically or professionally. This type of perfectionism also contributes to the productive side of worry. It helps people by encouraging planning for a family dinner, getting to work on time or remembering to bring your passports on an international trip. 

Toxic perfectionism leads to overthinking, inaction, judgment and limitations. It reflects negative mindsets and perpetuates low self-esteem and defensiveness. When toxic perfectionism appears on the scene, it brings along several of its associates: self-criticism, rigidity, fear of disappointment and a failure mentality. Toxic perfectionism combines with worry about disapproval to stop people from making efforts or completing things. As a writer, it can be paralyzing and discouraging. 

Perfectionism and ADHD

When perfectionism shows up with ADHD, there is an extra burden of negative self-talk. You may think you’’re not good enough because people have told you that neurodivergence means ‘less than’. It’s so easy to fall into the cycle of “compare and despair”– looking at what other people are doing that you aren’t. Perfectionism is an inadequate attempt to overcompensate for this nagging sense of not measuring up. But, when you hold out your ADHD approval cup to others instead of filling it up yourself, you will always feel deficient. 

Let’s look at how you can reduce your perfectionism and write more freely. It all comes down to relying on a growth mindset and accepting that being perfect is a myth. Remember, the part of you that wants perfection isn’t perfect either! Breaking out of the “all or nothing” constraints of perfectionism is possible once you apply these helpful strategies. 

  1. Set Reasonable Goals

You know yourself well enough to assess what is possible and what is too much. People with ADHD often underestimate how long a task will take and overestimate their capacity to accomplish it. How well can you assess the length of time and effort needed to complete items on your list? Start each day by setting up to three achievable goals based on urgency and time deadlines. Next, break these down into microsteps. For example, instead of having a goal of writing the entire introduction to your paper or report, set the goal of writing one page. If that is too tough to begin or feels daunting, set the goal for one paragraph. There is nothing to be ashamed of–our aim is movement. When you finish this goal, great! Keep going onto the other two.

Notice your time. How long is it taking you to reach this goal? This information will help you structure your work periods in the future. If you thought writing a three page essay or report in four hours was doable but it actually took you five hours, then plan on using this information when setting future goals and plans for working. Perfectionism is less likely to creep in and break your momentum when you’re working towards goals you know you can accomplish.

2. Aim for Progress, Not Perfection

Making any kind of progress is better than being stuck. Even if you end up heading in a different direction, it’s still better than doing nothing at all. Getting the words out of your head into a document is the point–not evaluating the quality of each sentence after you write it. You can and will edit what you’ve created later. Just keep writing. Even if what you are writing is a stream of consciousness and doesn’t seem useful, keep going. You never know what you will keep. It’s the flow that matters. So tell your inner ogre who focuses on what is good or bad to sit down. Initial writing is generative; the evaluation will come later.

We learn from our efforts. No one ever figured out how to ride a bike without a few bumps and bruises. If later, you see that what you’ve written isn’t quite working (and this happens to everybody), you will just have to regroup, edit and pivot. Begin again using the same break-it-down strategy that helped you before. 

3. Set up Co-working

Working alone can be tough for anybody, but especially for people with ADHD. When there are other people around, the group can energize you, keep you on track and offer support. I practice what I preach. I have a few writing buddies and we all gather on Zoom on Friday mornings. We share what we plan to work on and turn off our mics and get to work. If we want to communicate with each other, we write something in the chat. Then at the end of our session, we check in again, sharing what we did and how we are feeling. It’s so helpful to break the isolation and feel the solidarity. Sometimes if one of us is stuck, we will ask if we can talk through an idea with them. This has been very helpful for addressing writer’s block.

4. Use Technology as Your Personal Assistant

Whether it’s a speech to text program or an online writing tool, there are many aids to help people write more effectively and efficiently. Grammarly, Scrivener or Evernote are great places to start. I especially like to recommend Goblin Tools to my clients. It has a Magic To Do list (type in a big task and it will break it down into smaller steps with a time estimate), Formalizer (transforms text into more formal writing), Compiler (do a brain dump and it will create a list for you), and Estimator (enter a task and it will give you a rough idea of how long it might take).

One of my favorite features of Goblin is the “Judge” tool – this feature acts as an impartial reader of your communication. Dump a draft memo or email  into “Judge”, and it will help you to determine if the tone of your communication could be misread, as well as suggest an alternate way to better communicate your message. It’s a great way to escape the grips of paralysis and anxiety caused by those pesky “what if’s”. 

5. Maintain a Growth Mindset

A growth mindset is the best tool in your ADHD toolbox, especially for perfectionists. More than just positive thinking, a growth mindset is about accepting yourself for who you are while opening your heart and your mind to learning and improving. It’s about understanding that we grow through trial and error, and that mistakes are part of that process. Errors don’t make you a failure, they reflect your natural humanity. Perfection is not the yardstick against which you measure yourself.  Aim for steadiness, consistency, and self-compassion instead. When you live with ADHD, it’s easy to fall back on perfectionism to compensate for executive functioning challenges and social insecurities. Unfortunately, this only feeds the pattern of needing approval to be ‘okay’. A growth mindset along with self acceptance will help you nurture essential resilience and lead you to share what is wonderful about yourself – warts and all. 

Everything You Need to Know About IEPs and 504s

 (for Children and Teens with ADHD)

Navigating the ins and outs of getting help for your child in school can be overwhelming, especially when it feels like everyone is speaking a language you’re not familiar with! This week, I’ll help demystify two very different avenues of accessing school support for your child or teen – I’ll share  everything you need to know about IEP and 504 plans for children and teens with ADHD. You’ll be able to advocate for them more effectively and they’ll be able to manage classes and homework with more ease and success.  

 

Many kids with ADHD struggle in school–not just with accessing what they know when they need to use it but also with co-occurring learning disabilities that occur about 70% of the time.  There are several paths that lead to the provision of an Individualized Education Plan (IEP) or Section 504 Service Agreement (504 SA) for your child, but they all start with one thing – concern that your child may need additional support to be successful in school, and a psychoeducational or multi-disciplinary team evaluation to determine why they are struggling.  Your child’s school might request to initiate this evaluation, you might request an evaluation, or you might provide the school with documentation of your child’s existing disability or neurodivergence…there are many different scenarios in which a student can be referred to determine eligibility. 

 

Where to begin the process

Ultimately, everyone wants to ensure that if your child does need modifications or accommodations due to neurodivergence, they receive tools and strategies to be successful at school. This process often starts with a team meeting (that you or your school team typically have to formally request) to discuss concerns that can

 lead to a psychoeducational evaluation, functional behavioral assessment or recommendation to meet with your primary care provider. If your child already has a diagnosis of ADHD and/or an evaluation that you obtained privately, then this meeting will most likely discuss the information that you already have, and any impact on school performance. Either way, you and the school team will discuss what’s going on and the team will decide whether a school based evaluation is appropriate to determine if your child is eligible under IDEA for an IEP or Section 504. If so, then they will develop a plan that outlines what, how, and where any needed supports or accommodations will be provided.  

Now that we’ve laid out how to begin, let’s talk about the basics of an IEP and 504, what each of them is (and is not), and who they are appropriate for. In order to do this, I will be using the word ‘disability’ here when referring to ADHD instead of ‘difference’ because school based services are only provided based on the determination of a disability. 

Individualized Education Plans–IEPs

An IEP – “Individualized Education Plan”  is a legal document that outlines what supports and services your child will receive as a result of being found eligible for special education under a qualifying disability category.  Federal law under IDEA guarantees a free and appropriate education to all students. IDEA is about facilitating academic achievement and progress. IEPs are just one component of what falls under the umbrella of “Special Education” for children ages 3 through 21 in schools.  They offer a road map for teachers, support staff, related service providers, parents, and other team members to follow.  

The Details of an IEP

An IEP can only be drafted after the school has conducted a psychoeducational evaluation (or you bring one that the district accepts), shared the findings with you, and all participants agree that the student is eligible for special education under a qualifying disability category. The named disability has to be found to negatively impact their educational performance so that the student needs specialized support and services to make progress educationally. While disability categories can vary from state to state, federal law under the Individuals with Disabilities Education Act (IDEA, Part B) identifies thirteen categories of disability, including: Other Health Impairment, Specific Learning Disability, Traumatic Brain Injury, Orthopedic Impairment, Hearing Impairment, Emotional Disturbance, Autism, Speech/Language Impairment, etc. 

An IEP is characterized by the modifications that are deemed necessary to make the curriculum more accessible for the student to be successful. These are changes to what is taught or expected, through specialized instruction or the provision of related services (behavior supports, PT/OT, Speech, etc.).  An IEP means that the student has been found eligible for Special Education. 

ADHD and IEPs

Under IDEA, ADHD is considered an “Other Health Impairment.” The psychoeducational evaluation by the school cannot diagnose ADHD per se but will indicate that a child has the symptoms or behaviors commonly seen in attention disorders. This means that you will have to take the report back to your primary care provider or a licensed therapist for a formal diagnosis or clinical/medical follow-up. It’s a complicated process but worth it in the end to get services at school. 

 

Section 504 Service Agreement – 504 Plans

A “504 Plan” or “Section 504 Service Agreement” is a civil rights law that refers to

Section 504 of the US Rehabilitation Act of 1973.  It is a legal document that outlines what accommodations your child needs to ensure equitable access in their schooling.  

A 504 SA can only be drafted after the school has conducted an evaluation or reviewed one that you have provided and discussed the findings with you. All participants agree that the student has a disability that limits their functioning in one or more “major life areas” and qualifies for protection as a result.  ​​These functions include such things as self-care, performing manual tasks, walking, seeing, speaking, breathing, learning, working, eating, lifting, bending, reading, concentrating, thinking, communicating, and more. 

504 Plans Level the Playing Field

A 504 is characterized by the accommodations that are necessary for the student to access the curriculum. It is designed to “level the playing field”. 504’s eliminate barriers to allow students with disabilities to access the same activities and programs as their non-disabled peers. It offers protection to persons with disabilities from discrimination based on their disability. Again, within this definition, ADHD qualifies as a disability. 

Students – at any level – who attend a school program that receives federal funding can be eligible for protection under a 504 Service Agreement. They require accommodations to access the General Education setting.  This means a student who is enrolled in preschool, elementary, secondary, postsecondary, vocational, or adult education can qualify, regardless of age. 

 

With the technical information about IEPs and 504 plans out of the way, let’s look at some common misconceptions and the real truths. 

Myths vs. Facts about IEP AND 504 Plans

MYTH:  My child was diagnosed with ADHD by her psychiatrist/family doctor/specialist, she should have an IEP. 

FACT: She should have an IEP only if progress at her grade level is negatively impacted by her ADHD symptoms. 

A common misconception that many parents have is that a diagnosis of ADHD, “dyslexia” (or a specific learning disability), ASD, Anxiety, etc., made by a medical professional, means that their child automatically needs Special Education programming and an IEP.  This is only true when there is an educational impact because the symptoms of that diagnosis make learning at grade level difficult for the student. 

If she is learning at grade level, but needs accommodations like extra time on tests, verbal directions, etc., to address symptoms of ADHD, then a 504 SA could be appropriate. 

 

MYTH: Our son’s outside executive functioning coach thinks he has ADHD and maybe dyslexia. She thinks the school should diagnose him.  

FACT:  A school cannot diagnose a student with ADHD or diagnose dyslexia. For a clinical or medical diagnosis, you should follow up with a primary care provider or licensed therapist. But, if the school were to do an evaluation and also find him eligible under IDEA, he would have educational eligibility under “Specific Learning Disability” and “Other Health Impairment”, and an IEP could be drafted. Remember that in schools, ADHD is considered an “Other Health Impairment”, and dyslexia is considered a “Specific Learning Disability”. The reality is that the same diagnoses a child receives from an outside clinical/medical professional exist in schools but may be categorized or called something different. No wonder parents get confused!

 

When considering whether an IEP or 504 SA may be appropriate for your child at school, here are 5 key takeaways:

 Key Takeaways

  1. An IEP makes mandatory adjustments and modifications, a 504 SA affords access and makes some accommodations. 
  2. Not all students with neurodivergence need special education!
  3. Clinical and medical diagnoses and educational disabilities are often two different versions of the same language.
  4. A school-based evaluation determines eligibility for special education or a 504 SA. 
  5. Going through the process of determining what types of services are best for your child can be very confusing. Get the support you need by talking with your primary care provider, licensed therapists, special education advocates or knowledgeable coaches.

Overcoming ADHD Brain Fog

Dear Dr. Saline:

I’m a 30 year-old AuDHDer who would love your input. I pride myself on my ability to focus and concentrate on what needs to be done. I’m achievement-oriented and used to be able to blaze through a to-do list. Lately though, brain fog has been hitting me hard. It’s been a period of very high stress. I find myself struggling to make sense of things people say which I would previously decode with ease. I’m hoping this is temporary but it’s embarrassing. What can I do? 

Thanks!

Crystal

Dear Crystal-

Brain fog can certainly be disorienting, confusing and even a bit scary for folks with and without ADHD or autism. Brain fog refers to a group of symptoms that impact how you function cognitively–your thinking, your recall and your concentration. It can also reflect difficulty with making decisions, mental fatigue, slower response time and uncertainty. While we don’t know what causes brain fog exactly, research shows that it’s associated with chronic fatigue syndrome, long COVID, chemotherapy, autoimmune conditions or depression. But, brain fog is not a medical condition so you can’t be diagnosed with it. It’s more like a set of symptoms that arise when something else is going on and you are not thinking as clearly as you could.

As you have shared, the symptoms of brain fog can make it difficult for people to engage in conversations, perform routine daily tasks and follow instructions. Plus, brain fog differs from person to person, particularly women. In fact, it disproportionately affects women because of hormonal changes related to menstruation and menopause. For folks with ADHD who already struggle with focus, memory and organization, stress can bring on brain fog by overwhelming weaker executive functioning skills. 

Develop coping strategies for daily stress

Of course, living with ADHD and AuDHD means living with a baseline of stress that neurotypical adults don’t have to deal with. The consistent inconsistency of being neurodivergent leads to being unclear– if you will follow through on things, if you will arrive on time, and if people will like you. You may freeze in the moment, unsure of what to say or do. Perhaps you lose your train of thought more often and get distracted more easily. Or, maybe you interrupt others or say something awkward without knowing it. This is especially tough in the middle of social situations, peer interactions or important work meetings.

Rely on coping strategies

Crystal, it seems like you’ve developed some useful coping tools to help you make sense of what others are saying to you and respond effectively. I can’t even imagine how frustrating it is for you to deal with this disorienting brain fog. And, let’s be honest, everybody spaces out sometimes. Yes, this may happen more intensely and more often for folks living with ADHD due to how their brains are wired. You are not alone in your embarrassment when this occurs. But, being upset with yourself for something that you cannot control only increases your stress and worsens the very brain fog that is troubling you in the first place.

It seems that  the question you are asking is, “How do I navigate these moments with more ease and less self-criticism?” I think your first step to lower your stress. I am a big fan of being authentic. Authenticity means being transparent and non-defensive when you miss a comment in a conversation or do something that you later regret. Self-care, exercise and self-compassion are all ways to reduce the tension in your life and hopefully the brain fog too. Try these  strategies to lower your stress.

4 techniques to manage brain fog in your life:  

1. Reduce stress by focusing on one task at a time: In today’s busy, constantly connected world, we live with too much to do and not enough time to reset. When we take a walk while talking on our phone or scroll while eating lunch, we don’t actually give ourselves the true break that we really need. We shred our time into distracted chunks instead of having space to exhale and regroup. When we multitask, we stress our brains and exhaust ourselves. Opt for single tasking as often as possible. You may not be able to eliminate all media multitasking habits but, with single tasking, you’ll feel more productive and less stressed.

2. Get enough sleep:Nothing weakens our coping abilities like a lack of sleep. Many people with ADHD struggle with sleep issues. Typically, folks wrestle with three aspects of sleep: falling asleep, staying asleep and waking up. It can be tough to turn off your mind. Perhaps you experience racing thoughts, intrusive worries or a fitful night of sleep marked by “tossing and turning” throughout the night.

Some people sleep so deeply that they struggle to get up in the morning, requiring numerous alarm clocks or physical reminders. Think about your sleep needs: how much, when and what helps you relax. Practice consistent sleep habits by going to bed and waking up at the same times and staying off screens for at least thirty minutes before you nod off.

3. Exercise regularly: I cannot emphasize enough how much exercise helps with clear thinking. The endorphins that are released during exercise enhance focus and increase your overall sense of well-being. Moving your body has been found to improve motivation, build energy and reduce confusion. The Centers for Disease Control (CDC) recommends that adults engage in at 150 minutes per week of moderate-intensity activity such as brisk walking, running, biking, etc. Of course, eating well helps your overall health too. So the next time that you are feeling brain fog descend, try to move your body and see what happens.

4. Chunk your activities and write things down: Instead of relying on hyperfocus, try breaking tasks down into 30-45 minute work blocks. You want to give your brain time to reset and rest a bit throughout the day rather than go intooverdrive and burnout. It can be tough for a lot of people who like to hunker down and plow through a set of projects. But overworking like this uses up the natural glucose fuel in the brain and then relies on cortisol. You wind up creating stress that doesn’t need to be there. Trying to remember everything also adds pressure. Give yourself a break and write things down. This also reduces stress and gives you the visual cues you need to be productive and stay focused.

Aim for reducing brain fog not eliminating it

Learning how to schedule adequate down time to integrate and process information, asking for someone to repeat what they said without self-criticism and taking care of yourself with good sleep, nutrition and exercise habits will reduce your overwhelm and your shame. Remember, brain fog is not your fault; you didn’t choose this. Instead, just explain what’s going on to someone when it is happening and move on. You’ve got this!

Surviving Back To School: A Neurodivergent Parent’s Guide

As thoughts begin to turn from planning picnics and BBQ’s to planning school lunches, our parental priorities shift from “summer fun” to “get it done.”  The back-to-school transition helps set the stage for a successful school year. It is a great opportunity to help equip kids with the tools they’ll need for a smooth start. But for parents and caregivers of neurodivergent students, this time of year can feel especially overwhelming, as it is so much more than just pencils and pens that our students need.  In fact, parents of children who have learning and thinking differences are more likely than other parents to say they feel stressed (39% vs. 28%, respectively), unprepared (19% vs. 12%), scared (17% vs. 9%), and/or lonely (10% vs. 3%) when it comes to back-to-school season. This week, I’ll share practical tips for how you can survive and thrive during this back-to-school season.

Adjust Expectations

As the parent or caregiver of a student with unique learning needs, you know that being flexible is essential. Why not give yourself that same space (and grace) to be able to NOT do it all, and remain flexible with what you’d like to accomplish? Setting too many goals at once – “I’ll arrange playdates every weekend,”  “We will eat breakfast as a family every day,” or “I’ll volunteer 5 hours in the classroom” – can feel overwhelming to both you AND your child.

Families living with ADHD can be especially sensitive to changes in routines. When new tasks are thrown into existing ones, confusion and frustration often come along for the ride. This year, consider viewing back-to-school tasks through the lens of what is truly important to your family’s needs. Instead of one long “to-do” list to slog through, focus on one or two things that are truly important for your family right now.  By limiting your goals and adjusting your expectations, you’ll minimize pressure on everybody and reduce family stress.  

Start Preparations Now with Low-Key Conversations

Now is a great time to begin easy conversations about returning to school – asking what your child is most excited about doing or seeing when they go back, what foods they look forward to in their lunchbox, who they’ll high-five first, etc. These are no-pressure conversations that signal change is afoot. Start with “Tell me what you know about….” this new grade or this new school. You’ll get a sense of their level of understanding and be better prepared to meet them where they are.

By pairing these conversations with visual cues at home such as a countdown calendar, displaying photos of familiar school staff and classmates, meeting their teacher or walking the hallways of a new school, you’ll help make going “back to school” seem less frightening and more familiar.  These conversations are just as important with college age students so set aside some time to start now! 

Set a Positive Course with Collaboration

Setting a positive course for this year depends on collaborating with your son or daughter to establish clear goals and useful strategies. Kids with ADHD spend a lot of time listening to what they could do differently from caring adults, friends,

coaches, etc. By including some of their opinions in whatever program you create, you increase their buy-in. When they feel like their ideas matter, these kids are far more likely to cooperate. So, start this school year with a calm, honest family conversation.This chat sets the tone for how you will work together to make it a success.

Take the Time to Reflect First

Before you sit down with your son or daughter, consider your responses to these questions: 

  • What do you hope for your child or teen this year?
  • What went well last year and why?
  • Can you identify any behaviors or decisions that made a positive difference? 
  • What were some of the challenges? What improved them?

When you’re ready for your conversation, ask them similar questions. Offer some of your reflections and see if you can agree on some goals for this fall. Write these down and, together, choose one to start with.  It can be fun to treat this as a “time capsule” too: make a copy and place it in an envelope to be opened at the end of the semester. Then you can review how things actually worked out–the successes and the challenges.- kept in an envelope until the end of the year (or month, semester, etc.), then reviewed together and discussed.  

Practice time management skills now

Many children who are neurodivergent struggle with time and get frustrated.This makes morning routines tricky and causes conflict.

It’s harder for them to feel time, plan for things accordingly and then actually do them. They tend to overestimate how long a task will take and how much effort it entails. Then they feel overwhelmed, procrastinate or avoid it altogether. Or, they underestimate how long a task will take and the effort involved. Then they leave things until the last minute, rush to complete them and feel very stressed in the process.

Use Backwards Design to Teach Time and Planning Skills

When planning school schedules, practice using backwards design with your child to help them plan – in reverse – for where they want to be (or want to have done) in the future.  This means working backwards  by starting with the end goal and allocating time accordingly.  Sit down in advance and review what needs to be accomplished and how long things actually take.

“You have to be at school by 7:30. It takes  twenty minutes to ride your bike, lock it up and get to homeroom so that puts you at 7:10. Before that, you want to eat breakfast (ten minutes), go to the bathroom, brush your teeth and get dressed (fifteen minutes) which puts you at 6:55 am. Then you have to wake up. Usually you hit the snooze button once or twice which lasts another fifteen minutes. So that means you have to set my alarm for 6:40 if everything goes perfectly. Maybe we should set it earlier for this week, just in case.”

Backwards design benefits kids by teaching them how to estimate time, develop the ability to sequence events and improve planning and prioritizing. 

Notice the Positive to Raise Self-esteem

Parents of neurodivergent children are 2.4 x’s more likely to experience challenges related to their mental health than their parent peers, making self care strategies an essential component of your back-to-school parenting toolkit.  Equally important, however, is to extend these practices to neurodivergent learners with ADHD. They benefit from explicit support and instruction in identifying and incorporating positive events in their day that nurture self-esteem.

Spend a few minutes at the end of the day and check in with your child, asking “What are two things that went well today? What were your favorite times of the day?” Many kids with ADHD tend towards negative mindsets marked by internal self-criticism and judgment. Shifting their thinking not only nurtures growth mindsets but also self-care. By noticing what is working, they start to feel more confident and courageous. Set aside a time to review two highs and one low of the day. Often dinner is a good place to do this. One of my clients calls this talking about “the happy and the crappy;” for another it’s “the rose and the thorn.” 

Your Self-Care Makes Family Life Stronger

Noticing the positive applies to you too. Self-care goals or guidelines for this year bc when parents are stressed kids pick it up and act out.  As adults, we tend to think acts of self care look like bubble baths, a piece of chocolate, reading a book, etc. But setting boundaries, keeping organized, and lowering the pressure of unrealistic expectations also provide much needed relief.  Before tending to your child, start this school year off on the right foot by reflecting on your capacity, your limits and treating yourself with compassion. Then you can show up and guide your child towards thriving once classes begin.

  Ready, Set…LET’S GO!

Back to school will be a breeze for you and your child with neurodivergence when it includes collaborative conversations, time for community support, opportunities to practice time management, setting realistic expectations, and room for personal growth and positive reinforcement.  Help your child or teen navigate this shift back to school by easing them into the changes ahead with the tips above, and you’ll feel ready to tackle this time of year together! 

 

Truth and Trust: Managing Lying in Children and Teens with ADHD

Dear Dr. Saline:

Is it standard for an ADHDer to lie so vehemently? Like he has been caught red handed and he denies it while his hand is in the cookie jar? Or is this because he’s a 13 almost 14 year old boy that thinks he can get away with everything? He lies about taking his medicine then complains we act like we can’t trust him. He is old enough to know what’s right and wrong but still refuses to acknowledge something if he thinks he can get away with it. Then says he didn’t know. What should I do?— Rosie

Dear Rosie: 

Living with ADHD means doing things that you regret, wish had never happened and want to avoid at all costs much more often than you would like to. We know that the ADHD brain lives in the present moment: it’s a Now/Not now existence. Lying is saying something false with a desire to deceive someone. Lying attempts to make the present moment better either through denial (“No, I didn’t eat any of that pie you made for dessert.”) or omission (“Oh yeah, I forgot to tell you that I failed my science test.) Lies aim to increase comfort in what’s happening now, to reduce stress about a problematic situation or to decrease conflict about something that happened in the past. 

ADHD and Lying

With their poor impulse and emotional control and other executive functioning challenges, many children and teens with ADHD engage in lying. Today, tweens and teens are also facing a number of mental health challenges as well. This means that they get themselves into sticky situations more frequently than neurotypical children and teens. When this happens, they will frequently lie to wriggle their way out. This is different from honestly getting facts mixed up, misremembering what occurred or elaborating on stories. Lying is an ineffective coping mechanism in real time situations where kids (or adults) lack alternatives or fear unpleasant consequences. 

Lies also involve magical thinking. For instance, let’s say that your son is wishing away that he didn’t break Grandma’s lamp when he was throwing his tennis ball in the living room even though he’s not supposed to. When you confront him, he may well say: “No, I didn’t do that,” even though you are holding the glass shards in your hands. He believes that if he wishes it away and denies it effectively, you, too, will believe that it didn’t happen.

Lying and Working Memory

But there’s also a very real issue of working memory for kids with ADHD. In some circumstances, it’s not completely a lie if a child or teen truly doesn’t actually remember it. So if you ask your son if he has everything he needs for school, he may say ‘yes’ but has forgotten his lunch on the counter because he was racing around to find his phone. In these instances, there’s no intent to deceive so it’s not really lying. It’s just ADHD forgetfulness and distractibility. When you add worry and shame about ‘messing up’ again into the mix, it can be tough to figure out what is really going on.

The Trust Bank Account

Trust is something that most teens expect their parents should give them automatically. But trust is actually earned. I like to use the analogy of a trust bank account: kids make deposits with truthful and cooperative words and actions. They make withdrawals when they purposefully do not tell the truth, when they do not follow agreed upon house agreements and when they are oppositional. Withdrawals can result in the loss of earned privileges. It’s more helpful to set up consequences in advance rather than create them on the fly when you are distressed.  

Let’s face it, lying behaviors are SUPER frustrating and really maddening. It’s natural for us to get activated, become demanding (“Are you kidding me? Of course you broke the lamp!!!”) and lose our tempers. The problem is that when we lose our cool with our kids, our upset becomes the focus, not whatever they did. 

Building Trust and Nurturing Honesty 

Start by defining lying in a family meeting. Write down what it is and what it is not. Post this in the kitchen as a reminder. Then use these five tools based on my 5C’s of ADHD™ approach:

  1. Self-Control: Lies occur between two people. How does your response increase the likelihood of lying or intensify it in the moment? Settle yourself before you speak to your son. Consider how his neurodivergence might be contributing to what is going on. Take a big pause if you need to manage yourself before responding to him. 

2. Compassion: You cannot ask for honesty and then punish it. That’s neither compassionate nor fair. A positive response to honesty includes having a discussion about what has happened when everybody is calmer. You don’t want to shut things down with anger, guilt or blame. Let him stew on the knowledge that the jig is up for a while and consider what would be a consequence that makes sense to him. Remember, he’s dealing with two things: the lie and and the failure of the attempted cover-up. Neither of these feel particularly good, despite what he may be showing you. This is where your empathy comes into play.

3. Collaboration: Create opportunities for cooperation and restoration. Give your son a chance to make things right and be part of the solution. Brainstorm ideas for Apologies of Action–to move beyond a quick, seemingly disingenuous, “I’m sorry”, to reparation and personal responsibility. What can he do to demonstrate his regret and make things better? Teach and show what a heartfelt apology looks like. If he needs incentives to engage with this process, that’s fine. Many kids struggle initially and need to earn something afterwards.

4. Consistency: Consider your expectations. Growing up as a neurodivergent boy in a neurotypical world is tough. How can your son be who he is and work towards improvements simultaneously? What are realistic expectations for him that you both agree about? He’s got to have skin in the game to build a habit. There is no perfection: we are aiming for his steadiness in honesty–that is to say more often than not. 

5. Celebration: Notice when he is honest and offer specific praise and acknowledgement. You don’t need to bake a cake but a high-five or a call-out will let him know that you see his efforting. Give him a chance to correct himself by offering a ‘Take back of the Day.” He can think about what lie or omission he said and then take it back right afterwards without negative consequences . The whole family can use this as it builds trust and personal accountability.

Changing habits related to lying in children and teens with ADHD takes time, practice, cues and repetition. People of all ages create lies to avoid shame. It’s important to remember that your son’s lying can be a reflexive response to wishing he had made a different choice. He just may not be able to say that–yet.

I hope that you found your time spent in my corner of the internet this week valuable, and that you were able to take away ideas or inspiration to help you along the way.  If you have any questions or thoughts about ADHD and lying, I’m always available at Ask Dr. Sharon and appreciate your thoughts and feedback – it helps keep me inspired for future books and blogs!

ADHD and Depression: 5 Strategies for Better Living

You’ve spent all the money, all the time, and all the energy planning for this – your son’s 11 year old birthday party. The gathering went off surprisingly well, everyone seemed to have a good time, and the day was filled with many special moments. So why are you feeling bad? After allowing yourself to accept accolades from friends and families, you start wandering around the dark corners in your mind of insecurity and self-doubt. Wasn’t the lasagna a bit soggy? Were the games too babyish? Did people really have fun or just say so to be polite? Despite the outward success of the day, you’ve circled right back to feeling like a failure with a bit of shame and self loathing thrown in for good measure. Your underlying depression and its symptoms have officially re-entered the arena. 

ADHD rarely travels alone

I frequently say that “ADHD doesn’t travel alone”, and it is very true – an estimated 18% of adults with ADHD also have major depressive disorder, and about half of adults with ADHD have anxiety.  This is often referred to as “co-occurring conditions”- when two or more diagnoses (or symptoms of diagnoses) exist at the same time. Depression is estimated to be 2.7 times more prevalent in adults with ADHD than those without.  So how do you know which one came first, and more importantly, how do you know which should be treated first?

Explaining Depression

Depression is a complex mental health condition with a variety of symptoms that can affect somebody’s physicial, cognitive and emotional functioning. Typical signs of depression include: feelings of sadness, hopelessness or worthless; irritability; changes in sleep patterns (too much, interrupted sleep or too little); lethargy including; physical problems (including headaches or digestive issues) with no clear cause; suicidal thoughts or attempts; increased use of drugs or alcohol; isolation and withdrawal from social contact.

While depression can affect concentration and focus, these issues vary and mostly occur under stress. Depression is first and foremost a mood disorder so troubles with paying attention are secondary to emotional and physical distress. If you (or someone around you) are having several of these symptoms persistently (for most of the day, nearly every day, for at least two weeks), then please seek professional help by contacting your primary care provider. 

Key Traits of ADHD

ADHD is a neurologically-based condition that typically presents with a range of symptoms seen to inattention, hyperactivity, and impulsivity. In ADHD,  unlike depression, problems with concentration are primary and stem from the executive functioning challenges that come naturally. Inconsistency with attention is one of the hallmarks of having ADHD and one of its most frustrating aspects. Common issues for people living with ADHD include: disorganization, procrastination, emotional dysregulation, forgetfulness, distractibility, excessive talking or interrupting and chronic lateness.

People with depression and ADHD may experience chronic brain fog due to feeling emotionally overloaded in conjunction with their biological attentional challenges. They may also experience low motivation, a lack of joy from activities they previously enjoyed, persistent low energy and profound sadness.

Get Help!

If you are experiencing any of these symptoms typically associated with ADHD and depression, it is important to start with a professional evaluation to help rule in (or out) each of these diagnoses, and understand the impact they might have on each other (and yourself!).  This information will help you and your provider develop a plan with targeted priorities and measurable goals.  In terms of treatment priorities, typically the symptoms that most impact your day to day life will be of initial focus.  

Tips for Reducing Depression with ADHD

Whether you are diagnosed with co-occurring ADHD and depression or struggling with some of the issues outlined above, here are some important tips to keep in mind to help you along the way: 

  1. MOVEMENT: I can’t emphasize enough how beneficial moving your body can be to your overall physical, mental, and emotional well-being. Having endorphins surge through your brain elevates your mood and helps with focus. Whatever you choose to do, start small that you can actually accomplish each day. Keep it simple – gentle stretching, a short walk in the neighborhood, riding a bike around the park–these are great activities to start with. Exercise in any form can help create new routines that brains wired for ADHD and/or depression really benefit from. 
  2. BE EASY ON YOURSELF. Be kind to yourself in the ways that you would treat a friend or loved one. When brains wired for ADHD experience depression, it can make even the most simple of tasks feel doubly insurmountable. There are days when getting a shower or putting away groceries require all of our mental, physical, and emotional reserves. When struggling with ADHD and depression, these reserves are already in even shorter supply, and so completing even the smallest of tasks is worth celebrating.  Be kind to yourself, and celebrate the smallest of successes each day along your journey.
  3. A WORD FOR WOMEN: Women tend to be referred for anxiety or depression instead of even considering ADHD. As familial, work and social pressures increase in intensity with age, women are more than twice as likely to develop depression compared to those without ADHD . ADHD and depression often “look” different in women than men, as these symptoms and feelings are more often internalized (kept inside, invisible to others) than externalized (able to be seen or observed by others typically in anger).  
  4. START SMALL. For brains that get bored easily (yet also struggle with organization and motivation), it may be tempting to feel as though you need to make ALL the changes, RIGHT NOW.  And while change can be good, it’s important to think long term – what is sustainable, and easy to do again and again? What will fit your lifestyle? What is a good “environmental  fit” – ie, what small changes can you make that will meet you where you’re at, in this moment, that you can do consistently each day? Imagine beginning to feel better like training for a marathon – start small, do it each day, and slowly increase the difficulty as you feel better each day.  
  5. ARM YOURSELF WITH KNOWLEDGE. Simply reading this newsletter helps to make protective, positive deposits in your knowledge “bank”!  When our brains struggle with symptoms of ADHD and/or depression, education can be an incredible tool to help tame negative self-talk, and counter spirals of shame and self-doubt that repeat in our head.  Use trusted resources and information from professionals available online, and consider time spent online working towards feeling better time well spent!

Ask Dr. Saline: Do you have any advice for women with ADHD going through menopause?

 Dear Dr. Saline,

What advice do you have for women with ADHD going through menopause? I’m already pretty forgetful and moody, even before “going through the change”. Should I expect my ADHD symptoms to get worse? Would fluctuating hormones affect me? Any insights would be truly appreciated!

Thanks,

Becca

Dear Becca,

ADHD shows up differently in females than in males. Girls and women with ADHD tend to have more challenges with anxiety, social awkwardness, overwhelm, and depression than boys and men. So it can be expected that there are female-specific symptoms and manifestations of ADHD at different stages of a woman’s life. Moreover, there is evidence of the relationship between declining hormone levels, mood and cognitive capacity. Let’s take a closer look at how menopause can affect ADHD and what you can expect in this season of your life.

ADHD and Menopause

Research has shown that hormonal changes can affect ADHD symptoms, increasing distractibility, mood changes, and forgetfulness. The onset of perimenopause and menopause can lead to extreme mood and cognitive shifts related to the declining levels of estrogen and progesterone. Women who may have experienced mild symptoms of ADHD (known or unknown) may suddenly experience issues that seem ‘new’ and distressing to them including decreased working memory and time management abilities and increased impulsivity, reactivity, disorganization, and overwhelm. Some women report that their pre-existing ADHD symptoms seem to get worse during menopause.

In a recent ADDitudemag.com survey, women between the ages of 40 and 59 reported that their most problematic ADHD symptoms were overwhelm, brain fog, memory issues, and time-management difficulties. And women over 60 reported struggling with brain fog and memory issues, procrastination, and overwhelm. It is still not clear whether menopause amplifies ADHD symptoms or vice versa. Regardless, these and other issues like difficulty sleeping and mood swings need to be managed.

What Can You Do For Yourself?

Despite limited research about ADHD and menopause and a lot of misleading information found across social media, my best advice is to work with your health care team to help accurately diagnose and treat your symptoms. In addition to that, there are some things you can do for yourself to help you stay grounded, confident, and strong as you navigate menopause. Here are a few suggestions:

  1. Find support in your community

Whether it’s friends, coworkers, neighbors or family members, make sure you have a supportive community around you. Menopause can be a difficult time for women, physically, psychologically, and emotionally. A group of understanding and like-minded women can make all the difference. Remember that virtual communities and online groups are also great options if getting together in person is difficult.

2. Stay informed

Read articles, listen to podcasts and follow news sources which provide accurate, verified information about ADHD and menopause. Becoming well-informed and reading up on the latest research is empowering. When in doubt, consult with your physician and other knowledgeable health professionals before believing social media posts or TikTok videos.

3. Practice Self-Care

So many women provide great care for others but don’t take care of themselves. Try to make yourself more of a priority. Unless you are healthy and strong, you won’t be able to meet all your obligations, so start putting yourself first more often. Nutrition, exercise and sleep hygiene are critical during menopause. And don’t forget about the importance of emotional wellness and confidence. Many women find that meditation and journaling help them achieve focus and clarity in their day-to-day. Others seek out a therapist or coach to assist them with addressing shifting emotions and developing effective strategies.

4. Show yourself kindness and empathy

It’s easy to feel down and be hard on yourself due to your ADHD-related challenges. When you’re already stretched thin, the tasks of daily living, working and parenting can require more effort, time, and focus than you would like. Remember that you are doing the best you can with the tools available to you in a given moment. So, try to find some extra compassion and understanding for yourself. Instead of listening to the relentless nagging of your inner critic and its messages of doubt and judgment, identify the skills and supports you need to live your best life as a woman with ADHD. Connect with others who have shared a similar journey: reach out to the sisterhood of neurodivergent women. You are not alone, and you will get through this.

“Boosting or Breaking Productivity: The Impact of Hyperfixation on People with ADHD”

Are you ever so engrossed in an activity you love that you completely lose track of time? Does it seem like you lose sense of where you are and what’s happening around you? And when you snap back into the reality of what’s going on around you, are you disoriented? People with ADHD and neurodivergence are more likely to experience this heightened state of focus known as “hyperfixation” than neurotypical children and adults. Hyperfixation is defined as full immersion in something of interest to a point where a person appears to ‘tune out’ everything else. While this can be viewed as a productivity superpower, it can also draw you into unproductive, procrastinating activities. That’s part of what makes it both exhilarating and frustrating.

Hyperfixation, it seems, is a double-edged sword: a great capacity for effective performance on interesting, high-value tasks on the one hand and a great capacity for avoiding things by disappearing into pleasurable distractions on the other. So how can you harness hyperfixation as a productivity tool more often while not letting it become a mechanism of avoidance and procrastination? Nurturing executive functioning skills such as prioritization, time management and self-awareness will help you apply the power of your hyperfixation more efficiently. 

ADHD Hyperfixation vs. Hyperfocus

The terms ADHD hyperfixation and hyperfocus are often used interchangeably, but they refer to two distinct phenomena.

ADHD hyperfixation refers to an intense and often prolonged state of concentration on a particular activity or object which is pleasurable and can be productive. Because hyperfixation is fueled by a deep passion for or interest in the activity, it can quickly become an obstacle to productivity. When you’re fully engrossed in an activity that you lose track of time, you may neglect other tasks and obligations to your own detriment.

On the other hand, hyperfocus is task-driven and is often accompanied by clear goals and a sense of purpose. It’s less about enjoyment and satisfaction and more about getting into the flow of an activity. It’s a state of being fully engaged in a task for which you have a clear sense of direction. Hyperfocus is linked to increased productivity and a sense of accomplishment.

Both hyperfocus and hyperfixation may be challenging to regulate. If not managed well, they can get in the way of daily living. That’s why learning to manage these states is important, especially for people with ADHD and neurodivergence.

4 Tools to Help You Manage Hyperfixation

Productivity is an important aspect of life for kids and adults alike. However, it’s a process that many folks with ADHD and neurodivergence struggle with, especially when hyperfixation gets in the way. The best way to cope with hyperfixation is not to fight it by forbidding certain activities, but rather to use it. Making work or school stimulating can capture your focus in the same way as your favorite activities. By finding a job that caters to your interests, an individual with ADHD can truly shine, using hyperfocus to their advantage.

Here are four strategies to assist adults with ADHD with managing hyperfixation and using it as a superpower: 

  1. Identify and investigate: Learn more about your pattern of hyperfixation by increasing self-awareness. What does it look like for you? How long does it occur? Do you neglect self-care? How do you respond to interruptions? Notice when you tend to engage in hyperfixation by examining the situation, the environment and your motivation. Are you focusing on an interesting task or avoiding something unappealing? This type of reflection builds your capacity for metacognition. Thoughtful self-evaluation will help you monitor when hyperfixation takes over and what you can do to exit mindfully from an episode.
  2. Plan and prioritize: Do a brain dump of all of the tasks in front of you for the day or the week. Then make another, shorter list where you order them in terms of urgency (do it now because of a deadline) or importance (value and satisfaction with less pressure). Break down your day into blocks of time and assign the urgent tasks first followed by the important ones. Flag the ones that can be rolled over into the next day. Limit the quantity of the tasks so you can complete tasks and feel accomplishment.
  3. Improve time management: Use tools to increase your awareness of time and how it passes. Set up several alerts using a variety of tools–your phone, your computer, banners across the screen, or analog clocks or timers. Work in intervals with planned, structured breaks to keep yourself on track and limit the negative aspects of hyperfixation. If you struggle with initiation, help yourself overcome task paralysis by setting up meaningful incentives and breaking down large tasks into smaller, more manageable ones.
  4. Find an accountability buddy: You don’t have to address the challenging, over-absorbing aspects of hyperfocus alone. Ask someone in your life who understands ADHD and cares about you (a family member, friend or colleague) to check in within you at times or during activities when you are prone to hyperfixation. This can help you break up these periods. If this person also has ADHD, you can support each other as well. Helping somebody else with their hyperfixation can assist you with self-regulation too!

Boost Mental Well-Being for Women with ADHD: Reduce Self-Criticism and Build Self-Confidence

May is Women’s Health Month: a time to recognize and advocate for women’s physical and mental health care. Women with ADHD, and those who care for neurodivergent children, frequently deal with additional stressors, anxiety and depression, often without adequate support. At the same time, they can berate themselves for the things they are not in the face of impossible social standards laid out for females of all ages. Self-doubt frequently creeps in and plagues your ability to make decisions and feel good about your choices. Sadly, too many women with ADHD are often their harshest and loudest critics, making it tougher to feel good enough, worthy and empowered. Psychological and emotional wellness for women begins with learning to quiet that negative inner-voice, practice self-compassion and develop resilience.

The harsh feedback loop in women with ADHD

Women are socialized to please others and take care of them–emotionally, physically and psychologically. Their self-worth can be tied to what people think about them and how many friends (real or virtual) they have instead of the uniqueness of their innate talents and personal traits. In today’s busy and over-connected world, it’s easy to compare yourself to others and come up short. Suddenly you may find yourself in a cycle of negativity in the midst of scrolling your Instagram while waiting in line for a latte or for school pick-up. This self-critical feedback, generated from years of messages about missing the mark, tuning out during a conversation, or being chronically late, can be hard to shake off. Women with ADHD, already sensitive to feedback or rejection, repeatedly interpret things more negatively and personally than the situation may actually call for. They are especially vulnerable to feelings of low self-worth.

Change your relationship with the negative voice

While it’s unrealistic to eliminate negative thinking, reducing its power and influence is crucial for fostering self esteem and resilience–two key issues for women. You have to change your relationship to the negative voice: to separate actions you regret and the layer of shame you add onto them. Identify the lies that voice tells you such as: “You are stupid, you make bad choices or nobody likes you.” We all have moments when we doubt or blame ourselves. But there is a difference between what happens in real life and the stories that you tell yourself about those events. These harsh interpretations directly influence the way someone takes meaning from whatever occurred. 

Although the inner critic seems to increase insecurity and self-loathing, deep down it’s goal is to protect you and ensure you are safe. It puts you down in a misguided effort to keep you from experiencing pain from others. If you already think you aren’t good enough, then whatever anybody else says on this subject can’t hurt you. Nobody can be more critical of you than you are of yourself so you avoid the vulnerability of receiving negative feedback. This may sound confusing and even crazy but it happens for all of us.

Stumbling and regrouping is part of being human

It’s natural for all of us to stumble and make mistakes. Being accountable for an error and making amends to set things on a better course differs significantly from repeated apologies, not learning from your experience and engaging in the blame game. Your goal is to turn down the volume and intensity of that negative voice by acknowledging and accepting who you are in a given moment with whatever resources you have available. You don’t have to believe what the inner critic is saying. Instead, acknowledge the feedback loops in your mind without being ruled by them. See the inner critic as the irrational, unbalanced and demented protector it is–holding you back from taking risks and sharing your true self with the world.

Make space for confidence and resilience with a growth mindset

The most powerful tool women have to counter negative thinking is self-esteem and its cousin, resilience. Confidence empowers you to make decisions, get through life’s ups and downs and recover after setbacks. It’s your inner ally. Confidence also helps quiet the inner critic by reassuring it that your wise, inner self has the resources to meet whatever challenges you are facing. So while you’re quieting your inner critic, turn up the volume on the voice that nurtures you with compassion, kindness and support.

  1. Identify limiting core beliefs and negative self-talk. Name your limitations and the ways that you put yourself down. Then, find evidence that contradicts those beliefs. Write these down. If you believe that people don’t really like you, think about the ones who do. Recall a time when you had fun together. Write this down as a reminder. Remember that no one is judging you as harshly as you judge yourself. Talk to people in your life who love and know you best and get their perspective on all your best qualities.
  2. Separate feelings from being: Feeling bad doesn’t mean you are less than or unworthy. It may be tough, but your work is to stop letting negative feelings from defining who you are. Imagine that your mind is the sky and your thoughts and feelings are clouds that pass by. They aren’t the essence of the beautiful blue expanse of who you are. Use self-affirming phrases such as “I can feel anger without overreacting,” “I’m disappointed in myself but I’m not a bad person” or “I can try something new and handle whatever happens because I’ve done that before.” 
  3. Nurture a growth mindset approach: Shift away from trying to prove your worth to others, using false comparisons or judging yourself as less than. Transition from seeing yourself in a negative light to practicing compassion and kindness toward yourself. If you are saying something to yourself that you wouldn’t say to a third grader with a skinned knee, stop. Remember that we are all works in progress, learning and developing at our own speeds. Believe in the power of “YET.” Tell yourself, “I may not be able to do this YET, but I am learning.” Practice kindness and patience towards yourself.
  4. Create phrases of encouragement to strengthen your inner ally: Having a few helpful phrases to say to yourself can really help you get through those low moments. Positive self-talk counter-acts that negative voice so you don’t have to believe it. Build your confidence, reinforce your strengths and tame your inner critic with reminders of your gifts and traits. Sample statements might be: “Everyone makes mistakes, including me. What can I do differently next time?” OR, “There’s no such thing as perfection. It’s okay to stumble, just keep trying.” Write these down on your phone so they’re handy when you need them.
  5. Practice mindfulness and self-compassion with meditation: Picture yourself in your “happy place”–somewhere you love where you feel calm and content. Visualize the face of someone whom you love and trust. What supportive words would this person say to you? How would these words comfort and encourage you? Put your hand over your heart and send their love to you. Write these phrases down and return to these images and words whenever you need a boost. Learning how to fill up your own bucket fosters the essential resilience women need now more than ever. 

If you’ve been stuck in a pattern of knocking yourself down, learning to pull yourself back up takes A LOT of practice and grit. Learning to control the volume on that negative voice is a life skill based on persistent resilience and genuine self-esteem. It’s one step at a time so stay patient because two steps forward and one step backwards is still forward motion. 

 

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