Ways in Which I Attempt — and Fail — to Mask

I buy an extra-large calendar for work and use a rainbow of colors to never forget my to-dos, attempting to visually imprint the needed information in my mind. I set timers. And alarms. And reminders on my Alexas.

I hang up a 48-inch by 47-inch magnetized chalkboard on the wall near my kitchen, so I’m able to see it from three rooms away. This way, all appointments and reminders are front and center, smacking me in my face.

I coated the board with chalkboard paint, but the wait in between each coat made me fear I’d lose interest in my attempted organization before I was able to finish.

When all was said and done, the board didn’t erase as I hoped. It turned out I accidentally painted the board’s porous side, not the slick side. So the board is now anchored to the wall with the month of July crossed out, August written in its place. A reminder of another grand idea that met a swift demise.

[Read: 5 ADHD Organization Tools That Never Work for Me – and 5 That Do]

I buy a trending keychain that comes with 24 tags hanging off of it. Their purpose? To annoy and remind me to get my tasks done so I can remove said tags from my wrist. I need reminders to take my medicine, to remember my computer, to charge my phone, to pack my lunch and coffee, and all of the other things I tend to forget.

But wait, there’s more. The back of my hand serves as the backup to my backup. Reminders smeared on my skin for appointments I’m sure to miss.

I Mask, and Pay the Price for It

The memory on my laptop keeps running out. A clean sweep is warranted, but I only end up deleting a few downloads at a time because I’m afraid of deleting a document, file, or picture I may someday need.

I have 30,700 unopened emails, 549 unheard voicemails, and 125 tabs open on my phone browser. It’s no surprise that I missed last month’s email telling me my story placed 11th in Round One of a contest I entered. Or that I completely missed Round Two.

[Read: “Masking with ADHD Is the Ultimate Energy Drain”]

A few months ago, I entered another writing contest, made the honorable mentions category, and received an exciting monetary award. I kept waiting for the check to come in the mail, telling myself, “next week.”

But next week never came, and instead I missed the email, and subsequently the window, to collect the funds.

And so, I hide.

I buy the new journal, or planner, or whatever I feel I need, to appear and attempt to be a little more organized.

So, How Do We Break the Masking Cycle?

We accept and educate ourselves. It is only through a deep dive into how our minds work that we better understand why we think and do the things we do.

We speak up and out. We tell our truth, remove our masks, and allow our voices to be heard, normalizing the conversation surrounding ADHD and other mental health disorders.

And finally, we have a sense of humor.

Neurodivergent Masking: Next Steps

• Free Download: The Funny Side of Living with ADHD
  
• Read: Why ADHD Masking Is a Form of Self-Sabotage
• Read: “We Are Who We Are. There’s No Shame in That.”

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RSD makes everyday, non-threatening social encounters incredibly stressful. Because of RSD, I’ve missed one too many social activities to avoid dealing with the emotional fallout of potential rejection. Horrified that I would say or do something wrong, I would decline invitations from friends or skip optional work activities. My friendships and intimate relationships suffered as a result.

A change of plans, even if rational, would send me into a panic. My mind raced with catastrophic worst-case scenarios – beyond “this person doesn’t like me.” I scanned facial expressions for the slightest hint of negativity to confirm my irrational thoughts. At work, I second-guessed every decision and comment from coworkers, constantly fearing I’d be fired. As someone highly sensitive to feedback due to ADHD, perceived rejection or even constructive criticism felt unbearable and left deep emotional wounds.

Overcoming Rejection Sensitivity with Mindfulness

It took realizing that I was experiencing RSD in the first place for things to improvement to begin. Awareness of the biological roots of my intense reactions helped reduce my shame over what felt like a personal failing. But knowledge alone doesn’t always curb anxious thoughts in the moment. That’s where mindfulness steps in.

Mindfulness teaches you to observe your thoughts and feelings in the present moment without judgment. The idea is this: Pausing to observe calms intense emotions and provides space to avoid getting carried away by them. Below, I share a few mindfulness practices that have helped me cope with RSD.

[Get This Free Download: Understanding Rejection Sensitive Dysphoria]

1. Get Moving

At first, I struggled to literally sit still with racing RSD-fueled thoughts for more than a few minutes. I learned that it’s easier to enter a state of mindfulness while I walk. As I walk, I notice physical sensations to anchor my attention to, like my every inhale and exhale and the contact my feet make against the ground. Tracking small details is such an effective distraction from worrying narratives. Over time, I was able to sustain non-reactive awareness for longer periods.

2. Thoughtfully Question

Mindfulness also helps me recognize the cognitive distortions behind RSD. I learned to question whether my perceptions line up with facts. Was someone really angry at me just because their voice sounded off? Why assume the worst with little evidence? Approaching each situation with the willingness to question my reactions, again and again, eventually grew easier.

3. Write It Out

What is writing, if not a pure exercise in mindfulness? The process of channeling thoughts onto paper forces me to slow down, name what I’m feeling, and eventually look for a balanced perspective rather than stew in emotion.

4. Kind Self-Talk

Whether you’re walking or writing, kind self-talk is part of mindfulness. The trick is breaking patterns of harsh criticism after setbacks and replacing those with a thought or two about what went well. Learning to notice and appreciating small social wins boosted my confidence and made future interactions easier.

[Read: The Power of Positive Self-Talk — Increase Productivity and Happiness]

Today, RSD still comes, but I’m armed with coping skills. When anxiety rises, I breathe deeply and shift focus outward rather than spiraling inward. I try my best to pause before I react and stretch the space between desire and action. I accept uncertainty instead of constantly seeking reassurance that only prolongs distress. I don’t always get it right, and RSD sometimes gets the best of me, but regularly practicing mindfulness has undoubtedly upped my emotional resilience. Most importantly, I’m learning to be gentle with myself.

Overcoming Rejection Sensitivity with ADHD: Next Steps

• Get This Free Download: Emotional Regulation & Anger Management Scripts
• Read: “I Can’t Handle Rejection. Will I Ever Change?”
• Read: How Fear of Failure & Rejection Keep Us from Trying New Things

SUPPORT ADDITUDE
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As a family physician who specializes in ADHD, I see patients who are not just frustrated by their interactions with providers but devastated by the way they have been treated. They have significant impairments that provider after provider has minimized, and they have a very hard time getting help.

I have been treating ADHD for more than 15 years and what my new patients tell me about the struggles they’ve endured while seeking care is disheartening and depressing. Many of us providers haven’t been taught about ADHD in adults and are afraid to diagnose or treat it. To help you, the provider, be part of the solution, instead of part of the problem, I offer the following points to help you understand ADHD and really see the patient in front of you.

The Person in Front of You

• The person in your office is scared to death that you are going to judge them or invalidate their experiences. They have probably spent weeks or months debating whether they should say anything about their impairments.
• This person likely has been let down by the medical system that minimizes their impairments and even scoffs at their pain. As they’ve learned to expect such treatment, they may feel they have to go overboard to convince you that they really are impaired.
• At the same time, the person in front of you likely feels ashamed that they can’t “adult” — that they can’t handle the mundane details of human existence that we all have to deal with, so they may minimize their impairments. Patients, in sum, will either overstate or minimize their impairments. Both sides are normal.

[Read: Is Adult ADHD Real? Yes — and Still Heavily Stigmatized]

You, the Provider

• Please check your filters at the door and listen to your patient with curiosity and an open mind. It may help to think, “What if everything they’re saying is true?” Remember that your patient showed up because they are sure that something is wrong with them. They feel awful, tired, and overwhelmed no matter what they do. Attend to your patient’s concerns thoroughly.
• Pause if you catch yourself thinking, “That’s normal. I do that.” We all know what it is to experience forgetfulness, moments of impulsivity, and other behaviors that look like ADHD. What signals ADHD is the degree to which a patient’s symptoms cause impairment and suffering.
• Treating ADHD is incredibly rewarding. Most of us went into medicine to help people and make a positive difference in someone’s life. Helping a patient manage their condition results in truly life-changing outcomes.

On Diagnosing ADHD

• There is no one perfect way to diagnose ADHD. Most people are diagnosed with the use of rating scales like the ASRS, Barkley, or Conners, which are often sufficient to screen for ADHD alone.
• Even if you aren’t a specialist, you can diagnose ADHD.
• Neuropsychological tests are not a good way to diagnose ADHD. The psychologists who do those tests feel even less comfortable diagnosing ADHD than you do.
• ADHD is more underdiagnosed than it is overdiagnosed.

[Get This Free Download: The Clinicians’ Guide to Differential Diagnosis of ADHD]

On Treating ADHD

• Stimulants really are the best first-line treatment for ADHD.
• The Schedule II controlled substance classification for stimulants makes them sound more addictive than they actually are. After all, consider the fact that many patients who take prescribed stimulant medication for ADHD frequently miss doses and, in my experience, days of medication. How often do you think your patients who take opiates or benzodiazepines forget to take their medication? Not very often because they get physical withdrawal symptoms if they miss a dose.
• There is no way to know ahead of time what stimulant and dosage will work best for a patient. Trust what the patient says about how their medication is working. My experience shows that, if left to make the decision on their own, most patients will choose too low of a dose.
• Stimulants need to work for as long as possible during the day, not just for a few hours. A patient shouldn’t have to pick and choose the hours during which their medication should work in order for them to function and meet life’s demands. Would you want that for yourself? Would you present your most focused, productive self only to your morning patients? What about your afternoon patients and your family? Is it fair that they see your most irritable, unfocused self? These are the kinds of decisions patients have to make if their stimulant doesn’t last all day long.
• Most patients are not drug seeking. They are desperately trying to find a way to function like adults and gain control over their lives. What they seek most is your understanding and support.

Listening to Patients with ADHD: Next Steps

• Get This Free Download: The Clinicians’ Guide to Treating Complex ADHD
• Read: A Clinicians’ Guide to Better Patient Communication
• Read: Racial Disparities in ADHD Care — How Clinicians Can Better Serve Patients

SUPPORT ADDITUDE
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As a therapist, I treat so many people with ADHD who struggle to meet intention with action. It results in draining, self-sabotaging habits and forgotten goals. It makes my clients feel like they have no control over their lives.

Though executive dysfunction is a part of living with ADHD, there are ways around it. The following tools have helped my clients with ADHD break free from its grip and take action in their everyday lives.

How to Get Out of ADHD Paralysis: 5 Tools to Beat Executive Dysfunction

1. The Countdown Trick

In many of our kitchens is a handy device to propel us to action: The microwave timer.

The magic of microwave timers is that they constrain an activity, giving it a fixed end time. Bring this principle to other activities in your life! Commit to, say, tidying your kitchen until your clothes are done washing. Only scroll through social media while the pasta cooks. Get up from the couch when a podcast episode ends.

[Get This Free 2025 Calendar of Small Wins]

2. “Do It for Future Me.”

What actions of today will your future self – whether it’s the you of later today, next week, or next year – thank you for? Carry this with you to help you build motivation and accountability. For some, their future selves feel like different people, which helps even more with accountability.

If you want to get better about brushing your teeth or flossing, for example, consider leaving a sticky note in your bathroom that reads, “Do it for future you.”

3. Pair a Treat

Whether it’s filing taxes while drinking your favorite tea, jogging while listening to an audiobook, or studying with a cup of hot chocolate, add in a small treat to boost the fun factor of an otherwise boring or dreaded activity. You can even supercharge this by only letting yourself enjoy the fun activity while you’re doing the boring one.

4. Find a Buddy

The mere presence of another person, even a stranger, is a powerful tool for maintaining focus and consistency. And it doesn’t have to be in person. Video chat with a friend while doing chores. Have a tough time sticking to hobbies you enjoy? Join a club or two. Head to the library or a coffee shop to get into study mode.

[Read: Get More Done with a Body Double]

5. Do It Imperfectly

Avoid falling into the all-or-nothing trap – avoiding a task if you can’t do it perfectly or completely in one sitting. Perfectionism is the surest path to overwhelm, guilt, and paralysis. You don’t have to wash everything in the sink now or declutter your entire home. Do a dish or two. Focus on one small area of your home for 10 minutes. Commit to doing a “medium” job, not a perfect job.

How to Get Out of ADHD Paralysis: Next Steps

• Get This Free Download: Your ADHD Dopamine Menu Template
• Read: Intention Deficit Disorder – Why ADHD Minds Struggle to Meet Goals with Action
• Read: How to Sharpen Executive Functions – Activities to Hone Brain Skills

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We try so hard to fit in at family gatherings. We do our best, yet we end up feeling disconnected, misunderstood, and left out when what we most want is belonging and connection.

My neurodivergent kid is now a teen. Over the years, I’ve figured out a few things that have saved me during the holidays. I share them with you so that they might save you some agony as you navigate and potentially redefine your family’s holiday traditions.

How to Survive the Holidays: A Guide for Neurodivergent Families

1. Ditch the guilt.

I used to feel guilty about not being able to do the holidays “right.” But guilt didn’t help me at all, and it won’t help you. You’re doing the absolute best you can, and that’s more than enough!

I had to stop agonizing over homemade gifts and mailing out custom photo cards with personalized letters that detailed the year’s achievements. We now skip the family photos in front of our tree, and we happily share some hilarious snapshots of our kid (and us) having a good time instead.

[Get This Free Download: Your Free Holiday Survival Kit]

I used to beat myself up for not baking cookies, not having a perfectly decorated home, and not organizing every holiday activity. But I didn’t even enjoy doing many of these activities! I’ve learned that it’s OK to let go of the expectations I thought I had to meet. My kid is happy with a few select traditions, and he’s happiest when I’m not freaking out about making things perfect. Perfectionism is the thief of joy.

2. Redefine normal.

What does a “normal” holiday gathering look like, anyway? Is it perfectly cooked meals? A perfectly behaved family? Or is it a cozy night in, playing board games and watching a favorite movie?

Our holiday activities have evolved over time, and today we enjoy a low-key celebration with just our immediate family. We’ve also been known to skip traditional Christmas dinner and opt for Chinese food and a favorite movie (Elf). We may find a nearby hotel with a heated pool. Why not? We’ve created our own rituals that work for our family.

3. Communicate openly with family and friends.

While it’s never easy, things are a lot smoother when everyone is on the same page in advance. We’ve learned to be upfront about our family’s needs and limitations. We set boundaries and request relaxed expectations for manners and mealtimes. One year at a holiday gathering, I explained my goals to our host (enjoy my meal and have a pleasant conversation). I also decided to take my son’s chair away entirely. At that age he rarely sat to eat, anyway. I asked the other adults to ignore what (and how) he was eating. We had a backup plan (kiddie movie) but we didn’t need it. That was the first year he actually ate some of his dinner and participated in the conversation!

[Related Reading: Bring This Article to Your Next Family Gathering]

Long goodbyes are a thing in my extended family, but sometimes we make a run for it (and explain later) because my child desperately needs a break.

When I start to feel ‘othered’ during the holidays, I try to remember that everyone does well when they can. This also applies to my extended family members, who aren’t always as aware of neurodiversity and inclusion as I am – but they can learn!

4. Minimize sensory overload as much as possible.

While we can’t take our hammock swing or trampoline with us when we visit family, we can take noise-canceling headphones, weighted blankets, and fidgets. Being neurodivergent myself, I need to minimize noise, bright lights, and strong smells – or I feel stress on top of my stress! I also can only handle so much small talk, so I’m the first to volunteer to walk a dog or take the kids to the playground. That way, we all get fresh air, and we get to swing, jump, and climb!

5. Plan ahead but embrace flexibility.

We try to think ahead of possible tricky scenarios and have an exit plan. We check in with each other during the event and we make sure to schedule plenty of downtime later. We’ve also learned to adjust our plans based on how intense the gathering feels.

6. Practice radical self-care.

This holiday season, I urge you to prioritize self-care so you can be the best parent you can be.

For me, self-care looks like…

• …a spontaneous kitchen dance party with our whole extended family
• …a quick walk around the block
• …a podcast while cleaning up
• …or a few minutes of journaling.

If a certain activity or event is going to be too stressful, I’ve learned it is better to just say no. Self-care might also mean setting boundaries with family and friends (and not skipping my therapy appointment if I can help it).

I’ve also learned the power of taking turns with my partner. When each of us has some time to recharge, holiday trips and events go more smoothly.

7. Focus on what matters most.

I’ve spent a lot of time thinking about my core values and priorities. It’s important for me to spend time with loved ones, create joyful memories, and practice gratitude. What’s not as important for me during the holidays is to check off a list of tasks. I don’t want to race around and pack my family’s days. I want to allow space for wonder. How about you – what do you value? What ‘shoulds’ will you say no to?

No matter your answers, may this holiday season go smoothly for your neurodiverse family.

Getting Through the Holidays: Next Steps

• Read: Minimize Holiday Havoc with These ADHD-Friendly Strategies
• Read: “My Christmas Meltdown – A Yearly Holiday Tradition”
• Q: “How Do We Avoid Family Drama and ADHD Ignorance This Holiday Season?”
• Watch: “Family Ties – Managing and Advocating for Your Child with ADHD in the Extended Family”

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

The lag in her social skills — not uncommon among individuals with ADHD — made for rough going during her first semester in college. She started strong in planned group activities but floundered once they ended. A bout with COVID and the stress of a rigorous course load compounded her isolation, and by the time Willa came home for winter break, she was pretty miserable.

Something had to change. I couldn’t bear to see my sweet kid so unhappy at her first-choice college, a perfect-for-her place full of like-minded kids who could be her besties.

Why Friendships Are Hard to Foster

Follow-through was the primary issue for Willa. She’d enjoy lunch with a group but lose track of where they’d head next. She’d have a great conversation with someone but fail to get their name or number. Or she’d let weeks go by without reaching out to a cool kid she’d met. She was constantly starting back at square one, which was exhausting and nerve-wracking.

What Willa needed was continuity — the opportunity to build on new connections so they could blossom into nourishing relationships in which she felt at ease. So I came up with a plan – a game I call Friendship Bingo.

[Get This Free Download: The ADHD Guide to Making Friends]

Friendship Bingo, Explained

Willa and I made a list of potential friends she had met during the first semester. Her mission for the next semester was to find various ways to connect with each of them several times over a week, from dinners and walks back from class to study sessions. The idea was that stacking multiple interactions with someone within a short span of time would make Willa feel solid enough to relax and be her charming self.

We aimed for three outside-of-class-or-club interactions per week. Two could be dining hall meals, the easiest opportunity for hanging out, but one had to be something else — anything unstructured and social. And we agreed that, over the course of several weeks, Willa would try this with different people, to give herself options in case she didn’t vibe with someone.

The “bingo card” she ended up with looked something like this:

Friend	Week 1, Meal 1	Week 1, Meal 2	Other Hangout	Bonus Hangouts
Hannah
Finn
Isobel			!	!
Tye			!	!
Summer

The chart appealed to Willa’s love of spreadsheets and data and made it easy to see and celebrate wins. It also made it clear with whom Willa was undeniably becoming real friends.

In Willa’s Words: Friendship Bingo Works

I was initially doubtful about Friendship Bingo. I was anxious about “failing” the goals and uncertain I would make progress. But I was proven wrong – it was amazing how quickly Friendship Bingo showed meaningful results.

[Read: Making Friends in College – a Buddy System]

1. Most People Say Yes

I started small, texting people and asking if they wanted to eat together. Sometimes they responded, “Sorry, I have other plans” or, “Sorry, I have homework,” and I had to work to reel my rejection-sensitive brain back from “THEY HATE ME.” But more often than not, people said yes, and that felt good! And the more meals I ate with different groups, the better I was able to determine who I enjoyed spending time with.

2. My Social Battery Doesn’t Deplete So Fast

Most importantly, Friendship Bingo helped me expand my capacity for socializing. The game encourages constant practice, which made socializing feel more natural, as I was able to spend longer periods with people without feeling tired or overstimulated.

3. Making Friends Doesn’t Feel Like a Mystery Anymore

Friendship Bingo was a stroke of genius because it hit on two things that are crucial for me: 1) specific goals, and 2) a gamified system to help me reach those goals. The game demystified friendships for me, making the process feel less like a mysterious labyrinth to navigate and more like a formula of repeated (but manageable) social encounters and effort that I could track.

The real breakthrough came a few weeks into the game, when I went to brunch with two people with whom I’d been regularly hanging out One of them mentioned visiting the woods behind the school, and I spontaneously went along! After that, we made our way into town for bubble tea, where another friend joined, and we all stopped by a comic book store before heading back to campus. It was a solid half-day of unplanned, unstructured social time, the longest I’d had since starting college. And it felt incredible.

Those three people I spent that successful day with went on to become my best friends. We eat dinner together regularly, text each other over school breaks, have a standing Dungeons & Dragons campaign, and cheer each other up when we’re stressed. It’s made a world of difference to my confidence and happiness to have these close friendships.

How to Make Friends in College: Next Steps

• Get This Free Download: Become a Small-Talk Superstar
• Read: The College Survival Guide for Students with ADHD
• Read: The Art of Forming Friendships

SUPPORT ADDITUDE
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It’s a question I throw at the end of coaching sessions with my clients. I stole the question from the Coursera version of Yale’s most popular class ever, “The Science of Well-Being,” led by Laurie Santos, Ph.D. In this course, you’re tasked with writing down the things for which you’re grateful every day for a week.

Why Is Gratitude Important

The idea is two-fold. One, it breaks you out of negativity traps by training you to focus on and acknowledge the real good in your life, which helps you develop a positive outlook. Two, if you recall the things you’re grateful for in detail, your brain thinks it’s experiencing them again — so you’ll have multitudes of goodness in you.

[Read: ADHD and the Power of Positive Thinking]

Gratitude is an essential practice for those of us with ADHD, as we often harbor a nagging assumption that we’re less than. The extended logic is that because we are less than, we must have crappy lives – a self-defeating cycle that doesn’t make our lives any easier.

But we’re not less than. Our lives are full of beauty that we often don’t acknowledge. Noting the good around us and within us is a type of reality check that sparks awareness, acceptance, balance, and happiness.

If you’re looking for ways to practice gratitude in your life, try this fun exercise with friends and family. Propose that everyone join in on this gratitude game at your next gathering.

How to Practice Gratitude: A Group Gratitude Exercise

1. Gather a group of people together — around the Thanksgiving table, in the living room, at the beach, in the car during a long drive. Whatever works.

[Read: For to Log Daily Victories for Your Family]

2. Take turns answering the following questions.

• What’s one thing you’re grateful for in your life? (This could be your whole life or just this past week.)
• What are you grateful for about each person in this group?
• What are you grateful for about yourself?
• What are you grateful for about the natural world?
• What was your favorite answer that each person gave?

Each person should take the time they need to formulate an answer and should wait for others to formulate theirs. Go where your heart leads and have fun with it. Be chill. (I view this exercise as a game, though this is very different from the cutthroat card tournaments I played with my extended family growing up, where being chill was never an asset.) Beyond this one-time activity, make gratitude a daily practice in your life. Challenge yourself, in particular, to reflect on the positive aspects of your neurodivergence.

How to Practice Gratitude: Next Steps

• Free Download: Bonding Activity Ideas for ADHD Families
• Read: The Key to ADHD Emotional Regulation? Cultivating Gratitude, Pride & Compassion
• Read: “The ADHD Characteristics I’m Most Thankful for Are…”

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.

If you hold a leadership position in your workplace, commit to these five strategies to create a positive work environment. While its benefits will extend to everyone, for neurodivergent employees, these strategies could mean the difference between struggling in silence and thriving in an environment that understands and meets their needs.

1. Be Open About Your Productivity Practices

Talk openly about your own practices to achieve productivity and a healthy work-life balance. This can be particularly beneficial for neurodivergent employees who often struggle to maintain boundaries and who may need more time to recharge or manage stress. You might say to your team:

• “I make sure to log off at 5 p.m. to spend time with my family. It’s important to me to have that downtime, and I encourage you all to do the same with your personal time.”
• “I take a short walk every afternoon to clear my mind. It’s a small thing, but it really helps me reset. I encourage you all to find a routine that helps you recharge during the day.”

2. Openly Discuss Accommodations and Tools

Everyone needs a little help to reach their full potential. Openly discuss accommodations to demystify and destigmatize the process. You could share:

[Read: DIY ADHD Accommodations for Your 9 to 5 Job]

• “I find that noise-canceling headphones help me concentrate better in our open office. If there’s something that could help you work more effectively, let’s talk about how we can make that happen.”
• “I often break down larger projects into smaller, more manageable tasks with clear deadlines. This helps me stay focused and organized. If you ever need clarification or a different approach, just let me know.”

By normalizing accommodations and other approaches, you create an environment where neurodivergent employees feel empowered to request the support they need without fear of judgment.

3. Champion Diverse Communication Styles

We all take in information differently. Acknowledging and respecting communication preferences can significantly improve team dynamics. You might say, “I’ve noticed that some of us prefer written updates, while others like quick verbal check-ins. Let’s find a way to accommodate both so everyone feels comfortable and informed.”

4. Model Vulnerability to Create a Safe Communication Space

Show your team that it’s okay to express uncertainties, mistakes, or personal challenges by sharing some of your own. When you’re open, others are more likely to follow suit and feel comfortable talking about hurdles in their productivity. Here are other ways to foster open communication, build trust, and ensure that neurodivergent employees feel valued:

[Read: An ADHD Cheat Sheet for Effective Workplace Communication]

• Practice active listening — paraphrase what your colleague said to confirm understanding and show that you are invested and engaged.
• Use neutral language and tone when responding to ideas, even if you disagree. Encourage brainstorming sessions where no ideas are labeled “bad.”
• Implement a feedback system, such as anonymous suggestion boxes (digital or physical) or a regular survey.
• Hold regular one-on-one meetings where you ask open-ended questions and allow the employee to lead the conversation, which can reduce the intimidation of speaking in front of a group.

5. Take the Lead on Awareness and Inclusion

• Set up awareness workshops. Education is key to fostering an inclusive environment. You might suggest, “Let’s set up a workshop on neurodiversity so we can all better understand how to support each other. I’m excited to learn more and see how we can apply these insights to our daily work.”
• Propose a workplace mentorship program. Such programs can provide neurodivergent employees with pointed career guidance and access to a supportive network where they’ll likely meet other neurodivergent employees, too.
• Lead or engage with a disability Employee Resource Group. These groups offer a platform for employees to share their experiences. By engaging with ERGs, leaders gain valuable perspectives on the challenges and needs of underrepresented groups, enabling them to make informed, empathetic decisions that enhance workplace culture.

Positive Work Environment: Next Steps

• Get This Download: 10 Rules for ADHD-Proof Productivity
• Read: Neurodivergent Leadership Skills — How to Run a Business with ADHD
• Read: What’s the Secret to Thriving at Work? 5 Keys for ADHD Adults
• Read: How ADHD Inclusivity Drives a Key Competitive Advantage

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These are the qualities of an untrustworthy person – qualities I lived and breathed while (trying) to manage my undiagnosed ADHD.

ADHD – especially untreated – is a condition of inconsistency. We’re inexplicably “on” one day and “off” the next. It causes us to struggle to understand our behaviors and work out why we did (or didn’t) do something.

I’d say one thing but do another; make a plan, then forget it. I’d blurt out random things and make the simplest mistakes. I was scared to make future commitments because I couldn’t be sure what I’d be like when the day arrived – brilliant, or so off that it was hard to leave the house.

I was inconsistent in mood, attention, behavior, focus, and even goals. I had no inkling that there was any pattern to it. I wanted to do interesting things but committing to something out of the ordinary – like writing this blog post – risked months of dread, guilt, and procrastination.

A lifetime of inconsistency led to some strange consequences. Making even a small error would trigger an intense emotional reaction. Around other people, I tried to stay quiet, to hold in the ‘weirdness.’ And I’d check my work again, again, and again.

[Read: Intention Deficit Disorder – Why ADHD Minds Struggle to Meet Goals with Action]

Why Don’t I Trust Myself? The Roots of Inconsistency

Before I knew anything about ADHD, I thought I had a clear picture of the root of my problems: anxiety and low self-confidence. I worked my way through the go-to tools: cognitive behavioral therapy, books about social skills, special breathing techniques, you name it. I even read Self-Esteem for Dummies.

Over the years, it all helped. But while I could stand up straighter, smile at myself in the mirror, and name three of my greatest qualities, I still was caught in spirals of procrastination, zoning out, obsession, and impulsiveness.

My old friend anxiety kept my brain awake enough to let me drive a car, find my keys, and pay my bills. Low self-confidence kept me out of sticky situations but led to a smaller life over time.

Then I heard about inattentive ADHD and what it looks like in women. Many, many hours of research later, I was finally able to make sense of my experiences and actions. As I learned about executive dysfunction and common support strategies, I was able to recognize those I was already using – and where I was tripping myself up.

[Read: Your Regret Won’t Change the Past. These Tips May Save Your Future.]

But I was also assured that my brain would inevitably function fabulously in certain situations. The wealth of insight around the web from people who live with ADHD nudged me toward greater self-awareness. (After I read on the web that an unofficial trait of ADHD is argumentativeness, I asked a friend if that applied to me. He laughed in my face – I think that’s a yes.)

I learned how to plan my day in a way that my brain can “see.” I do things at a pace and plan that works for me. For example, rather than write this blog post in one sitting, I’ve taken to writing it in multiple locations, while wearing ear plugs, for 15 minutes at a time, while checking in on my emotional state. No matter the task, I regularly ask myself, “How does my ADHD play into this?” and “What will make this task easier for Future Me?”

Learning to Trust Myself – Even with ADHD

I’ve experienced some unexpected changes now that I trust myself more. For one thing, I now believe that it’s okay to make mistakes. I can calm down after the inevitable Big Feelings, and I know how to motivate myself to make amends. I even have an “oops quota” – if I go over my limit, I know it’s a sign that I need to tweak my systems. My ADHD-friendly systems take care of me, and I take care of them.

I can also now resist the urge to apologize for being the way I am. True, if you say, “How are you?” I may tell you in exquisite detail, or I may stare at you and not be able to think of a response. So what? I’m learning the words to explain why I do what I do, without framing it as a deficit. I want to get good at standing up for my right to be myself.

Perfection isn’t a prerequisite for self-trust (or to gain the trust of others). It’s consistency in another form: knowing that I do my best, learn from my mistakes, practice honesty, and pull through most of the time. Understanding my version of ADHD has transformed my ability to trust myself.

Learning about ADHD not only solved the mysteries of my inconsistency, but it helped ease my anxiety and increase my confidence. It released me from the fear that I was simply a bad person. It freed me up to create new, better stories about myself. Now, I can be pretty sure that if I say I’ll do something, I’ll probably do it… like writing this blog post!

Why Don’t I Trust Myself? Next Steps

• Free Download: A Guide to Becoming Your Best You!
• Read: Why ADHD Self-Awareness is the Key to Effective Action
• Read: 5 Little Changes That Freed My ADHD Mind

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ADHD gives me plenty of skills I can model for my kids, but good frustration tolerance isn’t one of them. I can make up silly songs on demand, but I’m rubbish at remaining unruffled when my 6-year-old’s temper flares.

My younger child is a lovable ball of brightness, kindness, and fun, but many things short her circuit and invoke her iron will, from unsolicited carrots to socks that won’t reach their requisite height.

She might well be neurodivergent herself. (We’re waiting in line for assessment.) But whatever the root of her proneness to grievance, it feels like we’re peas in a pod. My patience is apt to desert me the second she loses hers.

There are things I can give her directly to help her stay grounded and happy: empathy, boundaries, nutritious meals, plenty of nourishing cuddles, choice where possible, my fullest attention, the conscious uncoupling of me and my phone. But kids need a stable, consistent caregiver who they can watch and copy. If I can’t manage my own frustration, how will she ever handle hers?

Modeling Calm When Anger Strikes

I’ve been thinking a lot about how to model calm when it counts, and it strikes me that there are two things I need to nail if things are to be less shouty around here.

[Get This Free Download: 5 Ways to Improve Emotional Control at Home]

1. Meeting my own needs first

Most of what gives me balance is basic. Exercise, fresh air, and eating well. Walking up hills and through parks. Pilates and painting and learning new things. Time with no screens or voices to allow me to drift and dream.

They’re simple remedies, but my mental health slides if I fail to give them priority. Luckily, my partner has his own list too, so we tag-team to tick off as much as we can.

2. Keeping my cool in the moment

Much harder to master is the consistent deployment of effective strategies when my daughter digs her heels in.

When my child gets stuck in an emotional vortex, reason cannot reach her. I know how that feels myself and I’m often inclined to join her. But some recent therapy has helped me to see that I do have a choice in the moment. I can either hop aboard the resentment express and trot out a pointless monologue that spikes my cortisol and guarantees escalation. Or I can pause and make a conscious decision about how I’d like to proceed.

It’s not easy. The stress in my body is physical and real. I feel it in my chest and my neck. My ears ring and my heart races. But there are ways of letting it go. I can notice the tightness and relax the tension. My mind will often follow. I can focus on breathing more slowly and deeply (if I’m actually breathing at all). I can silently soothe myself in the tone of a grown-up who knows this will pass. When I pull it off, I’m not faking or in toxic denial. I just feel a lot more balanced and able to ride out the storm.

[Read: When Angry Kids Lash Out – How to Defuse Explosive Reactions]

Modeling Calm – Putting Techniques to the Test

I get a chance to deploy my new tactics in the art of non-reaction on a Saturday, when we fancy a walk in the woods. The little one won’t get dressed, of course. Weekends are for lying down, she declares, as she burrows under our duvet, tucking it in around her to secure her fortress against potential incursion.

We could be here a while, I think. Last week we aborted completely. I implore her to put on some clothes. She kicks off the covers and thrashes around, emitting a grating whine. My chest tightens, my heart rate quickens, and I want to launch into my lecture.

But I stop. I breathe. I remember that calm breeds calm and that staying centred will help us both. She performs a series of loud exhalations, but I say to her softly that we’re leaving. Voices do not get raised. I exit the room and in minutes she’s clothed and skipping out to the van.

She briefly objects to my offensive plan to take a jacket just in case. But I let it wash over me and it burns out fast. Off we go in peace.

The same trick works on Tuesday when I commit a transgression with celery and she CANNOT EAT THIS LASAGNA (she does) and again on Friday when it puts to bed a debate over whether jellybeans constitute breakfast (they don’t).

Modeling Calm, One Little Test at a Time

There are blips involving poached eggs and car seats. I’m tired and hormonal and late – and I yell. But part of my internal deal is that I’m kind to myself when I fail. Improvement is still improvement if it’s only some of the time.

I’m buoyed by how things are going. My girl is more flexible and she’s proud of herself when she lets things go. I’m feeling quite proud of me, too.

So maybe I can crack this. Maybe soon I’ll add “measured response to frustration” to the list of things I can pass to my children. It’s not as fun as singing ditties about teachers or toilets, but it’s arguably a more essential skill that will serve them well in life.

How to Be a Calm Parent: Next Steps

• Read: ADHD and Emotional Regulation – A Parent’s Guide
• Free Download: Get a Grip on Tough Emotions
• Read: “Our Home Can’t Withstand All of These Emotional ADHD Explosions!”

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8 Ways to Stop Losing Track of Time

Alarms

If you aren’t already, get into the habit of setting alarms (on your phone or other devices) to keep you on track. You can use alarms in multiple ways:

• as prompts (like to remind you to check your email at a certain time)
• as transition warnings (e.g., “10 minutes to go before your meeting”)
• as check-ins (e.g., “Did you check your email when you said you would?”)
• as time markers (like an alarm with distinct chimes on the hour)

[Get This Free Download: Keep Track of Your Time]

Clocks

Place analog/visual clocks in all your spaces so that you can readily see time passing with the hands on the clock. Consider other visual time-keeping tools, like hourglasses and the Time Timer, a clock that shows the passage of time via a disappearing red disk.

Comparison

Come up with a list of activities that you know take 5, 15, 30, 60 and 90 minutes. When you are estimating the length that an activity will take, use your list to compare. Will doing the dishes take longer than….

• listening to two songs in a row (5 to 6 minutes)?
• listening to five songs in a row (13 to 15 minutes)?
• watching an episode of a sitcom (30 minutes)?
• watching an episode of a TV drama (45-55 minutes)?
• watching a movie (90 minutes)?

Unique Visuals

Take your to-do list a step further by adding your tasks to your calendar as time-blocked activities. Keep your daily calendar as visible and eye-catching as possible, with different colors for each task/activity. Throughout the day, compare what you’re doing to what’s on your visual schedule to see if you are keeping the correct pace.

[Read: “7 Reasons Why You Need Analog Clocks”]

Regular Routines

From morning to evening, routines do an amazing job of keeping us on schedule. Doing the same activities over and over will eventually give you an intuitive benchmark and take the guesswork out of time estimation, at least for part of your day.

Audio Playlist

Use timed playlists as fun cues to signal the passage of time. A study playlist, for example, can subtly remind you that you have 5 minutes left until your break once a certain song starts to play. You can also create playlists that match the length of a task (like a 10-minute bedroom cleanup).

Task Chunking

Avoid getting lost in a large task by breaking it down into smaller parts, which can also help with time estimation. Working in shorter intervals can also help you reset your focus.

Estimation

Not sure how long various task or activities take? Play the estimation game and guess the length of time for a task and then time yourself while doing it. Compare your estimate with the actual time (be honest) and then adjust your expectations accordingly. Doing this often can improve your time estimation skills across the board.

Losing Track of Time? Next Steps

• Free Download: Get There On Time, Every Time
• Read: “Running Late… Again! On Time Blindness and My ADHD Brain”
• Read: ADHD Minds Are Trapped in Now (& Other Time Management Truths)

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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.

“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

SUPPORT ADDITUDE
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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
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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

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.