Autism in Girls: Key Takeaways

• Autism in girls is overlooked because symptoms manifest differently across genders, and because of persistent gender bias in clinical and research settings.
• Compared to boys, autistic girls are more socially motivated, which may make their social challenges less apparent and thus more likely to be missed by clinicians.
• Autistic girls seldom demonstrate repetitive movements, and their special interests are more likely to be seen as typical.
• In-depth evaluations are often necessary to identify or rule out autism in girls. Other supports — from therapy to emotional regulation skill-building — can significantly help.

Autism in Girls Looks Different

About one in 36 children in the U.S. is autistic, a diagnosis that is four times more common in boys than in girls.¹ What explains this gender gap?

Science is working to determine factors that may explain autism’s diagnostic prevalence in males, but many clinicians who specialize in autism in girls and individuals assigned female at birth clearly see that gender bias — in referrals, diagnostic criteria, and tests — plays a role in diagnostic outcomes.

Autism is more readily identified in boys than in girls because, historically, the clinical and research focus has been on boys almost exclusively. Many clinicians who are trained in diagnosing autism are unaware how its traits can uniquely manifest in girls. Failing to realize that girls and women don’t always demonstrate the more stereotypical signs of autism, many clinicians end up overlooking behaviors that are indicative of autism. This is part of why girls and women are often diagnosed as autistic later in life than boys.

Signs of Autism in Girls

Social Motivation

Autism is characterized, in part, by difficulties and differences with social communication and interaction. Some autistic children may have trouble initiating or engaging in social interactions, which can result in them feeling left out or different. Some children, meanwhile, may prefer solitary activities.

Some children may struggle to understand when and how to join a conversation. An autistic child may follow up to a peer’s question with a brief response or with nothing at all, bringing the interaction to an end. Sometimes, conversations and interactions can become one-sided; an autistic child, for example, may not realize that others want to play differently and will continue to insist that everyone play a game according to very fixed rules. Autistic children may also show differences in use of eye contact, gestures, and facial expressions or misinterpret these cues from others.

[Take This Free Screening Test: Autism in Girls]

Autistic girls may experience all of the above. However, many demonstrate more social motivation — the drive to understand, connect, and enter relationships with others — than do autistic boys, which may make their social challenges less apparent and thus more likely to be overlooked.

• Autistic girls are more likely to want to fit in. As such, they are more likely to mask (i.e., hide or compensate for autistic traits) and mimic neurotypical behaviors.
• Autistic girls are more socially observant, which helps them pick up on details that allow them to better fit in and mask. It’s common for autistic girls to painstakingly study patterns in how people interact to reverse engineer “normal” behavior.
• Autistic girls are often perfectionists. The urge to fit in and flawlessly mask drives
  perfectionistic tendencies. Sensitivity to rejection is also common; when autistic girls stumble and experience social exclusion — despite their best efforts and desires to make and maintain
  friendships — the pain of rejection is profound.

Autism in Girls: The Consequences of Masking

We can’t talk about autism in girls without talking about masking. While masking often emerges as a coping strategy for socializing, especially for autistic girls without intellectual development disorder or who may not have observable behavioral or academic needs, it can create lots of issues, too.

• Masking is mentally taxing. Constantly trying to figure out others, understand unspoken
  social rules, and fit in with changing circumstances is highly exhausting.
• Masking interferes with self-understanding. Autistic girls often have trouble tuning into their own needs and emotions because masking has long forced them to suppress their authentic selves. Identity and self-esteem issues are common; some girls don’t even realize when they are masking. Masking can also interfere with friendships, as girls are unable to bring their full selves to these relationships or know what they want in a friend.
• Masking can impact clinical evaluations. Autistic girls who have become accustomed to hiding their traits may struggle to express and make sense of their behaviors and experiences, which can interfere with autism evaluations and lead to underdiagnosis or misdiagnosis. (This compounds the gender bias that causes girls’ autistic behaviors to be downplayed.)
• Masking can cause health issues. Constantly worrying about blending in with societal norms can turn into anxiety and other internalizing and physical issues. Many autistic girls tend to suppress their feelings, which causes more mental health challenges.

[Read: What Does Autism Spectrum Disorder Look Like in Children?]

Differences in Restricted and Repetitive Behaviors

Autism is characterized by restrictive, repetitive patterns of behavior, interests, or activities as demonstrated by the following signs:

• hand flapping, finger flicking, rocking, and other stereotyped behaviors (or “stims”)
• lining up, stacking, spinning, sorting and/or categorizing toys and objects
• echolalia and other forms of repetitive speech
• a strong preference for routine; resistance to change
• rigid, perseverative thinking; insistence on adherence to rules
• highly restricted, fixated interests (i.e., special interests)
• hyper- or hyporeactivity to sensory input

While autistic girls can show the above signs, these behaviors may manifest differently.

• Autistic girls are less likely to demonstrate repetitive movements. When they do, they are more likely to demonstrate different types of repetitive movements than boys, like tapping their fingers or twirling their hair, which can be easily overlooked.
• Autistic girls’ special interests are more likely to center on animals, celebrities, or fictional characters, which can seem more socially acceptable and thus less likely to be flagged as a sign of autism.

Autism in Girls: How to Support Neurodivergent Youth

Know the Signs — and Myths

Early detection is key for autistic girls to receive the support they need so they can develop self-
understanding without shame. Parents, educators, and clinicians should be aware of the above signs of
autism in girls and these common autism myths:

Clinicians: Peel Back the Layers

Clinicians overlook autism in girls, especially in those without intellectual or language disorders, because these girls can be adept at camouflaging. Their symptoms tend to be more internalizing, and they may have trouble verbalizing their experiences and what they need. Even when girls do show signs of autism, to the untrained eye, these girls can appear “not autistic enough.”

• Dig deep. Ask about relationships when evaluating girls for autism. How does your patient experience friendships and connecting with others? How does your patient feel about their ability to make friends and maintain them? How does this experience connect to her self-esteem? What is the toll of social interactions on your patient? Watch for cues that your patient finds social interactions exhausting and effortful. You may need to carry out longer assessments and observe your female patients over time so you can dive deep into their experiences. If they do not show signs of or report impairment across settings, watch for signs of subjective distress.
• Screen for comorbid conditions. Autism and ADHD co-occur at high rates, and the symptom overlap cannot be overstated. Anxiety and specific learning disorders are also common.
• Actively educate yourself on autism in girls. Seek out training and review the latest literature. Listen and learn from patients with lived experience.

More Ways to Support Autistic Girls

• Seek interventions and supports. From speech, physical, and occupational therapy to IEPs or 504 plans, secure the services that support your child’s individual needs. Medications are available to help support mood and reactivity. Talk to an autism specialist about the best interventions for your child and seek a second opinion if your provider makes you feel disrespected or unheard.
• Provide structure and routine. Stability and predictability reduce anxiety, stress, and overwhelm in autistic children, who often struggle with rigidity, inflexibility, and stress during transitions.
• Support executive functions. The cognitive skills that allow us to plan, prioritize, organize, manage time, start tasks, and self-regulate are often impaired in autistic individuals and can significantly impact daily functioning. Scaffolding in the classroom and at home can help.
• Teach healthy coping skills. Emotional dysregulation is very much a part of autism. What’s more, girls are socialized to suppress their emotions, which can accumulate and lead to intense emotional outbursts. Autistic girls must be taught emotional awareness, including how to monitor, label, and understand their emotions. Breathing exercises, mindfulness, muscle relaxation techniques, and other strategies can help improve emotional regulation.
• Talk about autism from a neurodiversity-affirming standpoint. Viewing autism from a strengths-based perspective can help young girls accept themselves, refrain from masking, and gain the confidence to advocate for themselves throughout their lives.

Autism in Girls: Next Steps

• Get This Free Download: The ADHD-Autism Link in Children
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: 4 Autism Myths — Dispelled
  

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD” [Video Replay & Podcast #511] with Karen Saporito, Ph.D., which was broadcast on June 27, 2024.

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Sources

¹ Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., Ladd-Acosta, C. M., McArthur, D., Pas, E. T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A., Hall-Lande, J., Nguyen, R. H. N., … Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2020. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 72(2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1

From boredom to shame, here are the emotional states tangled up with decluttering, along with strategies to calm or circumvent these feelings so you can stay organized.

Unpacking the Emotional Web of Clutter: Disorganization Solutions

1. Shame

Does your disorganized home spark feelings of humiliation and inadequacy? Fear of rejection and criticism due to clutter are common, and they may be so overpowering that you feel driven to escape the task of decluttering and organizing, leaving the problem to grow.

Solution: Shift to self-compassion

Acknowledge your feelings of self-loathing and treat yourself with the same kindness that you would offer a friend in a similar situation. Keep on hand a few positive phrases that you can easily read when shame appears. Remember that no one is devoid of clutter, and that yours doesn’t define your worth. Recognizing and challenging your shame will open the door to taking small steps toward a more organized space.

[Read: Making Peace With Your Clutter]

2. Overwhelm

When organizing a cluttered space, how do you know when to start, take breaks, and call it a day? Executive function weaknesses, common in ADHD and hoarding disorder, make it difficult to identify the logical and explicit steps required to declutter and organize living and working environments. Often, the result is procrastination and task abandonment.

Solution: Grab a Hula Hoop

Lay a hula hoop over an area that needs organizing and commit to cleaning only the space within the hoop. Set a realistic amount of time to organize (preferably under 30 minutes). Don’t have a hula hoop? Use tape, string, shoelaces, or any other method to clearly mark the boundaries of your focus. By concentrating on a single area, you’ll see a more obvious transformation, which will help maintain motivation. Take it a step further by covering ancillary areas with bedsheets or drop cloths.

The key to reducing overwhelm is to break down tasks into manageable parts, whatever that looks like for you. That may mean setting timers and taking breaks, identifying specific to-do list tasks, and/or separating items to organize into a box that you can chip away at little by little.

3. Anxiety and Fear of Regret

When decluttering, do you become anxious about discarding items you may later want? You may have once regretted cleaning out an item of sentimental value, or something you ended up needing after all, and so you avoid making that mistake again by keeping everything. The fear of regret is often strong in individuals with HD, who believe that they cannot tolerate any remorse from unwisely discarding possessions.

Solution: Recognize that regret won’t last forever

Regret is an emotional state that, like all other emotions, passes with time. Chances are that you’ve felt regret before, but you don’t feel the same intensity of regret today as you did in the moment. You are more capable of tolerating and coping with difficult feelings and mistakes than you know.

[Get This Free Download: 22 Clutter-Busting Strategies for Adults with ADHD]

4. Boredom

Boredom is a catastrophic and even physically painful state for people with ADHD, who have steeper and higher mental effort hills to climb. Any task that requires lots of mental effort to initiate and sustain — like decluttering, organizing, and maintaining tidy systems — will be experienced as boring and aversive.

Solution: Gamify It!

• Set a timer for a short period (e.g., 10-15 minutes) and see how much you can clean or declutter in that time. You can make it a race against the clock or try to beat your previous record.
• Create a bingo card with different cleaning tasks in each square. Mark off tasks as you complete them and aim for a full row, column, or diagonal.
• Turn cleaning into a scavenger hunt by making a list of specific items to find and put away.
• Create an upbeat playlist and challenge yourself to finish your task list before it repeats.
• Team up with a friend or family member and turn cleaning into a cooperative game.
• Treat yourself to something you enjoy, like watching a movie or having a special snack, after finishing a certain number of organizing tasks.

How to Deal with Clutter Anxiety: Next Steps

• Free Download: Hoarding Disorder Vs. ADHD Clutter
• Read: 17 Ways To Cut Back on Clutter
• Read: How to Declutter with an ADHD Brain — Organization Solutions for Real Life

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Clearing the Chaos: ADHD-Informed Strategies for Tackling Clutter and Hoarding” [Video Replay & Podcast #510] with Michael Tompkins, Ph.D., which was broadcast on June 18, 2024.

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Advice for Parent-Teacher Collaboration

Up to a third of children with ADHD will experience school avoidance at some point during their academic journey. A student’s school avoidance, also referred to as school refusal, can last weeks or months during an academic year. In severe cases, it can last longer. Follow this advice to facilitate collaboration and get your child back to school.

#1. Request Help Early

Call the school at the first signs of possible school avoidance. Time is of the essence. Research and real-life experiences show that earlier interventions improve outcomes.

Schools have staff dedicated to helping students with mental health challenges, learning disabilities, and family issues. Your goal is to meet with these staff members and discuss where your child is struggling and what’s going on at home. Let them know that you consider this to be serious and that early interventions are extremely important. Work with the school intervention team on strategies to help your child.

#2. Get Educated About School Avoidance

Because school avoidance is misunderstood, your school may not know the best practices and evidence-based strategies for addressing it. As a caregiver, you will need to advocate for your child and educate the school staff. Arrive at school meetings equipped with information and specific requests for help.

[Read: “Help! My Child Won’t Go to School.”]

#3. Know Your Rights

Federal and state laws require public schools to provide a free, appropriate, public education to all students. Your understanding of these laws is important because schools sometimes have difficulty interpreting and applying them to school avoidance.

#4. Establish Accommodations

Most kids who avoid school qualify for a 504 Plan or an Individualized Education Program (IEP), and benefit from accommodations and services that can reintegrate them into school. Some schools will modify workloads, homework, and attendance requirements to help your child return to school.

#5. Develop a Reintegration Plan

Collaborate on a plan to get your child back into the classroom. Your child’s therapist should be communicating with the school about how to best do this.

#6. Know When to Activate Plan B

If you feel the current school environment cannot support your child appropriately or blatantly disregards their needs, seek alternative school options. Your child deserves a caring and supportive school where they feel safe and valued.

[Get This Download: How to Teach Children with ADHD — Classroom Challenges & Solutions]

Avoid These Missteps

Common mistakes parents make while working with their child’s school include:

• Working too long with your intervention team without a defined plan for getting your child back to school
• Not requesting a 504 Plan or IEP in writing. Once you ask for an evaluation for a 504 Plan or IEP in a letter or email (get proof of receipt), the clock starts to ensure that timelines are followed according to the law
• Crafting a 504 Plan or IEP that says nothing about the steps, changes, or strategies to help your child return to school

School Avoidance Interventions: Next Steps

• Read: “Couldn’t I Just Stay Home from School Forever?”
• eBook: How to Teach (and Inspire) Students with ADHD
• Sign Up: ADHD @ School — A Free 10-Part Class for Parents

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If you know what it takes to procrastinate, then you also know, in effect, what it takes to not procrastinate. With some reverse-engineering and creativity, you can concoct an anti-procrastination formula to realistically outmaneuver your unique escapist tendencies. Get started with this three-part plan.

1. Reverse-Engineer ADHD Procrastivity

Procrastivity happens when you avoid a higher-priority task by escaping to a less-critical yet still productive task.

While a self-defeating endeavor, procrastivity can teach you how to not procrastinate. After all, you’re still being productive when you do it — just not in ways that benefit your long-term goals.

[Self-Test: How Seriously Do You Procrastinate?]

There’s a reason you choose to mow the lawn when you’re really supposed to be doing your taxes. The key features of most procrastivity-friendly tasks make them easy to slip into. Apply those features to the tasks you’ve been avoiding in order to help you get started and maintain momentum.

2. Embrace the “Ugh”

Procrastination arises from unpleasant feelings (the “ugh”) associated with a task, which is much more difficult to tolerate with ADHD.

Overcoming procrastination, however, is not about eliminating discomfort. (Realistically, you won’t be excited about every task you’ll do.) While some steps can reduce overwhelm and create more positive thoughts, navigating procrastination is really about normalizing the “ugh.”

• Label the unpleasant feeling associated with the task. Be specific. Say, “This is my ‘I hate doing taxes’ stress coming up.” Labeling emotions lowers their intensity.
• You will never be in the mood to do it. And that’s OK. Waiting until you feel like it or until circumstances are just right to act is a form of perfectionism. Remind yourself that you don’t have to be discomfort-free to get started and keep going.
• It may go better than you think. You’re anticipating that spending 10 minutes engaged with the task will be awful or useless, but you won’t know until you try.
• Beware of woulda, coulda, shoulda thoughts. Don’t beat yourself up about not starting sooner. Give yourself credit for where you are. Some progress on a task is still better than none.
• Coach yourself through it. Say aloud, “Okay, [name], you just need to open the book first. Then it’s two pages of reading. Yes, it sucks, but you can still read despite your discomfort. You know you’ll feel so much better after you do it.” Trust your ability to keep going and stick to your plan even when the task feels tougher than anticipated.

[Free Download: 18 ADHD-Friendly Ways to Get Things Done]

3. Leverage Your Why

Think hard about your reasons for working on a task you’ve been avoiding — a powerful way to build and maintain momentum. Consider keeping these prompts in highly visible places to remind you why you don’t want to procrastinate:

• “I want to get this done so I can ______.”
• “Why does this task matter to me? Why do I want to do it in the first place?”
• “How does this task align with my personal role(s)?”
• “How does this task align with my values?”

Sometimes you get results with the carrot (positive reinforcement), and sometimes you get results with the stick (negative consequences). If spite — whether you’re out to prove someone wrong or avoid consequences — motivates you, use it to your advantage to avoid procrastination. Take inspiration from the following examples:

• “If I don’t finish writing my report on time, I will publicly announce on social media that I didn’t meet my deadline.”
• “If I don’t finish filing my taxes by the end of the week, I will donate $50 to a political candidate with whom I strongly disagree.”
• If I don’t finish outlining this project proposal by noon, I will wear my rival team’s jersey to work tomorrow.”

How to Not Procrastinate: Next Steps

• Free Download: The Eisenhower Matrix for ADHD Decision-Making
• Read: Stop Dodging That Dreaded Task! 9 Ways to Halt Avoidance Procrastination
• Read: “Am I Tricking Myself into Thinking Busy = Productive?”
• Read: How Do I Prioritize Tasks and Chores on My To-Do List?

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

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Q: Do people with ADHD experience winter depression more often and more severely than do neurotypical individuals? Also, why is my quality of sleep affected in winter?

Winter depression is marked by two or more weeks of low mood, usually starting in the Northern Hemisphere’s fall or winter when there is less daylight, that resolves in the spring or summer when there is more light. There is an association between winter depression, also known as seasonal affective disorder, or SAD, and ADHD.

In the Netherlands, where I live, researchers asked 259 patients with ADHD about seasonal mood swings; 27% reported winter depression compared with 3% in neurotypical people.¹ Other researchers have confirmed this increased rate among people with ADHD.² What’s more, females are four times more likely than males to have winter depression.¹

Sleep problems are also common among people with ADHD: About 80% are late sleepers³ , which means they have a short sleep duration — they fall asleep at a later time and sleep less because they must wake up for work or school.

Q : How does winter depression relate to screen addiction in children with ADHD?

Children with ADHD who are late sleepers and who experience winter depression may turn to video games and the Internet. Screens emit blue light, and they’re often held close to the eye, so the effects are similar to light therapy if you’re staring at them for a while.

[Get This Free Download: How to Sleep Better with ADHD]

Screen use at night can induce delayed circadian rhythms, disrupting your sleep-wake cycle.⁴ Many children with ADHD are already late sleepers, so using screens after 9:30 pm will delay their rhythm even more; this is not recommended. Keep in mind that when sleep gets delayed, mood is affected.

The good news is that winter depression and sleep problems can be easily and quickly treated with artificial light therapy. A 10,000-lux light therapy lamp can be used for 30 minutes a day for 5 to 20 consecutive days. The lamp, or light box, should be used at a close distance to your eyes; the distance is very important for the intensity of the treatment. It’s best to do this every day at the same time, preferably between 7 and 8 am, to reset your biological clock and alter the sleep-wake cycle.

You may also consider using light therapy glasses, which work in the same way as lamps. You can wear these for 30 minutes a day while you’re dressing or eating breakfast; in other words, without disrupting your routine.

Light therapy is a serious antidepressant that often unlocks better mood, improved sleep, and more energy.

[Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain]

Q:  Is vitamin D recommended for people with winter depression?

If your vitamin D is too low, then taking vitamin D is recommended. Vitamin D is generally low in people with ADHD, though we don’t know why.⁵ You get vitamin D from sunlight; in winter, when there is less light, you may need to take a supplement. Another way we can get vitamin D is by eating fatty fish, though many people don’t eat enough to affect levels.

Winter Depression: Next Steps

• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Read: 9 Sleep Deprivation Solutions for Adults with ADHD
• Read: 6 Tips to Overcoming Winter Depression
  

J.J. Sandra Kooij, M.D., Ph.D., is a psychiatrist and head of the Expertise Center Adult ADHD at PsyQ in the Netherlands.

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Sources

¹Amons, P. J., Kooij, J. J., Haffmans, P. M., Hoffman, T. O., & Hoencamp, E. (2006). Seasonality of mood disorders in adults with lifetime attention-deficit/hyperactivity disorder (ADHD). Journal of affective disorders, 91(2-3), 251–255. https://doi.org/10.1016/j.jad.2005.11.017

²Wynchank, D. S., Bijlenga, D., Lamers, F., Bron, T. I., Winthorst, W. H., Vogel, S. W., Penninx, B. W., Beekman, A. T., & Kooij, J. S. (2016). ADHD, circadian rhythms and seasonality. Journal of psychiatric research, 81, 87–94. https://doi.org/10.1016/j.jpsychires.2016.06.018

³Van Veen, M. M., Kooij, J. J., Boonstra, A. M., Gordijn, M. C., & Van Someren, E. J. (2010). Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biological psychiatry, 67(11), 1091–1096. https://doi.org/10.1016/j.biopsych.2009.12.032

⁴Hartstein, L. E., Mathew, G. M., Reichenberger, D. A., Rodriguez, I., Allen, N., Chang, A. M., Chaput, J. P., Christakis, D. A., Garrison, M., Gooley, J. J., Koos, J. A., Van Den Bulck, J., Woods, H., Zeitzer, J. M., Dzierzewski, J. M., & Hale, L. (2024). The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement. Sleep health, 10(4), 373–384. https://doi.org/10.1016/j.sleh.2024.05.001

⁵Khoshbakht, Y., Bidaki, R., & Salehi-abargouei, A. (2018). Vitamin D Status and Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Observational Studies.. Advances in nutrition, 9 1, 9-20 . https://doi.org/10.1093/advances/nmx002.

“He would tell me I was the best thing that ever happened to him. Then he started telling me I needed to lose weight and that my clothes were too revealing. He said my parents were abusive and didn’t care about me; that he was the only one who truly cared about me.”

“She told me that no one would believe me if I told them she was abusive. She said girls can’t be abusive and that she was just reacting to me being abusive.”

“The more my parents stopped me from seeing him, the more ways I found to see him. It almost became like a challenge. He encouraged me to defy them.”

These are glimpses into toxic relationships, as told to me by a few of my teen clients with ADHD. And their stories are not uncommon. Teens with ADHD may become easy targets for perpetrators of emotional abuse and manipulation due to their lagging maturity, difficulty with friendships, low self-esteem, and other factors.

Toxic relationships are stealthy. They begin with a love-bombing phase, during which a person is lavished with gifts, attention, and ego-boosting compliments. This phase is especially intoxicating and powerful for people with ADHD who finally feel a sense of acceptance. Then the devaluing phase begins; their love interest tells them all the reasons they’re not good enough. Your child might hear, “If you were a little bit taller, that would make you more attractive to me.” Or “Why can’t you just be a good partner?”

[Read: What Are the Signs of a Controlling Relationship?]

Signs of a Toxic Relationship

Maybe your kid comes home and is excited because they met somebody. Then, six months later, you start noticing that their sparkle has faded; their personality seems blunted. They don’t seem as close to family members, and they’re not hanging out with their friends as much. This is by design; the perpetrator’s goal is to isolate and gain ultimate power and control over your child.

You might say to your child: “I really love you. It seems like things have changed. You don’t seem as happy. I wonder if you’ve noticed that, too. Let’s talk about this.”

Keep in mind that your child has already gotten the message from their partner that they should not listen to you. This is why it’s important to be non-judgmental. If you say something bad about their partner, your child will defend them to the hilt.

Just having a dialogue with your child, without pointing out how unhealthy their partner is, can be really helpful. And keep communication open.

How to Move on from a Toxic Relationship

Tell your child not to initiate or respond to any communication from the perpetrator. Cutting off contact with them is the most effective solution. They should block the perpetrator on social media to prevent a return to the cycle of pathology. You should monitor your teen’s devices and know who they’re talking to. Find out from your Internet provider about features to help you protect your child.

[Read: The Rules of Dating (and Breaking Up) with ADHD]

When someone leaves this type of relationship, it can be almost like experiencing a drug withdrawal; it’s much more intense than a typical breakup. Parents in this situation need to keep a close eye on their kids and watch for signs of self-harm. Make sure your teen continues taking their ADHD medicine and going to therapy. Check in with them, not just right after the breakup, but over time.

The more time your teen spends away from this unhealthy person, the more likely they will enter and maintain healthy relationships in the future.

Signs of a Toxic Relationship: Next Steps

• Self-Test: Is Your Relationship Toxic?
• Read: Why Do Toxic Relationships Swallow People with ADHD?
• Watch: Toxic Relationship Red Flags and Interventions for Teens with ADHD

Stephanie Moulton Sarkis, Ph.D., is the author of Healing from Toxic Relationships — 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse (#CommissionsEarned)

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#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Communication in Healthcare: Key Takeaways

• Ask open-ended questions to build trust and gather rich patient information.
• Actively listen to patients without rushing to treat. Be mindful of verbal and non-verbal communication.
• Restate patients’ concerns in your own words and acknowledge their feelings to demonstrate understanding and empathy.
• Invite patients’ feedback on treatment plans to ensure their buy-in.

Medical school teaches us many skills, like how to decipher symptoms, perform a physical exam, and document medical history. But it doesn’t always teach us the skill of patient communication. In fact, research indicates that clinicians “listen” to patients for a mere 11 seconds, on average, before interrupting.

Respectful, open communication vastly improves a patient’s outcomes. This is especially true for patients whose conditions may provoke distrust and miscommunication — depression, anxiety, trauma, and ADHD, to name a few. With stronger patient-provider communication, we are more likely to win over patients and improve treatment adherence. Take the following communication strategies to your next patient appointments.

1. Shift to Open-Ended Questions

Do close-ended questions — which only produce “Yes,” “No,” and “I don’t know” answers — dominate your interactions with patients? You’re sure to obtain rich, insightful information about a patient’s health and build trust if you shift to open-ended questions. The trick is to invite patients to tell you about a topic. Take social activities.

• Instead of: “Do you spend time with friends?”
• Try: “Tell me about your friends and the activities you do together.”

• Use empathetic responses as your patient shares.
  • Normalize (e.g., “I can understand why you would feel scared if…”)
  • Self-disclose (e.g., “We never seem to stop worrying about our kids, even as adults.”)
  • Highlight and amplify (e.g., “I’m impressed with how clearly you’ve communicated your concerns.”)

• Look for shame and stigma, which makes it difficult for patients to trust and open up. Patients with ADHD, for example, often develop shame as a result of criticism and negative feedback from peers and authority figures.
  • Say, “I sense that you’re feeling some shame. Is it something I said? Is there something going on in your life that’s causing it?”

• Avoid blaming and lecturing patients, making dismissive comments, and minimizing their complaints.

[Free Download: How Is ADHD Diagnosed? Your Free Guide]

2. Listen. Don’t Rush to the Treatment Plan.

It’s second nature for us — because it’s our job — to immediately devise treatment plans in our heads as patients communicate their concerns. But if your attention is on plans and processes, then it’s not on actively listening to your patients. Momentarily abandon all agendas and be present as your patient shares.

• Listen for needs. The basic human needs — to feel loved, to be important, to belong, and to be good at something — are particularly relevant here. When these needs are not met, depression, anxiety, and other mental health conditions are often the result. What does your patient want you to hear and understand about them and these needs?
• Look up from your screen. Eye contact lets your patient know that you are present.
• Consider all forms of communication, including body language, facial expression, and tone. Be mindful of your expressions, posture, and affect, too.
• Don’t try to get ahead of the patient. You know a lot about treating conditions in your specialty, but your patient doesn’t. Don’t fall into the “I know what’s going on” trap and risk cutting your patient short. Trying to bring your patient up to speed will only result in pushback. See problems from the patient’s perspective, not the clinical one.

3. Share Your Understanding

Clinical empathy is achieved when your patient sees that you understand what they’re saying and feeling. You don’t need to mirror the patient’s emotional state, but you do need to recognize and acknowledge it. You may not agree with the patient’s concerns, but they should feel you’re taking them seriously.

To convey understanding, restate the patient’s concerns in your own words. Consider the following openings:

• “So, you’re saying…”
• “It sounds like…”
• “You’re wondering if…”
• “I hear you saying…”

[Use This Expert Overview: Choosing the Right Professional to Treat ADHD]

4.Negotiate, Don’t Impose

After sharing your understanding of your patient’s health concerns, it’s time to share ideas for how to move forward. This is not a one-way conversation to force a treatment plan on your patient. This is a two-way exchange in which you invite the patient — who is now more inclined to open up — in shared decision-making about their health. Find areas that you both agree to focus on first.

Preface your ideas with the following scripts:

• “Would it be okay with you…”
• “What do you think about…”
• “Does it make sense to…”

Throughout the exchange, remember that the patient is the most important member of the health team. Emphasize that you can’t do this without them and their buy-in, which may mean compromising on a treatment plan.

Let the patient know that this won’t be your last meeting. Explain that you are available to troubleshoot and modify their treatment plan if needed.

Encouraging Words Patients Want to Hear

• “There is hope for your future, despite these problems.”
• “You are not alone in dealing with this problem.”
• “Your condition is not your fault.”
• “I understand what you are saying and navigating.”
• “You have many strengths.”

The Power of a Minute

You may think it impossible to implement these strategies within the short timeframe of an appointment. Yes, following these strategies may extend your patient visits, but not as much as you think. What’s more, investing in effective communication early on will save you and your patients time in the long run, as you’ve invested in truly understanding needs and collaborating first. If time remains an issue for implementing these strategies, consider splitting appointments into two or more sessions.

If you only have one minute with a patient, don’t spend that minute leaving. Your full, undivided attention — even for just 60 seconds — can go a long way in making patients feel respected and heard.

Communication in Healthcare: Next Steps

• Download: New! The Clinicians’ Guide to Treating Complex ADHD
• Read: How Collaborative Care Models Deliver Quality ADHD Care – Seamlessly
• Read: “Collaborative Care” Improves ADHD Symptoms in Children

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “For Clinicians: Common Treatment Barriers for Patients with Depression, Trauma” [Video Replay & Podcast #471] with Lawrence Amsel, M.D., which was broadcast on September 13, 2023.

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This isn’t about playing hooky. School refusal, also called school avoidance, is a serious matter. An acute case can last from two weeks up to a year; a chronic case might persist for a year or two. School refusal may stem from underlying struggles associated with ADHD, learning disorders, or separation or generalized anxiety. A student might be overwhelmed by academic challenges, bullied at school, rejected by peers, and/or troubled by family distress at home.

School refusal has grown worse since the COVID-19 pandemic. When schools reopened and resumed in-person learning, experts say, many students didn’t return to the classroom. Generally, school refusal affects 5 to 28 percent of students at some time in their lives, according to the School Avoidance Alliance.

What School Refusal Looks Like

Elementary-age children cling to their parents and resist entering the school building. At home, they complain of stomachaches, headaches, nausea, or vomiting. They have tantrums when talking about homework or express worry about school. Sometimes, they run away from home to avoid going to school.

A child’s teachers might report a change in their behavior, or their mood might shift unexpectedly in school and at home. The child generally starts to worry about things unrelated to school.

[On-Demand Webinar: School Avoidance & Refusal Strategies for Parents and Educators]

School refusal looks different in adolescents and teens. Many of them leave school early, skip class, or avoid certain parts of the day by going to the nurse. Some have sleep problems and complain of stomachaches and other ailments. Some experience panic attacks.

Older students can’t always communicate their feelings or anxieties. Instead of saying something like, “School is really hard and I’m struggling,” they become defiant, irritable, and angry toward peers and family members. Older kids also become more self-conscious about their academic performance, how they think others perceive them, and their physical appearance.

Identifying Underlying Fears of School

Distractibility, sensory overload, poor working memory, disorganization, and time blindness can make school challenging for students with ADHD. Those with anxiety may seek to escape the pressure of classroom tests, quizzes, and social situations. Others may avoid school to gain access to rewards at home, like video games or screen time.

Addressing school refusal is critical — and achievable. Many therapists recommend cognitive behavioral therapy (CBT) because it can help kids identify their underlying fears and support a gradual shift in their behavior.

Children with ADHD commonly struggle with anxiety, which brings a fight, flight, or freeze response. Avoidance, an example of the flight response, is common for kids who have anxiety and ADHD. To improve anxiety, you must address avoidant behavior.

Think of it this way: A boy is scared of his neighbor’s dog. When he steps out of his house and sees it, his heart races and he thinks, “The dog is going to bite me.” He runs back into his house and calms down, but only temporarily.

When he sees the dog again, his anxiety grows in intensity because avoiding the dog only confirmed his anxiety. His urge to run away is even greater.

[Download: Social Anxiety Facts and Falsehoods]

So how does the child conquer his fear of dogs? By not avoiding them. The more children are exposed to what they fear — in safe, incremental doses — the more they teach their bodies to understand: “I can do this, even though it’s really hard.” This helps build a tolerance for things that are uncomfortable.

This process is called exposure therapy: It means exposing an individual to the fear that triggers their anxiety in gradual, increasingly challenging steps. This is a critical part of the treatment plan for school refusal. When kids confront their fear, and ride the wave of anxiety that builds, crests, and subsides, they learn that their anxiety will pass and that they can tolerate the feeling while it’s happening.

An effective school refusal treatment plan, called a hierarchy, requires a nuanced understanding of a child’s specific situation. The hierarchy should include motivating rewards upon completion of each step. But keep in mind: It’s important to break down the hierarchy into very small steps. Practice the first step until a child’s anxiety level drops from a rating of 8 out of 10 to a 4 or 5. Then move to the next step.

Below is a sample hierarchy plan:

1. Drive to school
2. Walk to school door
3. Walk through school door
4. Walk to selected location in school
5. Walk to classroom, sit outside for 5 minutes
6. Walk to classroom, sit outside with a friend for 10 minutes
7. Walk into class, sit in“safe spot” for 5 minutes
8. Stay in school 1 (2, 3, 4) period(s)
9. Stay in school until lunch
10. Stay all day

Working with Your Child’s School

An effective partnership between parents, the school, and a therapist may look like this:

• The child goes to CBT once a week or more. The therapist works on exposure therapy as well as cognitive reframing tools and coping strategies.
• The child’s parents meet with the therapist regularly to learn how to provide support.
• The school collaborates with the parents and the therapist on creating and implementing a re-entry plan.

Schools can offer supports and accommodations to ease the intense anxiety caused by attending school. This could include reducing the homework load, changing deadlines, moving the child’s seat, or having the child start their day in the therapist’s office.

If the child’s anxiety is so impairing that none of these interventions help, consider medication, or an alternate school setting, such as a therapeutic school with more robust supports.

[Download: 30 Great Accommodations for Children with ADHD]

Staying Home from School

If you allow your child to stay home from school, consider the following:

• Keep everything as boring as possible, including meals.
• Turn off the Internet. Remove devices until after school hours.
• Direct your child to do schoolwork and chores.
• Do not allow playdates, outsides activities, or rewards.

Make sure to prepare your child for their return to school the night before and the morning of.

The night before:

• Help your child engage in a relaxing activity.
• Use supportive statements and positive self-talk together.
• Practice strategies that will calm your child.

The morning of:

• Calmly state that you understand how your child is feeling. Say, “I can see this is really hard for you.”
• Express confidence in their ability to cope. Say, “I know you can do this.”
• Review rewards and consequences.
• Keep calm. Refrain from emotional reactions.

Reader Insights

ADDitude magazine asked readers whether their child ever refused to go to school for an extended period. Forty-three percent responded yes. Of this group, 41% said that school refusal lasted for days, 20% said weeks, 11% said months, and 28% said it lasted for a year or longer. Some shared their experiences.

“In kindergarten, it was hard for my oldest to leave the comfort of home. His ADHD made it hard to adapt to new expectations and routines. He ran away from school often, hid from his teachers, and just plain refused to leave the house in the mornings. When his teacher started preparing a card with a new word and definition for him each morning, inspired by his hyperfixation on words, he suddenly became excited to go to school. He kept those cards in a collection. Now he’s in fifth grade and absolutely loves school and his teacher.”

“It was too hard for my child to sit all day and the teachers didn’t understand. We sent him to a school that understood ADHD better. Now he gets up early and goes happily.”

“My son was willing to go to school, but not to stay in class. Health issues, peer bullying, and lack of educator support made him feel lost in the middle school classroom. We found private tutors who could work with him daily at home to rebuild his academic skills and confidence. After four months, he was ready to return to a new school.”

“My daughter hated middle school. She had a hard time socially, the school felt too big, and one day she announced she was never going back there. But, true to form for ADHD people, she had already thoroughly researched her options and found an online school that would give her academic support while allowing me to be her teacher. The program fit her learning needs, and when high school started, she was ready to return to a conventional school environment. It was a lot of work for me, but I admired her for articulating the problem and finding a reasonable solution on her own at the age of 14.”

School Refusal & Avoidance: Next Steps

• Download: The Top 6 Learning Challenges Associated with ADHD
• Sign Up: ADHD @ School — A Free 10-Part Class for Parents
• Read: Why School Stress Is Toxic for Our Children
• Read: 6 Good Reasons to Change Your Child’s School
• eBook: How to Teach (and Inspire) Students with ADHD

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According to SHRM, the human resources trade association:

• 47% of U.S. employees with a nonapparent disability chose not to disclose at work
• 1 in 5 believe they would not be promoted if they disclosed their disability
• 16% of U.S. employees report having a nonapparent disability
• 1 in 3 believe others would scrutinize their behavior, think they can’t do their work, and talk behind their backs if they disclosed their disability

The decision to disclose a diagnosis — or not disclose it — requires careful consideration. To that end, we sought a wide range of perspectives from leading experts. Here’s their advice for making a thoughtful and wise decision.

“Discuss Strengths & Weaknesses, Not Diagnosis”

Instead of disclosing the official (inaccurate) name of the condition, I advise folks to have a discussion with their supervisor about their strengths and weaknesses. All employees ought to do this to make sure their job description is a good match for their brain. I can’t tell you how often mismatches occur and cause subpar performance.

Without naming ADHD, you can explain that you’re more of an idea generator than a detail maven; that punctuality isn’t your strength, but you make up for it with hard work and persistence; that you engage deeply in your work because it brings out the best in you.

[Get This Free Download: What to Ask Yourself to Find the Perfect Job]

Generally speaking, I’m not a fan of workplace accommodations in the name of ADHD. That said, you can and should ask for conditions that facilitate your best work, which any supervisor should grant to get the best out of your brain.

The best “workplace accommodation” is finding the right job to suit your ADHD brain!

— Ned Hallowell, M.D., author and co-author of many books, including Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder (#CommissionsEarned)

“Employers Can’t Support You Unless They Know There’s a Need”

It’s hard to support someone without knowing if there’s a need. In recent years, there’s been a heightened awareness of neurodivergent conditions like ADHD and autism, and more employers have prioritized mental health and supporting employees in general. Employers are recognizing that not all disabilities are obvious, and if an employee discloses they have a disability that is creating a hindrance, it’s the employer’s responsibility to explore ways to support them.

—Katie Brennan, HR knowledge advisor, Society for Human Resource Management, a professional membership organization

“Request Informal Accommodations First”

The issue of whether to disclose an ADHD diagnosis to an employer is tricky. Outcomes are hard to predict, though recognition of neurodivergence is seemingly trending in a positive direction.

[Read: What’s the Secret to Thriving at Work? 5 Keys for ADHD Adults]

Perhaps you have gained a sense of the workplace vibe and established your place there. You might start by making an appeal for an informal accommodation that does not require you to mention ADHD. You might request adjusted hours, such as arriving later and staying later, without saying this is to allow your morning meds to kick in. In the same vein, you could request frequent check-in meetings with a supervisor or a colleague to stay on track with projects (akin to body doubling), simply stating, “It helps me stay on top of things better.”

When seeking accommodations in a job that is protected under the Americans with Disabilities Act, start by consulting Human Resources. You will be asked to provide documentation of your ADHD diagnosis and to formally request specific adjustments to your duties or to communication protocols, such as receiving written follow-up summaries of verbal directions.

Your treatment provider may need to complete some forms and work with you to define specific requests. Still, even in this setting, you might try the informal route first for things like wearing earbuds or working in a closed office to reduce distractions.

— J. Russell Ramsay, Ph.D., co-founder, Penn Adult ADHD Treatment and Research Program, University of Pennsylvania

“Get the Right Treatment”

Ultimately, I hope to empower my patients with treatment that helps them function and thrive in any job regardless of their ADHD.

If a type of accommodation is helpful, I would hope that it would be available to all employees regardless of ADHD diagnosis, so that employees who are undiagnosed can also benefit.

Ideally, all employees would be able to find and adapt to work environments that best fit their skill sets.

— Jacob Behrens, M.D., CEO & Medical Director, Envision ADHD Clinic

“Reinforce That ADHD Is a Value-Add”

What’s the culture of your office? I imagine [the decision to disclose] would change depending on the sector. If you do disclose, show your proficiency of knowledge and reinforce that ADHD is a value-add.

In the creative world, I see my ADHD as a superpower and leverage the energy burst and the hyperfocus. I feel empowered by having ADHD, and it’s one of my favorite parts of myself.

— Sarah Yourgrau, owner, Common Ground Studios, a television and film production company

“Before Disclosing, Consider How Your Boss Will Likely Respond”

Before disclosing your ADHD, make an honest assessment of the likely response by your boss and company. How do they tend to handle situations that challenge standard procedures? How much do they value employee satisfaction (a.k.a., retention) versus efficiency? After disclosing, you may find that their attitude toward you has shifted, that they’re paying more attention to your every action, and maybe even taking notes. Keep in mind that HR’s job is to protect the company, not you.

If there are some reasonable steps your employer or co-workers can take to make you a better employee, ask for them. Don’t feel bad or minimize your requests. And definitely don’t apologize. This can make others feel like it’s their job to make sure you feel okay.

Also, if you choose to disclose your ADHD and ask for accommodations, do so while you’re in good standing. If you’re on a performance improvement plan or on the verge of one, your boss may be less receptive because you didn’t let them know earlier — before they filled out all the paperwork.

Regardless of when you disclose your ADHD, you need to show your boss that your requested accommodations are designed to make you a more effective employee. In the end, the burden is on you to earn your keep.

— Ari Tuckman, Psy.D., author of More Attention, Less Deficit: Success Strategies for Adults with ADHD (#CommissionsEarned)

ADHD in Workplace: Next Steps

• Get This Free Download: How to Manage Your Time at Work
• Read: The Real-Life Risks and Rewards of Disclosing ADHD at Work
• Read: Should You Tell Your Boss About Your ADHD?
• Read: Can My Employer Use ADHD as an Excuse to Fire Me?
• Read: “Women with ADHD Prefer Silence Over Disclosure. This Needs to Change.”

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

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

ADHD & Neurodivergent Workplaces: What’s the Secret?

The ADHD-entrepreneurship connection is neurological. The ADHD brain is starved of norepinephrine and dopamine, the neurotransmitters that contribute to feelings of alertness and satisfaction. When these levels are low, people with ADHD seek new and stimulating activities to compensate. This is why they’re often seen as driven, enthusiastic, and creative.

I’m a business owner with ADHD. Those who work with me will tell you that I bounce around from topic to topic and can be difficult to follow. But when an idea, problem, or situation is in my line of sight, I focus on nothing else until it’s solved. This hyperfocus has helped me tremendously, but it has also caused conflict and communication challenges within my team. Things that seem clear to me are often missed or misunderstood by others. Communicating effectively can be difficult, but it is vital.

Creating and Cultivating Opportunities

I teach business leaders how to interview, hire, retain, and advance workers with ADHD. I believe that fear and a lack of understanding dissuade many leaders from hiring and retaining candidates who reveal that they have ADHD. Many of these same employers have employees who are neurodivergent; they just don’t know it. Workers with ADHD often mask their symptoms until they burn out or have a communication or sensory breakdown.

[Download: What to Ask Yourself to Find the Perfect Job]

In 2022, I co-founded the Colorado Neurodiversity Chamber of Commerce, the first such organization in the U.S., along with psychologist Amanda Kelly, Ph.D., and business leader Tiffany Feingold. Our mission is to create and nurture opportunities for neurodivergent workers by guiding business leaders in adopting neuro-inclusive communication, job descriptions, and hiring practices. To date, nearly 100 businesses, large and small, and from diverse industries, have joined the chamber. We also provide employee and leadership training, and our resources have reached hundreds of thousands of employees.

In my own organization, we share a meeting agenda and topic at least 24 hours in advance to give everyone time to process and prepare for questions. We record each meeting and provide transcripts for employees to review and reference. Additionally, we use colors and symbols as headings and markers to help relay specific sequencing, importance, and organization. These are simple and cheap practices that provide structure and accessibility for everyone.

Mentor programs and employee resource groups, plus reasonable accommodations, help workers feel supported and promote inclusion. These practices benefit all employees. By adopting best practices and strategies for neurodivergent employees, employers create an inclusive workplace that leads to innovation, creativity, and community — all of which benefit their bottom line.

Understanding Neurodiversity at Work

Researchers at Birkbeck, University of London surveyed 1,117 neurodivergent people — 990 employees and 127 employers — with the aim of helping managers support differences and drive inclusivity. These were among the findings published in their report, Neurodiversity at Work 2023.

[Read: Why Won’t Employers Take a Risk on Different Thinkers?]

Struggles and Challenges

• Looking after yourself mentally: 77.6%
• Concentration: 76.5%
• Asking for help when you need it: 69.5%
• Working memory: 64.8%
• Managing boundaries at work: 64.4%
• Understanding others’ intentions: 2%
• Long-term memory: 60.1%
• Organizing tasks: 51.3%
• Working with others: 34.7%

Strengths

• Hyperfocus: 80%
• Creativity: 78.1%
• Innovative thinking: 75%
• Authenticity: 64.4%
• Entrepreneurialism: 46%

Barriers to Disclosure

• Stigma, discrimination from management: 64.7%
• Stigma, discrimination from colleagues: 55%
• No supportive or knowledgeable staff: 40.5%
• Existing supports inadequate or unhelpful: 33.9%
• Supports they needed were not provided: 29.3%

Understanding these specific challenges and strengths can help drive more inclusive and prosperous workplace environments.

Inclusivity at Work: Next Steps

• Read: How to Run a Business When You Have ADHD
  
• eBook: Getting Things Done with Adult ADHD
• Watch: Workplace Strategies for Professionals with ADHD
• Read: How to Gauge Diversity, Equity & Inclusion at a Prospective Employer
  

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

Sources

¹Freeman, M.A., Staudenmaier, P.J., Zisser, M.R. et al. (2019). The prevalence and co-occurrence of psychiatric conditions among entrepreneurs and their families. Small Bus Econ, 53, 323–342. https://doi.org/10.1007/s11187-018-0059-8

²Lerner, D.A., Verheul, I. & Thurik, R. (2019). Entrepreneurship and attention deficit/hyperactivity disorder: a large-scale study involving the clinical condition of ADHD. Small Bus Econ, 53, 381–392. https://doi.org/10.1007/s11187-018-0061-1

Dyslexia, a genetically rooted reading disability, affects the ability to decode (sound out) and spell words. Students with dyslexia are typically inaccurate in reading and spelling. They do not understand how to manipulate the sounds that form words. Their oral reading is often slow. They may focus so much on decoding individual words, not content and meaning, that their comprehension is compromised.

When teaching students with dyslexia, it is important to use evidence-based practices that have a significantly higher success rate than other approaches. Structured literacy is one such approach. It provides daily instruction in phonics through a carefully sequenced program offered to small groups of students with similar skill levels. This type of teacher-supervised instruction, also referred to as multisensory or Orton-Gillingham based, integrates the teaching of reading, spelling, and handwriting.

How to Help Students with Dyslexia

• Provide an appropriate, evidence-based reading program that requires implementation as designed, not piecemeal, until a student shows that they are ready to move on.
• Assign homework that reflects the student’s current reading level so they can complete work independently.
• Utilize oral exams that allow them to show what they know until reading skills are remediated.
• Give untimed tests.

A side note: Some students benefit from audiobooks reflecting what is being taught, though this does nothing to improve reading.

[Take This Self-Test: Does My Child Have Dyslexia?]

How ADHD Affects Reading

Roughly half of children with ADHD have learning disorders that affect academic achievement. This is in addition to the impact of inattention and related ADHD symptoms. Executive function challenges also impact reading and writing. Students with ADHD may decode well, but still not read accurately. Executive function includes the ability to stay focused on the correct place on the page, as well as to process and organize information.

Students with ADHD may also skip around the page, read impulsively or too quickly, or miss word endings, modifiers, and smaller words. They may lose track of content details and struggle to sort new information. They may not be able to maintain attention or retain information through longer passages. Comprehension becomes undermined by these inaccuracies.

Students with ADHD would benefit from:

• Use of prescribed stimulant medication, which has been shown to improve reading abilities.
• Placement in less distracting classrooms (such as having desks facing forward and less clutter) and with well-organized teachers.
• Strategies that help students stay focused on the page, like using a straight edge or their finger to stay on a line.
• Textbooks in which students have permission to underline and annotate pages, which aids focus.
• Direct instruction in higher level reading strategies, such as notetaking, previewing, and summarizing text.

Students with dyslexia are entitled to an Individualized Education Program (IEP) or 504 Plan that includes comprehensive direct instruction using an evidence-based reading program. For students with ADHD, an expansive plan should support all areas of executive function.

If this seems like a lot to ask, rest assured that supports for students with dyslexia and ADHD benefit all students’ growth.

Dyslexia and ADHD: Next Steps

• Read: The Defining Signs of Dyslexia Too Often Ignored
• Get This Free Download: Signs of Dyslexia at Every Age
• Read: Reading Strategies That Grow with Your Child
• Read: When Your Child Has ADHD and Dyslexia  — Treatment for Complex Symptoms

Mark Bertin, M.D., is a developmental pediatrician and author of How Children Thrive.

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In this final installment of ADDitude magazine’s two-part series, “The Future of ADHD” (the first part appeared in the Winter 2023 issue), I’ll explain each of the developments poised to revolutionize ADHD understanding and treatment.

New Pharmacologic Interventions for ADHD

Development of pharmacologic interventions for ADHD has mushroomed over the last two decades. Though researchers have made progress in developing non-stimulant treatment options (i.e., long-acting forms of clonidine and guanfacine, as well as atomoxetine and viloxazine), most of the FDA-approved agents are simply tweaks of methylphenidate and amphetamine compounds.

There are now more choices available to prescribers and patients, offering stimulant preparations of varying durations, delivery formats (patch, liquid, tablet, capsule), and pharmacokinetic profiles. It should be noted that both older and newer preparations are exceptionally effective for most patients and, when comparing them to non-stimulants in head-to-head trials and in clinical practice, the psychostimulants generally win hands-down. However, the various forms of psychostimulants differ in their rate of onset, duration of coverage, convenience (once daily vs. multiple doses daily), and cost.

Psychostimulants, however, are not effective for everyone; about 30% of patients may not have a satisfactory response.¹ As a result, researchers are increasingly exploring the benefits of combining psychostimulant treatment with other compounds (e.g., methylphenidate paired with atomoxetine, or a dextroamphetamine compound plus guanfacine).

[Get This Free Download: 2024 Scorecard of ADHD Treatments]

The robust effectiveness of psychostimulants in treating ADHD has somewhat slowed the development of alternatives. However, researchers are exploring newer agents that target different neurotransmitter systems, including:

• Solriamfetol (used to treat excessive daytime drowsiness)
• Tipepidine (used as a cough suppressant)
• Amantadine (used to treat Parkinson’s disease)
• Dasotraline (used to treat depression and other disorders)

Not yet FDA-approved for ADHD, these compounds face two main challenges: matching the effectiveness of psychostimulants and effectively targeting symptoms not currently treated by psychostimulants.

ADHD and the Gut-Brain Axis

Emerging research suggests a significant, but underappreciated, relationship between the gut biome — a diverse community of microorganisms living in the digestive tract — and behavior and emotions. The gut and the brain communicate through the gut-brain axis, allowing gut microbiota to influence brain function and vice versa.

Multiple studies have now shown that abnormalities in the gut microbiome can affect mood, anxiety, and stress levels.² Certain gut bacteria can even produce neurotransmitters like serotonin and gamma-aminobutyric acid (GABA), which play a crucial role in regulating emotions.³ Other gut bacteria can produce toxins, inflammatory molecules, and other metabolites that can cross the blood-brain barrier to adversely impact brain health and cognitive function.⁴

[Get This Free Download: Lifestyle Changes for Adults with ADHD]

Imbalances in the gut microbiome can be caused by diet, stress, and even antibiotic use during the prenatal period or during infancy.^{5 6} Longitudinal studies have shown that these gut factors can be linked to mental health disorders, including ADHD, in later childhood.⁷ Multiple studies also suggest that restoring a healthy gut balance through probiotics, prebiotics, or dietary changes might improve emotional wellbeing.⁸ Research involving the microbiome’s impact on human behavior and emotions is still emerging.

ADHD and Gene-Environment Interactions

ADHD is highly heritable; however, environmental influences are exceptionally important in determining whether, when, and how a set of genes will manifest in ADHD symptoms. Environments determine whether a particular illness or disease manifests. This area of research — how certain genes are differentially expressed due to differences in environments — is in its infancy.

A major challenge: Because there are so many genes and possible environmental factors unfolding over time, there are literally trillions of possible gene-environment interactions that could affect the timing, severity, and persistence of ADHD. Due to the likely number and complexity of these interactions, multiple replications across independent studies will be essential.

Several studies have already shown that the severity and persistence of ADHD can be a function of parent-child interactions and supervision across different settings.⁹ This is not a “blame the parents” finding, but, instead, suggests that certain interventions from caregivers (and possibly teachers, coaches, and other adults) may mitigate a child’s symptom severity and persistence. For example, teaching parents how to remain neutral, or even express warmth in the face of difficult behaviors, is likely an important area of intervention. Related findings indicate that parental rejection¹⁰ can affect a child’s outcomes, as can the level of household disorganization¹¹, overall life stress¹², and other factors. Attention to such challenges offers an opportunity for targeted interventions.

Many different factors contribute to ADHD’s etiology, timing of onset, and severity, as well as possibilities for prevention and person-specific treatment. Our research to date, and our research programs unfolding over the next decades, will continue to lead to advances in the way we diagnose and treat ADHD in childhood and in adults.

ADHD Research: Next Steps

• Read: The Evolution of ADHD — Examining the Last 25 Years and the Future
• Read: Prenatal and Early Life Risk Factors of ADHD
• Watch: Epigenetics — Understanding Its Role in ADHD and Future Applications
• Hub: ADHD News & Research

Peter S. Jensen, M.D., is the founder of The REACH Institute, which trains providers in interventions for children’s mental health care.

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Sources

¹ Spencer, T., Biederman, J., & Wilens, T. (2004). Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. The Psychiatric clinics of North America, 27(2), 373–383. https://doi.org/10.1016/j.psc.2003.12.001

² Xiong, R. G., Li, J., Cheng, J., Zhou, D. D., Wu, S. X., Huang, S. Y., Saimaiti, A., Yang, Z. J., Gan, R. Y., & Li, H. B. (2023). The Role of Gut Microbiota in Anxiety, Depression, and Other Mental Disorders as Well as the Protective Effects of Dietary Components. Nutrients, 15(14), 3258. https://doi.org/10.3390/nu15143258

³ Chen, Y., Xu, J., & Chen, Y. (2021). Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients, 13(6), 2099. https://doi.org/10.3390/nu13062099

⁴ Parker, A., Fonseca, S., & Carding, S. R. (2020). Gut microbes and metabolites as modulators of blood-brain barrier integrity and brain health. Gut microbes, 11(2), 135–157. https://doi.org/10.1080/19490976.2019.1638722

⁵ Madison, A., & Kiecolt-Glaser, J. K. (2019). Stress, depression, diet, and the gut microbiota: human-bacteria interactions at the core of psychoneuroimmunology and nutrition. Current opinion in behavioral sciences, 28, 105–110. https://doi.org/10.1016/j.cobeha.2019.01.011

⁶ Fish-Williamson, A., Hahn-Holbrook, J., Hobbs, M., Wallander, J., & Morton, S. M. B. (2022). Prenatal antibiotic exposure in pregnancy and early childhood socioemotional development. JCPP advances, 2(2), e12066. https://doi.org/10.1002/jcv2.12066

⁷ Cassidy-Bushrow, A. E., Sitarik, A. R., Johnson, C. C., Johnson-Hooper, T. M., Kassem, Z., Levin, A. M., Lynch, S. V., Ownby, D. R., Phillips, J. M., Yong, G. J. M., Wegienka, G., & Straughen, J. K. (2023). Early-life gut microbiota and attention deficit hyperactivity disorder in preadolescents. Pediatric research, 93(7), 2051–2060. https://doi.org/10.1038/s41390-022-02051-6

⁸ Bistas, K. G., & Tabet, J. P. (2023). The Benefits of Prebiotics and Probiotics on Mental Health. Cureus, 15(8), e43217. https://doi.org/10.7759/cureus.43217

⁹Haack, L. M., Villodas, M. T., McBurnett, K., Hinshaw, S., & Pfiffner, L. J. (2016). Parenting Mediates Symptoms and Impairment in Children With ADHD-Inattentive Type. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 45(2), 155–166. https://doi.org/10.1080/15374416.2014.958840

¹⁰ Brinksma, D. M., Hoekstra, P. J., de Bildt, A., Buitelaar, J. K., van den Hoofdakker, B. J., Hartman, C. A., & Dietrich, A. (2023). Parental rejection in early adolescence predicts a persistent ADHD symptom trajectory across adolescence. European child & adolescent psychiatry, 32(1), 139–153. https://doi.org/10.1007/s00787-021-01844-0

¹¹ Agnew-Blais, J. C., Wertz, J., Arseneault, L., Belsky, D. W., Danese, A., Pingault, J. B., Polanczyk, G. V., Sugden, K., Williams, B., & Moffitt, T. E. (2022). Mother’s and children’s ADHD genetic risk, household chaos and children’s ADHD symptoms: A gene-environment correlation study. Journal of child psychology and psychiatry, and allied disciplines, 63(10), 1153–1163. https://doi.org/10.1111/jcpp.13659

¹² Hartman, C. A., Rommelse, N., van der Klugt, C. L., Wanders, R. B. K., & Timmerman, M. E. (2019). Stress Exposure and the Course of ADHD from Childhood to Young Adulthood: Comorbid Severe Emotion Dysregulation or Mood and Anxiety Problems. Journal of clinical medicine, 8(11), 1824. https://doi.org/10.3390/jcm8111824

When Wingert’s ADHD brain bursts with ideas that simply must be shared with her employees right now, even during a meeting about something entirely different, her trusted assistant gently nudges her back on track and to the subject at hand.

“When I have a new idea and fall madly in love with it, well, it’s as if we don’t have other initiatives” to attend to, says Wingert, a licensed psychotherapist, coach, consultant, and serial entrepreneur. “As a leader, I need to empower the people around me to help me manage myself sometimes.

“I’ve taught my assistants to do this: Give me a little space to share my brand-new idea because I’m so excited that, if you shut it down right away, I might get triggered and double down. So then they ask: ‘Where does this fit with our current initiatives?’ Then I think, ‘Oh, yeah, where is this going to fit?’ Then my assistant says, ‘This is a great idea, boss. Let’s put it in the idea parking lot and come back to it at our next quarterly review and see if it makes sense then.’ I get the dopamine hit from sharing the idea, and we move on.”

Wingert calls this exchange an example of “radical self-acceptance.” Because she knows her ADHD strengths, triggers, and limitations “impeccably well,” and understands their impact on the workplace, she set out to recruit a team that complements her traits as well as each other’s perspectives and work methods.

[Free Download: How to Manage Your Time at Work]

Neurodivergent Leadership Gains Traction

The business case for neurodiversity in leadership — embracing different ways of thinking, processing information, identifying opportunities, and crafting solutions—is gaining attention and driving progress. Katie Brennan, an HR knowledge advisor at the Society for Human Resource Management, a professional membership organization, says businesses with neurodivergent leaders have a strategic advantage, thanks to their “unique perspectives that enhance problem-solving, fuel creativity, and improve decision-making.”

Equally important are the ways in which a boss’s neurodivergent traits affect their employees’ job satisfaction. For instance, Sarah Yourgrau’s excitement around new ideas often led to rapidly changing priorities, which suited her ADHD brain’s need for novelty but not her employees desires for structure and stability.

“My challenges as a boss are curtailing passion and sticking with priorities all the way through,” says Yourgrau, CEO of Common Ground Studios, a television and film production company in Los Angeles. “Not everyone can be comfortable shifting gears so quickly.”

”My team would say they’re energized by my passion but sometimes need a few more moments to process the pivots and quick shifts,” she continues. “Now that I’m running a business, I’ve had to get better at communicating and applying new ways of keeping myself on task.”

[Free Webinar Replay: How to Transform Your ADHD Into a Strategic Advantage at Work]

Let’s Talk About Your Performance

Emotional dysregulation, a core characteristic of ADHD, can handicap neurodivergent bosses and workers alike. When a manager seeks to address an employee’s performance problem, it can feel like navigating a minefield of sensitivities where latent feelings of inadequacy threaten to explode.

“Most people with ADHD have emotional dysregulation, so having conversations around not meeting expectations can feel like dealing with someone who has PTSD,” says Gail Suitor, owner and coach at Ignite Change Makers. “It’s important to start with, ‘I’m bringing this to your attention because you’re one of my most important employees.’ This disengages the PTSD trigger.

Addressing performance issues can also be triggering for neurodivergent employees who feel the lingering sting of childhood criticism and rejection. So what is a compassionate and effective way for leaders to provide constructive feedback?

First, invite your employees to participate in the conversation so they don’t feel like passive team members; this should mitigate their sense of vulnerability and insecurity. Then offer them a “sandwich,” HR parlance for a technique to soften the impact: It starts with positive praise, then provides constructive criticism or corrective action, and concludes with more positive feedback.

Here’s how a script might unfold after the initial praise is given, according to Wingert:

Boss: How do you think you’re performing in your current role? What’s going well, and what are you struggling with?

Worker: [Discloses the problem that has prevented them from doing their best work.]

Boss: I agree with you on the struggles [if appropriate], and this is the feedback I’m receiving from other team members [if appropriate]. Do you have thoughts on how to make this better?

Alternatively, if the worker has trouble expressing their problems or feels under fire:

Boss: You and I are not on opposite sides. I may be the boss, but we both want the same thing: for you to thrive in this position. Let’s close the gap between where you are and where we’d like you to be. Let’s creatively solve this problem together.

Suitor says it’s important to figure out why a valued employee isn’t meeting expectations. Sometimes, she says, the slightest tweak to a job can make a meaningful impact. “If you’re noticing your worker with autism is having to stim more often, is it because they are overstimulated? Is there a light that’s bothering them? Does an employee find one part of their job harder to do because it’s not as interesting? If so, set up a system that works better.”

For bosses who also have trouble with the mundane or intimidating parts of a job, Suitor offers this advice: “Get mindset coaching. Plan your day around when your meds are the most effective and do more difficult tasks at that time.

“Mindfulness practice helps a ton with focus. And hire a person to offset your weaknesses and who is great with executive function — hire your frontal lobe.”

4 Mistakes Managers with ADHD Make

Avoid these unforced errors common among neurodivergent leaders.

Mistake #1: Lacking Self-Awareness

Bosses who fail to understand and appreciate the impact of their executive functioning deficits on team planning, prioritizing, and time estimating can create a chaotic environment and upend business goals. This leads to Mistake #2.

Mistake #2: Not Hiring Support Staff

Hire an assistant to keep you organized and focused; this will undoubtedly boost your effectiveness as a boss.

Mistake #3: Never Soliciting Feedback

Give employees permission to tell you how your management and communication styles affect them.

Mistake #4: Hogging the floor

Bosses are infamous for talking at length during meetings, effectively blocking others from engaging and contributing. This is not productive or collaborative. A better option: Seek a diversity of opinions by soliciting ideas and recommendations from disparate team members.

Neurodivergent Leadership: Next Steps

• Free Download: 8 Dream Jobs for Adults with ADHD
• Read: What’s the Secret to Thriving at Work? 5 Keys for ADHD Adults
• Read: Be the Boss: 9 Sanity-Saving Strategies for ADHD Executives
• Resource Hub: ADHD at Work

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

There is nothing effective or compassionate about punishing your child to transform a frustration response. It is better to directly (and proactively) involve your child in solving the root problems that trigger their outbursts. This is the evidence-based approach called Collaborative and Proactive Solutions (CPS), a non-punitive intervention to decrease conflict and enhance relationships.

Follow the CPS model’s roadmap (abbreviated here) to uncover the roots of your child’s concerning behaviors and create lasting, positive change.

Collaborative Problem Solving for The Explosive Child

Be observant.

Identify the skills that make it hard for your child to respond adaptively to problems and frustrations. The mantra of the CPS model is: Kids do well if they can. If your child is responding maladaptively to a problem or frustration, it is because they’re struggling with important skills, such as flexibility/adaptability, frustration tolerance, problem-solving, and emotion regulation.

Identify unsolved problems.

Any expectation your child is having difficulty meeting, even if they can meet it sometimes and not others, is an unsolved problem. It is those unsolved problems that are causing your child’s frustration response (concerning behavior). In the CPS model, rather than try to modify those behaviors, you solve the problems that are causing them. But you have to identify them first. Both skills and unsolved problems are identified using an instrument called the Assessment of Skills and Unsolved Problems (ASUP).

[Get This Free Guide to Ending Confrontations and Defiance]

Prioritize problems.

Once you have a comprehensive list of the expectations your child is having difficulty reliably meeting, pick your top three to address. Here’s a process for prioritizing:

• Safety first. Are any of your child’s problems tied to dangerous behaviors (like hitting others)?
• Frequency. Which unsolved problems contribute to concerning behaviors most often?
• Gravity. Which unsolved problems have the greatest negative impact on your
  child or others?

Your child is your problem-solving partner. The problem-solving process involves the following steps:

1. Gather information from your child about what’s making it hard for them to meet an expectation. It might sound like this: “I’ve noticed you have difficulty turning off your video game when it’s time for dinner. What’s up?” If your child doesn’t answer, make a few guesses. Ask them to rate each guess on a scale of one (not true) to five (very true).

2. Explain why it’s important that the expectation be met. Concerns usually fall into one of two categories: how the unsolved problem affects the child or how the unsolved problem affects others. Typically, concerns are related to health, safety, and/or learning.

3. Work with your child on a solution that is realistic and mutually satisfactory.

[Get This Free Download: Your 10 Toughest Discipline Dilemmas – Solved!]

A Win-Win Approach

A father once told me about his young daughter’s reluctance to brush her teeth at night before bed. The father was sure that the taste of the toothpaste was the problem. He bought several flavors but the problem remained. He asked his daughter what was hard for her about brushing her teeth before bedtime. She said, “Water gets all over my face when I brush my teeth, and I hate the feeling.” This was a concern that different flavors of toothpaste would never have addressed.

Next, he outlined his concerns. “If you don’t brush your teeth, you could get cavities, which are painful and expensive to fill.” Then came the invitation to collaborate: “I wonder if there’s a way for us to make sure that you don’t get water on your face while you’re brushing your teeth, and also make sure that you don’t get cavities. Do you have any ideas?”

His daughter said, “Can I wrap a towel around my face before I brush my teeth?”

Problem solved. Both the father and daughter got their concerns addressed, and no one’s authority was undermined.

You may be thinking, “This plan sounds great, but how do I deal with my child’s behaviors during an eruption?” Once your child is escalated, you’re late. You don’t want to be late. The point of this parenting model is to solve problems proactively, so you don’t find yourself in the heat of the moment in the first place.

Collaborative Problem Solving: Next Steps

• Free Download: A 2-Week Guide to Ending Defiant Behavior
• Read: 6 Truths About Child Behavior Problems That Unlock Better Behavior
• Read: What Are the Lagging Skills Holding Your Child Back?

Ross W. Greene, Ph.D., created the Collaborative and Proactive Solutions (CPS) model of care. He is the author of The Explosive Child (#CommissionsEarned) and Lost at School (#CommissionsEarned), and the founding director of the nonprofit Lives in the Balance.

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As part of an ongoing research project, my college students and I have been interviewing dozens of adults with ADHD who are, in some way, thriving in their work lives. We focused deliberately on thriving and not “success,” which often has connotations of accomplishments, fame, or tangible rewards. Thriving has more to do with feeling valued in what you do, finding meaning in your contributions, and pursuing a trajectory toward optimal performance and engagement.

What Is Job Crafting?

We’ve interviewed individuals in many fields — professional sports, law enforcement, education, health professions, entrepreneurship, and more — and found at least one element that may be as important as treatment and environmental accommodation in determining whether an adult with ADHD will thrive. It’s their ability to actively seek and/or construct their environment to better align with their needs, skills, and limitations.

In some cases, the people we interviewed have chosen a discipline or occupation that aligns well with the characteristics of ADHD — jobs that reward creativity, problem-solving, or high energy. In other cases, those interviewed were able to shape their existing jobs by restructuring their day-to-day tasks to better match their strengths and manage their challenges. This is called job crafting.

The concept of job crafting in organizational psychology refers to a person’s self-initiated, proactive strategies to reshape or modify aspects of their work environment to align with their strengths, interests, and values. This, in turn, increases job satisfaction and improves performance.

[Download: The ADHD “Brain Blueprint” to Finding Your Passion]

Not all environments are equally malleable, but employees with ADHD can often find ways to adjust their tasks or schedule for greater satisfaction at work.

Aligning Environments with ADHD Traits

According to our interviewees, creating or finding a job that suits the traits associated with ADHD involved some combination of the following strategies.

1. Novelty

Individuals with ADHD generally do better in jobs that offer novelty, not repetitive tasks. One worker we interviewed settled on IT because it brought a steady stream of new problems to solve. He eventually started his own business and grew it into a regional leader in the field.

Other people found ways to create novelty within the boundaries of an existing job. One microbrewer described how she intentionally varied her day-to-day activities by experimenting with recipes, marketing, and managing the brewing process to regulate her interest.

[Read: It’s Borture! What ADHD Boredom Really Feels Like]

2. Flexibility

Many of our interviewees indicated that they had more difficulty when aspects of their work were rigidly defined or “curated” for them. Thriving, for them, involved seeking flexibility and/or finding ways to rearrange their work demands.

A teacher said she chose special education precisely because it allows her to adapt to the daily needs of her individual students, rather than strictly adhere to a prescribed curriculum as a general education teacher. A chief budgeting officer described how he deliberately sought ways to re-imagine and dismantle long-standing processes rather than simply follow them.

3. Distractibility and Hyperfocus

Many people with ADHD struggle to sustain attention amid distractions, but they also report intense periods of hyperfocus. Many interviewees said hyperfocus often powers their ability to solve stubborn problems at work. One worker talked about how, as a chef, he would lose himself in the creation of meals, even amid the fast-paced, chaotic environment of a restaurant kitchen. In some contexts, however, shifting attention might also be adaptive. One law enforcement officer described how his hypervigilance helped to keep him alert and attentive when on patrol.

4. Impulsivity

Underestimating risks and failing to consider consequences are sometimes the negative byproducts of an entrepreneurial spirit that drives innovation. However, many of our interviewees said their willingness to take chances was key to starting new ventures, even when others tried to dissuade them from taking a risky leap.

5. Urgency

High levels of energy are hallmark symptoms of ADHD for some people. Many of our interviewees said their energy helped generate a sense of urgency, or a need to act, that has helped them overcome important barriers in their work. One psychologist described how his boundless energy caused problems in some areas of his life but helped him push through the immense time demands of starting an early intervention agency.

For managers, understand this: Encouraging and empowering employees to reshape their environments to align with their strengths and preferences can create competitive advantages for the organization so long as the job crafting supports business goals.

ADHD at Work: Next Steps

• Download: 20 Questions to Figure Out Your Career Calling
• Watch: Workplace Strategies for Professionals with ADHD
• Read: The Best Work Schedule for ADHD Brains — Flexible or Rigid?
• Read: “Why Hiring Upside Down Thinkers Is a Competitive Advantage“

Mark J. Sciutto, Ph.D., is a licensed psychologist and a professor of psychology at Muhlenberg College in Allentown, Pennsylvania. Special thanks to the students who collaborated on this project: Alexis Hall, Ashley Henry, and Sam Levin.

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