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

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

The Person in Front of You

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

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

You, the Provider

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

On Diagnosing ADHD

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

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

On Treating ADHD

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

Listening to Patients with ADHD: Next Steps

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

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

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

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

1. The Countdown Trick

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

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

[Get This Free 2025 Calendar of Small Wins]

2. “Do It for Future Me.”

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

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

3. Pair a Treat

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

4. Find a Buddy

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

[Read: Get More Done with a Body Double]

5. Do It Imperfectly

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

How to Get Out of ADHD Paralysis: Next Steps

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

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

Leaded gasoline and exposure to its exhaust may help explain an estimated 151 million U.S. cases of psychiatric disorders, including ADHD, depression, and anxiety, according to a new cross-sectional study spanning the last 75 years published in the Journal of Child Psychology and Psychiatry.¹

Exposure to leaded gasoline from car exhaust was tied to population-wide cases of mental health disorders from 1940 to 2015 by researchers from Duke University, Florida State University, and the Medical University of South Carolina. They estimated that more than half of the current U.S. population was exposed to harmful levels of lead in childhood, resulting in profound effects on their mental health, personality traits, and overall well-being. People born between 1966 and 1986 (referred to as Generation X) experienced the highest rate of lead exposure and are at the greatest risk for anxiety, depression, ADHD, and personality changes.

“Research on lead as a developmental neurotoxicant is robust,” says Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “Its correlation with ADHD is also well established. Even low levels of exposure have an effect on ADHD.”², ³

Nigg was the principal investigator on several studies suggesting that lead exposure has a causal role in ADHD. One study published in Psychological Science found that children with ADHD who had the HFE C282Y gene mutation exhibited significantly more symptoms of hyperactivity and impulsivity than did children with ADHD who lacked the mutation.⁴

“Because the C282Y gene helps to control the effects of lead in the body, and the mutation was spread randomly in the children, it is difficult to explain these findings unless lead is, in fact, part of the cause of ADHD, not just associated with it. Numerous animal studies also support a link,” he says.

Leaded Gasoline Exposure Is a Public Health Crisis

Nigg’s study and others have linked lead exposure to life-long mental, physical, and behavioral issues; lowered IQ points; and personality changes.⁵, ⁶, ⁷, ⁸ However, the findings from the Journal of Child Psychology and Psychiatry’s study highlight the historic and pervasive effects of lead exposure on the cognitive and psychological health of a staggering slice of the U.S. population.

“Lead’s potential contribution to psychiatry, medicine, and children’s health may be larger than previously assumed,” the researchers wrote.

The study analyzed lead levels in children’s blood collected for the CDC’s National Health and Nutrition Examination Surveys (NHANES) and correlated that with historic leaded-gasoline data. The researchers calculated “mental illness points” based on the fraction of changes in the mental health of Americans born in different years and the population elevations of mental health symptoms associated with lead exposure.

The researchers identified a cumulative increase of 602 million general psychopathology points across the population, corresponding to an estimated 151 million additional mental disorders. They found that lead exposure heightened the risks for anxiety, depression, and ADHD; increased neuroticism, associated with negative emotionality; and decreased conscientiousness, reflecting less self-control and goal-oriented behavior.

While the study’s results do not prove causation, the researchers say that their findings will provide doctors with insights about their patients’ symptoms and underscore the need for expanded lead testing in patients and the recognition of lead poisoning as a neurodevelopmental disorder within a psychiatric diagnostic framework.

Leaded Gasoline Exposure: Next Steps

Lead was added to gasoline in the 1920s to improve engine performance. During the early childhood years of Generation X, leaded gasoline became the predominant fuel type in the U.S. In the mid-1970s, the U.S. Environmental Protection Agency (EPA) began phasing out leaded gasoline, but a U.S. ban did not go in effect for on-road vehicles until 1996. Lead is still found in some paints, children’s toys, and deteriorating water pipes.

According to The CDC, high levels of lead exposure can lead to seizures, vomiting, memory loss, and even death. Exposure to even small amounts of lead can be harmful. Children 6 years or younger are most vulnerable to lead poisoning, which can cause development and growth delays, hearing and speech problems, difficulty learning and paying attention, and serious illness and death.

Symptoms of lead poisoning can be hard to recognize in children. The CDC recommends discussing possible lead exposure with a child’s healthcare provider and testing children ages 1 to 5 for lead if they:

• Live in a home built before 1978
• Receive Medicaid services
• Are an immigrant, refugee, or adopted from another country
• Live near a known source of lead, such as a lead smelter or mine

Sources

¹McFarland, M.J., Reuben, A. and Hauer, M. (2024). Contribution of Childhood Lead Exposure to Psychopathology in the US Population Over the Past 75 Years. J Child Psychol Psychiatr.https://doi.org/10.1111/jcpp.14072

²Sanders, T., Liu, Y., Buchner, V., Tchounwou, P.B. (2009). Neurotoxic Effects and Biomarkers of Lead Exposure: A Review. Rev Environ Health. https://doi.org/10.1515/reveh.2009.24.1.15

³Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M., Cavanagh, K., Karmaus, W., & Rappley, M. D. (2008). Low Blood Lead Levels Associated with Clinically Diagnosed Attention-Deficit/Hyperactivity Disorder and Mediated by Weak Cognitive Control. Biological Psychiatry. 63(3), 325–331. https://doi.org/10.1016/j.biopsych.2007.07.013

⁴Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. (2016). Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological Science.https://doi.org/10.1177/0956797615618365

⁵Reuben, A., Schaefer, J.D., Moffitt, T.E., Broadbent, J., Harrington, H., Houts, R.M., Ramrakha, S., Poulton, R., Caspi, A. (2019). Association of Childhood Lead Exposure With Adult Personality Traits and Lifelong Mental Health. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2018.4192

⁶Heidari, S., Mostafaei, S., Razazian, N. et al. (2022). The Effect of Lead Exposure on IQ Test Scores in Children Under 12 Years: A Systematic Review and Meta-Analysis of Case-Control Studies. Syst Rev. https://doi.org/10.1186/s13643-022-01963-y

⁷Roy, A., Bellinger, D., Hu, H., Schwartz, J., Ettinger, A.S., Wright, R.O., Bouchard, M., Palaniappan, K., Balakrishnan, K. (2009). Lead Exposure and Behavior Among Young Children in Chennai, India. Environ Health Perspect. https://doi.org/10.1289/ehp.0900625

⁸Schwaba, T., Bleidorn, W., Hopwood, C.J., Gebauer, J.E., Rentfrow, P.J., Potter, J., Gosling, S.D. (2021). The Impact of Childhood Lead Exposure on Adult Personality: Evidence from the United States, Europe, and A Large-Scale Natural Experiment. Proc Natl Acad Sci USA. https://doi.org/10.1073/pnas.2020104118

Brain volume, and the genetic variants that influence it, is tied to ADHD and Parkinson’s disease risks, suggests one of the most extensive international studies to date on DNA and brain structure.¹

The new study, published in Nature Genetics, examined how brain size and genetic differences influence key subcortical or ‘deep brain’ regions crucial for memory, emotional regulation, proprioception, sensory processing, and responses to rewards and punishments.

A team of 189 researchers from 45 countries analyzed data from genome-wide association studies (GWAS) and magnetic resonance imaging (MRI) brain scans of 74,898 participants across 19 countries. They identified 254 genetic variants that impact brain volume and the likelihood of developing ADHD and Parkinson’s disease.

“Genetic variants associated with larger brain volumes in key brain regions also increase the risk of Parkinson’s disease, while variants linked to smaller brain volumes in key regions are associated with an increased risk of ADHD,” said Miguel Rentería, Ph.D., study principal and associate professor at the Queensland Institute of Medical Research (QIMR Berghofer) in Australia, in a statement. “These findings suggest that genetic influences that underpin individual differences in brain structure may be fundamental to understanding the underlying causes of brain-related disorders.”

However, more studies are needed on the causal relationship between genes and brain-based diseases. “It’s worth noting that these are correlations, not causal relationships, and so interpretation must be approached with caution,” Rentería said.

“My theory is that the underlying mechanisms involve genes crucial to brain development, growth, and aging processes,” Rentería told Medical News Today. “We plan to further investigate to identify the exact biological pathways involved. Understanding these mechanisms could illuminate how brain structure impacts susceptibility to both neurodegenerative and psychiatric conditions, potentially guiding future therapeutic strategies.”

The researchers used data from the Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) consortium, an international effort led by Keck School of Medicine of USC; the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) at Baylor College of Medicine; the UK Biobank; and the Adolescent Brain Cognitive Development (ABCD) study.

ADHD and Parkinson’s Disease

According to the World Health Organization and the Centers for Disease Control and Prevention, rates of Parkinson’s disease and ADHD continue to rise.

In 2018, researchers from the University of Utah Health found that the risk of early-onset Parkinson’s disease and similar disorders is 2.4 times greater among patients with ADHD than it is among individuals of the same gender and age without ADHD. The study, published in Neuropsychopharmacology, examined medical records from the Utah Population Database (UPDB) of 31,769 patients with ADHD and 158,790 individuals without the condition.²

Sources

¹ García-Marín, L. M., Campos, A. I., Diaz-Torres, S., Rabinowitz, J. A., Ceja, Z., Mitchell, B. L., Grasby, K. L., Thorp, J. G., Agartz, I., Alhusaini, S., Ames, D., Amouyel, P., Andreassen, O. A., Arfanakis, K., Arias-Vasquez, A., Armstrong, N. J., Athanasiu, L., Bastin, M. E., Beiser, A. S., … Rentería, M. E. (2024). Genomic Analysis of Intracranial and Subcortical Brain Volumes Yields Polygenic Scores Accounting for Variation Across Ancestries. Nature Genetics. https://doi.org/10.1038/s41588-024-01951-z

² Curtin, K., Fleckenstein, A.E., Keeshin, B.R., et al. (2018). Increased Risk of Diseases of the Basal Ganglia and Cerebellum in Patients with a History of Attention-Deficit/Hyperactivity Disorder. Neuropsychopharmacology. https://doi.org/10.1038/s41386-018-0207-5

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.

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

Running late again? Missing appointments and deadlines? Losing focus and motivation for tasks? And where did you put those car keys? It’s no secret that people with ADHD often bear the burden of living with these and other functional impairments caused by executive function (EF) weaknesses.

Executive function is a set of skills that allow people to plan for short- and long-term goals, make adjustments to meet those goals, manage time effectively, remember what they’ve heard and read, and exhibit self-control. In many people with ADHD, executive function doesn’t work as it should because the parts of the brain that control these skills are impacted by ADHD. And that affects everyday actions like making decisions, meeting financial responsibilities, adapting behavior in response to a changing environment, and navigating relationship dynamics. But there are strategies you can employ to improve these skills for better results.

In this webinar, you will learn:

• About the cognitive skills that define executive function
• About the brain-based mechanisms that cause many people with ADHD to have weak executive function skills
• How working memory difficulties can manifest in workplace settings, social interactions, and personal organization, leading to common struggles such as forgetfulness, procrastination, and difficulty in planning
• Whether these challenges evolve with age and how adults with ADHD can adapt to or mitigate these changes over time
• About practical strategies and interventions to develop skills that enhance executive function and working memory

Watch the Video Replay

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

Executive Functioning in Adults: More Resources

• Self-Test: Do You Have a Working Memory Deficit?
• Read: 7 Executive Function Deficits Tied to ADHD
• Read: How Adults with ADHD Think
• eBook: The Adult’s Guide to Stronger Executive Functions

Obtain a Certificate of Attendance

If you attended the live webinar on December 5, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Peg Dawson, Ed.D., NCSP, received her doctorate in school/child clinical psychology from the University of Virginia. She worked as a school psychologist in Maine and New Hampshire, and recently retired after 30 years at the Center for Learning and Attention Disorders in Portsmouth, New Hampshire, where she specialized in the assessment of children and adults with learning and attention disorders. Along with her colleague, Dr. Richard Guare, she has authored many books on the topic of executive skills, including The Smart but Scattered Guide to Success, a self-help book for adults who want to strengthen their executive skills.

#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.

Webinar Sponsor

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Struggling to keep track of tasks or organize your thoughts? You’re not alone. For adults with ADHD, working memory and executive function challenges can make daily life feel overwhelming. That’s where Inflow comes in. Our science-backed app offers targeted insights and brain hacks to strengthen your mental juggling skills and boost your ability to plan, prioritize, and follow through. Ready to unlock your brain’s full potential? Take our free quiz today and start your journey to better cognitive control.

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

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

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

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

Controlled Substances: What We Get Wrong About Stimulants for ADHD

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

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

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

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

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

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

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

For All Their Dangers

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

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

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

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

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

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

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

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

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

On Stimulant Misuse

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

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

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

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

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

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

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

Schedule II Drugs: The Case for Reclassifying Stimulant Medication

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

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

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

Schedule 2 Drugs and Stimulants: Next Steps

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

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

Sources

¹ Drug Enforcement Administration. Drug Scheduling. DEA.gov. https://www.dea.gov/drug-information/drug-scheduling

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Academic achievement is strongly predicted by the presence of certain non-cognitive skills, like persistence and motivation, which are linked to genetic factors and become increasingly important as children age, according to a study published in Nature Human Behaviour.¹

“Children who are emotionally stable, motivated, and capable of regulating their attention and impulses do better in school, independent of their level of cognitive ability,” the researchers wrote.

The study involved a U.K.-based sample of more than 10,000 children aged 7 to 16 that used surveys and multiple genetic methods, including twin models and DNA-based analyses. Data was collected at ages 7, 9, 12, and 16.

Non-Cognitive Skills

Parents, teachers, and twins were asked questions related to the child’s performance at school and non-cognitive skills, including academic interest and self-regulation. After accounting for general cognitive ability, researchers performed multiple regression analyses that revealed an association between non-cognitive skills and academic achievement at all ages studied.

Non-cognitive skills grew more predictive of academic achievement as children approached late adolescence. Self-report surveys revealed the biggest effect sizes (as compared to surveys completed by parents and teachers). The correlation between self-reported, education-specific non-cognitive skills and academic achievement grew significantly over time (from r=0.10 at age 9 to r=0.51 at age 16).

While cognitive skills refer to objective traits, such as memory, reasoning, and IQ, non-cognitive skills refer to more subjective qualities. In this study, non-cognitive skills were broadly classified as:

• Education-specific non-cognitive skills (academic interest, attitudes towards learning, academic self-efficacy)
• Domain-general self-regulation skills (behavioral and emotional regulation that exist outside of school).

“These findings highlight the important role that non-cognitive skills play during primary and secondary education and suggest that fostering such skills might provide an avenue for successful educational strategies and interventions,” the researchers wrote.

Genetic Influence

Similar findings were revealed using polygenic scores, or PGSs, which estimate the effect of multiple genes on a specific trait. Non-cognitive PGS on academic achievement doubled from ages 7 to 16, while cognitive PGS stayed the same. By the end of the study, the variance in academic achievement was equally accounted for by non-cognitive and cognitive skills.

When controlling for shared family environments, as in the case of siblings, the effects of non-cognitive PGS were slightly diminished but still significant. According to the gene-environment correlation theory, or rGe, this can be attributed to genetic control over environmental exposures.² As children grow up, they “evoke and actively select academic environments that correlate with their genetic disposition towards non-cognitive skills,” the researchers wrote. These traits are then reinforced over time. In contrast, cognitive PGS predictions remained the same through development.

Socioeconomic status did not alter the overall findings. Although children from higher socio-economic backgrounds performed better academically, the slope of association between academic achievement and non-cognitive skills did not change from one group to the next.

“Higher PGS, for both cognitive and non-cognitive skills, corresponded to higher academic achievement, and higher SES corresponded to both higher mean PGSs and higher achievement, indicating a correlation rather than an interaction between genetic and environmental influences on academic achievement,” the researchers wrote.

Mental Health & ADHD

The study confirmed strong correlations between cognitive and non-cognitive genetic factors and their links to psychiatric, personality, and socioeconomic traits. But non-cognitive skills played a bigger role in certain outcomes, like mental health. The disparity between genetic factors was more pronounced for certain psychiatric traits, such as autism and ADHD, compared to earlier studies.³

Some studies suggest mental health conditions are influenced by the same genetic factors. A study published in Nature in 2023 and covered by ADDitude found that 84% to 98% of common genetic variants tied to ADHD seemed to influence other psychiatric disorders, including autism, depression, and schizophrenia.⁴ Genetic research has also linked ADHD to emotion regulation and motivation.⁵

“One of the main areas of the brain affected by the genetics of ADHD is the reward center — in particular, the transmission of a chemical called dopamine. The neurons in the brain of a person with ADHD act differently…They need higher levels of stimulation from their environment,” said Maggie Sibley, Ph.D., in her 2022 ADDitude webinar “My Teen with ADHD Lacks All Motivation! How to Build Executive Function Skills and Drive.”

“You can see that translating into prominent motivation difficulties in kids with ADHD,” Sibley said.

Limitations and Future Research

Targeted interventions that build non-cognitive skills could benefit children with relative social and emotional weaknesses, including those with ADHD. But more research is needed to understand how non-cognitive skills develop. Future studies should focus on the association between these and academic achievement.

Sources

¹ Malanchini, M., Allegrini, A.G., Nivard, M.G. et al. (2024). Genetic associations between non-cognitive skills and academic achievement over development. Nat Hum Behav. https://doi.org/10.1038/s41562-024-01967-9

² Jaffee, S., & Price, T. (2007). Gene–environment correlations: a review of the evidence and implications for prevention of mental illness. Mol Psychiatry, 12, 432–442. https://doi.org/10.1038/sj.mp.4001950

³ Demange, P. A. et al. (2021). Investigating the genetic architecture of noncognitive skills using GWAS-by-subtraction. Nat. Genet., 53, 35–44. https://doi.org/10.1038/s41588-020-00754-2

⁴ Demontis, D., Walters, G. B., Athanasiadis, G., Walters, R., Therrien, K., Nielsen, T. T., … Børglum, A. D. (2023). Genome-wide analyses of ADHD identify 27 risk loci, refine the genetic architecture and implicate several cognitive domains. Nature Genetics, 55(2), 198–208. https://doi.org/10.1038/s41588-022-01285-8

⁵ Merwood, A., Chen, W., Rijsdijk, F., Skirrow, C., Larsson, H., Thapar, A., Kuntsi, J., & Asherson, P. (2013). Genetic association between the symptoms of attention‐deficit/hyperactivity disorder and emotional lability in child and adolescent twins. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 209‐220. https://doi.org/10.1016/j.jaac.2013.11.006

So we asked ADDitude readers to put their creative ADHD brains to work by brainstorming the most important lessons they’ve learned about living well with ADHD. From the pragmatic — set your clock ahead by 10 minutes — to the profound — guidance on fostering self-compassion — readers offer up hard-won wisdom that they’ve found transformative, in the hopes you might benefit from it, too.

“Grace. Give yourself grace. The everyday mistakes you make can distract you from more important things. Know that doing right by the humans around you is far more important than having your laundry done or being all caught up at work.” —Kate, Texas

“It is essential to find a medical professional who you trust and who is an ally. Do not tolerate doctors who don’t listen to your symptoms or concerns.” —Suzanne, Canada

“Like a fingerprint, ADHD is different for each individual. We can learn from doctors’ opinions and others’ experiences, but we must discover for ourselves how to best deal with our own ADHD.” —Philip, Ohio

[Download: Rate Your ADHD Coping Strategies]

“Find your people! There is nothing that helps more than sitting in a room with a group of others saying, ‘Me too!’ You finally feel validated and less alone as well as understood and accepted.” —Nicky, Scotland

“Don’t resist medication if it will help. It’s not a character failing to take it. On the contrary, it shows your bravery in facing your condition.”  —Richard, Maryland

“Actively search for things to celebrate in yourself and others. It’s natural to be critical but noticing what’s good takes intentionality. The fruit of that is peace and joy.” —Shari, Tennessee

[Watch: “ADHD is Awesome – The Holderness Family Guide to Thriving with ADHD”]

“Write everything down.” —Jennifer

“It’s imperative to learn all you can about how ADHD affects the brain, so you can better understand (and be less judgmental) about your thoughts and behaviors.” —Louis, California

“Find help — and don’t settle for the wrong help.” —Dorothy, Ohio

“Do what you need to do to recharge. I take a 15-minute nap at lunch everyday, which brings up my dopamine so that I’m still productive at work in the afternoons.” —An ADDitude Reader

“Find people who can relate to your struggles and, if you feel safe doing so, share stories of successes and failures. You may be pleasantly surprised by the number of people who feel the same way you do, regardless of whether they have ADHD.” —AJ, Minnesota

“Always divide tasks into very small turtle steps — something that you can easily do.” —Marietjie, South Africa

“The brilliance of ADHD is that our minds and talents can be a playground. ‘Not possible’ isn’t a thing if it is something we are interested in. Want to learn how to build furniture? Done. Make macarons? Done. Run a marathon? Got it. We absolutely thrive when we can chase the dopamine high associated with our areas of interest. I may be awful at adulting, but I wouldn’t want to live any other way.” —Suzanne, Tennessee

“The most important thing I’ve learned is to change my inner monologue of ‘I’m lazy’ to ‘This is just extra hard today.’” —Kendel, Indiana

“Finding what you love may be more important to ADHD people than to non-ADHD people. Being quick to boredom and having quick tempers means if you don’t like your job, you won’t be at it very long.” —Tim, North Carolina

“One trick that changed my world was the concept of a ‘catch-all’ area near the door where I put everything I need to leave the house; and where everything will go once I walk in the door. I have saved so much time over the years not constantly looking for my keys, sunglasses, and wallet.”—Dana, Michigan

“You have ADHD; you are not ADHD. It is an attribute you have but it does not have to define who you are.” —Craig, Oklahoma

“I set my clocks forward 10 minutes. Somehow it always tricks my mind and gives me extra time.” —Karen, Virginia

“I have learned that for every storm, there is a rainbow. My ‘problems’ — sensory gifts, ADHD daydreaming, and deep processing abilities — made me an excellent teacher of 38 years. I have learned to embrace my differences and view them as positives that have enriched my life.” —Jane, California

“Many judgmental people just can’t stand that I am hyperactive, talk a lot, and interrupt without meaning to — but judging others is far, far worse than any symptoms ADHD might cause. Try not to let anyone’s attitude make you feel bad about yourself. You are beautiful. You are valuable. You have been born with your own special talents and abilities that will help to advance mankind.” —Janet, Texas

Self Love, Self Acceptance & ADHD: Next Steps

• Read: You Are Not the Sum of Your ADHD Challenges 
• Read: Self-Compassion – The New ADHD Treatment
• Read: ADHD at the Center – A Whole-Life, Whole-Person Condition

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

This October, ADDitude is shifting the focus from ADHD awareness to empowerment. From educating others to lifting up our own community. From seeking external acceptance to celebrating self-knowledge.

The first-ever ADHD Empowerment Month will kick off October 1 with a live webinar featuring Penn and Kim Holderness of ADHD Is Awesome, who will discuss the new definitions of ADHD proposed by ADDitude community members. The month will continue with exclusive profiles of creative ADHD powerhouses like novelist Rebecca Makkai, stand-up comic Rachel Feinstein, and illustrator Hayley Wall.

Each day in October, ADDitude will highlight a different definition of ADHD brought to life through stories told by our readers, who said ADHD is creativity. ADHD is curiosity. ADHD is solving problems. ADHD is resilience. And so much more. Below are two examples of these powerful community insights.

ADDitude will be sharing messages like these each day in October on social media and at http://additu.de/empowerment, and a free ADHD Empowerment Month calendar is available now at http://additu.de/oct-cal.

“The ADHD community is beyond ready to shift the focus away from dispelling ADHD myths and educating ADHD doubters,” says ADDitude General Manager Anni Rodgers. “Twenty years after the first ADHD Awareness Day, we are deliberately moving from an external focus to an internal one this October, We are shining our spotlight on the incredible stories, reflections, and definitions of ADHD contributed by members of the ADDitude community. Their voices usher in a new era of ADHD empowerment.”

ADDitude Editor-in-Chief Carole Fleck and General Manager Anni Rodgers are available during ADHD Empowerment Month to discuss the important and timely shift from awareness to empowerment, to highlight the insightful reflections from the ADDitude community, and to introduce Penn and Kim Holderness, and other role models profiled on http://additu.de/empowerment

About ADHD Awareness Month

Twenty years ago, the U.S. Senate established a national ADHD Awareness Day to spur greater understanding of the condition that affects an estimated 7 million children (11%) and 8.7 million adults (10%) in America. Over time, ADHD Awareness became a month-long observance with an external mission: dispelling myths, disseminating truths, and advocating for support among neurotypical populations. The campaign was a success. Virtually everyone now knows about ADHD.

About ADDitude magazine:

Since 1998, tens of millions of readers have trusted ADDitude to deliver expert advice and caring support, making it the leading media network for clinicians, educators, parents, and adults living with attention deficit hyperactivity disorder (ADHD). ADDitude is not only the world’s most trusted source of strategies and information about ADHD and related conditions, such as learning disabilities, anxiety, depression, and oppositional defiant disorder. ADDitude is the voice of and advocate for the ADHD community. In 2021, ADDitude joined the WebMD family of health brands.

When a member of ADDitude’s ADHD Support Group on Facebook recently appealed to other members for help lifting the spirits of her discouraged son, she was inundated with responses enumerating the benefits of ADHD. Here are 18 of our favorites.

“A little more than 18 years ago, I gave birth to a super hero. His super power was electricity.” Read this beautiful blog post.

“Hitting rock bottom helped me find the hidden, gritty, scrappy fighter within me.” ADDitude readers share how ADHD resilience and perseverance keep them moving forward with resolve.

A professor analyzes the essays of French writer Michel de Montaigne, and finds his brilliance may be one upside of a distracted ADHD brain. Read more.

Simone Biles, Greta Gerwig, Mark Ruffalo, Emma Watson, Trevor Noah, and other inspiring celebrities and famous people with ADHD.

In your standard-issue “How to Be a Parent” manual, you might find job requirements such as consistency and firmness. Those are all fine and good, but parents of children with ADHD know that more is required of us. Here are the Top 10 essential qualities our kids require every day.

To shed light on a complex and often dismissed part of the ADHD experience, we asked ADDitude readers to tell us: What does boredom feel like to you? Here’s what they said.

ADDitude readers share the (sometimes uncomfortable) truths about attention deficit disorder that they most wish the neurotypical world would understand and respect here.

“I am spirited — even frantic sometimes. I strike gold in the 11th hour. I jump off the highest cliffs. And all of these qualities make me a better leader to my teammates at work. They also expose some serious ADHD weaknesses, which is where my teammates get my back.” — Rich Atkinson

Most people are neurologically equipped to determine what’s important and get motivated to do it, even when it doesn’t interest them. Then there are the rest of us, who have attention deficit — ADHD or ADD — and the brain that goes along with it.

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

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

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

“My creativity has blessed me at every stage of my life. My grandkids and I write songs or make videos, and I do sing-a-longs at my mom’s nursing home. Being ADHD is a rollercoaster ride, but I love the thrills along the way!” Read more.

Imaginative, resourceful, and fast-thinking ADHD brains can often solve problems that stump everyone else. Here, readers share their stories of seeing the solution everyone else missed.

Star of the stand-up comedy special “Big Guy,” Rachel Feinstein talks about her ADHD journey, from adrenaline highs to rejection lows (and how she’s always losing her passport). Meet Rachel

“When I get to engage in an adrenaline-filled experience, like jumping off a 40-foot cliff, I take it.” Learn more about the risky, sensation-seeking activities that ADDitude readers crave.

“I sometimes feel frustrated that the things that seem so simple (turning in homework, putting on BOTH shoes, turning off the stove) can be so hard for the ADHD brain. But the things my son’s brain creates leave me in awe.” _ Kim Holderness

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

“The more I talk to colleagues about my fresh diagnosis (ADHD, inattentive type), the more I see that others grapple daily with different demons. And some of the things that frighten or frustrate them about teaching come as naturally to me as breathing.” Read this blog post.

“You can’t see my constant struggles to stay on top of employment, housework, and personal affairs; you can’t hear my every thought scream for my total attention as I fail to hold onto a single one; you certainly can’t feel the smaller effects of ADHD pile on top of each other to create a web of executive dysfunction.” Read this blog post.

25 positive affirmations to lift up ADHD brains

Rebecca Makkai is a New York Times bestselling author whose books have been translated into more than 20 languages. She is a Pulitzer Prize and a National Book Award finalist. She teaches graduate fiction writing at Northwestern University, among other places, and she has ADHD.

“When your brain feels, sees, and smells everything, it is more likely than the neurotypical brain to notice something no one has ever noticed before. It is more likely to go down a rabbit hole and discover a new path. It’s more likely to see something in a way no one has ever seen it.”

How to live better with ADHD, according to the experts.

ADDitude readers describe the undeniable signs, symptoms, and strengths of ADHD that may be invisible to others. Read more.

“These mottos have helped me practice self-compassion and affirm my own neurodiversity.” Read more.

From the pragmatic to the profound, readers offer up hard-won wisdom that they’ve found transformative, in the hopes you might benefit from it, too. Read more.

“What if my intense drive is because of — not in spite of — my ADHD?” asks Tracy Otsuka, JD

If you could pay a visit to your childhood self, what words of affirmation, advice, or messages of self-love would you impart? ADDitude readers respond here.

These insights on living and (mostly) thriving with ADHD from the Holderness Family will make you laugh, nod in agreement, and feel a little more understood.

Disorder. Condition. Impairment. These are the words commonly used to describe ADHD. Their accuracy is debatable. What’s for certain: they’re insufficient on their own.

What does ADHD mean to you? Adventure. Gift. Advantage. Creative engine. Superpower and kryptonite, all rolled into one. According to ADDitude readers, this is the essence of ADHD.

This October, we move beyond awareness and acceptance. As we step into ADHD empowerment, ADDitude will amplify the myriad voices comprising our community and share their powerful, telling stories.

What is ADHD? It’s whatever you say it is.

ADHD Is . . .

“. . . a kaleidoscope. I see, hear and think in stereo. The beauty of ADHD is how my mind endlessly sees and hears things others around me can’t.” — Jon, United Kingdom

. . .a different gameplay mode, enabled on some brains.” — Mia, New York

“. . . eye-opening.” — Zak, Florida

“. . . like a powerful wild horse — beautiful and strong but untamed. Imagine what it’s like to ride on its back and be taken where it wants to go. You just need to train your horse, and to develop your strength and agility and learn to hold on.” — Giedre, United Kingdom

“. . . complicated.” — Ava, Canada

[Read: Holderness Family Values – 9 ADHD Truths (with a Side of Laughter)]

“. . . an adventure. ADHD is curious. ADHD is playful. ADHD is a roller coaster.” — Emma, Scotland

“. . . exhilarating. There is always something new to learn.” — Erin, Missouri

“. . .wonderfully maddening. Wonderful because of the ability to focus intently on things that interest you and maddening because you’ll need to develop ways to complete tasks that don’t interest you. You have awareness, perspectives and abilities that are likely different from your peers and those skills make you exceptional.” —Becky, Indiana

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

ADHD Is . . .

“. . . hopeful. People with ADHD can help create a future that has justice, empathy, curiosity, and creativity as the guiding principles.” — Sara, Canada

“. . . liberating.” — Noreen, Oregon

“. . .an uphill and downhill battle.” —An ADDitude Reader

“. . .a horse without blinders. Someone with ADHD can see so many things at once.” —John, Illinois

“. . .both a superpower and kryptonite.” — Tyra, Arizona

“. . . a channel to dream big dreams.” — Tara, Canada

“. . . is the key that unlocks universes. Wanting to know more about topics I’m interested in is a gift.” — Nicole, Ohio

“. . . a hurdle — one that makes you more resilient.”  — An ADDitude Reader

ADHD Is . . .

“. . .being upside down in a neuro-normative world which is ‘right way up.’” — Rachel, United Kingdom

“. . . a new day every day, sometimes every hour.” — Jana, Tennessee

“. . . differently powerful.” — Betsy, New York

“. . . hyper-focusing.” — An ADDitude Reader

“. . . magical.” — Sam, United Kingdom

“. . . misunderstood.” — Jamie, Tennessee

“. . . multi-faceted and pervasive, affecting all aspects of one’s life.” — Kathryn, Michigan

“. . . something that gives you the energy to accomplish great things. It may be hard to sit in a class, but you are one of the greatest builders of society.” — An ADDitude Reader

ADHD Is . . .

“. . .a mixed bag. At times it really does feel like a superpower, like when I’m writing for fun; the metaphors and creativity flow like water. At other times, it really does feel like a curse, like when I lose what feels like the 50th pair of prescription sunglasses. My biggest asset is simultaneously my biggest struggle.” — David, Oregon

“. . . determination, focus, tenacity, and courage.” — Heather, Alabama

“. . . balance.” — Maggie, Michigan

“. . . a beautiful brain in a challenging environment.” — Dee, Canada

“. . . overwhelming — and empowering.” — Ariel, Wisconsin

“. . . something that can both control you, and be controlled.” — Andrew, New York

“. . . not good and not bad. It just is.”  — An ADDitude Reader

What Does ADHD Mean?: Next Steps

• Read: “ADHD Is Hard, But…” Crowdsourced Advice for the Newly Diagnosed
• Watch: “ADHD is Awesome: The Holderness Family Guide to Thriving with ADHD”
• Read: “The ADHD Characteristics I’m Most Thankful for Are…”

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Wisdom is the hard-won result of experience; there are no shortcuts. But if you could time travel back to speak with your childhood self, what advice would you offer that tiny, still unformed version of yourself? What lessons about living and thriving with ADHD — school, work, relationships, self-love — would you impart? What words do you most wish you’d heard to avoid some headache and heartbreak, and to find more fulfillment and acceptance?

Here, ADDitude readers reflect on ADHD life lessons learned and offer everything from practical hacks to tender compassion. Threaded together, these words form a brilliant tapestry of self-advocacy, self-empowerment, and, above all, self-love.

“Oh, love, hi there! It’s me, your 34-year-old self. I just want you to know that you are wonderful. Absolutely wonderful! I know you feel like people don’t get you and that you have to be perfect to be liked. But, cute one, you are not weird, your brain is just different and you have something we call ADHD. It’s why you sometimes lash out and why you dream for hours. It’s also why you love so many different things. I know it feels safer to hide these things with your fears, but you are hurting yourself by doing that.” — An ADDitude Reader, Netherlands

“Be kind, be kind, be kind. Especially to yourself. It will feel rebellious, maybe even dangerous, to be kind to yourself, but you must try.” — Laura, Louisiana

“You are not lazy. You are not flawed. The world is just not ready for you yet.” — Adrienne, Virginia

[Read: Birds of a Feather – The Joy of Neurodivergent Friendships]

“Take notes, drink coffee.” — Courty, Pennsylvania

“You’re not crazy — you are different. There’s this thing called rejection sensitive dysphoria. It’s real, it explains a lot of what you feel all the time, and it really freaking sucks.” — Chiara, Oregon

“Post-It notes are your friend! Write things down so you remember to do stuff!” — Lisa, Ohio

[Read: Everyday ADHD – Quirky Productivity Hacks for Easily Bored Brains]

“Tell those you trust about how you feel. The sooner you tell someone, the sooner someone can help.” — Sarah, United Kingdom

“Honey, yes, you are different, but it’s a beautiful kind of different. Nothing great was ever accomplished under the umbrella of normalcy.” — Michelle, California

“Get diagnosed now.” — Karon, Colorado

“Never be quiet, keep taking up space until you get the help and support you deserve. It will be better when you’re allowed to make your own decisions.” — Mariah, Illinois

“You are irreplaceable.” — Remy, California

“Keep taking the next right step.” — Anne, Wisconsin

“You will be a great adult. Hold on until you get there.” — Michele, Texas

“Find whatever sparks joy and live your dreams as fully you possibly can.” — Deniz, Massachusetts

“Learn how to apologize.” —Paul, California

“Connect with those who thrill and want to be thrilled … then go home to calm. I have found that people like me are not the ones I like to live with.” — An ADDitude reader in New Zealand

“Don’t drink or do drugs to soothe, it makes things worse.” — An ADDitude Reader

“Choose a trade. You’re creative, enjoy working with your hands, and find satisfaction seeing the end product of your efforts.” — Matt, Canada

“There’s a reason why things that are supposed to be simple feel like they’re written in a foreign language. There are others out there who can understand, appreciate, and see the value in your own unique language.” — Jessica, Texas

“Don’t worry so much about fitting in with others. You will find your tribe along the way.” — Noreen, Oregon

“Bring a fidget everywhere.” — M., Virginia

“Become comfortable with being uncomfortable.” — Jamie, United Kingdom

“Oh, sweetheart, it’s not your fault. Your brain is built a bit differently from other people, and that’s okay. It doesn’t mean you’re a bad student, or a bad person. It doesn’t mean that you’re a weirdo, or unlovable, or a problem.” — Peyton, Oregon

“It’s not you, it’s the world. Keep doing your thing. It’s going to get complicated and confusing but you will develop some amazing strategies and skills to manage it, without even realizing.” — Lucy, Australia

“Learn about your brain. Teach others!” — Wendy, Canada

“Trust your gut. Pay attention to your needs; they’re not lying to you.” — An ADDitude Reader

“God has a plan for you, sweetheart. You are teary-eyed and alone right now, but I promise a whole world of amazing, creative, heart-centered people across the globe will be at a finger tip’s distance from you in the future.” — Erin, Canada

“Work hard at making nutrition, exercise, and sleep as routine and automatic as possible, to serve as a good foundation.” —Beth, Texas

“Figure out what works and what doesn’t, and then design your life around your strengths. Find a job that fires your passions, which means you’ll work hard at it. Find friends who appreciate your spontaneity without punishing you for poor planning and communication. Find a spouse who pushes you to grow as a person and loves you for your good qualities.” — Josh, Utah

Words of Affirmation and ADHD: Next Steps

• Watch: “How to ADHD – An Insider’s Guide to Working with Your ADHD Brain“
• Read: You Are Not the Sum of Your ADHD Challenges 
• Read: ADHD at the Center – A Whole-Life, Whole-Person Condition
• Download: Rate Your ADHD Coping Strategies

Episode Description

To kick off ADHD Empowerment Month, ADDitude asked you (our readers) to tell us how you define ADHD and its impact. More specifically, we asked: “If you were describing ADHD to a newly diagnosed child, how would you portray it in a way that builds self-esteem, hope, and resolve?”

In this webinar, we will share your responses and explore core ADHD strengths such as creativity, curiosity, problem-solving skills, and resilience with Penn and Kim Holderness, authors of the book ADHD Is Awesome: A Guide To (Mostly) Thriving With ADHD. Along the way, we will also celebrate some of the ways our ADHD brains make us undeniably awesome and essentially irreplaceable.

We know having ADHD is sometimes stressful , but the Holderness Family is very good at showing us how to shift our mindset and lean into the aspects of ADHD that make us unique and wonderful. In this webinar, we will discuss…

• Names that better describe ADHD
• Ways to reframe ADHD through a lens of strength to bolster a child’s or adult’s self-esteem
• Real-world examples of ADHD creativity and curiosity
• Favorite stories of ADHD problem-solving acumen from ADDitude readers
• The ADHD ability to bounce back and keep learning in the face of challenges
• How ADHD can help you win “The Amazing Race” (just kidding, but they actually did win!)
• And much more

Watch the Video Replay

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

Download or Stream the Podcast Audio

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ADHD Empowerment: More Resources

• Free Download: All the Best Parts of ADHD
  
• Replay: ADHD is Awesome — The Holderness Family Guide to Thriving with ADHD
  
• Read: “How My ADHD Makes Me a More Dynamic, Resourceful, Passionate Leader”
  
• eBook: Inattentive ADHD in Adults — An Essential Guide to the Underdiagnosed, Undertreated Subtype

Obtain a Certificate of Attendance

If you attended the live webinar on October 1, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Penn & Kim Holderness are authors of The New York Times Bestselling Book, ADHD Is Awesome: A Guide To (Mostly) Thriving With ADHD. (#CommissionsEarned) They are award-winning online content creators known for their original music, song parodies, comedy sketches, and weekly podcast. Their videos have resulted in over two billion views and over nine million followers. Penn and Kim have been married for 19 years and were also winners of The Amazing Race (Season 33) on CBS.

Throughout all their endeavors, Penn and Kim have never shied away from tackling topics like living with ADHD and anxiety. The overwhelming positive feedback and support from their online community was a major motivation behind their ADHD book. Penn and Kim live in Raleigh, North Carolina, with their children, Lola and Penn Charles, and their dog, Sunny.

For more on The Holderness Family, visit theholdernessfamily.com.

#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.

Listener Testimonials

“Penn and Kim are great, and the webinar was indeed empowering. Thank you so much!”

“Thank you. I liked the added feature (video) to today’s webinar. Great addition!”

“Such encouraging and enlightening information from Penn, but also from the comments sent by participants. Thank you!”

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