Many of us with ADHD, autism, and other forms of neurodivergence only started to “bring our whole selves” to work quite recently. As a result of neurodiversity training and DEI efforts, we began to unmask. We spoke more openly about executive dysfunction and sensory needs. We asked for accommodations, formally and informally.

But today, as DEI programs fade and inclusion efforts stall, many of us feel a familiar pressure returning. Overtly or covertly, we are no longer encouraged to be ourselves at work. Instead, we’re expected to mask and conform to neurotypical standards again. The pressure is back — to people-please, to be extra easy, extra agreeable, extra adaptable, and to act like everything is fine.

And it’s exhausting. We expend energy in ways most people never notice: suppressing our stims, rehearsing conversations, monitoring our behaviors. The extra cognitive load carries consequences: more burnout, more dysregulation, and far less access to our actual strengths.

What do we do when the progress we counted on begins to recede?

1. Avoid Personalizing It

Sometimes it’s easy to recognize what’s happening because the signs are obvious: The DEI team is cut. The language in the handbook changes. Sometimes it’s just a vibe shift — silence replacing celebration. The unspoken expectations to get things done and avoid standing out or speaking up. Either way, the signal is the same: Masking is back on the table.

Recognizing what’s actually happening – that these are structural changes and not a reflection on your abilities – will, I hope, help you avoid internalizing these changes as personal failures. As with all structural changes, the problem is not yours alone to fix.

[Read: “DEI – and Neurodivergence – Are Under Attack”]

2. Redefine Professionalism Before It Defines You

Too often, “professionalism” is code for “hide what makes you different.” But professionalism isn’t about being quiet or predictable. It’s about communication, accountability, and showing up with intention.

From scripts and stim toys to time-blocking apps and task batching, plenty of  tools and supports exist to help you do your job. Just remember: You don’t have to become someone else to meet expectations.

3. Find Safe Micro-Spaces

Even when company culture shifts, individuals inside it often don’t. Think of the co-worker who quietly advocates. The manager who gets it. The group chat where you can be blunt. These safe micro-zones can make a big difference. Tread carefully and look for the places where you can breathe. If you can’t find safe spaces at work, try participating in anonymous online support groups.

4. Don’t Trade Peace for Your Job

If your workplace culture no longer holds space for who you are, protect your energy accordingly. Set boundaries. Scale back. Exit as soon as you can. Do your best to remember that your job does not define you or anyone. You’re not being lazy, dramatic, or “too much” by keeping your peace. You’re responding to an environment that no longer feels safe — and your body knows it before your brain does.

[Q&A: “How Can I Stop People-Pleasing Behaviors at Work?”]

5. Look for the Helpers

In these trying and unprecedented times, it’s important to focus on the people who are doing the work to bring positive change. Whether it’s recognizing the manager or colleague at your job who continues to advocate for inclusive workplace practices or following like-minded, outspoken advocates on social media, make an effort to look for signs that not all is lost.

Perhaps the masking era never really ended. But the promise of inclusion gave many of us hope that we could work — and live — a little more authentically. If that promise is gone, it’s OK to grieve. But it’s also OK to hold your ground. You’ve already learned how to show up. You don’t need to shrink just because the culture did.

Lack of Inclusion in the Workplace: Next Steps

• Read: 4 Steps to Claiming the Career You Deserve
• Read: “Great Leaders Foster a Positive Work Environment for All Employees”
• Read: “Women with ADHD Prefer Silence Over Disclosure. This Needs to Change.”

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

The ramifications of abuse are dire and, in some cases, life-threatening: half of female homicide victims are killed by current or former partners.² The consequences of psychological abuse — the most frequent kind of IPV and often a precursor to physical violence — are no less critical. Research shows that psychological abuse is an even stronger predictor of post-traumatic stress disorder and depression than is physical abuse.³

Though intimate partner violence is startlingly common and harmful, many avenues can lead victims to help and health care providers are instrumental in connecting patients to these paths. Though traditional IPV screening is an effective intervention, it’s not the only one. For some providers, distributing safety cards may be a better fit.

The size of business cards, these safety cards contain information about the red flags and health consequences of IPV. They share contact information for hotlines as well as guidance for safely seeking help, and they let people know they’re not alone.

“It takes 30 to 45 seconds to share the card, and it can change someone’s life,” says Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. “We hear from women with lived experience of violence: ‘Why didn’t anyone ever give me something like this? It could have made all the difference to me.’”

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Obstacles to IPV Screening

With traditional IPV screening, a provider uses a survey like the HITS (Hurt, Insult, Threaten, Scream) to detect if a patient is experiencing violence. This can be transformative.

“If you trust your provider, it can be a very empowering experience to connect with someone who can listen, make you feel less alone, talk to you about making decisions,” Sullivan says.

But several significant obstacles stand in the way of effective screening for IPV. Survivors may be hesitant to disclose their experiences of violence, fearful of retaliation by their partners, or of being reported to police and potentially losing custody of their children. They may worry they’ll be judged, blamed, or shamed. These concerns may be particularly salient for women with ADHD who receive near-constant criticism, correction, and judgement.

[Watch: “How to Avoid Toxic Relationships and Find Your Ideal Match”]

These obstacles contribute to relatively low rates of disclosure in IPV screenings; less than a quarter of women who have experienced IPV report disclosing this to a health care provider.⁴

The efficacy of screenings also relies on a meaningful response from the provider. Many providers don’t feel comfortable addressing such a sensitive and personal revelation because they’ve not received training in IPV.

“We shouldn’t expect people to develop expertise in responding,” Sullivan explains. “But we want the provider to feel comfortable enough so that they’re not being judgmental, so they can let the person know they’re heard, and connect them to someone who does have expertise.”

If a survivor reveals abuse on a survey and her disclosure is never addressed, or if it’s met with judgement, Sullivan explains, it can discourage her from revealing the abuse to others in the future.

Safety Cards: A Universal Approach

The part of IPV screening that helps survivors most, research has found, is the engagement with support services that happens after disclosure.⁵ This is where safety cards come in.

IPV safety cards, which are distinct from screening methods, bypass surveys altogether and take a direct path to offering help.

The method is simple: Providers order safety cards like these for free and hand them out to every female patient they see (without their partner present). The cards come in 10 languages and contain information about the red flags and health consequences of IPV. They also connect patients to support and resource hotlines

For providers looking for guidance on how to distribute the cards, Sullivan suggests the following language:

“We’ve started talking with all of our patients about relationship health and abuse in relationships, in case it’s ever an issue for them or for their friends and family. This card talks about healthy and safe relationships, ones that aren’t — and how relationships affect your health.”

Safety cards offer myriad benefits, including:

• Getting help to the people who need it, no questions asked. Offering resources to everyone, a universal education model, ensures that the women who need help will get access to it – regardless of whether they disclose abuse.
• Empowering women to help others. Many of the patients who receive cards may not be experiencing IPV, but they may know people who are. Safety cards enable these individuals to recognize abuse in the lives of loved ones, and empower them to offer helpful resources. Research found that people who received universal education were twice as likely as those who did not to share the number for an IPV hotline to someone in need.⁶
• De-stigmatizing conversations about IPV. Broaching the topic of intimate partner violence to all patients helps to break the taboo which often keeps women silent about their experience.
• Planting a seed for future action. It’s important for providers to distribute safety cards at every visit because it may take more than one interaction for patients to recognize abuse in their own lives, or to prepare themselves to consider next steps.  “Often, the cards plant a seed for future action. You give it to patients every time they come in so that it’s routine and becomes comfortable,” Sullivan says. “They come to understand that their relationships affect their health.”

While disclosures aren’t necessary in this IPV intervention, they may happen. When responding, providers should use non-judgmental, validating language, and avoid directing patients to take specific action. “It should never be a provider, trained or not, telling people what they should do,” Sullivan explains. “Though it’s likely well-intentioned, this prescriptive approach mimics the dynamics of abuse and disempowerment.”

Instead, follow the patient’s lead. “Let people know the supports available to them and listen to them,” suggests Sullivan. “You might ask: ‘Have you thought about what you want to do? Do you want help thinking about what makes sense? Would you like to call a helpline from this office?’”

What survivors of abuse need from providers, Sullivan explains, is autonomy, empathy, and information about their options for getting help.

To Order Free Safety Cards

• Visit Futures Without Violence.

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 8878
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 2252
• National Sexual Assault Helpline, Call 1-800-656-HOPE

Abusive Relationships and IPV Screening: Next Steps

• Read: “What Are the Signs of a Controlling Relationship?”
• Quiz: “Is My Relationship Toxic?” A Quiz for Adults with ADHD
• Read: How to Respond to Gaslighting — In Your Relationship and In Yourself

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

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

²Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

³Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

⁴Black MC, Basile KC, Breiding MJ, et al. The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA Natl Cent Inj Prev Control Centers Dis Control Prev. 2011;19:39-40.

⁵US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Grossman DC, Kemper AR, Kubik M, Kurth A, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct 23;320(16):1678-1687. doi: 10.1001/jama.2018.14741. PMID: 30357305.

⁶Miller E, Tancredi DJ, Decker MR, et al. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception. 2016;94(1):58-67. doi:10.1016/j.contraception.2016.02.009

ADHD raises the risk of obesity, but its effect is dampened for people living in large cities, according to two new studies.

Young adults with combined-type ADHD are more likely than their non-ADHD peers to carry excess weight around their midsection and to have an unhealthy waist-to-height ratio (known as the body mass index or BMI), according to a new cross-sectional study published in American Journal of Human Biology. ¹ Obesity-related health conditions, such as heart disease and Type 2 diabetes, are tied to excess abdominal fat.

“The effect of ADHD on obesity intensified with age,” however, “no significant association was found with blood pressure, but trends suggested hypertension may escalate with age among ADHD individuals,” the study’s authors wrote.

ADHD’s Behavioral and Biological Links to Obesity

The biological link between ADHD and obesity, and the influence of environment on this relationship, was the focus of another new study led by researchers from the Tandon School of Engineering at New York University and the Italian National Institute of Health. ²

The study, published in PLOS Complex Systems, proposed that ADHD influences obesity along two pathways:

1. Behavioral: Difficulties with motivation, planning, and sustained attention may lead people with ADHD to engage in less physical activity, increasing the likelihood of weight gain.
2. Biological: ADHD affects areas of the brain responsible for impulse control, decision making, and reward processing, making people with ADHD more susceptible to impulsive eating behaviors, such as bingeing or choosing high-calorie snacks.

“A lot of people I work with complain about using food for stimulation,” said Nicole DeMasi Malcher, M.S., R.D., CDES, during the ADDitude webinar “Eating with ADHD: Improving Your Relationship with Food.” “They are constantly looking for food to deliver a quick fix rather than thinking about the long-term effects.”

Malcher attributes this behavior, in part, to poor interoception, the ability to sense what’s happening inside the body, including cues such as thirst, hunger, and fullness. “People with ADHD are unable to recognize these cues until they feel really ravenous,” she said. “Then it’s too late, and they make more impulsive eating and food choices.”

ADHD and the City

Living in a city environment may mitigate the risk of obesity for individuals with and without ADHD. The research found that living in a large city offers more opportunities for physical activity, better access to mental health care, and higher overall levels of education, which could buffer the effects of ADHD that lead to obesity.

The NYU/Italian research team analyzed 915 cities in the United States using an urban scaling mathematical model to examine how rates of ADHD and obesity changed as cities grew. Their analysis showed that, in larger urban areas, ADHD and obesity become relatively less common as population grows. At the same time, access to education and mental health services tends to grow faster than the population. In short, bigger cities aren’t just more populated — they’re often better equipped to handle public health issues like ADHD and obesity. In contrast, cities with fewer opportunities for physical activity or more food insecurity demonstrated stronger links between ADHD and obesity.

“Our research reveals a surprising urban advantage: as cities grow, both obesity and ADHD rates decrease proportionally,” says Tian Gan, a co-author of the PLOS study. “Meanwhile, mental health services become more accessible, helping combat physical inactivity — a key link between ADHD and obesity. This pattern suggests larger cities offer protective factors against these interconnected health challenges.”

Similar patterns emerged when the researchers analyzed survey data from 19,428 children across the U.S. as part of the National Survey of Children’s Health. Children with more severe ADHD symptoms were more likely to be obese, especially if they lived in homes with fewer opportunities for physical activity or lower parental education levels.

The researchers also measured the differences between each city’s rates of ADHD and obesity, and those expected for its population, identifying several regional discrepancies. Cities in the Southeastern and Southwestern U.S. displayed greater disparities in ADHD and obesity prevalence, mental health access, and food insecurity than other regions. Neighboring cities often differed significantly, suggesting that local policies and resources could either amplify or reduce these health risks.

“These findings underscore the importance of city-level interventions in mitigating the impact of impulsivity disorders on the obesity epidemic,” says Dr. Maurizio Porfiri, Ph.D., senior author on the PLOS study. “It’s not just about how big a city is — it’s about how it uses its resources. With this kind of insight, policymakers can target investments in mental health care, education, and physical activity to break the link between ADHD and obesity where it’s strongest.”

Intuitive Eating for ADHD

Both studies suggest that effective management of ADHD symptoms can help reduce the risk of obesity and its complications, and that obesity management programs must take into account a patient’s ADHD diagnosis.

The practice of intuitive eating (IE), for example, may help address the underlying neurological traits that influence the eating habits of people with ADHD.

“Intuitive eating, when adapted for the ADHD brain, provides an evidence-based framework that works with rather than against ADHD traits,” Malcher said. “This approach helps reduce overwhelm, prevent binge eating, and create sustainable eating habits without triggering the restriction-binge cycle common in ADHD.”

Sources

¹Mishra, S., Choudhury, O., Chaudhary, V., Saraswathy, K.N., Shekhawat, L.S., and Devi, N.K. (2025). Attention deficit hyperactivity disorder in obesity and hypertension: A study among young adults in Delhi NCR, India. Am J Hum Biol. https://doi.org/10.1002/ajhb.70022 

²Gan, T., Succar, R., Macrì, S., Porfiri, M. (2025). Investigating the link between impulsivity and obesity through urban scaling laws. PLOS Complex Syst. https://doi.org/10.1371/journal.pcsy.0000046

Listening to music while practicing mindfulness exercises may improve focus, mood, and emotional wellbeing in people with symptoms of ADHD, anxiety, and depression, according to two new studies.

A systematic review examining the relationship between music and ADHD found that music listening activates brain regions involved in sensory processing, motor control, and motivation — networks that are often dysregulated in individuals with attention deficit.¹

Traditional thinking suggests that quiet environments help sustain attention; however, the opposite may be true. The review, published in Behavioral Science, indicated that music, especially calm music with or without lyrics, can improve focus and performance in individuals with ADHD, especially when it is heard before or during tasks. Listening to music can also help filter out distractions, leading to improved learning and mood.

“People with ADHD benefit from ‘rhythmic entrainment,’ using strong, steady rhythms to imprint structure and consistency. This assists with regulation of attention and behavior,” said Roberto Olivardia, Ph.D., Clinical Instructor of Psychology at Harvard Medical School, during his presentation titled, “We Got the Beat: The Impact of Music on ADHD,” at the 2024 Annual International Conference on ADHD.

Listening to music could become counterproductive if it causes overstimulation or if the listener is doing a challenging task that requires significant cognitive resources, the researchers noted.

Music Therapy Boosts Emotional, Social Skills

Music listening may be self-directed or facilitated by a trained music therapist, as part of music therapy. Music therapy sessions often incorporate active music listening, playing instruments, songwriting, or singing, as well as passive music listening.

The review made a compelling case for using music therapy to complement ADHD medications and other recommended therapies, citing evidence for the efficacy of music therapy in reducing symptoms of ADHD. For example, active music-making can enhance working memory and social skills while decreasing aggression. Conversely, passive music listening may improve learning and reduce disruptive behaviors.

“These insights highlight the potential for music to contribute to more holistic, non-pharmacological approaches, offering individuals with ADHD new avenues for enhancing cognitive functioning and overall wellbeing,” the study’s authors wrote.

The systematic review included 20 studies published between 1981 and 2023, reflecting data from 1,170 participants aged 2 to 56 years. Several limitations exist: The studies primarily focused on children and adolescents, rather than adults. Variations in study methods and design also resulted in some inconsistent findings.

“Despite these limitations, this review provides a valuable foundation for future research on the interaction between ADHD and music,” the study’s authors wrote.

Mindfulness Paired with Music Reduces Stress, Improves Mood

Another recent, smaller study, published in Frontiers in Neuroscience, suggests that listening to music while performing mindfulness exercises activates areas of the brain and body related to stress and emotional regulation that could reduce moderate symptoms of anxiety and depression in adults.sup>2

The study, led by a team of researchers from the Yale School of Medicine, assessed the physiological impact of music mindfulness by recording heart rates and EEGs from 38 participants, aged 18 to 65, as they engaged in a bilingual, two-week mindfulness program centered on “focus” and “mindfulness.”

“Anxiety and depression reduce autonomic system activity, as measured by Heart Rate Variability (HRV), and exacerbate cardiac morbidity, while both music and mindfulness have been shown to increase HRV,” wrote the researchers.

They found that music mindfulness quickly improved HRV — a sign of better stress regulation — and changed brain wave patterns (measured by EEG) in areas of the brain linked to emotion, awareness, and decision-making.

Both virtual and in-person sessions incorporated similar guided mindfulness exercises, accompanied by live improvised music, music listening, or no music at all. In addition to wearing mobile heart rate and EEG monitors during each session, participants completed surveys regarding their stress levels, degree of mindfulness, state of consciousness, and level of social connection before and after each session.

The virtual group exhibited a significant decrease in stress and a significant increase in altered states of consciousness during the “focus” sessions, but not the “motivation” sessions. This contrasted with the in-person sessions, where stress decreased and mindfulness and altered state of consciousness increased during both Focus and Motivation sessions.

The researchers said that the differences in music composition features (tempo, key, mode) between “focus” and “motivation” sessions may explain the physiological differences observed in heart rate variability.

In-person sessions with music boosted feelings of social connection more than the virtual sessions did, underscoring the value of live, shared experiences in therapeutic settings.

“Our results imply that, while virtual sessions reduce stress, they do not have as extensive an effect on psychological states as in-person sessions do,” the researchers wrote. “Important aspects of live social interaction may drive feelings of social connection and serve as a key differentiator between live and virtual sessions.”

The researchers also observed gender-specific effects via HRV; women appeared to benefit more physiologically from music mindfulness than men.

While the findings from the Behavioral Science and Frontiers in Neuroscience studies contribute to a growing body of evidence supporting the use of music as a viable adjunct treatment for ADHD and mood disorders, both research teams emphasize the need for further investigation. Future studies would include randomized controlled trials, long-term outcome assessments, and greater representation of adult populations.

Sources

¹Saville, P., Kinney, C., Heiderscheit, A., Himmerich, H. (2025). Exploring the intersection of ADHD and music: A systematic review. Behav. Sci. https://doi.org/10.3390/bs15010065

²Ramirez, C., Alayine, G.A., Akafia, C., Selase, K., Adichie, K. et al. (2025). Music mindfulness acutely modulates autonomic activity and improves psychological state in anxiety and depression. Frontiers in Neuroscience. https://doi.org/10.3389/fnins.2025.1554156

Reserve your spot in this free webinar, and get the event replay link plus a 15% discount to ADDitude magazine

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ADHD brings with it intense emotions, impatience, and stress — and our inability to regulate these feelings affects everyday life as well as our most important relationships. We overreact to situations and feel angry or dejected due to real or perceived criticism. We have trouble calming down and sometimes react in ways that we later regret.

Mindfulness and related contemplative practices offer a powerful counterbalance to these feelings. They are valuable tools that aid in stress reduction, self-awareness, cognitive flexibility, self-compassion, habit change, and more. And here’s the good news: Contrary to popular belief, these practices do not require a still mind and body. When these practices are integrated with a proactive approach to physical health, they can create a stable emotional foundation that supports comprehensive, evidence-based ADHD care.

In this webinar, you will learn:

• How ADHD impairs executive function and contributes to emotional dysregulation
• About the clinical importance of addressing emotional health as a foundational step in ADHD treatment planning
• How unmanaged emotional reactivity disrupts adherence to evidence-based ADHD interventions
• How to evaluate the role of mindfulness and contemplative practices in promoting emotional self-regulation and cognitive flexibility
• How to apply specific mindfulness-based strategies to support comprehensive, individualized ADHD care across clinical settings.

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meditation for Emotional Regulation: Resources

• Free Download: Make Mindfulness Work for You
• Read: Meditation for the Bored & Restless: How to Practice Mindfulness with ADHD
• Read: The Key to ADHD Emotional Regulation? Cultivating Gratitude, Pride & Compassion
• Read: The Ultimate List of Mindfulness Exercises
• eBook: Mindfulness & Meditation for ADHD Symptoms

Meet the Expert Speaker

Mark Bertin, M.D., is a developmental pediatrician and author of How Children Thrive, Mindful Parenting for ADHD (#CommissionsEarned), Mindfulness and Self-Compassion for Teen ADHD (#CommissionsEarned), all of which integrate mindfulness into evidence-based pediatric care. Dr. Bertin is a faculty member at New York Medical College and the Windward Teacher Training Institute, and has served on advisory boards for APSARD, ADDitude Magazine, The Screen Time Action Network, Common Sense Media, and Reach Out and Read. His blog is available through Psychology Today and elsewhere.

In addition to his clinical and writing work, Dr. Bertin leads workshops and retreats that combine mindfulness and practical support for families and professionals. Join him for Held and Whole: A Restorative ADHD Retreat Rooted in Nature, October 10–12, 2025, in the Catskills. For more information, please visit www.developmentaldoctor.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.

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Closed captions available.

No, it’s not cancer. In fact, the number of worldwide deaths from all types of cancer combined is equivalent to half the number of fatalities caused by heart disease in women.

More than 60 million women in the United States have heart disease — and for the large majority, serious cardiac problems begin in perimenopause when estrogen, which protects the heart, decreases dramatically.

While the risk for cardiovascular disease increases in all women during perimenopause, women with ADHD may face an even greater risk than their non-ADHD peers. Research has revealed that the prevalence of heart disease is higher among adults with ADHD of both genders compared to adults without ADHD: 38% vs 23%.¹

While research investigating the prevalence of heart disease among women with ADHD, specifically, remains incomplete, it is reasonable to hypothesize that rates are high because this population faces myriad heart disease risk factors including chronic stress, anxiety, depression, substance use disorders, sleep disorders, obesity, and diabetes.

To test this hypothesis, I partnered with the HeartLife Cardiology Clinic in the Netherlands. Included in the study were 300 women, the majority of whom were of perimenopausal age, as this is commonly the age at which women seek treatment for cardiac complaints.²

[Read: Let’s Talk About Perimenopause and ADHD]

We found that 35% of these patients met criteria for lifetime ADHD symptoms: a rate that is nearly 10 times that found among women in general. We also found that the women with ADHD symptoms experienced cardiac complaints two years earlier than their non-ADHD peers, suggesting that their cardiac problems may be relatively more severe.

This exploratory study indicated to us that further research is needed. To that end, my colleagues and I have launched the Women with ADHD Health Study, which has enrolled more than 3,000 female participants from across the world and is investigating the relationship between female hormones and cardiovascular issues, among other physical conditions. The ongoing research survey is accepting responses until the end of June 2025, and all women with ADHD or who identify as having ADHD symptoms are invited to participate.

Today, research shows that just 44% of women in the U.S. correctly identify heart disease as the greatest threat to their health.³ This lack of awareness is due, in part, to the fact that women often experience significantly different symptoms of cardiovascular disease than men. If patients, and their doctors, aren’t educated about how heart disease presents in women, potentially deadly health repercussions may result.

[Download: Free Guide to Hormones & ADHD in Women]

So, while we wait for research to be completed, we seek to equip at-risk women with the information necessary to protect their hearts from harm.

The Big Impact of Small Vessel Disease

When people think of heart disease, what usually comes to mind is coronary artery disease (CAD). In this disorder, plaques build up in the larger coronary arteries, causing a narrowing that may lead to an obstruction and possible heart attack. CAD is associated with risk factors such as high cholesterol, high blood pressure, obesity, diabetes, smoking, and lack of exercise.

Seldom discussed is another type of coronary heart disease that predominantly affects women, called coronary microvascular disease (CMD). Unlike CAD, which affects the heart’s large arteries and reduces blood flow due to obstruction, CMD also affects the heart’s smallest blood vessels, and reduces blood flow due to spasms.

Symptoms of CAD tend to occur after physical effort, whereas signs of CMD are more erratic in nature. Symptoms frequently occur during rest, even during sleep. They are also more commonly associated with chronic stress, depression, and anxiety.

Heart Attacks in Women Look Different

We are all familiar with the “classic” symptoms of a heart attack; sudden pain in the chest, often after physical effort, sometimes accompanied by pain in the left arm and jaw. These symptoms are real and serious, for women as well as men — but they are not the only signs of a heart attack.

For many women, signs of a heart attack include:

• tightness in the chest, the feeling of being in a harness or too-tight bra
• shortness of breath
• pain in the back
• indigestion
• nausea or vomiting

Though these symptoms are sometimes called “atypical,” the truth is that they are only atypical for men. They are quite common, and often under-recognized, in women.

Microvascular disease is much more difficult to diagnose than is CAD. Because it involves the heart’s smallest vessels, it’s not visible via routine angiography. Unlike blockages in the arteries that are fixed and persistent, the spasms associated with CMD come and go. It can be diagnosed through a provocative acetylcholine challenge test, however this is an invasive and uncomfortable procedure that is not often used.

Women with cardiac complaints frequently report going to the emergency room, where an angiogram is performed and finds no evidence of blockage in the arteries. These women are often misdiagnosed with anxiety, and told the problem is not in their heart, but in their head. They’re sent home, their cardiovascular disease unrecognized and untreated.

Female-Specific Risk Factors for Heart Disease

In addition to heart disease risk factors that impact both men and women (high cholesterol, hypertension, smoking, obesity), there are several heart disease risk factors specific and exclusive to women. These include:

• gestational diabetes
• a history of preeclampsia
• endometriosis
• polycystic ovarian syndrome
• autoimmune disorders
• oral contraceptive use
• premature menopause

Menopause most commonly occurs when a woman is in her early 50s. When it occurs before the age of 40, it’s considered premature menopause, which is a risk factor for cardiovascular disease. This is because the early drop in estrogen exposes the heart to more harm over a longer period.

Women with ADHD may experience premature menopause at relatively higher rates, according to a recent study in Nature Genetics.⁴ While the reasons for early menopause remain largely unclear, we do know that smoking can be a contributing factor. Surgeries that impact the ovaries can also result in early menopause.

Tailoring Treatment to ADHD Patients

When treating patients with cardiac problems, doctors often start with lifestyle changes. This can prove especially challenging for patients with ADHD. Unless their ADHD, sleep problems, and mood disorder are treated first, they will likely be too exhausted, forgetful, or disorganized to make changes to their lifestyle. For this reason, I advise addressing ADHD and other symptoms first to lay the groundwork for successful changes to diet, exercise, and other habits. Blood pressure and heart rate should be monitored during ADHD treatment, as stimulants may increase both.

I also urge perimenopausal women to address hormonal complaints that may be at play and to consider the protective effect of estrogen on heart function.

Heart Disease in Women: Next Steps

• Read: Falling Estrogen, Soaring ADHD: Menopause Care for Neurodivergent Women
• Read: Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research
• Learn: Menopause, Hormones & ADHD – What We Know, What Research is Needed

The content for this article was derived, in part, from a plenary address at the 2025 Annual Conference of the American Professional Society for ADHD and Related Disorders (APSARD) delivered by prof. J.J. Sandra Kooij, M.D., Ph.D., titled, “Gender & Endocrine Issues in ADHD.” J.J. Sandra Kooij is a professor on Adult ADHD at Amsterdam UMC/VUMc, the Netherlands.

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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

¹Li L, Chang Z, Sun J, Garcia-Argibay M, Du Rietz E, Dobrosavljevic M, Brikell I, Jernberg T, Solmi M, Cortese S, Larsson H. Attention-deficit/hyperactivity disorder as a risk factor for cardiovascular diseases: a nationwide population-based cohort study. World Psychiatry. 2022 Oct;21(3):452-459. doi: 10.1002/wps.21020. PMID: 36073682; PMCID: PMC9453905.

²Ter Beek LS, Böhmer MN, Wittekoek ME, Kooij JJS. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Arch Womens Ment Health. 2023 Dec;26(6):851-855. doi: 10.1007/s00737-023-01356-7. Epub 2023 Aug 18. PMID: 37594562; PMCID: PMC10632230.

³Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ; American Heart Association. Ten-Year Differences in Women’s Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation. 2021 Feb 16;143(7):e239-e248.

⁴Demontis, D., Walters, R.K., Martin, J. et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 51, 63–75 (2019).

Grown-ups write a weekly meal schedule on a Sunday and do careful calculations before drilling holes. They make sandwiches the night before and remember to take them to work.

Grown-ups quell their transient urges in the pursuit of long-term goals. They commit, they save, they resist, and they toil. They get where they were planning to go.

Tedium does not torment the regular grown-up. If a boring job needs doing, they simply get on and do it. They are not hijacked by the urgent need to be anywhere else but the present.

Grown-ups don’t pull their phone-charger cable out while chatting and distractedly plug it into their mouth. They hardly ever go to bed with their keys left hanging on the outside of the door, and I very much doubt that they have 14,000 unread emails. Grown-ups absolutely do not tell someone they’ve just met that their underwear is stuck up their bum.

So, nope. Not much grown-uppery going on around here.

Even motherhood has failed to rebirth me as a convincing adult, if I’m honest. I love with abandon, but I do not have the skill set of an executive PA, despite what my children’s school might assume.

I’m the parent with the kid in full uniform on wear-whatever-you-want day and no cash for the cash-only book fair. I’m the mum at the bounce party who demos an illegal maneuver and then watches as a 6-year-old copies and knocks out his tooth.

[Read: Diaries of “Adulting” (or Not) with ADHD]

I Don’t Feel Like an Adult: The Fallout from Falling Short

Like lots of people acutely aware of their flaws, I’ve learned to jump in and laugh at myself before others can take a shot. But I still feel small when I fail to measure up to societal norms, no matter how many jokes I churn out at my own expense.

I am also reduced to jelly by the ice-cold dead eye of those proudly logical humans repulsed by malfunctions of common sense. I see their disdain as a sign of deep self-loathing, but I nonetheless crumble at their condemnation of me and the faults I may well never fix.

My lack of adulting acumen has cost me. Failure to plan, persist, and apply what I learn from experience has thwarted my ambition and harmed my self-trust. It limits my capacity to meet my potential and avoid repeating mistakes. It hurts.

Why Can’t I “Adult?” It Was ADHD All Along

I cannot describe how I felt when I read about the symptoms of inattentive-type ADHD in women. I ticked almost all of the boxes and made sense to myself for the first time ever. A single condition explained what I had always viewed with quiet shame as manifestations of immaturity, weak character and sloth.

I waited 30 months for an assessment and then sobbed the whole way through it. When my diagnosis came, it felt like a big “welcome home” by people who finally got me. You are not alone! Come on in! Sorry about the mess. It was truly the biggest relief of my life.

[Take This Self-Test: ADHD Symptoms in Women]

Now I’m busy learning how my traits and behaviors conspire to keep me feeling like a child.

Of course I have trouble resisting temptation. My brain yearns for dopamine to bolster its fragile supply. And I leave things to the last minute not out of preference or bravado but because concentration evades me until a deadline is so close I can smell it.

There’s a reason too why I struggle to stay on-task when a job is neither urgent nor appealing. My filter for blocking out irrelevant stimuli has the authority of wilted spinach. Distracting noises and thoughts roll in freely while I’m trying to focus and the effort it takes to ignore them leaves me feeling drained and frustrated.

I am not devoid of reason (though I never really thought I was). My prefrontal cortex is clear-thinking and analytical. But when my lizard brain floods with emotion, the rational part of me doesn’t carry sufficient clout to talk it out of a spiral.

It’s empowering to have language and insights about ADHD to help me understand and convey to others what I’ve always known but lacked the words or concepts to explain.

Learning How to Be an Adult

My ADHD diagnosis hasn’t magicked me into a grown-up. But it has made me feel happier and more in control of my choices. I’ve grieved for lost dreams and stopped beating myself up all day long. Decades of self-castigation, it turns out, yield little positive change.

And ADHD is not all bad, let’s be honest. My neurodivergent strengths and leanings make life a lot more fun. They predispose me to creativity, which brings me joy and flow. It can feel like the meaning of life itself when ideas spill forth with apparently mystical ease. I’m entertained by my daydreaming too, which helps me spot links and patterns that don’t always jump out at others. I’m flexible and adaptable and I come alive under pressure. I’m pretty sure ADHD makes me more tolerant as well. Being aware of my own annoying quirks makes it natural for me to cut others some slack over theirs.

I’m not sure I’d swap any one of these traits for an immaculate car or the ability to tell you what I’m having for dinner next Tuesday.

Will I ever feel like a grown-up? Never completely, I hope. I’m pleased my diagnosis has helped me find ways to manage. But I plan to grow more than just upwards. I intend to grow outwards, inwards, and in any direction that my passion and curiosity take me. That is the most authentic, and surely therefore the most grown-up thing I can do.

“I Don’t Feel Like an Adult:” Next Steps

• Sign Up: Essential Support for Women with ADHD
• Read: The Adult in the Room — I’m Not It!
• Read: 42 Raw Confessions from Women with ADHD
• Read: “I Learned I Couldn’t Trust Myself, Then I Found I Had Undiagnosed ADHD.”

SUPPORT ADDITUDE
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“Women with ADHD Are More Sensitive to Hormonal Fluctuations.”

Women with ADHD experience significant hormonal fluctuations from puberty through menopause, as sex hormones like estrogen and progesterone directly affect brain regions linked to ADHD’s challenges.

Studies suggest that women with ADHD may be more sensitive to hormonal fluctuations across the cycle than are women without ADHD.¹, ² Of course, ADHD varies from person to person, and individual reactions to hormonal fluctuations differ based on the ADHD profile.

[Read: Let’s Talk About Perimenopause and ADHD]

If your ADHD profile is defined by inattention and emotional dysregulation, higher estrogen levels around ovulation may come as a very welcome energy and mood boost. On the flipside, you may suffer tremendously from depressive symptoms and rejection sensitivity during the premenstrual or luteal phase.

One small study from the Netherlands has explored cyclic or flexible dosing — increasing the dose of ADHD stimulant medication around the premenstrual period.³ We need more research, but the theoretical model is there for cyclic dosing. However, as clinicians, we have no guidelines and very little support on which to rely. We must consider every woman’s individual hormonal profile and make treatment decisions in that context.

Treatment and diagnosis become more complicated during perimenopause and menopause, when women with and without ADHD are affected cognitively and physically. Then the challenge is trying to disentangle whether symptoms are related to midlife hormonal changes or stem from undetected ADHD that a woman has been able to mask for a lifetime.

Research on menopausal women with ADHD is scarce, but some studies show that women without ADHD in perimenopause experience improved cognitive function while taking stimulant medications.⁴,⁵,⁶ We also see that women with ADHD may experience reduced ADHD symptoms when taking hormone replacement therapy. (https://www.additudemag.com/low-estrogen-adhd-menopause-treatment-hrt/) This is an extremely important topic, and we are just scratching the surface.

— Lotta Borg Skoglund, M.D., Ph.D., is an associate professor at Sweden’s Uppsala University, Department for Women’s and Children’s Health

[Watch: Free Replay of ADDitude’s Expert Roundtable on Women with ADHD]

“There’s Pride in the Struggle.”

ADHD in Black women is often completely overlooked because they generally don’t want to be observed. Black women are specifically taught not to be observed as a protective measure for their own safety in a society with racial and gender biases. Clinicians then misinterpret their outward challenges as signs of mood disorders or bipolar disorder, which is a stigmatizing mental health diagnosis.

I’ve worked with women who were given multiple mental health diagnoses without anyone considering ADHD. Misdiagnosis delays access to the right treatment and leaves women feeling frustrated and even more misunderstood. They come to believe, “Something is inherently wrong with me.”

Secondly, Black women often don’t recognize their own symptoms of ADHD because they’ve been so conditioned to push through struggles on their own. And symptoms tend to align with society’s toxic stereotypes about Black people as a whole: emotionally unstable and lazy.

Many of us grew up hearing that we had to be twice as good to be recognized as even half as much. When executive function issues make it hard to keep up, we internalize them as a personal failure instead of seeking help. We think, “I just need to try harder.” This leads to overcompensating, overworking, overachieving, and constantly masking to appear competent.

And that works until it doesn’t. Eventually, it leads to burnout and anxiety, and sometimes, to physical health issues like migraines, chronic fatigue, and even high blood pressure. Research is now suggesting a connection between autoimmune diseases and chronically high levels of cortisol in the body.⁷It’s an exhausting cycle and one that many Black women don’t realize is tied to undiagnosed ADHD.

Finally, we can’t ignore the fact that many Black women don’t seek care due to a well-founded mistrust of the healthcare system. Black women historically have been over-pathologized and mistreated in medical settings. Many women fear that they will be dismissed, judged, and over-medicated, so they avoid even seeking out a diagnosis because they don’t know whom to trust.

For neurodivergent women, it’s all or nothing. If the task looks daunting and is riddled with a high probability of rejection or harm versus help, do we take the chance? Usually, we don’t. So the long-term impacts are just massive for Black women, who experience continually deteriorating mental health as they try to figure out, “Is this me? Am I just a failure?”

The key is normalizing these feelings so Black women have words to clearly communicate what they are experiencing. Unfortunately, the strong Black woman stereotype makes that very difficult. Have Black women even been shown the possibilities of living life without it being so defined by struggle? There’s pride in some of the struggle. We need to let go of that. It’s not great to work in hard mode constantly. There’s no prize at the end of the race for that.

— Diane Miller, Psy.D., M.Ed., is a clinical psychologist who specializes in adult ADHD, racial identity issues, and sex therapy.

[Are You Burned Out? Take This Self-Test]

“I Call It the Chasm.”

Women internalize their ADHD symptoms. They do not volunteer the pain they experience living in a world built for non-ADHD brains.

When women internalize their experience with ADHD, they are more likely to use isolation and perfectionism as ways to manage their symptoms. These behaviors contribute to an inauthentic picture that’s intended to appear more “socially acceptable.”

In their clinicians’ offices, women often respond to gender role expectations by people pleasing, controlling their behaviors, and downplaying their struggles. Without observing hyperactive or impulsive behaviors, clinicians may not consider an ADHD diagnosis, and women will continue to go untreated.

What’s more, if a woman meets a clinician in the week after her period, when estrogen is high, she will appear to be really together and may feel good. The clinician may dismiss a woman who masks successfully as not meeting diagnostic criteria. Two weeks later in her menstrual cycle, that woman may feel stressed, worried, tearful, or hopeless, which may be mistaken for observable signs of anxiety or depression and lead to misdiagnosis.

Most women with ADHD have spent a decade or more not knowing that the challenges and stressors they’re experiencing are the result of undiagnosed ADHD. They believe their difficulties reflect flaws in their character. They compare themselves harshly to their neurotypical peers. Over time, they are likely to develop unhealthy coping strategies.

We can’t change brain wiring, but we can help women reframe their behavior and view themselves through a more forgiving lens. We can help them understand that they are living with a different set of strengths and weaknesses. We can drive home the idea that the societal expectations for women are antiquated and unhealthy. We can help them release those internalized judgments and allow themselves to feel empowered and confident.

— Ellen Littman, Ph.D., is a clinical psychologist and pioneer in the identification of gender differences in ADHD.

[Get This: ADHD Diagnosis Guide for Women]

“Parenting Requires a Great Deal of Executive Functioning.”

Mothers with ADHD often experience two types of core parenting challenges: First, ADHD impairs executive functioning, which is responsible for planning, organization, problem-solving, and memory. As we all know, parenting a child with ADHD requires a great deal of external structure and scaffolding. When parent and child both have ADHD, it is tough to consistently maintain routines, household structure, calendars, and to-do lists.

Another challenge is emotional regulation. Though this feature isn’t in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), emotional dysregulation is prominent for many people with ADHD and can make it much harder for parents to maintain their cool or practice patience when they have a challenging child who might be pushing their buttons. Parents with ADHD might yell, which contributes to negative feelings about their parenting.

Traditional interventions for kids with ADHD require a parent to be extra structured, very consistent, reliably calm, and patient. In my practice, we break this down.

We work with parents on keeping just one calendar where they put every single activity, including things they need to do for themselves. We help them keep a prioritized to-do list where they begin by writing down everything they need to do and then asking, “Are these items all vital? Am I putting way too much pressure on myself as a parent?” The magic is in prioritizing and weeding out unnecessary tasks so parents can focus on what’s most important.

We also try to emphasize the value of self-care. Mothers who make time to do the things they enjoy and value end up in a happier, more relaxed place when they’re with their child. We help parents build small activities into their day-to-day lives to prioritize. They can observe how these things help facilitate more positive interactions with their kids.

Finally, we teach mindfulness and relaxation so that mothers with ADHD can learn how to remain calm and ignore some of their kids’ minor annoying behaviors. Most of all, we work with parents to give themselves grace and not be so hard on themselves. Parenting is difficult. When parents have ADHD, they don’t need more blame or shame. They need support and skills.

—Andrea Chronis-Tuscano, Ph.D., is the director of the ADHD Program for SUCCEEDS College ADHD Clinic at the University of Maryland.

[Free Download: Mindful Meditations for ADHD]

“ADHD Often Underlies Women’s Mental Health Conditions.”

The DSM is our system, as clinicians, for deciding who qualifies for a clinical diagnosis of ADHD. At the American Professional Society of ADHD and Related Disorders (APSARD), we don’t have the authority to rewrite the DSM, but the Diagnostic and Screening Subcommittee, on which I serve, is developing guidance to help clinicians identify adults who have ADHD and make sure that people who don’t meet the criteria for ADHD aren’t mistakenly given the diagnosis. The subcommittee includes seven women and two men, and we have very much been thinking about addressing issues with women’s diagnoses, specifically.

ADHD often underlies the anxiety, depression, and substance use problems that bring women in contact with the mental healthcare system. But clinicians working in those settings often miss that these disorders are a consequence of ADHD. The APSARD adult diagnosis guidelines, due to be published later this year, hope to address this by suggesting and recommending ways for clinicians to gather the key information they need to make the right diagnosis, and by offering advice and guidance about overcoming the issues that can sabotage a woman’s diagnosis.

Part of our work is developing a clinician education program that will make possible system-level changes, like screening and catching people where they’re likely to show up in the healthcare system. Also, if clinicians are not confident in diagnosing ADHD in women, they’re going to play it safe. They may not diagnose ADHD in women who didn’t show clear symptoms when they were younger because, as providers, there’s a stigma around just handing out ADHD diagnoses.

APSARD is working to address factors on both the provider and patient sides by publishing clear, accurate information that clinicians can point to and say, “I’m following these guidelines responsibly.” I’m hopeful these guidelines will bring the country onto a level playing field in terms of what’s acceptable, what procedures should be followed, and what best practices look like.

—Maggie Sibley, Ph.D., is a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital.

[Free Download: The Facts About Major Depressive Disorder in Women]

Neurodivergent Women: Next Steps

• Free Workbook: Track ADHD Symptoms During Your Menstrual Cycle
• Read: Falling Estrogen, Soaring ADHD: Menopause Care for Neurodivergent Women
• Read: Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research
• Learn: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.

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

¹Handy, A.B., Greenfield, S.F., Yonkers, K.A., & Payne, L.A. (2022). Psychiatric symptoms across the menstrual cycle in adult women: a comprehensive review. Harvard Review of Psychiatry, 30(2), 100–117. https://doi.org/10.1097/HRP.0000000000000329

²Roberts, B., Eisenlohr-Moul, T., & Martel, M.M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

³de Jong, M., Wynchank, D.S. M.R., van Andel, E., Beekman, A.T.F., & Kooij, J.J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

⁴Epperson, C.N., Pittman, B., Czarkowski, K.A., Bradley, J., Quinlan, D.M., & Brown, T.E. (2011). Impact of atomoxetine on subjective attention and memory difficulties in perimenopausal and postmenopausal women. Menopause (New York, N.Y.), 18(5), 542–548. https://doi.org/10.1097/gme.0b013e3181fcafd6

⁵Epperson, C.N., Shanmugan, S., Kim, D.R., Mathews, S., Czarkowski, K.A., Bradley, J., Appleby, D.H., Iannelli, C., Sammel, M.D., & Brown, T.E. (2015). New onset executive function difficulties at menopause: a possible role for lisdexamfetamine. Psychopharmacology, 232(16), 3091–3100. https://doi.org/10.1007/s00213-015-3953-7

⁶Shanmugan, S., Loughead, J., Nanga, R.P., Elliott, M., Hariharan, H., Appleby, D., Kim, D., Ruparel, K., Reddy, R., Brown, T.E., & Epperson, C. N. (2017). Lisdexamfetamine effects on executive activation and neurochemistry in menopausal women with executive function difficulties. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 42(2), 437–445. https://doi.org/10.1038/npp.2016.162

⁷Song H, Fang F, Tomasson G, et al. (2018). Association of stress-related disorders with subsequent autoimmune disease. JAMA, 319(23):2388–2400. https://doi.org/10.1001/jama.2018.7028

Black women with ADHD often live in a state of high performance and hidden (largely ignored) exhaustion — constantly managing symptoms while navigating the pressure to show up as competent, composed, and emotionally controlled. This webinar explores the compounded impact of rejection sensitivity and double-masking, a survival strategy wherein both ADHD symptoms and aspects of cultural identity are suppressed to avoid judgment, stigma, or rejection.

The session will break down how this cycle of masking starts early, how it shows up in adulthood, and its effect on mental health, relationships, and sense of self for neurodivergent Black women. Participants will gain insight into the emotional toll of chronic masking; the generational messages that shape how Black women relate to rest, vulnerability, and achievement; and how race, gender, and neurodivergence intersect in complex, often overlooked ways.

This session is for Black women with ADHD, the providers who support them, and anyone who wants to better understand how racial and gender dynamics intersect with neurodivergence.

In this webinar, you will learn:

• How ADHD commonly presents in Black women and why it’s often missed or misdiagnosed
• What rejection sensitivity looks like and how it can drive overcompensation, perfectionism, and self-silencing
• The emotional and physiological cost of double-masking and chronic emotional suppression
• How generational messaging like “be twice as good” and “never let ’em see you sweat” impact self-worth and behavior
• Practical, culturally responsive strategies to reduce masking and build emotional safety
• What healing and authenticity can look like for Black women with ADHD

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.

RSD and ADHD in Black Women: Resources

• Free Download: Understanding Rejection Sensitive Dysphoria
• Read: New Insights Into Rejection Sensitive Dysphoria 
• Read: How ADHD Ignites RSD: Meaning & Medication Solutions 
• Read: Rejection Sensitivity Is Worse for Girls and Women with ADHD
• Read: “I Could Have Been Myself for So Much Longer.”
• Read: Why ADHD Is Different for People of Color

Obtain a Certificate of Attendance

If you attended the live webinar on May 22, 2025, 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

Diane Miller, Psy. D., M.Ed., a dedicated clinical psychologist who specializes in adult ADHD, racial identity issues, and sex therapy, holding a Doctorate in Clinical Psychology and a Master’s in Human Sexuality from Widener University. With over a decade of expertise, she has dedicated her career to serving marginalized communities across various settings such as community mental health, and psychiatric hospitals. Currently at The Center for ADHD in Philadelphia, she empowers individuals to navigate ADHD’s complexities, fostering self-acceptance and proactive living. Dr. Miller’s approach is deeply informed by her extensive work with underserved populations, offering a therapeutic space of trust, equity and support.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

A lifetime of masking can cause chronic stress and anxiety for many autistic people with ADHD who identify as AuDHD. Add in a reduced tolerance for stimulus, frequent social isolation, and a lack of support — and burnout becomes equally common and devastating. AuDHD burnout is a serious mental health problem that can cause extreme distress and debilitation.

Often, burnout is mistaken for other mental health conditions. But we can only recover from burnout when we recognize why it’s happening and take appropriate steps to get support. After all, you cannot prevent, reduce, or recover from burnout when you don’t know what’s causing it.

In this webinar, you will learn:

• About the differences and similarities between ADHD and autism
• About the importance of an accurate autism diagnosis in adults and why the current diagnostic criteria does not reflect the lived experiences of many
• Why autistic people mask and how a lifetime of masking can lead to chronic stress and burnout
• How to identify warning signs of burnout, including fatigue, withdrawal, and a decline in skills, and how this differs from other mental health issues like depression
• About strategies to prevent or recover from burnout

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.

AuDHD Resources

• Take This Self-Test: Autism in Women
• Read: AuDHD — An Overview
• Read: “A Living Contradiction:” The AuDHD Experience
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus

Obtain a Certificate of Attendance

If you attended the live webinar on April 30, 2025, 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 »

Webinar Sponsor

Masking your neurodivergence is exhausting, but you don’t have to hide who you are. Inflow gets it, and is here to support you. Their science-backed app is built by leading ADHD clinicians and can help you embrace your AuDHD, reduce burnout, and build resilience. Ready to drop the mask and thrive? Start by taking the free ADHD traits quiz today.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Meet the Expert Speaker

Dr. Amy Marschall is a licensed psychologist, author, and speaker. She is an expert in neurodiversity-affirming care, especially for the autistic and ADHD communities. She is the author of several books, including Neurodiversity-Affirming Therapy: What Every Mental Health Provider Needs to Know (#CommissionsEarned), which will be released in April 2025.

Dr. Marschall was diagnosed as AuDHD as an adult and is an advocate for her communities, bringing both professional and personal expertise. She has mental health resources and continuing education courses for therapists, which can be found on her website, www.resiliencymentalhealth.com.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

People with ADHD may struggle with disordered eating patterns due to the condition’s impact on executive function, emotional regulation, and reward processing. Research shows that ADHD significantly impacts eating behaviors through multiple mechanisms, including altered hunger and satiety signaling, difficulties with meal planning and preparation, increased emotional eating, and the use of food for dopamine stimulation.

Most recommendations around nutrition and healthy eating fail to address these neurobiological challenges, often promoting restrictive diets that can worsen both mental health and eating behaviors in individuals with ADHD. People with neurological differences require specialized approaches beyond conventional dietary advice.

Intuitive eating, when adapted for the ADHD brain, provides an evidence-based framework that works with rather than against ADHD traits. This approach helps reduce overwhelm, prevent binge eating, and create sustainable eating habits without triggering the restriction-binge cycle common in ADHD.

In this webinar, you will learn:

• How ADHD’s neurological differences affect eating behaviors, including hunger and fullness cues, executive function challenges in meal preparation, and the brain’s reward response to food
• The connection between ADHD and disordered eating patterns and why traditional dieting approaches often fail or cause harm
• Why intuitive eating principles, when modified for ADHD, can effectively address common challenges like emotional eating and food-related overwhelm
• Practical strategies to implement ADHD-friendly eating habits that support both physical and mental health without restrictive dieting
• Specific techniques to manage executive function challenges around meal planning, grocery shopping, and food preparation

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

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

ADHD and Nutrition: More Resources

• Free Download: Health & Fitness — Lifestyle Changes for Adults with ADHD
• Self-Test: Eating Disorders in Adults
• Read: 40 Ways to Eat Healthy and Resist Impulsive Snacking
• Read: Healthy Eating Habits for Impulsive, Dopamine-Starved ADHD Brains
• Read: Build a Better Relationship with Food to Benefit Your Brain

Obtain a Certificate of Attendance

If you attended the live webinar on March 25, 2025, 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

Nicole DeMasi Malcher, MS, RD, CDCES, is a Registered Dietitian and Certified Diabetes Care & Education Specialist with a Master’s Degree in Nutrition & Food Science. After a late ADHD diagnosis, she dedicated her career to helping adults with ADHD heal their relationship with food and body image through intuitive eating and weight-inclusive care.

As the founder of the Eating with ADHD Online Course & Community, she has helped hundreds of individuals develop sustainable, non-restrictive eating habits using ADHD-specific strategies for executive function and emotional regulation.

Drawing from personal experience and over a decade of clinical expertise, DeMasi Malcher empowers adults with ADHD to overcome food-related overwhelm, prevent binge eating, and reconnect with their body’s internal cues, without restrictive dieting.

Webinar Sponsor

Struggling with eating habits and ADHD? You’re not alone, and Inflow is here to help. Developed by leading ADHD experts, their science-backed self-help program offers proven strategies to help you build a healthier relationship with food, manage impulsive eating, and create sustainable habits. Take the free ADHD traits quiz to get started.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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DBT can help obvious forms of emotional dysregulation in ADHD, like overblown reactions. It can also address other ADHD-related challenges like low motivation problems and high procrastination. Its principles and skills target common frustrations with both emotional regulation and executive function that lead to distractibility to disorganization.

What Is DBT?

DBT is a skills-based form of talk therapy designed to help people manage intense emotions, improve relationships, and make thoughtful decisions. It used to treat ADHD, anxiety, depression, and more.

DBT focuses on four core areas:

• Emotion Regulation: Understanding and balancing emotions
• Distress Tolerance: Managing crises without making them worse
• Mindfulness: Staying present and aware in the moment
• Interpersonal Effectiveness: Communicating clearly and setting boundaries

1. Master Emotional Regulation

Emotions Are Not the Problem

Many adults say emotional dysregulation is the most impairing aspect of living with ADHD. DBT reminds us that emotions are important because they tell us about our environment and move us to action. Ignoring emotions is not the answer; learning to dance with them is key. With frequent practice, the following skills can improve emotional regulation.

• Understand and label emotions. Investigating your emotions will allow you to become clearer about what’s really going on. Labeling is also an act of mindfulness that cools the amygdala and limbic system. You can say to yourself, “I am experiencing ___ right now.”
• Accept emotions. Experiencing emotions intensely does not make you an irrational or bad person. Fighting their presence only depletes energy that is better used taking positive action to regulate them.

Improve Your Emotional Baseline

Taking care of your overall emotional health can reduce the frequency and intensity of emotions and improve your regulation of them.

• Practice daily mastery. When you actively seek challenges, you are exerting influence on your immediate environment, which builds self-efficacy and self-esteem. So do something every day that improves your sense of competence. Mastery can be found in the mundane, whether it’s doing the laundry or the dishes. (It isn’t important whether the activity you find challenging is also challenging to others.)
• Seek pleasant experiences. Focusing on positive experiences will help you break out of negative rumination cycles and build resilience against life’s stressors. Each day, engage in activities that bring you a sense of interest, satisfaction, and joy. These activities can be simple, from gardening and listening to music to watching a show with your family.

[Get This Free Download: Emotional Regulation & Anger Management Scripts]

2. Reverse ADHD Paralysis

“Opposite Action” is a DBT skill for calming emotions that are disproportionate to a situation. It entails doing the opposite of what your emotions tell you to do to interrupt and eventually change your feelings. Feel the urge to yell? Speak softly or adopt a half smile instead. Feel like withdrawing? Call a friend instead.

Opposite action is also helpful for overcoming ADHD paralysis. This skill can help you generate the emotional energy you need to start and complete tasks that you find boring or overwhelming. Are you frozen on the couch and know that you need to wash the dishes? Try wiggling your toes. Bring one leg off. Then the other. Stand on your feet for a few moments. Bring one foot in front of the other and make your way to the sink. Adopt a determined facial expression. Roll up your sleeves. Say aloud, “I’m going to wash this dish.”

3. Cope with Discomfort

Discomfort is a core part of our lives. We feel it when we try to control impulsive behaviors or emotional outbursts. We feel it when fielding comments and criticism. And sometimes when we try to manage this discomfort, we may end up engaging in self-sabotaging behaviors that worsen feelings of shame.

[Read: 13 Ways to Beat ADHD Paralysis]

Enter distress tolerance — a core DBT module that centers on the ability to endure stressful, overwhelming thoughts, feelings, and situations without engaging in self-defeating behaviors. Distress tolerance skills help you cope with tough feelings and reduce their intensity. The following distress tolerance exercises activate the parasympathetic nervous system in real time and downregulate flooded emotional states:

TIPP

• Temperature: Hold an ice cube or splash cold water on your face.
• Intense exercise: Do jumping jacks or sprint in place.
• Paced breathing: Take slow, deep breaths, extending your exhale.
• Paired muscle relaxation: Tense a muscle group while inhaling, then release as you exhale.

STOP

• Stop. Physically don’t move a muscle. Freeze.
• Take a step back. Create some distance, literally and/or figuratively, from the person you’re in conflict with or the frustrating task. Leave the room if possible. Think, “What’s happening here? What are the thoughts and emotions I’m having?”
• Observe. Notice what’s happening without holding onto anything.
• Proceed mindfully. Move forward with intention and in a way that aligns with your values.

4. Practice a Mindful Life

Mindfulness is at the root of all DBT skills. Learning how to pay attention to the present moment — an ongoing practice — will allow you to balance reason with emotion and act in ways that better serve you. In DBT, this state is called “Wise Mind,” and it is activated by practicing the following skills:

DBT Skills for ADHD: Next Steps

• Free Download: What Is Dialectical Behavior Therapy (DBT)?
• Read: DBT — The Emotional Control Therapy You Need Now
• Read: The Emotional Resilience Playbook for People with Big Emotions

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “How DBT Promotes Emotional Regulation, Distress Tolerance, and Mindfulness” [Video Replay & Podcast #527] with Scott Spradlin, LPC, which was broadcast on October 31, 2024.

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What is Hope, Exactly?

Hope is believing that a positive future is possible and trusting in your ability to achieve it. Hope provides a structured approach for setting goals and taking steps to achieve the future you desire, rather than simply contemplating it.

Experiencing hard times reduces an individual’s capacity for hope, but here’s the good part: Hope itself is a protective factor against adversity. Also, hope and resilience can be nurtured, taught, and restored.

Hope comprises three parts:

• Goals (short- and long-term) are the cornerstone of hope. 
• Pathways emerge, identifying routes towards goals and illuminating solutions around obstacles. This is the strategic aspect of hope. 
• Agency, or willpower, is the ability to sustain motivation to move through pathways and meet goals, especially during hard times. 

[Read: The Mystery of ADHD Motivation, Solved]

How to Build Hope

Hope can be taught in incremental steps. You can expand your capacity for hope and strive for a better future, even in the face of apathy and despair.

• Develop and clarify your goals. Define relevant and clear goals to increase your sense of agency. What future do you want for your relationships, career, health, and so on? Consider whether your goals are avoidant- or achievement-oriented. Are you setting goals for what you do not want to occur? Are your goals driven by anxiety or fear of the future? While it’s natural for some goals to stem from avoidance, you want most of your goals to be aspirational.
• Define and refine pathways. Consider viable routes and potential barriers to achieving your goals. Challenge yourself to find solutions to obstacles as they appear. Think about what’s in your power to change. Remember that setting different goals is always an option.
• What motivates you? Identify and describe what fuels your willpower. Use the following strategies to help sustain attention and build willpower as you move toward your goals:

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

• Call on your imagination. Envisioning a successful future helps to stoke willpower.
• Practice mindfulness. Just as stress and anxiety can deplete willpower, mindfulness and breathing exercises can help settle your thoughts so you can dedicate more energy to your goals.
• Create a hope map. Develop a visual reminder of your goals, pathways, and motivations.
• Ask for help. Look for support from friends, family, colleagues, coaches, and other positive influences in your life.

Why Is Hope Important Now?

What happens when the issues we face seem beyond our control? The last several years have brought a deadly pandemic, a deepening political divide, global conflict, and climate changes that produced life-threatening weather patterns. In the midst of such adversity, it is easy to slip into despair.

In these moments, hope is not the light at the end of the tunnel; hope is the light we need in the tunnel. During times of extreme hardship, we keep our focus on very short-term (perhaps daily) goals, where we have some degree of control in our pathways.

Brené Brown recently referred to these as microdoses of hope. Focus on the priority areas of your life: family, work, leisure, and community. Our research shows that short-term, specific goals are a better protector of hope and predictor of goal achievement during times of adversity. Once you identify a short-term goal, take a moment and think about a time when you achieved something that made you proud. What barriers did you face and how did you overcome them? Remember, you have done hard things.

Hope begets hope. Making progress toward your goals will increase your confidence and belief that the future is yours for the taking.

Building Hope and Resilience: Next Steps

• Watch: “The Science and Power of Hope”
• Read: The Color of Hope
• Learn: Building Resilience Begins Here – Motivation Strategies for ADHD Families
• Read: “I’m Resilient, Strong, and Proud. Thank You, ADHD.”

Chan M. Hellman, Ph.D., is a professor at the University of Oklahoma and director of The Hope Research Center. His research focuses on helping children and adults overcome trauma and adversity.

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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.