Poor impulse control can cause teens with ADHS to make poor choices – and lie about those choices. Lying stems from avoidance, denial, or a desire to skirt punishment.

But lying compounds the problem. There’s the lie, and then there’s the original problem that caused the lie.

There is something called earned trust. Through their actions, children and adolescents build on or destroy what has accumulated in a “trust bank account” with their parents. Kids think their trust bank accounts are flush with cash just because they exist. That’s not the case. Trust is earned. When a parent loses trust because a child lied, the child must earn it back, perhaps by complying with agreements or behaviors you both negotiated, for example.

When younger kids with ADHD lie, it doesn’t typically mean they’re trying to deceive you. Usually, kids lie to increase comfort in the present moment. Kids or teens may lie because they feel uncomfortable or ashamed, or in hopes of reducing stress or minimizing conflict.

[Free Download: Your 10 Toughest Discipline Problems — Solved!]

I suggest that you sit down with your child or adolescent and say, “There’s lying going on. How do we want to handle that? Let’s talk about agreements and logical consequences.”

Here’s a critical point to remember as a parent: You can’t ask for honesty and then punish it. If you say, “I want you to call me at any hour, wherever you are, and I’ll pick you up,” then you must follow through on this promise without judgement.

The ride home is not the time for lectures or to express your frustration. Refrain from telling them all the things that they’re going to lose; otherwise, they’re not going to confide in or call you again when they’re in a pickle. Instead, wait and gather your thoughts carefully. There’s nothing wrong with making your kids sweat a little bit. Then have the conversation later when everybody is calmer – and more clear-headed.

A positive response to dishonesty includes discussion and understanding; don’t shut things down with anger, guilt, blame, and shaming. When you show up with curiosity and compassion, you offer your child the opportunity to come clean and work with you on collaborative solutions to earn back your trust. This process builds connection and reduces conflict.

Parenting a Habitual Liar: Next Steps

• Read: A Survival Guide for Parents with ADHD: Strategies from Preschool to High School
• Free Download: Questions to Get Your Child Talking
• Watch: “A Parent’s Guide to Trading Defiance for Cooperation”

Sharon Saline, Psy.D., is a clinical psychologist who specializes in working with children, teens, and families living with ADHD and coexisting conditions.

Yes, I could be seeing patients inside a clinical office to discuss suppressing or ignoring old behaviors while allowing a deeper self to arise. Or I could just remind them to bring an umbrella to our session today as we delve into these issues.

Three months into the COVID-19 pandemic, I moved across the country with my three young children to Palo Alto, California, for the University and College Mental Health Fellowship in psychiatry at Stanford University. But instead of joining a vibrant academic community, I worked from my apartment. Alone. A few months later, forest fires made the air quality so bad that we couldn’t even go outside.

[Free Download: How to Choose the Right ADHD Treatment Profesional]

As the pandemic began to lift, we wore masks when we treated patients in person. But in doing this emotional work, revisiting the difficult moments of a patient’s childhood, it is so important to see kindness on a psychiatrist’s face. So I made a decision: Whenever possible, I met with patients outside in nature, where masks weren’t required.

Benefits of Nature Therapy

After the pandemic ended, even as we sat in coats under umbrellas during the rainy season, I repeatedly asked my patients, “Do you want to do this in an office?” The answer was always the same: “Absolutely not.”

When patients are diving deeply into old pain, desperately hoping for connection while also fearing it, I can simply say: “What do you see, right now? What do you hear?” They look around at the grass and the trees, hear the birds, feel the sun on their skin, or hear the rain drumming on their umbrella. They discover that their fear is about the past, not the present. Try as they might, they can’t force their fear away any more than they can stop the rain. But they can notice it. They can choose to ignore the narrative it generates in their inner monologue. They can breathe and let the tears fall so that something new can grow.

The rainy season of change can be hard. But it doesn’t last forever. Eventually, spring comes. And the grass grows. To allow growth to change us for the better, we need to trust this deeply in our bodies. For my patients, I’ve found there is great power in learning from the change of the seasons. So we do the work. Outside. And sometimes it rains.

[Read: Go Take a Hike! (No, Really, It Helps.)]

Nature Therapy for ADHD: Next Steps

• Free Download: Everything You Need to Know About Cognitive Behavioral Therapy (CBT)?
• Read: How Green Time Promotes Better Focus
• Read: Never Underestimate the Healing Power of Mother Nature

Aaron Winkler, M.D., is a board-certified psychiatrist in California. He founded and directed the Adult ADHD Clinic at Stanford University before deciding to pursue private practice.

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A complex condition requires a thoughtful treatment approach, and multiple diagnoses often require treatment with more than one medication. Unraveling the answers takes time, plus trial and error. Thanks to years of research, however, clinicians are now equipped with highly effective options for addressing tough-to-treat cases of ADHD plus comorbidities.

Use this evidence-based information to begin a conversation with your doctor about treating complex ADHD with combination therapy.

Is Combination Therapy Safe?

The stimulants used to treat ADHD generally have no major drug-to-drug interactions, so they don’t increase the levels of other medications you may be taking, and vice versa. They are safe to use in combination with other medications, including non-stimulants, antidepressants, and antipsychotics. However, some of the non-stimulants, such as atomoxetine (brand name Strattera) or viloxazine (brand name Qelbree), may affect the blood levels of other medications.

Which Condition Do I Treat First?

We generally recommend treating the more sever condition first. If untreated, the symptoms of severe conditions like bipolar or panic disorder can undermine or hijack ADHD treatment. If a patient has mild anxiety, for example, it makes sense to address the ADHD first and then assess any remaining anxiety. Sometimes, anxiety improves when the ADHD is addressed.

Even the most optimized treatment regimen may need to be adjusted over time. After feeling quite stable, a person with ADHD and depression, for example, may feel as though their ADHD is suddenly worse. Worsening depression may worsen the ADHD response. Treating the depression may enhanced the effectiveness of ADHD treatment. Clinicians must take time to sort out such issues when dealing with multiple diagnoses.

[Free Course: The Adult’s Guide to ADHD Treatment]

Anxiety and ADHD

Generally, stimulants don’t worsen anxiety, but they may for some patients. If ADHD symptoms are causing anxiety, stimulants may lessen the anxiety. If the anxiety is unrelated to ADHD, if won’t be improved by stimulants and may, in fact, be exacerbated. A meta-analysis of studies concluded that, in the aggregate, treatment with stimulants significantly reduced the risk of anxiety compared to a placebo.³ The first-line treatment for anxiety is a selective serotonin reuptake inhibitor (SSRI), such as Lexapro, Prozac, or Zoloft.

Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that can effectively treat both anxiety and ADHD with a single medication. There is a caveat: For reasons we don’t yet understand, atomoxetine is not as effective in patients who have already tried a stimulant. If you’re a new patient, talk with your doctor about trying atomoxetine first to treat both the ADHD and the anxiety.

Autism and ADHD

Addressing ADHD in autistic patients may improve functioning dramatically. However, studies show that ADHD medications may cause more side effects and be less effective for autistic people, particularly those with lower intellectual functioning.⁴ Research has found that autistic patients taking ADHD medication experienced a 50% response rate for symptoms including hyperactivity and emotional regulation, which is lower than the 70 to 80% response rate found in children with ADHD who do not have autism.⁵

Begin slowly and monitor closely when increasing the dosage of ADHD medications in autistic patients. It is not uncommon to see an autistic child or adult have a good response to a particular dose of medication, whereas a slightly higher dose may cause many side effects and lessens response. Rather than seeking the “best” ADHD treatment, doctors may aim for good treatment with manageable side effects.

[Read: Interventions for Adult Autism and ADHD]

When severe irritability, aggression, and acute outbursts occur, it may be necessary to stabilize these episodes before addressing ADHD symptoms. Second-generation antipsychotics, such as risperidone or aripiprazole, can work very well to create a calm and controlled context before introducing stimulants or non-stimulants.

OCD and ADHD

Untreated OCD can significantly impede treatment of ADHD, so most practitioners initially prescribe medication and/or psychotherapies like exposure response prevention for OCD, and then tackle the ADHD with stimulant or non-stimulant medication. Both SSRIs and SNRIs are indicated for the treatment of OCD, though SSRIs appear to be more effective. Most medications for ADHD can be used safely in combination with SSRIs/SNRIs.

Depression and ADHD

For children with depression and ADHD, treatment options are limited to an SSRI plus a stimulant or non-stimulant. Adults may benefit from bupropion (brand name Wellbutrin), an antidepressant that is used off-label for ADHD. While depression in adults is commonly treated with SSRIs/SNRIs, some patients report that tricyclic antidepressants help with symptoms of depression and are also quite effective for ADHD.

Eating Disorders and ADHD

Clinicians sometimes hesitate to prescribe ADHD medications to patients with eating disorders due to the common side effect of appetite suppression. These patients’ weight and eating patterns should be monitored closely during treatment, but fear of the side effects should not preclude ADHD treatment, which is shown to improve overall health outcomes.

Though non-stimulants like atomoxetine or viloxazine may be tried first, stimulants need not be ruled out. In fact, the stimulant lisdexamfetamine (brand name Vyvanse) is FDA-approved for the treatment of binge eating disorder as well as ADHD.

Executive Dysfunction and ADHD

The executive function deficits that come with ADHD – difficulties with organization, time management, and sequential thinking – are often burdensome and impairing. For these patients, non-stimulants such as atomoxetine or viloxazine may be used in combination with a stimulant for treating both ADHD and executive function deficits.

Adding an extended-release form of an alpha agonist, like guanfacine or clonidine, to a stimulant is another option that can be useful for executive dysfunction. These medication combinations (e.g., clonidine or guanfacine plus a stimulant) are FDA-approved for treating ADHD in children under 17. They are sometimes used off-label in adults with ADHD.

Research suggests that the Alzheimer’s medication memantine added to the stimulant methylphenidate may improve executive functioning and social cognition, or the capacity to read verbal cues.⁶ This can be especially helpful for autistic children with ADHD.

Comorbid Conditions with ADHD: Next Steps

• Free Tool: The ADDitude Symptom Checker
• Read: What Is Complex ADHD?
• Read: Stimulant, Non-Stimulant, or Both? Combination Therapy for ADHD

Timothy E. Wilens, M.D., is a professor of psychiatry at Harvard Medical School.

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Sources

¹Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3

²Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 53(3), 343–360. https://doi.org/10.1080/15374416.2024.2335625

³Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced Risk of Anxiety with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder. Journal of child and adolescent psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075

⁴Joshi, G., & Wilens, T. E. (2022). Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Individuals with Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America, 31(3), 449–468. https://doi.org/10.1016/j.chc.2022.03.012

⁵Joshi, G., Wilens, T., Firmin, E. S., Hoskova, B., & Biederman, J. (2021). Pharmacotherapy of attention deficit/hyperactivity disorder in individuals with autism spectrum disorder: A systematic review of the literature. Journal of psychopharmacology (Oxford, England), 35(3), 203–210. https://doi.org/10.1177/0269881120972336

⁶Biederman, J., Fried, R., Tarko, L., Surman, C., Spencer, T., Pope, A., Grossman, R., McDermott, K., Woodworth, K. Y., & Faraone, S. V. (2017). Memantine in the Treatment of Executive Function Deficits in Adults With ADHD. Journal of attention disorders, 21(4), 343–352. https://doi.org/10.1177/1087054714538656

ADHD and schizophrenia are distinct neurodevelopmental disorders with some overlapping symptoms, such as inattention, impulsivity, weak working memory, and emotional dysregulation. Symptoms of schizophrenia may also include hallucinations, delusions, and paranoia. Understanding how ADHD fits into this diagnostic picture, and untangling overlapping symptoms, leads to better treatment approaches and outcomes.

While most people with ADHD will never develop schizophrenia, these factors increase risk: family history of schizophrenia, adverse childhood experiences or trauma, and abuse of psychoactive substances, such as marijuana that contains elevated levels of THC.

Schizophrenia typically emerges in the late teens through early thirties. ADHD can be diagnosed at any age, though it usually emerges in the early grade school years.

[Watch: “Understand How ADHD and Schizophrenia Overlap”]

ADHD and Schizophrenia: Treatment Options

When treating comorbid schizophrenia and ADHD, a priority must be to treat any psychosis with first-generation antipsychotics such as Haldol and Trilafon, or second-generation antipsychotics such as Abilify and Risperdal. Antipsychotics can be taken orally in the form of daily pills or as injectables. Recent innovations have yielded exciting new medications, such as injectables effective for as long as three months, and other promising new interventions are on the horizon. Antidepressants, mood stabilizers, or anti-anxiety drugs may also help in treating associated symptoms of schizophrenia, as do adjunctive therapies such as cognitive behavioral therapy and family therapy.

Only after the psychosis is under control can clinicians clearly identify symptoms associated with ADHD and prescribe treatment. ADHD is associated with low dopamine levels in the brain, and most ADHD medications are intended to increase these. Patients with schizophrenia tend to have high dopamine levels, so doctors must exercise caution when prescribing stimulants to them. If medication increases dopamine levels further, this may exacerbate schizophrenia by worsening psychosis.

[Read: Why ADHD Brains Crave Stimulation]

Under the consistent care of a clinician, patients with schizophrenia who adhere to their medication regimen tend to do very well. No matter a condition’s treatment challenges, I understand a patient and their symptoms more fully every time I see them. I learn from what we’ve tried, bringing us closer to getting a medication combination just right. This kind of treatment takes trial and error, thoughtfulness, and time spent with a doctor.

ADHD and Schizophrenia: Next Steps

• Read: When It’s Not Just ADHD – Symptoms of Comorbid Conditions
• Read: ADHD Comorbidity – An Overview of Dual Diagnoses
• Read: A Clinician’s Guide to Impulsive Aggression

Napoleon B. Higgins, Jr., M.D., is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and Kaleidoscope Clinical Research.

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Misdiagnosis is a significant barrier to care. Black children and adolescents with ADHD are more likely to be labeled with oppositional defiant disorder and to have their ADHD symptoms misunderstood as defiance. Also, cultural stigma surrounding mental health can prevent Black families from seeking care and from using ADHD medication when it is prescribed. Black parents report a preference for interventions like parent training and executive function skills training, to which their access is often limited.

One possible solution: integrated primary care, in which behavioral health services are embedded within primary care practices. When children go to a pediatrician appointment, they may also see a behavioral health care specialist for common concerns like depression, anxiety, and a range of disruptive behaviors from failing to follow caregivers’ directions to disrupting the classroom.

[Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children]

Integrated primary care can address the treatment disparities in Black youth by enabling more personalized, collaborative treatment for ADHD and its co-occurring difficulties. Parents should ask their pediatrician whether an in-office behavioral health specialist is available. Additionally, many primary care practices affiliated with academic medical centers or children’s hospitals have integrated primary care clinics.

Mental Health Stigma in ADHD Care: Next Steps

• Learn: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities
• Read: Evaluating and Treating ADHD in African American Children: Guidance for Clinicians
• Watch: “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis and Treatment” [Video Replay & Podcast #495]

Heather A. Jones, Ph.D., is an associate professor of psychology at Virginia Commonwealth University.
Alfonso L. Floyd, Ph.D., is a postdoctoral fellow in the Department of Child & Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia.

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As many as 62% of kids with ADHD receive a diagnosis and a prescription for medication without a recommendation for any type of parent behavior training or family therapy, according to the American Academy of Pediatrics. In a recent ADDitude survey, 57% of parents said they had participated in parent training. Of those, an astounding 93% recommended it.

Caregivers exert the greatest influence on their kids’ lives, and, let’s be honest, raising a child with ADHD can be extremely challenging. Parents may become frustrated, lose their temper, make allowances for inappropriate behaviors, or just give up in the face of relentless negative habits and attitudes. This is where parent behavior training, also called behavioral parent training (BPT), can help.

Moving from Reactivity to Proactivity

Parent training refers to a series of interventions designed to help caregivers learn effective strategies to manage their own emotions as well as their child’s behavior. The goals revolve around using positive reinforcement, setting effective boundaries, and providing scaffolding to increase positive connections, reduce negativity, and enhance a child’s successes.

This type of training helps parents learn to be proactive rather than reactive. The reactive parent responds to a child’s behaviors with threats of punishment based on intense feelings rather than logical thinking. Punishment fails to work in the long term because children with ADHD will need other options in their toolkit.

[Free Download: Your Guide to Parent Training Programs]

A good parent behavior training program can do the following:

• Teach parents real-world strategies for positive reinforcement and consistent discipline.
• Teach self-regulation, de-escalation, and calming strategies.
• Improve parent-child communication through reflective listening and accountability.
• Help parents set realistic expectations and routines based on their child’s skills and abilities.
• Replace reactive parenting with proactive strategies that rely on incentives rather than threats.

6 Popular Training Programs

The most effective parent training programs increase positive parent-child interactions by elevating the quality of attachment, the ability to communicate effectively, and the willingness to set and enforce boundaries. Here are six programs popular among families living with ADHD.

Parent-Child Interaction Therapy

Format: A therapist in an observation room watches parents interact with their child in real time. Parents wear an earpiece to receive in-the-moment parenting strategies from the therapist.

Goals:

• To help your child feel calm, confident, and secure in your relationship
• To learn how to be confident and calm in the face of your child’s most difficult behaviors

The Incredible Years

Format: Trained facilitators use video vignettes to present content and stimulate discussion. Separate programs are offered for parents of toddlers, preschoolers, and school-age children.

Goals:

• To strengthen parent-child interactions
• To foster parents’ ability to promote kids’ social and emotional development
• To reduce school dropout rates and delinquent behaviors
• To promote academic success

[Free Webinar: “The Power of Behavioral Parent Training for ADHD”]

Positive Parenting Program (Triple P)

Format: This online program is designed for two groups: parents of children ages 12 and under, and parents of children ages 10 to 16. The program provides a mix of videos, worksheets, tips, and activities that take 30 to 60 minutes to complete.

Goals:

• To set discipline guidelines
• To build parent confidence
• To raise happy children

Helping the Noncompliant Child

Format: Training sessions for parents and children ages 3 to 8. Skills are taught using active teaching methods, such as extensive demonstration, role play, and real-time practice.

Goals: To foster positive interaction by:

• Reducing parental coercive behaviors
• Giving positive attention to the child for appropriate behavior
• Setting limits and consequences

Parent Management Training

Format: Parents of children with moderate to severe behavioral difficulties work with a certified trainer online, in person, or over the phone.

Goals:

• To teach parents how to help their children cultivate positive behavior
• To learn how to effectively deal with anxiety and negative behavior

GenerationPMTO

Format: GenerationPMTO is an intervention program that is provided to individual families or parent groups, in person or via telehealth. The structure of individual training programs differs by location, both nationally and internationally.

Goals:

• To promote social skills that reduce delinquency, deviant peer associations, and mood disorders in parents and youths

Tips for Finding a Provider

Ask these key questions when interviewing a prospective therapist, coach, or program administrator:

1. What is your education in a particular parent behavior training model? Do you hold a certificate, license, or other accreditation in your field?
2. What is your training in ADHD and child development?
3. How do you monitor and support your clients’ progress?
4. What additional support is available after the program ends?

Behavioral Parent Training (BPT): Next Steps

• Free Download: 5 Ways to Improve Emotional Control at Home
• Read: How Does Behavior Therapy Work?
• Read: When Behavioral Parent Training is Working — But Tough to Maintain
• Sign Up: Parenting Class for ADHD Families

Sharon Saline, Psy.D., is a clinical psychologist and author.

Ryan Wexelblatt, LCSW, is a school social worker, camp director, and father to a son with ADHD and learning differences.

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A: Young people, and particularly neurodivergent students, should absolutely explore and question whether they’re truly ready for college. During the COVID-19 pandemic, we saw a dramatic rise in the number of students who deferred their college admissions and took a gap year. It was a good option then, and it remains a good option now for many.

A gap year refers to a period of time, typically after graduating from high school and before starting college, when a student takes a break from formal education to pursue activities like volunteering, working, or traveling.

[Q: How Do I Know If My Teen Is Really Ready for College?]

When we think about whether a gap year is right for a student, we look at several factors:

• Academic readiness: Is the student excited to tackle college course material or do they feel burned out?
• Motivational readiness: Is the student driven to live on their own and manage the rigors of college? Are they emotionally prepared for an environment that is less structured than high school?
• Self-regulation: Does the student have a healthy sleep routine and lifestyle? Are they taking their medication on their own? If unmonitored, will they be on their devices all the time, interfering with their ability to study?

[Q: Is My Teen Taking the Easy Way Out by Deferring College?]

I would approach the conversation with your teen from a strengths-based perspective and frame the gap year as an advantage. You might say: “You are very capable of doing well and succeeding in college. I want to make sure that you reach your full potential. Taking a gap year is not about delaying college. It is about setting you up for long-term success in your future career and life. We are not derailing your college plans; we are just finding an alternate way to get there. With this extra time, you will be in a stronger position to achieve your career goals and make the most of your education.”

If you are financially supporting their college education, you could add: “College is a significant investment, and I want to make sure it is money well spent. You have so much potential, and this extra time will help you maximize your experience.”

Invite your teen into the conversation and acknowledge their concerns, especially if they’re worried about what others might think. Reassure them that, in the long run, a gap year can position them for greater success.

Gap Year Decisions: Next Steps:

• Read: Gap Year Programs for ADHD Students
• Watch: “Gap Year Pros and Cons for Neurodivergent Students”
• Read: The 4-Year College Track is Not Right for Everyone

Carolyn Jeppsen is CEO and co-founder of BroadFutures, a nonprofit created to fund internships for neurodivergent youth.

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A: People with rejection sensitive dysphoria (RSD) experience extreme emotional pain related to real or imagined rejection, and they often respond intensely to any perceived injury or threat. In relationships marked by RSD, it’s difficult for one partner to separate amid distress.

Follow these four strategies to reduce conflict and halt toxic patterns.

#1. QTIP (Quit Taking It Personally)

Listen to your gut. If your partner’s bad mood really about you? If you’re lecturing, yelling, or interrupting instead of listening to your partner, ask yourself, “Why am I talking?”

#2. Use a ‘Takeback of the Day’

Here’s how this forgiveness freebie works: Each day, you or your partner can say, “I said something I regret. I’d like it to be my takeback.” Then the receiver agrees to take a breath and figure out how to forgive the partner without resentment.

[Read: How ADHD Impacts Sex and Marriage]

#3. Extend the Benefit of the Doubt

Don’t assume your partner has done something purposely harmful, painful, inappropriate, or irresponsible. Get some clarity by using “I” statements such as “I’m curious about,” “I wonder,” “It’s confusing to me,” “I was surprised,” or “It hurt me when…”

#4. Follow These STEPS

This five-step plan can help dysregulated couples reverse course, cool down, and move forward.

• Self-control. During intense conversations, focus on the physical signals that suggest you’re becoming activated. Is your heart beating faster? Are you perspiring or speaking louder? You can avoid a massive eruption if you catch your dysregulation early.
• Time apart. Establish a plan for signaling when you need a break during a conflict (one of my clients says, “giraffe”) and for taking time apart to cool down and stabilize. Agree on what works for both of you.
• Evenness. Being accountable for your actions returns relationships to baseline. Consider why you are upset and what you could have done or said differently. How can you express your thoughts or desires more effectively and empathically next time?
• Practice reflective listening. When intense feelings escalate, designate one person as the talker and the other as the listener. The talker says what’s on their mind, uninterrupted, for a set time. Then, the listener reflects and repeats what they heard – “What I heard you say is X. Did I get that right? Is there anything else?” Reset the timer and switch roles so each person is heard.
• Strategize. Set small goals that nurture positive connections. Schedule monthly date nights, or make it a daily goal to recognize something your partner did for which you’re thankful or grateful (e.g., “Thanks for cooking dinner.” “I really liked how you folded my clothes.”).

[Read: How ADHD Ignites RSD]

Q: As the non-ADHD partner, my concerns rarely get addressed. Everything I bring up is taken as a criticism or an attack that elicits strong reactions from my partner. I feel stuck and unheard, always walking on eggshells. What can I do?

A: Your question signals that you and your partner are not connecting as equals. I recommend discussing how to comfortably ask for help using questions based on curiosity, not blame.

• “How do we want to ask each other for help and support? The way we’re doing it isn’t working.”
• “When I tell you something, it seems that your reaction is anger and defensiveness. How should I say things in a way that would be easier for you to hear?”
• “How can I help you slow down and manage your feelings?”
• “I noticed that you looked at me. Was there anything behind that look? I’m prone to interpreting that look as a criticism, and I’m wondering what the thinking was behind it.”

If you are uncomfortable having this conversation, I strongly encourage you to find a couples therapist.

Hurt Feelings & Shame Spirals: Next Steps

• Read: 11 Rules for Fighting Right and Forgiving Faster
• Free Download: Manage ADHD’s Impact on Your Relationship
• Read: When You’re So Sensitive It Hurts
• Read: The One Ground Rule for Fighting Fair in an ADHD Marriage

Sharon Saline, Psy.D., is a clinical psychologist and the author of The ADHD Solution Deck.

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First, I would encourage you not to be defensive during your visit. Clinicians have to follow a process to give you a diagnosis. This may seem like a waste of time, but a full differential diagnosis requires more than just asking neurodivergent-related questions. You may be asked questions that you feel are irrelevant, but that are important nonetheless.

There might be something you can learn, and something that you can teach the clinician. I have thanked patients for correcting me about certain things and I think that those interactions have been transformative for them too. I know I’ve learned from them.

[Take the Autism in Women Self-Test]

Having said that, it is important for all of us to feel respected, and that includes respect from your clinician. If you feel your provider is cynical or not listening to you, or they’re not acting in a collaborative way, then you can say thank you and move on.

Q: “What are the common misdiagnoses given to girls and women with ADHD and autism?”

Autistic girls and women with ADHD are often diagnosed with borderline personality disorder. This is a difficult differential diagnosis because it entails so much — dichotomous thinking, emotional reactivity, and fears of rejection and abandonment.

They also get misdiagnosed with bipolar disorder and, more commonly, with obsessive-compulsive disorder (OCD). This is because many neurodivergent individuals like repetitiveness, or like to systematize things, and have trouble interrupting a sequence, but that doesn’t necessarily mean they have OCD. It’s also not uncommon to have co-occurring conditions.

Q: “Are autistic girls with ADHD more likely to experience emotional dysregulation than their neurotypical peers?”

Emotional dysregulation is not part of the diagnostic criteria for ADHD or autism, but it is very much a part of the lived experience for both conditions — and it can be very impairing. Rejection sensitivity (the tendency to intensely react to real or perceived rejection), along with spiraling emotions or thoughts, impairs a person’s functioning and ability to interact and listen.

[Get This Free Download: Your Autism Evaluation Checklist]

According to society’s gender roles, girls and women are not supposed to get upset or display anger. When faced with rejection, we may hold it in and mask — only to eventually explode. So being unable to understand our emotions and know when we need to breathe, or step away, is important.

AuDHD Diagnosis: Next Steps

• Take These Self-Tests:
  • ADHD in Women
  • Autism in Women
• Learn: How to Get Evaluated for Autism as an Adult
• Read: Autism and ADHD in Adults
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”
• Read: “What to Expect After Your AuDHD Diagnosis”
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: “A Living Contradiction” — The AuDHD Experience
• Free eBook: The Truth About Autism in Adults
  

Karen Saporito, Ph.D., is a licensed clinical psychologist who has been in private practice for more than 20 years.

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In research examining eating disorder symptoms among women aged 45 to 61, body dissatisfaction was cited as a key risk factor.¹ I have seen this firsthand. In 2024, more than 21% of calls to the National Alliance for Eating Disorders, a support and advocacy organization I founded in 2000, were from individuals (primarily women) age 40 and older.

Eating disorders are serious, brain-based mental illnesses with a strong genetic link.² They have the second-highest mortality rate among all psychiatric disorders.³ Yet many middle-aged and older women may not even recognize that they’re struggling with eating disorders due to misconceptions about these conditions and who they affect.

[Self-Test: Do I Have an Eating Disorder?]

An adult might have an eating disorder if they:

• experience extreme weight loss or dramatic weight fluctuations
• refuse to eat certain foods or skip meals
• exercise excessively
• show signs of purging

Calorie restriction, or bingeing and purging, can have a particularly adverse effect on an older body, possibly leading to poor health outcomes. When eating disorders go untreated, they can lead to bone loss, heart problems, and, in people who force themselves to vomit, lung conditions. And research shows that 11% of women with ADHD, compared to 1% of women without it, have a history of bulimia nervosa, a common eating disorder that involves gorging followed by vomiting or laxative use.
Other eating disorders common in older adults include:

• anorexia nervosa (extreme food restriction)
• binge eating (consuming large amounts of food beyond the point of feeling full)

Eating Disorder Triggers

For some women, the battle with eating disorders began in childhood. For others, body image struggles may be triggered by later-in-life events. These include:

• Perimenopause and menopause. The transition to menopause is now recognized as a high-risk time for eating disorders to develop or redevelop, in part because women are seeking ways to “control” their changing bodies amid significant estrogen shifts.⁴
• Aging and unrealistic ideals. The anxiety and stress of aging in a society that values youthfulness provides fertile ground for increased symptoms of disordered eating and dysfunctional attitudes, beliefs, and behaviors around food and physical appearance.
• Transitions. Divorce, an empty nest, widowhood, and other life events may lead to or reactivate disordered eating.

[Watch: “Eating Disorders Comorbid with ADHD — ARFID, Anorexia, and Others”]

“Too Old” for an Eating Disorder

Eating disorders are considered diseases of the young, and, consequently, they often go unrecognized in older women. Many clinicians believe their mature patients are “too old” to have such conditions.

If you suspect that you or a loved one may have an eating disorder, talk with a doctor trained in this area. The National Alliance for Eating Disorders offers guidance, resources, and referrals for treatment and care. It provides free, therapist-led virtual support groups for women at midlife and older to connect with others who are experiencing or recovering from eating disorders.

Do I Have an Eating Disorder: Next Steps

• Free Download: Types of Eating Disorders Associated with ADHD
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: ADHD and Eating Disorders: Research, Diagnosis & Treatment Guidelines
• Watch: “Eating with ADHD: Improving Your Relationship with Food”

Johanna Kandel is the founder and CEO of the National Alliance for Eating Disorders and the author of Life Beyond Your Eating Disorder: Reclaim Yourself, Regain Your Health, Recover for Good. (#CommissionsEarned)

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Sources

¹Kilpela, L.S., Hooper, S.C., Straud, C.L., Marshall, V.B., Verzijl, C.L., Stewart, T.M., Loera, T.T., Becker, C.B. (2023) The longitudinal associations of body dissatisfaction with health and wellness behaviors in midlife and older women. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph20247143

²Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont), Nov;1(3):18–25. PMID: 21191522; PMCID: PMC3010958

³van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry. https://doi.org/10.1097/YCO.0000000000000641

⁴Khalil, J., Boutros, S., Kheir, N., Kassem, M., Salameh, P. et al. (2022). Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women. BMC Women’s Health. https://doi.org/10.1186/s12905-022-01738-6

I’m sorry you’re going through this. It’s never too late to begin building a bottom line, and here is how I would recommend getting started.

Step #1. Find a Good Job

Consider looking for full-time employment with benefits. A job that provides health insurance and an employer-provided retirement match will help you build financial stability now and for your future.

Look for jobs that use your ADHD strengths. Consider engaging jobs and environments that are fast-paced, creative, and varied. Depending on your educational background, it may be helpful to look for companies that offer tuition assistance so that you may return to school or receive additional training and move up to a better position with better pay.

[Free Download: ADHD-Friendly Budgeting Guide]

Step #2. Budget and Save

Use financial tools that work for your brain. Automate bill paying to reduce your mental load. For budgeting, use apps like You Need a Budget (YNAB) to track your spending. YNAB offers a structured way to visualize the flow of your money and has built-in warning signs to let you know if you’re getting off track.

Other free apps include EveryDollar and PocketGuard. Make it a habit to check in with your budget regularly.

Also, automate your savings. Make sure you’re putting money away for less frequent expenses, like medical copays, vet bills, car repairs, and emergencies. Knowing that you can cover unexpected expenses will give you peace of mind.

[Free Guide to Building Healthy Habits]

Step #3. Curb Spending

Tracking your daily expenses will help you stay within your budget boundaries and reduce impulsive spending. Consider enlisting a friend as an accountability buddy and help each other curtain spending sprees and maintain thrifty habits.

Step #4. Model Good Habits

Talk with your kids about the changes you’re experiencing and help them learn to make good financial decisions. Suggest that they do extra chores around the house or walk a neighbor’s dog to earn some money of their own. Model better spending and saving habits for your kids now to help them become responsible money managers in the future.

Financial Freedom After a Divorce: Next Steps

• Read: You’re Four Steps Away from Your Financial Security
• Webinar Replay: “The Social Traps That Snare ADHD Adults”
• Read: “How Do I Support My Child with ADHD During Our Divorce?”

Stephanie Berman in a money coach. She owns Berman Budgeting Basics, LLC, in Washington State.

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The night Rollins left her husband, he knew what she was planning. “He had his hand on the gun in his holster and he threatened me,” says Rollins. “I remember trying to be strong and saying to my daughter, ‘What is happening now should never happen.’”

Rollins is focused now on trying to heal and cut herself some slack. Getting an ADHD diagnosis in adulthood has been an illuminating part of her journey. “It explains everything,” she says. “How self-critical I was, never feeling good enough, always feeling like, ‘Why can’t I just get it right?’ I think, in hindsight, I wouldn’t have chosen who I chose to marry if I’d known I had ADHD.”

IPV and ADHD

IPV can include physical, sexual, and/or psychological abuse executed by a current or former partner. It does not discriminate, and can affect people of any gender, race, socioeconomic status, or level of education, explains psychologist Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. Women, however, are far more likely to be victims. Intimate partner violence is more common among women than breast cancer, diabetes, or depression.

Among women with ADHD, rates of IPV are even higher. Recent research from Berkeley Girls with ADHD Longitudinal Study (BGALS) found that women aged 17-24 who had received a childhood diagnosis of ADHD were five times more likely than their neurotypical peers to experience physical IPV. Greater ADHD symptom severity in childhood was associated with increased risk for IPV. ¹

[Read: Why Adults with ADHD Are Particularly Vulnerable to Gaslighting]

“It’s underappreciated how difficult ADHD can be for girls and women because the consequences are more internal,” says Stephen Hinshaw, Ph.D., lead researcher of BGALS and professor of psychology at the University of California, Berkeley. “Girls with ADHD are smart, but they can’t get it together. As they age, the tendency is depression, very low self-image, unplanned pregnancy, intimate partner violence, and non-suicidal self-injury.”

Risks, however, are not predetermined outcomes, and information is empowering. Below, learn what intimate partner violence looks like, how its impacts are felt, and what help is available.

The Truth About IPV

What IPV Looks Like

• Psychological: threatening, intimidating, humiliating, criticizing, insulting, belittling, blaming, invading privacy, extreme jealousy/possessiveness, dismissing feelings
• Physical: hitting, pushing, slapping, punching, restraining, choking, dragging
• Sexual: coercing victim to have sexual acts or watch pornography, drugging victim
• Technological: tracking location, demanding check-ins, excessive texting, monitoring communications
• Financial: withholding access to bank accounts and credit cards, ruining the victim’s credit, taking the victim’s paycheck

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

Psychological Abuse Is Rampant—and Overlooked

“Media depictions focus on physical and sometimes sexual abuse, showing a woman fearing for her life on a daily basis,” Sullivan says. “By promoting only that stereotype, we do a disservice to women who experience IPV differently, because they think, ‘Well, that’s not me. I’ve never had a bruise or a broken bone.’”

While patterns and specifics of abusive behavior vary widely, psychological abuse is pervasive. Explains Sullivan: “You almost never see physical and sexual abuse alone, without psychological abuse.” Sullivan and her research team collected data from victims of IPV for 90 days and found that psychological violence occurred on 27% of days — 13 times more often than physical, psychological, and sexual violence together. ²

It’s critical to identify psychological abuse because it often appears first, and can lead to physical and sexual abuse, not to mention dire health consequences on its own.

IPV Has Far-Reaching Impact

The health implications of IPV are often severe:

• 51% of female homicide victims were killed by intimate partners ³
• 80% of IPV survivors display trauma symptoms
• 30% of survivors meet criteria for post-traumatic stress disorder (PTSD)

Survivors are at an increased risk for:

• diabetes: +51%
• total mortality: +44%
• cardiovascular disease: +31% ⁴

IPV is also associated with an increased risk for substance use disorders, depression, anxiety, suicidality, traumatic brain injuries, working memory declines later in life ⁵, and issues of the gastrointestinal, reproductive, and musculoskeletal systems.⁶

And, to be clear, psychological abuse can be as serious and detrimental as physical abuse — even more so, in some cases. “Psychological abuse erodes self-worth and self-efficacy, that feeling of, ‘I’ve got this,’” says Sullivan. “It can be a stronger predictor of PTSD and depression than physical abuse.” ⁷

Healing from Abuse

“Twenty years ago, the mentality was, How do we get her to leave? The approach now is survivor-centered: What does she want to have happen?” explains Sullivan. “Not every person wants the abusive relationship to end; some just want the violence to stop. Providers need to ask, ‘Have you thought about what you want to do?’ This gives the person voice, something that’s often taken away from them.”

Evidence-based therapeutic interventions should be present-centered with a focus on empowerment, Sullivan says. These include Cognitive Behavior Therapy (CBT), STAIR (Skills Training in Affective and Interpersonal Regulation), Interpersonal Psychotherapy (IPT), HOPE (Helping to Overcome PTSD through Empowerment).

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 88788
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 22522
• National Sexual Assault Helpline, Call 1-800-656-HOPE

*Name has been changed to protect the person’s privacy

Intimate Partner Violence and ADHD: Next Steps

• Read: “We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD
• Self Test: Is My Relationship Toxic? A Quiz for Adults with ADHD
• Q and A: “What Are the Signs of a Controlling Relationship?”
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”

Nicole C. Kear is Consumer Health Editor at ADDitude magazone.

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.

²Sullivan TP, McPartland T, Armeli S, Jaquier V, Tennen H. Is It the Exception or the Rule? Daily Co-occurrence of Physical, Sexual and Psychological Partner Violence In a 90-Day Study of Substance-Using, Community Women. Psychol Violence. 2012 Apr 1;2(2):10.1037/a0027106. doi: 10.1037/a0027106. PMID: 24349863; PMCID: PMC3859524.

³Jack 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.

⁴Chandan JS, Thomas T, Bradbury-Jones C, Taylor J, Bandyopadhyay S, Nirantharakumar K. Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse. J Am Heart Assoc. 2020;9:e014580. doi: 10.1161/JAHA.119.014580.

⁵Baker JS, Greendale GA, Hood MM, Karlamangla AS, Harlow SD. Self-reported history of physical intimate partner violence and longitudinal cognitive performance in midlife women. Womens Health (Lond). 2024 Jan-Dec;20:17455057241309782. doi: 10.1177/17455057241309782. PMID: 39707890; PMCID: PMC11663271.

⁶Stubbs, A., & Szoeke, C. (2022). The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma, Violence, & Abuse, 23(4), 1157-1172. https://doi.org/10.1177/1524838020985541

⁷Mechanic 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.

Here’s how to recover from early setbacks and forge a path to a satisfying work life.

How to Find a Job You Love

#1. Expose Your Strengths

You have unique talents, some of which may remain hidden. Take assessments like the VIA Character Strengths survey (free) and the CliftonStrengths Assessment to reveal them.

• Reflect on your talents, passions, and childhood interests. What did you do that made people say, “You’re a natural”? What do you love to do?
• Many adults with ADHD excel at creative problem-solving and pattern recognition. They’re curious and they can hyperfocus. What captures your interest?
• Brainstorm specific steps to develop your passions into career strengths.

[Need Help Finding Your Passion? Use This ADHD “Brain Blueprint”]

#2. Try Something New

Self-doubt can keep you from moving forward. Women with ADHD often duck under the radar at work to avoid “getting into trouble.” Others feel that trying something new invariably leads to failure, so they play it safe. Climbing the career ladder demands self-confidence and a willingness to step out of comfort zones.

• Start by setting small goals. Create routines, habits, or systems to overcome the issues that steal your confidence. Few problems resolve immediately, but consistent action will bring about change.
• Celebrate every small win. This will reinforce positive habits.
• Practice self-compassion. Change is hard. Setbacks are learning opportunities. Your self-confidence will grow as you begin to recognize and refine your abilities.

#3. Pursue Training

Some adults with ADHD avoid higher education or training because of significant struggles in secondary school. But training for the career you want will activate your strengths and interests. Plus, as an adult, you’ll have more agency and control over your educational experience.

• Enroll in one class at a time. Start small to prevent overwhelm. Don’t let setbacks discourage you. When I returned to university, I took one class each semester for two years. It took me almost nine years to graduate. I succeeded while working full-time and managing a household with two children.
• Explore flexible learning options. You can take online courses for which you set the schedule. Or you might prefer vocational training that is offered after 5 p.m.
• Set aside time to learn. Find a body double who will work on their own tasks beside you to prevent procrastination. If you can’t find someone, consider a service like Focusmate, a virtual coworking site with limited weekly sessions free of charge, or unlimited sessions for a fee.
• Apps like Speechify and other text-to-speech technology can help you overcome reading challenges. If you learn best by doing, consider an apprenticeship or volunteering with a nonprofit or a civic organization.

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

#4. Choose the Right Career

A rewarding career is one that utilizes and values your skills.

• Identify what you dislike. A client found the helping nature of social work attractive, but struggled under mountains of paperwork. She now applies her training in a patient advocacy group instead. She gets to help people without the bureaucracy.
• Before committing, interview and shadow professionals in your desired field.
• Start your next career as a side gig. A client of mine who enjoyed the creative side of social media took several online courses. As a freelancer, she managed her clients’ online accounts. Later, she was hired full-time by one of her clients.
• If you like your job, but some of its duties demand too much reliance on an area of weakness, talk with your employer. You’ll perform best if you work with your strengths, and your employer will get a bigger return on investment by shifting responsibilities accordingly.

Your options needn’t be limited because you have ADHD or you left the education system too soon. Keep building your skills and exploring opportunities until you find meaningful work.

How to Find a Job You Love: Next Steps

• Read: “I Love What I Do” — Jobs That Reward People with ADHD
• Read: Work Challenges — Common ADHD Pitfalls That Kill Productivity
• Read: 18 Questions That Reveal Your Ideal Career

Linda Walker, PCC, is the author of With Time to Spare: The Ultimate Guide to Peak Performance for Entrepreneurs, Adults with ADHD and Other Creative Geniuses.(#CommissionsEarned)

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

Despite earning the nickname “Busy” as a child because she rarely stopped moving, she had long dismissed her ADHD symptoms as personal weaknesses. Today the Dawson’s Creek, Freaks and Geeks, Cougar Town, and Girls5eva star reflects on life before and after her ADHD diagnosis at age 39.

Q: How has being diagnosed with ADHD as an adult made a difference in your life?
A late diagnosis allows you to look back at all the times when people in your life or career attributed certain ADHD traits – lack of organization or time management – to your not being able to get it together. I spent a great deal of my life not fully understanding why “easy” things were so difficult for me.

[How is ADHD Diagnosed? Your Free Guide]

The diagnosis has changed the way I view my past self. I’m so grateful that I know now. So many feelings of low self-worth have dissipated. With an earlier diagnosis and treatment plan, I probably would not have had the same kinds of struggles that I had in my 20s and 30s.

Q: Juggling motherhood and a career can feel like a precarious balancing act for just about any woman, let alone one with weak executive function skills. How did you manage when you were undiagnosed and untreated?
When I was a young mother and had small kids and was working full time on a network television show, I couldn’t keep appointments straight. I’d find myself double-booked or unable to make it at the last second. You really feel like you’ve let down your kid when you miss gymnastics class by an hour.

[Read: ADHD Symptoms in Women Aren’t ‘Hidden;’ They Are Misinterpreted]

I spent a great deal of my kids’ early lives being very weighed down by my own feelings of inadequacy. I felt I was failing them and myself. I thought that I couldn’t keep these things straight because of my lack of concentration, because I wasn’t trying hard enough, because I was tired, because all these other moms have it figured out and I don’t. I was very hard on myself.

Q: Some people with ADHD struggle with working memory. In your acting career, was it especially difficult to learn a new script and remember your lines?
If it’s something I’m interested in, I have no issue remembering that information. I recall my math teachers saying to me, “You can remember all those lines for the school play; why can’t you remember your times table?” I do think that has to do with my ADHD. I’m actually great at memorizing lines. I have a real gift for it.

Being an actor was something I was interested in, and so my ADHD let me focus on it. Even with time blindness, I was never late for a call time. This career that I loved so much and wanted to do – that took over and it was my only focus.

Q: Do you have any advice to help people with ADHD live better?
Make sure you’re able to get the treatment that works for you. You shouldn’t feel shame or stigma. There’s real power in owning it, even at work, even with people you love.

Adult Women with ADHD: Next Steps

• Free Women’s Health Month Calendar: 31 Days to Demand Attention!
• Read: Hormonal Changes in Women with ADHD — 4 Gaping Holes in Research
• Watch: Roundtable on ADHD in Women
• Read: “You Are Way Too Hard On 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.
Carole Fleck is Editor-in-Chief at ADDitude magazine.

Research suggests that women with ADHD are more likely than their neurotypical peers to engage in sexual exploration at a younger age and to have multiple sexual partners. Their behavior is often an attempt to find validation or soothe the emotional chaos that ADHD can create. For some, it’s a way to fill the void created by low self-esteem or a lack of meaningful connections.

Here’s what that looks like for the women with ADHD who have trouble setting boundaries, misjudge risk, and suffer poor self-esteem: In seeking connection, they find themselves in risky encounters without considering the potential consequences. They tolerate disrespect or unsafe situations to avoid rejection.

Risky Sex and Women with ADHD

Many teen girls and women with ADHD are unprepared to handle the consequences of risky behavior, whether it’s dealing with a sexually transmitted disease or an unintended pregnancy.

Understanding how ADHD affects decision-making, through education and self-awareness, can empower women to take a step back before acting. That can mean practicing how to assert your needs and say “no” under pressure to build confidence in relationships, and using checklists to plan safe dates, manage contraception, and schedule health check-ups.

[Read: How ADHD Impacts Sex and Marriage]

Dealing with Low Self Esteem

From a young age, females with ADHD endure criticism for being impulsive, disorganized, and/or emotionally labile. These experiences can create a narrative of self-doubt, where they internalize the idea that they are the problem. This mindset doesn’t disappear in adulthood and often affects their relationships.

When things go wrong in sexual relationships, due to a lack of intimacy, mismatched desires, or conflicts with a partner, many women with ADHD blame themselves. Self-blame can have a profound impact on self-esteem and emotional wellbeing. It can lead to feelings of shame, guilt, and worthlessness that make it harder to address the real issues in a relationship. Instead of expressing her needs and desires, a woman may withdraw in fear of rejection or criticism.

If you have experienced any of this, here’s how to shift your internal narrative:

[Watch: Are ADHD Symptoms, Medications Affecting Your Love Life?]

Making Healthy Choices

Emotional Hypersensitivity

Women with ADHD are deeply affected by any criticism, real or perceived. If a partner declines intimacy, you interpret it as a rejection because of your low self-worth.

• Do this: Recognize external factors. Work stress, family pressures, or physical health issues can all influence intimacy. Relationship struggles are rarely the fault of only one person.

Difficulty Communicating Needs

Expressing desires or frustrations can be challenging, especially for women who fear being misunderstood. When conversations about sex go awry, it’s easy to assume you’ve done something wrong.

• Do this: Communicate openly. Tell your partner how ADHD affects your emotions. Together, explore ways to navigate challenges without placing blame.

Negative Self Talk

Many women with ADHD have an inner critic who harps on their perceived flaws. This voice can be particularly harsh around the vulnerable topic of sex.

• Do this: Letting go of self-blame begins with embracing your authentic self and recognizing that you deserve relationships in which you feel valued and supported.

Build Intimacy and Healthy Relationships

Breaking the cycle of self-blame is an essential first step toward a fulfilling sexual relationship. Next comes the work of building and maintaining healthy intimacy. ADHD can sometimes create barriers, but you can strengthen your bond by:

• Planning regular moments together when you intentionally block the distractions that steal your attention.
• Focusing on what brings you joy. Physical affection, emotional vulnerability, and shared activities all contribute to a sense of closeness. If medication or stress dampens your libido, get advice about alternatives or supplements that can support sexual health.
• Learning to say “no” to situations that don’t feel right. This empowers you to protect your wellbeing and foster healthy relationships.

You deserve a relationship in which you feel loved, respected, and understood – not despite your ADHD, but because you are uniquely you.

Risky Sex, Hypersexuality and ADHD: Next Steps

• Watch: “ADHD and Sex: Building Focus and Attention for Intimacy”
• eBook: Women with ADHD
• Watch: Living with ADHD – It’s Different for Women 

Susan Young, Ph.D. is a clinical psychologist in London.

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.