By Beth Levine

Let’s face it, in these confusing times, we are all coping with a lot of stress: the pandemic, the economy, climate change, jobs that expect you to respond at all times, unstable employment, the 24-hour news cycles. And that’s just for starters.

People with ADHD, however, live with an even heightened level of stress. According to the non-profit Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD: “Researchers who study stress in people with ADHD have even noted higher levels of cortisol, a hormone released when a person feels stressed, than in people who don’t have ADHD. In fact, just thinking about the things that stressed them increased the amount of cortisol present in their bodies.”

Sharon Saline, PsyD, author of What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life, explains: “People with ADHD live at a high baseline of stress because living with a neurodivergent mind is very stressful. You see and experience things differently, and you don’t necessarily get the support you need. You’re struggling with executive functioning skills on a daily basis, and are always on heightened alert that you might be judged poorly.”

And chronic stress can take a huge physical toll on the body. According to the American Psychological Association, always being in fight-or-flight mode can have a negative impact on the body’s musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous and reproductive systems. It increases the risk for hypertension, heart attack and stroke.

Which Comes First — Stress or ADHD?

An ongoing discussion among the ADHD community is: Do ADHD symptoms cause stress, or does ongoing stress make ADHD symptoms worse? Both are true, says Stephanie Sarkis, PhD, author of seven books, including 10 Simple Solutions to Adults ADD: How to Overcome Chronic Distraction and Accomplish Your Goals.

“The symptoms create more stress, and more stress and accompanying difficulties — such as lack of sleep or appetite — can exacerbate ADHD symptoms,” she says.

“It can seem as if one’s stimulant medication isn’t as effective, when it may actually be due to increased stress.”

Taming the Stress Monster

Sarkis says “effective treatment reduces the intensity of symptoms and can decrease the number of stressful situations people with ADHD experience. Since we can’t eliminate all stress, it is important to practice proactive daily self-care.”

She adds: “It’s not so much the stress as your ability to cope with it. So if you have good coping mechanisms in place, your body and your brain can handle stress better and you have fewer lasting impact.”

The standard (and often unhelpful) tips are: do less, make sure you have “me” time and similar suggestions. But what do you do when stuff must get done, when everyone is expecting you to do more, not less? And, truthfully, organizing your life is definitely not your strong point?

Here are some expert recommendations on how people with ADHD can manage and decrease stress:

• Get moving

The Mayo Clinic says that any form of exercise relieves stress by boosting endorphins, a hormone released in your brain that can give a feeling of well-being. Exercise also builds self-confidence.

The U.S. Department of Health and Human Services recommends that adults do two-and-one-half to five hours per week of moderate-intensity aerobic activity, or 75 minutes to two-and-one-half hours per week of vigorous-intensity aerobic physical activity. But if you can’t fit in full workouts, it’s important to remember that even brief ten-minute bursts of activity can add up.

• Think small

When you look at everything that needs to get done, you don’t know where to start so you don’t. Break every job down into manageable bites. Write down each step and cross them off as you accomplish them.

• Control your technology

The constant bombardment and stimulation of emails, texts and voicemails is very hard for people with ADHD to manage. They can be a significant source of stress.

Sarkis recommends pausing them an hour before bed. “If that’s difficult to do, try shutting electronics off 15 minutes before bed, then increase it to a half-hour a few nights later, then 45 minutes to work your way up to an hour,” she says. “Because when we look at devices, our brain gets more active and (that) inhibits melatonin release. And so, if we shut them off, we’re able to transition better into sleep.”

• Create transition times

You can make those electronics work for you. People with ADHD generally have a hard time transitioning from one focus source to another. Mobile apps or software like Rescue Time keep track of your time and let you know when you have to be finished or go to the next task. Time Timer is a visual timer that lets you see the passage of time.

Saline also recommends leaving an alarm or your phone across the room, so that when it goes off, you actually have to get up to deal with it, thus breaking your fascination with whatever internet rabbit hole you have gone down.

• Establish a routine

Thursdays are laundry days; the dog gets fed at 5 p.m.; your daily walks are at noon. Everyone can have a routine. “Your body gets used to that rhythm, and it becomes easier to follow. You reduce stress by knowing what you will be doing when,” says Sarkis.

• Write it down

You think you can keep it all in your head, but that hasn’t worked in the past. Instead, make visual reminders. Get big erasable calendars and post them at sight level in the most trafficked areas of your house or workplace. If you are waking up at 3 a.m. and worrying about everything that has to get done, get up, make a list and place it where you will have to see it, like on the bathroom sink.

• Stop judging yourself

One of the problems of having ADHD is that you may see your issues in judgmental terms, such as: “I’m hopeless. I can’t do anything right. I always screw up. Why can’t I just do this?”

Remind yourself that these issues have nothing to do with lack of will power; they are a concrete issue of the way your brain works.

Saline recommends that you offer yourself encouragement by trying to notice what’s actually going well.

“There’s been a lot of research that shows that if, at the end of the day, you write down three things that went well or good enough, it can shift you away from pessimism into more positive thinking. It doesn’t have to be huge accomplishments – just three things that made you feel good,” she says.

• Meditation and mindfulness

What’s the worst thing someone can say to you when you are stressed? “Calm down!”

Just saying that makes you more anxious, right? Learning to meditate or be mindful is a way you can calm yourself. Practice it daily and not just in the heat of the moment, and you will reap a cumulative effect.

Saline recommends Headspace and Insight Timer, which are easily accessible mobile apps that can help you slow down and settle down. An added bonus: that can help you sleep better.

• Do relaxation training

Relaxation training techniques like progressive muscle relaxation, guided imagery or deep breathing can be very helpful. A 2021 study published in Evidence Based Complementary Alternative Medicine found that all of these techniques produced states of relaxation. As with meditation, practice them often; don’t just rely on the effects to kick in when you are in the middle of an anxiety attack.

• Practice makes better … not perfect

Remember: No one can be perfect. In fact, that expectation of perfection is just another stressor. But you can learn to make your load a little lighter.

Sarkis reiterates that more important than the stressors is your ability to cope with them. “If you can practice and implement these skills, they can eventually become a habit and will kick in much more quickly when you need it,” she says.

Whether it is the spring or the fall time change, switching the clocks can be difficult, particularly for the first few weeks until the body adjusts to the new schedule. However, for those with ADHD, this twice-a-year switch is particularly challenging. Fortunately, there are ways to make this time of year a bit easier to deal with.

Why is the Time Change Harder?

There are a number of reasons why the time change can hit harder if you have ADHD. First, ADHD is a risk factor for sleep disturbance. In a review of the relationship between ADHD and sleep in the journal Nature and Science of Sleep, the authors note that ADHD and sleep problems often go together. The researchers also note, however, that the exact relationship between poor sleep and ADHD remains unclear. In childhood and adolescence, the authors note, this can present as fragmented sleep, resistance to going to sleep and sleep onset insomnia. Later on, adults with ADHD can show up as having reduced amounts of rapid-eye-movement, or REM, sleep. They can also have more difficulty falling asleep and an increased number of nocturnal awakenings. And all of this occurs without throwing the time change into the mix.

What Can you Do to Make this Transition Easier?

ADHD can simply make sleep more difficult and setting the clock forward or back doesn’t help. However, there are a number of simple steps you can take to reduce the impact that this time change can have.

Talk to Your Doctor about Your Medication Regimen

Stimulant medication is a mainstay of treatment for many with ADHD. If you are on this type of medication, it might be necessary to adjust your current schedule to adjust to the time change. Discuss this change with your doctor first, however, advises the website for the non-profit Children and Adults with ADHD, or CHADD. It might be that your regiment needs to be altered.

Ease in Slowly

EverydayHealth.com recommends that instead of changing your schedule by an hour all at once, you ease in gradually and change it by fifteen minutes over the course of four days prior to the change. That way, it is not so much of a shock. In other words, if your regular bedtime is 10 o’clock, go to bed at 9:45 the first night, 9:30 the second night, etc., so that over the course of those four days, you will go back an hour. While this is helpful for anyone, it is particularly of use for those with ADHD.

Keep Your Routines

The website for the Brain Balance Centers — which offer a non-medical program to help children build and strengthen brain connectivity — suggests that whatever bedtime you have developed, stay with that routine even if you have to begin that routine at an earlier time. For instance, if you take a shower, do your yoga and read for a while before bedtime, don’t alter that now. And also make sure to include some low-key, wind-down activities before sleep and avoid anything that is too stimulating.

Be Patient

If your child has ADHD and you are trying to help them adjust, try to explain to them in terms that they can understand what the time change is and why you are having to adjust their bedtime. Even with easing in gradually, there still may be some crankiness for the first few weeks after the time changes. So patience is important, according to the Brain Balance Centers website. It is also important to understand that the sleepiness that comes from the time change might make some ADHD symptoms (such as working memory) a little worse, according to CHADD.

In short, the time change brings challenges with it, especially if you have ADHD and may have problems with sleep rhythms anyways. However, following these simple steps can help these twice-a-year changes go more smoothly.

Sources:

Nature and Science of Sleep: Sleep patterns and the risk for ADHD: a review

Progress in Neuro-Psychopharmacology and Biology Psychiatry: Circadian rhythms and attention deficit hyperactivity disorder: The what, the when and the why

Children and Adults with ADHD: Spring Forward This Weekend

Everyday Health: ADHD and Daylight Saving Time: 5 Tips for Navigating the Time Change

Brain Balance: Parent Tips for Daylight Saving Time and Kids with ADHD

So what is it about ADHD and the trouble with transitioning? Where does that struggle come from? And how do we address it?

Dr. Gayle Jensen Savoie is the Division Chief for Psychology and Teletherapy for ADHD Online and has been working and has been more than 30 years of experience working with adolescents with ADHD. She joined Lindsay to explain the basics of why transitions are a struggle for people with ADHD and explained how the world around us and those changes have increased the impact of issues with transitions. 

By Cathy Cassata

Life transitions are hard for many people. Going to a new school, moving out of your parents’ house, or getting your first job can all cause stress. However, for those living with ADHD, these events can be especially difficult.

“I think of this as a balance between the environmental demands and the available resources,” explains Kevin M. Antshel, Ph.D., professor of psychology at Syracuse University.

Environmental demands include things like keeping up with academics, finding a place to live, and to work. These types of demands tend to increase in number, scope and complexity as people get older, says Antshel.

The available resources to meet these demands include both internal and external resources. Internal resources are the ability to:

• sustain focus
• plan and prioritize tasks
• use your working memory

External resources include people such as parents, teachers and others who help navigate environmental demands.

“As we get older, the external resources tend to go down while the environmental demands are going up, and this creates an imbalance that is hard for those with ADHD,” Antshel says.

For example, he notes that a lot of data suggests elementary teachers are more hands on with students and give them more attention and guidance than teachers in middle school. And middle school teachers are more attentive with students than teachers in high school.

“Everything is new — a new building to navigate, new teachers to get used to, and new friends to meet. During these transitions, (those with ADHD) are at increased risk for impairments,” Antshel says.

Different transitions may be harder for some than others. Antshel notes that, as people age, those with ADHD become more aware that life changes may affect them. For example, he notes, by the time young adults with ADHD graduate college and enter the workforce, they understand that the transition will be challenging.

“But this could be a bias sampling because people who transition out of college have been successful with college. They’ve developed a way to manage it,” he says.

Antshel adds that going to college is one of the most difficult challenges for those with ADHD.

How to cope with entering college

Graduating high school and moving on to college or out of a parent’s house is a more significant transition than going from middle school to high school, says Antshel. In high school, many kids are living with a parent under parental supervision.

“When they leave, it can be more jarring as they are living away from home, expected to have financial independence, and might be working and dating,” he says.

When he works with young adults with ADHD going through this transition, Antshel helps them implement the following coping strategies:

• Understand college is different than high school

Parents and others should give a college-bound student a realistic picture of how the experience will differ from high school. That’s the first step toward students knowing what is needed to succeed in college.

“Explain that things like essay writing will be the top priority in college or that lecture attendance is seldom mandatory, how there might be just a few papers or tests that can determine their entire grade, or that class sizes can range from four people to 500,” says Antshel.

• Develop a routine

Routine is important for people with ADHD who have a shorter attention span or decreased working memory. The more that minor things can become habitual, the more people are able to open up their working memory “to be able to deal with new things,” Antshel says. “So when you transition to something new, try to develop a routine as quickly as possible.”

Daily routines begin with a healthy sleep/wake cycle. “Even if you don’t have a class until 2 p.m., you want to develop a consistent wake-up time so your sleep/wake routine becomes consistent,” Antshel says.

Even if sleep/wake routines were established in high school, there are more distractions in college that could break the routine, he says.

Establishing weekly routines like days to exercise, wash laundry, work on homework and socialize can also help. “This should all be planned in advance so that they become as habitual as possible. Practicing the summer before college is a good way to get started,” says Antshel.

• Focus on strengths, not limitations

Focusing on everything a teenager cannot do does not create a climate that allows them to flourish.

“We want the child to move toward self-determination and autonomy,” Antshel says. “Figuring out what their strengths are and how to build them into their routine will help them be successful.”

• Use of planners and schedulers

Antshel talks to his clients about the difference between a planner and calendar. He explains that calendars are for marking when things are “due” and planners are best for noting when you are going to “do” things. “People with ADHD need a planner,” he says.

• Parental guidance on intrusive behaviors

Antshel works with parents of young adults living with ADHD to identify the parents’ own behaviors that may be unwittingly limiting autonomy for their college student. He says autonomy-limiting behaviors from parents might include a parent trying to:

• prevent their kid’s mistakes
• structure their child’s life
• perform direct interventions, such as calling the son’s or daughter’s roommate, intervening with the child’s romantic partner, calling to wake them up for class, washing their clothes, or helping with college assignments.

“These behaviors may have gone on in high school, but shouldn’t occur in college,” Antshel says. “I try to get parents to be aware of this and why it’s not the best for the child during a transition.”

He does encourage parents to engage in information-seeking behavior like getting a periodic update from their teen on a daily, weekly or monthly basis.

“Asking about their grades, having an awareness of their schedule, helping them make decisions — these tend to be associated with better transitioning than the autonomy-limiting, direct-intervention stuff,” he says.

Getting a job, becoming a parent, and losing a loved one

Other life transitions can also be difficult for those with ADHD.

• New jobs

Getting a first job or transitioning to a new job can pose challenges with time management and balance. Therapy and medication might help during this time.

“This is a time when I might recommend medication to help with the transition until they can get acclimated to the new job,” Antshel says. “And once they establish routines and feel like they’re functioning well at their job, they can consider going off medication.”

• Becoming a parent

Parenthood is another major life change that Antshel says especially affects women with ADHD.

“Unfortunately, there still seems to be a bias in our society — a lot of the parenting and direct intervention falls on moms. There is more data on parenting in mothers who have ADHD and how this can be a tremendous transition for them,” Antshel says.

The silver lining, he notes, is that by the time many women become mothers, they have some awareness that the transition will be difficult. Leaning on methods that have helped them manage their ADHD before parenthood, as well as asking for additional support from family and friends, can make it easier to navigate parenthood.

• Death of loved ones

The death of a loved one is a difficult life change for most people. For those with ADHD, Antshel says, loss can be particularly hard if the person who passed away was a source of social support.

“This can push someone into a state of imbalance,” he says. “Try to harness the available social supports that are there to help correct that loss of an external resource.”